Tuesday, November 02, 2010


I noticed this interchange on Facebook:

Jane Sarasohn-Kahn, a health economist and management consultant (and blogger) had this in her status bar:

In London meetings all day with UK and US colleagues, arguing about whose health system is worse. It's a draw: it you don't have health insurance or a medical home in the US, then the UK system looks awful great. If you're in the UK and have access/rationing/queueing challenges, the US looks great.

This drew a response from Matthew Holt, of The Health Care Blog fame:

I am prepared to bet you a nickel Jane that every one of your UK colleagues has private health insurance and doesn't have to worry about said rationing, but no poor Brit goes bankrupt because they're in hospital.

A long time ago, I wrote about how the US and European health systems will eventually converge.

The health systems in these countries are owned and financed by the government and are often appropriately cited for the quality of care offered to the public. Indeed, in debates here in the US, they are often called out as examples of what we might strive for in terms of universal coverage and a greater emphasis on primary care than we have.

[In a nationalized health system, the] appropriation by the parliament is a politically derived decision, just as it would be for any appropriation for a program of important national priority, and it therefore competes with other worthy national programs for resources....

In the face of inevitable limitations on the ability of the national hospital system to offer all services demanded by the public, a growing parallel system is emerging, in which private practitioners offer elective therapies and procedures outside of those supported by the national system.

As I note above, I am not saying one is better than the other. Just different. I predict, though, that the systems will start to look more and more alike over time. Pressure in the US for a more nationally-determined approach. Pressure in Europe for more of a private market approach. It shouldn't surprise us to see this convergence. After all, the countries are dealing with the same organisms, both biologically and politically.

A final note from the Facebook back-and-forth:

Neil Versel asks,

What about cost and quality?

Liz Scherer replies,

One word: oy.

Suggesting that -- in all systems -- a concerted focus on quality, safety, transparency, and process improvement would be well worthwhile.


richard.blogger said...

"The health systems in these countries are owned and financed by the government"


In the UK 1/6 of healthcare spending is on private care. You can also get private care in an NHS hospital. The NHS often uses private hospitals for extra capacity so that the NHS can meet waiting list targets. We also had a (failed) experiment of NHS contracting to private healthcare (ISTC) for elective procedures but that proved very expensive and the contractors cherry-picked the patients so it was not equitable.

In other parts of Europe there are many different systems, some hospitakls are private, some are central gov owned, some are local gov owned, some are charity owned. There are also many different ways to finance them.

So in terms of healthcare you simply cannot talk about "Europe" as one system.

One final point. The life expectancy of an American is shorter than that of a Briton: surely that is the bottom line when it comes to healthcare?

Anonymous said...

Final point clearly reflects dietary differences: Fish and chips make the difference!

Yes, of course, there is not one European system, but in broad strokes, it is fair to say that the national approach to health care in most European countries has universal access and stronger emphasis on primary care than the US.

richard.blogger said...

Ah, now you are onto something.

In the UK we are moving towards much more work in primary care (my county ~500k population, strategy for next 5 years says primary care will increase by 30%, secondary decrease by 20%). Of course family doctors have always been gatekeepers to secondary care - you *cannot* refer yourself to a hospital specialist. The only routes are through GP or A&E.

As for fish & chips, well you have to get your omega 3 from somewhere ;-)

Anonymous said...

Paul - I have always thought that national healthcare reform in the U.S. should include five items that could be written on a single piece of paper and pretty much provide full coverage and help somewhat on the cost curve: 1) Kids can stay on parents plan up until age 25. 2) All kids under 18 with no other access to insurance would be eligible for Medicaid or, preferably, a managed Medicaid option. 3) An inexpensive catastrophic policy which would include coverage for basic annual preventative care, available to everyone else and premium adjusted based on income. 4) Tort reform with caps on damages. 5) All Medicare patients in some form of managed Medicare unless they want to pay more privately for greater freedom. These five items are not perfect but on a single page of paper you could accomplish quite a bit.