This analysis of a report seems pretty bad, even with only the title and abstract available.
Firstly, the report doesn't even cover the entire developed world, just 11 countries. Notably, Japan doesn't appear to be included. To be honest, I found that slightly offensive.
Secondly the U.K. isn't the overall clear "best" of those 11. It's not bad, and does better on some things, worse on others.
In my subjective experience (as a Brit) British people often think the NHS is the best health service in the world. It's not bad, and it's free. Waiting times are often long, particularly for non-urgent conditions. Compared to the U.S. system I prefer the NHS, but there are other options, and the NHS could provide a better service than it does.
In my subjective experience (as a Brit) British people often think the NHS is the best health service in the world
Having experienced it, I'm surprised that Brits feel that way. When I was studying abroad a while ago (which was not a great experience for other reasons... https://jakeseliger.com/2012/11/18/about-the-university-of-e...), I needed an x-ray and then a CT scan for what appeared to be a minor issue. So I went to the clinic and signed up for one, only to discover a week later that an x-ray typically takes 6 - 8 weeks to be done! I asked around and was told to go to Bupa facility (https://en.wikipedia.org/wiki/Bupa). To the Brits this seemed like an obvious solution, and paying in cash is in fact a good way to get things done quickly. It turns out that when people have something really wrong with them, the solution is often to just pay out of pocket!
This disabused me of any notion that publicly-provided healthcare is automatically superior.
I'm also really puzzled by the omission of Japan. It has the highest life expectancy in the world, I would expect a comparison of health systems in the developed world to include it.
As a resident of the UK and a former resident of Switzerland, I can't understand how they came to this conclusion. Don't get me wrong, the NHS is great and the system works much better than in the US, but health care in Switzerland is just on another level.
Before you say "but in the UK it's free" - considering what I paid for (private, mandatory) insurance in Switzerland, and the National Insurance contribution that gets deducted from my paycheck in the UK, I'm not so sure...
On cost (which is under the Access category), Swiss seem to self-report having at least somewhat more problems even with the health insurance. For example: 22% of Swiss self-report having had a "cost-related access problem to health care in the past year" (UK 7%, US 33%), and 21% of Swiss report skipping dental care or check up in the past year because of cost (UK 11%, US 32%). Also, 46% of Swiss report having paid more than US$1000 for out-of-pocket medical expenses in the past year, which was the highest of any country in the study (UK 4%, US 36%).
Basically UK spends less overall, 9.9% of GDP vs SWIZ's 11.1%. While UK ranks higher than SWIZ on the report's definitions of Care Process, Access, Efficiency and Equity. SWIZ ranks higher on Health Care Outcomes.
I don't think anyone, in the UK at least, thinks the NHS is free. Most people in the UK who describe it as "free" really mean "free at the point of use" (i.e. no invoice after treatment), but that's a bit of a mouth full.
> the National Insurance contribution that gets deducted from my paycheck in the UK
National Insurance nominally covers state pension and unemployment benefits, not the health service.
Of course, it all goes into one pot of money, but your entitlement to the above goes up the more years of NI you have paid in, whereas your entitlement to NHS does not change.
"In general, the U.K. achieves superior performance compared to other countries in all areas except Health Care Outcomes, where it ranks 10th despite experiencing the fastest reduction in deaths amenable to health care in the past decade."
If you look at the graph Exhibit 4. Mortality Amenable to Health Care, 2004 and 2014[1] it shows that for 2014 the UK wasn't 10th. They have taken an average for the decade leading to 2014. So it isn't as clear cut as just being 10th.
As a swede living in London, I was shocked to find the NHS still uses paper prescriptions that are consumed upon use, at least in my limited experience. In Sweden, every prescription I have is digital and tied to my ID, accessible from any pharmacy or hospital in the country and is not necessarily consumed upon use, I can easily reuse it and renew it.
Is the abstract really shorted and the author is mentioned but as affiliation it only says "London". They really don't want to know much about the paper before you pay for this paid research.
This really is a matter of what variables you choose to measure.
