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.”
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?"
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.