U.S. Healthcare: Out of control

05 May U.S. Healthcare: Out of control

CHICAGO– The Obama Government mission to tackle the U.S. Healthcare system is no easy project, as there are so many components that need fixing. Do you fix the increasingly high cost of healthcare, or expand the coverage to a universal system, or try to digitalize (read “computerize” or make electronic)? The Obama Government will try to do all three and more.
The U.S. Healthcare system has the reputation of being the highest quality in the world, but is it the “best”? What does being the “best” entail? Michael Moore in his recent documentary “Sicko” compares the U.S. Healthcare system with that of Canada, France, Cuba, and the UK, and while I have not seen this movie, the U.S. Healthcare system does not come out well.
According to a New York Times article (August, 12, 2007) entitled “World’s Best Healthcare?”, the World Health organization (WHO) made a first attempt back in 2000 to rank health systems in 191 nations. The U.S. ranked 37th in this study, and France and Italy ranked first and second. Yet another more recent assessment by the Commonwealth Fund ranked health systems in advanced nations, and the U.S. ranked last or next-to-last compared to 5 other countries: Australia, Canada, Germany, New Zealand, and the UK.
Some of the key parameters measured in this study included:

1. Access: the key issue here is costs faced by low-income people without insurance or with minimal insurance. Germany rated better than U.S.

1. Fairness: the U.S. ranked last in this category due to the great disparity between rich and poor in obtaining healthcare.

1. Health lives: the U.S. surprisingly has a very high infant mortality rate, ranking behind 23 other countries in this category; but there were other negatives for the U.S. including a sub-category of “healthy life expectancy at age 60” where the U.S. also ranked low, and “deaths from a wide range of illnesses that would have not been fatal if treated with timely and effective care” where the U.S. ranked 15 out of 19 countries.

1. Quality: here the U.S. ranked first out of 5 countries for providing “the right care for a given condition”, but scored poorly, according to the article, in several other categories:
• “coordinating the care of chronically ill patients”
• “protecting the safety of patients”
• “meeting patients’ needs and preferences”

A final comment here was that American physicians and hospitals apparently kill patients through surgical and medical mistakes more often than other industrialized nations.

1. Life and Death: comparing outcomes in a number of diseases left the U.S. with a mixed review compared to 5 industrialized countries :
• breast cancer survival rate: ranked first
• cervical cancer and childhood leukemia: ranked second
• kidney/liver transplants: worst/near-worst
• colorectal cancer: near-worst

In another similar type analysis of 8 countries, the U.S. ranked last in “years of potential life lost to disease such as diabetes, respiratory diseases, circulatory diseases, and had the 2nd highest death rate from bronchitis, asthma, and emphysema.

1. Patient Satisfaction: in the Commonwealth Fund survey of 5 countries, American attitudes towards their healthcare system were the most negative; a third of adults felt the entire system needed to be rebuilt versus only 13% in the UK and 14% in Canada.

1. Use of Information Technology: despite the U.S. advance in computer hard- and software, American primary doctors significantly lag behind their counterparts in other advanced nations.

1. Top-of-the-Line Care: faced with a life-threatening disease, most Americans would rather be treated in the U.S.; nevertheless, with the high cost of U.S healthcare and the availability of very good quality healthcare in developing nations (with physicians trained in the U.S. and Europe), there is a significant rise in “medical tourism” supported by U.S. insurance companies.

It is clear that the Obama Government faces a difficult challenge, because it gets worse! The WHO (http://www.photius.com/rankings/world_health_performance_ranks.html) ranking of “ Health Performance Rank by Country” lists two key rankings: 1) level of health, and 2) Overall Health System Performance. The U.S. ranked 72nd in the first category and 37th in the second category. Oman, Malta, and Italy ranked 1, 2, and 3 in the first category, and France and Italy 1rst and 2nd in the second category. In “Healthcare Expenditure Per Capita in International $”, the U.S. ranked first followed by Switzerland and Germany.
From recent personal experience in getting an annual physical which included the normal blood and urine tests, EKG, with a few extra test such as PSA (prostate specific antigen for prostate cancer), and fecal tests for colon cancer, I received a bill from my physician totaling $1,128. This bill was just the diagnostic cost and blood draw cost, and did not include the cost of the physician consult. Additionally, I had requested a cardiac stress test and echocardiogram (both of which took under 30 minutes to run in combination), not because I was feeling any problem but due to familial history. The charge for these two tests amounted to another $2700. So, total “testing” was over $3,800, not including any physician charges.
Now, I realize that my medical insurance company will come to some agreement with these institutions at a negotiated lower rate, and that my insurance will cover a large component of this cost, and I will end up paying only a small percent of the final bill, but I was thinking – what happens if I did not have any medical insurance?
Surprisingly, I have been unable to get these test results electronically, i.e. via an email (in fact, to even get them “mailed” via snail mail to me is difficult). The only access is via going back to the physician’s office and requesting a photocopy.
I also recalled a few years ago when I had undergone the same combined tests in Bogota, Colombia, while visiting that country, with a leading Colombian cardiologist on hand to run the cardio tests, and all of the charges, including the physician consult, was under $300. I was able to get information on the test results fairly quickly, within 1-2 days of my taking the tests.
If this huge “cost gap” continues in the U.S., more and more patients (and insurance companies) will be forced to search for healthcare alternatives outside of the U.S. This has led to the growing importance of Medical Tourism and websites such as: The Medical Tourism Guide (http://medicaltourismguide.org/) and Medical Tourism (www.medicaltourism.com) which focus on physician and hospital accreditation, destination and leading treatments including hip and knee replacement, to name a few.
Some of the top destinations include Costa Rica, India, Korea, Mexico, and Thailand.
They also include cost comparisons for medical procedures:

In summary, President Obama’s move to reform our U.S. Healthcare System comes none too soon! The only issue for me is there seems to be so many different components that need fixing, that a prioritization process is critical. It is also evident that some kind of “best practices” study should be looked at in healthcare systems in various countries to compare against the U.S.
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