For example, the US is by far the world leader in medical research spending - 44% of global medical research is spent in the US. (Until recently it was even higher). [1]
On the same note, many nations regulate the price of prescription drugs - drugs where the initial R&D was done in the states. (Yes, drugs are sold at a huge markup, but that's to recoup the huge initial costs of research). In other words, Americans are taking it in the chin to invest in pharmaceutical innovations, which other countries then treat as a public good.
An additional point that's often obscured: there's no purely capitalistic healthcare system in the world. Even pre-Obamacare, the US system was about 46% funded by the government. (As with the US education system, the availability of government funds has massively pushed up prices). [2]
On a personal note - I'm a brit, but I've lived abroad, and the NHS is one of the reasons I'm considering settling abroad long-term. I simply don't trust the organisation as a whole to take care of my health. If you get assigned a good doctor for your condition, you're OK, but I have my own stories (and I've heard many others) of conditions being ignored or misdiagnosed, even after multiple visits.
In contrast, I went to a hospital in Bangkok that was of far higher quality than the average NHS hospital. (Granted, this was a private hospital, but it puts things into perspective). One Israeli friend said that walking into a UK clinic was like walking into a clinic in a third-world country. It's shabby, the wait is long, the bureaucracy is confusing, etc.
Strange as it may sound, I trust a for-profit entity more with my health, because their livelihood directly depends on taking good care of me. The common argument that healthcare can't be a market because of information asymmetry and doctors being in a position of power doesn't wash: the same holds true for other complex services, like auto repair, and the solution is simple: third party reviews. (On the moral argument, about affordability, I think with a truly private healthcare system entrepreneurs would be able to drive the costs down for people on middle-incomes, and only the bottom 15-20% would be reliant on government or charity spending).
American medical R&D spending amounts to something around $500 per capita per year. Our total medical spending is $9,000, which is more than $5,000 above the OECD average. Medical R&D spending makes up a mere 10% of our excess costs (and that's only if you assume the entire thing is excess) so I wouldn't describe it as taking it on the chin, nor does it seem reasonable to paint us as altruistic martyrs for paying for so much medical research.
Interesting thought regarding the r&d spending in the US versus the rest of the world and hence subsidizing global health care. I did look at some numbers in a more recent publication [1](page 21) where the latest r&d numbers for both healthcare and biotech are listed. Germany‘s spending seems to be on average a little less than 1/3 of the US which would make them equal on a per capita level. The UK seems to be a little below those levels. Do you have any data to support your claim?
> If you get assigned a good doctor for your condition
You can chose your doctor. You can change your GP at any time and you don't need to give a reason. You can choose and book your consultants.
About the only time you don't get to chose is for mental health treatment.
> because their livelihood directly depends on taking good care of me.
their livelihood directly depends on them giving the appearance of taking good care of you, and avoiding you suing them. this means they make much more use of testing and scanning which results in a lot of overtesting, overdiagnosis, and overtreatment, which all cause harm.
> This really is a matter of what variables you choose to measure.
>
> For example, the US is by far the world leader in medical research spending...
Medical research companies will naturally gravitate to a country where the medical industry is particularly profitable: for example in a country where citizens pay over the odds for healthcare due to disfunction.
If this is the reason that the US spends the most on medical research, is that really something that qualifies as a valid variable for some definition of "best"?
I like how you mentioned there's no purely capitalistic healthcare system in the world, even in the U.S. there is massive government involvement in Health Care (120 millions Americans are on medicare/medicaid for instance which is twice the population of the UK if i'm not mistaken), additionally Switzerland which seems to have the best healthcare in the world also has very strict government regulation. When it comes to drug pricing there's another caveat which is a lot of the incredible R&D breakthroughs aren't even done in the states but rather they are done by British and Canadian companies that then markup the prices in the US because it's the only place they can charge people lots of $ (and even in the US they have to sell at a reduced cost to the third of the population that is on medicare/medicaid as stated earlier). So in short the U.S. healthcare system isn't entirely capitalist and the pharmaceutical companies in countries with national health insurance are very capitalist when it comes to selling their drugs in the U.S...basically nothing is what it seems.
