U.S. health care system doesn't measure up - to Britain's?
For all we spend, the U.S. still scores poorly in key measures of patient outcomes.
U.S. health care system doesn't measure up - to Britain's?
Jeff Gelles, Inquirer Business Columnist
Pediatrician and health-care blogger Aaron Carroll says that U.S. journalists are continually "burying the lede" when we write about Britain's National Health Service - you know, the one celebrated, to the outrage of U.S. conservatives and the bafflement of many Americans who fear "socialized medicine," during the opening ceremonies of last year's London Olympics.
Carroll points readers to a piece in the British Medical Journal about a presentation by Robin Osborn, vice president of the New York-based Commonwealth Fund. Though the BJM piece is mostly behind a subscription wall, Carroll shares some of its findings and his observations - including some perhaps-feigned shock that it shows the NHS scoring well on access, out-of-hours care, and patient engagement. "After all, one of the knocks against a system like the UK’s is that access is limited. The wait times! Surely you’ve heard of them? Turns out, not so much," he writes.
But the key point for U.S. readers - hey, Aaron, this is only my third paragraph! - is that the article shows the NHS lagging on patient outcomes, but not against everyone. As Carroll's chart here shows, Britain lags comparable nations on a key measure of health-system effectiveness, "years of potential life lost," which quantities premature deaths. But it doesn't lag everybody.
And what country does even worse? The United States, even though we spend roughly twice as much on health care as Britain.
In his Incidental Economist post, Carroll says he wasn't surprised by some elements of the praise for the NHS, even if it runs counter to the assumptions of some VSP (Very Serious People) on this side of the pond. Quoting BJM:
On almost every slide Osborn showed (except the one on outcomes) the NHS came out best or nearly best in an international comparison of 11 advanced countries: on access, out of hours care, patient engagement, shared care plans, electronic medical records, and patients’ and doctors’ opinions.
She ended her presentation by expressing the hope that healthcare in the United States would change dramatically in the next 10 years, “inspired by the example the NHS sets.”
Carroll writes:
All of these are areas where our health care system doesn’t do so well. I’ve shown these slides many times. So none of these things were a surprise. Still, for a system that gets so maligned in our press, it was nice to hear about data on actual access metrics where the UK outperforms the opinions of VSP in the mainstream media.
Are there tradeoffs? Carroll doesn't doubt that. He says that on "mortality amenable to healthcare," another way to measure a system's effectiveness, "the United Kingdom performed worst in 1997-8 and second worst in 2006-07 of the seven countries Osborn compared for this (France, Australia, the Netherlands, Germany, New Zealand, the UK, and the US)."
For U.S. readers, Carroll thinks those comparisons are worth much more attention, though he expects the message here to be: "Sure, the UK does well in terms of access, but their outcomes are terrible. Do you want that to happen here?"
He concludes:
What will be missed is the fact that the outcomes are, perhaps, terrible, but they are worse here. So “would I want that to happen here”? If you mean that we could spend less than half of what we do on health care, see access improve massively, and see our outcomes go from worst to second worst? I could live with that.
For the record, using 2010 data, the UK would have moved up a spot. The US would still be last.
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My job doesn't give us healthcare coverage. No preventive maintenance or anything. People are conditioned to believe that food, shelter and healthcare are an entitlement. In a civilized society they are your rights. We do not live in a civilized society though.- Another professional victim here. If you dont like what your job offers....get a new job!
That's the beauty of freedom. And in a civilized society people take care of themselves...not siphon off of others.
BTW, Britain's healthcare is WORSE than the US's...Enjoy....
http://articles.latimes.com/2012/aug/08/opinion/la-oe-dalrymple-british-health-system-20120808— Professor1982 
Agree. The most important thing the Brits (and the French and every other civilized country) does much better is making sure everyone has access to basic care. I have no insurance, my employer dropped it when she became medicare eligible. I have a pre existing condition that requires monitoring and medication, which I can't get. What will happen is this....I will have 3 or 4 hospital visits this year, AT A TOTAL COST TO THE TAXPAYER OF PROBABLY OVER $100,000.00. I work, and make too much for Medicaid, and am too young for Medicare. private insurers want 80% of my income for a policy that won't cover my condition anyway. We need single payer in this country.— intelliwoman- No one has a right to a skill that is acquired by someone else. There is no right to health care, it IS an entitlement.— Howard Beale UBS
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Howard Beale UBS - Well, aren't YOU opinionated? You have no right to watch TV either since it is the work of other people. You have no right to use a highway, ride public transit, etc. Oh! That is what taxes are for. My bad. Hey! New concept! Socialized Medicine! Oh, that doesn't work in your perfect world of "no entitlements" either? Goon. Fail.- Every one has access to healthcare last time i checked. just like everyone has access to food. is grocery shopping a right too? guess we should just throw whatever we want in the cart and walk right out the door. nothing is free. get educated, work hard and you will be rewarded. actually in this country it's the laziest that make out best— FBO4ever
- If you take this article at face value, which I don't, they forgot to mention one small little fact: IT IS NOT FREE. They tax basis in Britain is is as high as 90%. And normal is 60-70%. So give it a rest on FREE. Hey Joyce you need to understand what a "Right " is. When they say you have a "right" to medical care it does not mean FREE.
— puddydawg - Joyce is uneducated on most subjects on this site. She is a taker and doesn't care how she get her free stuff....as long as it free to her.
- Dude, you'd best take a chill pill and stop pretending to be black in one section and white in another. I got you.
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— Tyrone Biggums Jr. - everyone absolutely has a right to healthcare. that's called living in a civilized sane world. anything else is barbaric, cruel, and downright evil.— Ryan
- This might be the most ridiculous article I've ever read. I work for a company that is based in the UK and speak with our UK colleagues often. We had an employee in the UK and an employee diagnosed with cancer around the same time a year and a half ago. The reason the treatment is half as expensive in the UK is because they don't do as much! The US employee is back to normal and cancer free and the UK employee died last week, after receiving the most dispicable excuse for healthcare I have ever heard of. I don't claim to be either a Democrat or Republican, but public healthcare is a TERRIBLE idea, both economically and for the health of our citizens.— Temple718
- A right, according to our founders, comes from nature. We have a right to think for ourselves and speak our minds. We do not have a right to knowledge and skills acquired by other people. Health care can only be had by someone giving it away or the government taking money from others to pay for it. If that is the case, then anything that we want (cell phones, for instance) can be defined as a need and subsequently become a right. If anyone thinks that food is a right, then--as stated above--I recommend that you go to your local supermarket, fill up a cart, and walk right out the door with it. You can then claim that the government (taxpayers, really) will pick up the tab since you have a "right" to food. It's the same argument. Please, give it a try.— Howard Beale UBS
- Temple...I've heard similar stories. I have quite a few english friends that are quite happy with how the medical system works here. Its not perfect and it's not cheap. I definitely think we could streamline the and tweak the system but to tear it down all together, which are in the process of doing, is ridiculous. I say this while i sit next to my 3month old at dupont hospital. he is recovering from pneumonia. been here for a week.— FBO4ever
Comment removed.- Government's job is to protect rights, not create them. That's what the Declaration of Independence says, anyway. But who cares about that anymore, right?— Right:&Right
Reach Jeff at jgelles@phillynews.com.