> In other words, Americans are taking it in the chin to invest in pharmaceutical innovations, which other countries then treat as a public good.
I completely reject this line of argument. Just because the spending is here, and that a huge profit center is in Ameriica, you can't conclude anything about R&D. A large portion of the marketing spend is also in America too.
All the large drug companies are multi-national. Once the income arrives from various nations, that money is fungible within the accounting of the company. One really can't say a pound coming in from the UK isn't funding R&D in America, any more than you could say a dollar is.
It's true that America's higher drug prices ultimately subsidize the world. But this certainly isn't the only thing driving up costs. Administration costs in healthcare are significantly higher in the US than other countries, and heroic end-of-life care is a sort of religion that sucks money down a black hole. Some chronic health issues like obesity are more common in the US. And there's this:
Expat American here now living in Thailand for many years and have been treated numerous time to the outstanding medical care at both private and public hospitals here.
Question: As far as you know, do the private hospitals here in Thailand receive any government money? Because it sure seems like a real market here with private hospitals competing on services and prices. And they advertise those services and prices in the media regularly.
I plan to never return to my home country and one of the main reasons is the health care debacle in the U.S. It's so much better and affordable here.
> As with the US education system, the availability of government funds has massively pushed up prices
Although people on here keep saying one reason insured people are overpaying for treatment is because Medicare/Medicaid generally underpay for services rendered and hospitals have to make up the difference on other paying patients?
having had a fair amount of experience of the british healthcare system i find this very hard to believe, ive been treated like shit by them many times, been talked into an operation i didnt really want (i think they were extra keen because its a rare condition) which they then managed to screw up and cripple me.
another little gem is my current insurance claim, i was knocked off my motorbike over a year ago, yet i still havent received a payout from my insurance, id assumed their lawyers were dragging the process out but by this point she has been convicted, my insurance company have been paid by hers but i still havent had anything back, when i asked my lawyer what was holding it up he said it was just one thing they need, they are still awaiting the medical records from my GP which were requested and paid for back in September but despite monthly attempts to get them to send it they still havent done so and every time i try and contact them to ask why im told that the medical secretary isnt in at the moment and only she can deal with it, but they will tell her to call me as soon as she gets back in, i have yet to receive a single call from them.
i could go on to site a ton of other various reports of shit service that i have personally experienced let alone that of others i know. if i was insurable id have taken private medical insurance long ago and still strongly advise any healthy person in the UK to get private medical insurance ASAP, sure its an extra cost no one wants to pay but if you ever do get sick youll be damn glad you have it
[+] [-] comstock|8 years ago|reply
Firstly, the report doesn't even cover the entire developed world, just 11 countries. Notably, Japan doesn't appear to be included. To be honest, I found that slightly offensive.
Secondly the U.K. isn't the overall clear "best" of those 11. It's not bad, and does better on some things, worse on others.
In my subjective experience (as a Brit) British people often think the NHS is the best health service in the world. It's not bad, and it's free. Waiting times are often long, particularly for non-urgent conditions. Compared to the U.S. system I prefer the NHS, but there are other options, and the NHS could provide a better service than it does.
[+] [-] jseliger|8 years ago|reply
Having experienced it, I'm surprised that Brits feel that way. When I was studying abroad a while ago (which was not a great experience for other reasons... https://jakeseliger.com/2012/11/18/about-the-university-of-e...), I needed an x-ray and then a CT scan for what appeared to be a minor issue. So I went to the clinic and signed up for one, only to discover a week later that an x-ray typically takes 6 - 8 weeks to be done! I asked around and was told to go to Bupa facility (https://en.wikipedia.org/wiki/Bupa). To the Brits this seemed like an obvious solution, and paying in cash is in fact a good way to get things done quickly. It turns out that when people have something really wrong with them, the solution is often to just pay out of pocket!
This disabused me of any notion that publicly-provided healthcare is automatically superior.
[+] [-] ramchip|8 years ago|reply
[+] [-] mboto|8 years ago|reply
[+] [-] ggambetta|8 years ago|reply
Before you say "but in the UK it's free" - considering what I paid for (private, mandatory) insurance in Switzerland, and the National Insurance contribution that gets deducted from my paycheck in the UK, I'm not so sure...
[+] [-] _delirium|8 years ago|reply
On cost (which is under the Access category), Swiss seem to self-report having at least somewhat more problems even with the health insurance. For example: 22% of Swiss self-report having had a "cost-related access problem to health care in the past year" (UK 7%, US 33%), and 21% of Swiss report skipping dental care or check up in the past year because of cost (UK 11%, US 32%). Also, 46% of Swiss report having paid more than US$1000 for out-of-pocket medical expenses in the past year, which was the highest of any country in the study (UK 4%, US 36%).
[+] [-] guelo|8 years ago|reply
Basically UK spends less overall, 9.9% of GDP vs SWIZ's 11.1%. While UK ranks higher than SWIZ on the report's definitions of Care Process, Access, Efficiency and Equity. SWIZ ranks higher on Health Care Outcomes.
[+] [-] JamesMcMinn|8 years ago|reply
[+] [-] bboreham|8 years ago|reply
National Insurance nominally covers state pension and unemployment benefits, not the health service.
Of course, it all goes into one pot of money, but your entitlement to the above goes up the more years of NI you have paid in, whereas your entitlement to NHS does not change.
[+] [-] jseliger|8 years ago|reply
I'm not so sure about that: https://news.ycombinator.com/item?id=14774718
[+] [-] dbcooper|8 years ago|reply
It ranks the UK 10th out of 11 on "Health Care Outcomes".
[+] [-] inopinatus|8 years ago|reply
[+] [-] mboto|8 years ago|reply
If you look at the graph Exhibit 4. Mortality Amenable to Health Care, 2004 and 2014[1] it shows that for 2014 the UK wasn't 10th. They have taken an average for the decade leading to 2014. So it isn't as clear cut as just being 10th.
http://www.commonwealthfund.org/interactives/2017/july/mirro...
[+] [-] staofbur|8 years ago|reply
[+] [-] galadran|8 years ago|reply
[+] [-] coldcode|8 years ago|reply
[+] [-] tonyedgecombe|8 years ago|reply
[+] [-] jlarsson89|8 years ago|reply
[+] [-] tehabe|8 years ago|reply
[+] [-] salted-fry|8 years ago|reply
http://www.commonwealthfund.org/~/media/files/publications/f...
http://www.commonwealthfund.org/publications/fund-reports/20...
[+] [-] zkms|8 years ago|reply
[+] [-] IsaacL|8 years ago|reply
For example, the US is by far the world leader in medical research spending - 44% of global medical research is spent in the US. (Until recently it was even higher). [1]
On the same note, many nations regulate the price of prescription drugs - drugs where the initial R&D was done in the states. (Yes, drugs are sold at a huge markup, but that's to recoup the huge initial costs of research). In other words, Americans are taking it in the chin to invest in pharmaceutical innovations, which other countries then treat as a public good.
An additional point that's often obscured: there's no purely capitalistic healthcare system in the world. Even pre-Obamacare, the US system was about 46% funded by the government. (As with the US education system, the availability of government funds has massively pushed up prices). [2]
On a personal note - I'm a brit, but I've lived abroad, and the NHS is one of the reasons I'm considering settling abroad long-term. I simply don't trust the organisation as a whole to take care of my health. If you get assigned a good doctor for your condition, you're OK, but I have my own stories (and I've heard many others) of conditions being ignored or misdiagnosed, even after multiple visits.
In contrast, I went to a hospital in Bangkok that was of far higher quality than the average NHS hospital. (Granted, this was a private hospital, but it puts things into perspective). One Israeli friend said that walking into a UK clinic was like walking into a clinic in a third-world country. It's shabby, the wait is long, the bureaucracy is confusing, etc.
Strange as it may sound, I trust a for-profit entity more with my health, because their livelihood directly depends on taking good care of me. The common argument that healthcare can't be a market because of information asymmetry and doctors being in a position of power doesn't wash: the same holds true for other complex services, like auto repair, and the solution is simple: third party reviews. (On the moral argument, about affordability, I think with a truly private healthcare system entrepreneurs would be able to drive the costs down for people on middle-incomes, and only the bottom 15-20% would be reliant on government or charity spending).
[1] https://www.urmc.rochester.edu/news/story/4233/u.s.-slipping...
[2] https://en.wikipedia.org/wiki/List_of_countries_by_health_ex...
[+] [-] mikeash|8 years ago|reply
[+] [-] elmalto|8 years ago|reply
[1] https://www.iriweb.org/sites/default/files/2016GlobalR%26DFu...
[+] [-] DanBC|8 years ago|reply
You can chose your doctor. You can change your GP at any time and you don't need to give a reason. You can choose and book your consultants.
About the only time you don't get to chose is for mental health treatment.
> because their livelihood directly depends on taking good care of me.
their livelihood directly depends on them giving the appearance of taking good care of you, and avoiding you suing them. this means they make much more use of testing and scanning which results in a lot of overtesting, overdiagnosis, and overtreatment, which all cause harm.
[+] [-] rlpb|8 years ago|reply
Medical research companies will naturally gravitate to a country where the medical industry is particularly profitable: for example in a country where citizens pay over the odds for healthcare due to disfunction.
If this is the reason that the US spends the most on medical research, is that really something that qualifies as a valid variable for some definition of "best"?
[+] [-] porterrobertson|8 years ago|reply
[+] [-] dv_dt|8 years ago|reply
I completely reject this line of argument. Just because the spending is here, and that a huge profit center is in Ameriica, you can't conclude anything about R&D. A large portion of the marketing spend is also in America too.
All the large drug companies are multi-national. Once the income arrives from various nations, that money is fungible within the accounting of the company. One really can't say a pound coming in from the UK isn't funding R&D in America, any more than you could say a dollar is.
[+] [-] scythe|8 years ago|reply
http://johnhcochrane.blogspot.com/2017/04/the-second-origina...
[+] [-] geomark|8 years ago|reply
Question: As far as you know, do the private hospitals here in Thailand receive any government money? Because it sure seems like a real market here with private hospitals competing on services and prices. And they advertise those services and prices in the media regularly.
I plan to never return to my home country and one of the main reasons is the health care debacle in the U.S. It's so much better and affordable here.
[+] [-] kalleboo|8 years ago|reply
Although people on here keep saying one reason insured people are overpaying for treatment is because Medicare/Medicaid generally underpay for services rendered and hospitals have to make up the difference on other paying patients?
[+] [-] galadran|8 years ago|reply
Some of the data from the Appendix on Equality pulled out. The difference between countries is quite astounding!
[+] [-] warsharks|8 years ago|reply
another little gem is my current insurance claim, i was knocked off my motorbike over a year ago, yet i still havent received a payout from my insurance, id assumed their lawyers were dragging the process out but by this point she has been convicted, my insurance company have been paid by hers but i still havent had anything back, when i asked my lawyer what was holding it up he said it was just one thing they need, they are still awaiting the medical records from my GP which were requested and paid for back in September but despite monthly attempts to get them to send it they still havent done so and every time i try and contact them to ask why im told that the medical secretary isnt in at the moment and only she can deal with it, but they will tell her to call me as soon as she gets back in, i have yet to receive a single call from them.
i could go on to site a ton of other various reports of shit service that i have personally experienced let alone that of others i know. if i was insurable id have taken private medical insurance long ago and still strongly advise any healthy person in the UK to get private medical insurance ASAP, sure its an extra cost no one wants to pay but if you ever do get sick youll be damn glad you have it
[+] [-] cmurf|8 years ago|reply
[deleted]
[+] [-] unknown|8 years ago|reply
[deleted]