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a briefing document

a comparison between international health services

New translation, the Magna Carta

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the uk’s national health service - the nhs: usa comparison
for those who care about comparative data on health services

One of the central points is that is, it is very difficult to compare systems. In the United States, both ‘sides’ of the health care discussion are trimming mightily, some are even making it up as they go along! Most are dreadfully uninformed, and are making little effort to correct that problem. Most are just cheering for football teams without even knowing the point of the game.

The reasons for the French and the British reporting better life expectancy and infant mortality rates than those in the USA, while their health services cost less as a percentage of GDP, are complex. One is the USA being ahead on the fat curve - they have started to reduce the numbers of morbidly obese people. Another reason is that, in the States, there are guns for killing in ghettos and for convenient suicide. These statistics are very poor and dubious indicators of the state of a country’s medical services. There are many extraneous factors making such statistics unreliable.

In the USA, people can choose medical services. People are neurotic, especially about their own health. There is much corruption in the US health industry. For instance, the estimate is the drug companies employ about one sales rep. for every 4.7 medics. The profits pay for ‘conferences’ in exotic locations. In the USA, law makers are handsomely bribed to produce laws that suit large corporations such as big pharma and the insurance industry.

US medics are extremely cautious, they order every test they can manage, in order to protect themselves against law suits. That also ups the bills! Most advances in medicine originate (or are developed) in the USA. They are sold cheaper in overseas government-run systems than in the USA, thus American medicine tends to subsidise the likes of the NHS.

For examples of corruption in US government see, for example, Dick Morris.click to return

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“An embarrassed Conservative Party leadership was forced to rebuke one of its MEPs yesterday after he spent the last week on a tour of the United States rubbishing the NHS in a series of interviews.

Daniel Hannan, an outspoken and popular Conservative politician, gave a damning verdict on the British health service, telling American television viewers: "I wouldn't wish it on anybody." ” [Quoted from timesonline.co.uk]

  1. Both the UK and the US health systems ration.

  2. Stephen Hawking, who has motor neurone disease [Gehrig’s disease, also known as ALS - aminotrophic lateral sclerosis] and has recently claimed that he owed his life to the NHS. He is both wealthy in his own right and is enmeshed in Cambridge academic society. Cambridge has one of the most advanced health centres in the world for that sort of disease.

  3. In both countries, the richer you are, the better off you are. But I suspect you are better off in the UK if you are poor.

  4. Both the French and British health systems are packed with medics who should be better educated. US medics I have met are better trained. The UK system is filthy compared with anything I have seen in France. The service is much quicker in France, they have about twice the medics per head of population.

  5. All Western societies provide for the poor, including the USA.

  6. In my view, a major improvement in France is that (those) who can afford to, pay about 30% of bills (and that is widely covered by private insurance). Anything given away ‘free’ is expensive.

  7. A major advantage in France is it is simple and easy to obtain second opinions and to dump incompetent medics.

If you want the NHS, you’re welcome, but no serious politician dare say that! Of course the politicians will go private when it matters, just as they do in education.

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a partisan article on stephen hawking’s involvement with the uk national health service

  1. Stephen Hawking is wealthy in his own right and is not solely dependent on the NHS.

  2. He is embedded in Cambridge academia, with access to one of the world centres of excellence for his type of problem (motor neurone disease).

    Research into diseases, such as motor neurone disease, is an integrated whole with the patients being the guinea pigs and with high-level people (neurologists in this case) running the trials. Statisticians, ethicists, biochemists/big pharmaceutical companies all working together. Even GPs and generalist neurologists form links in the teams. Commonly, medics go on to be part of research teams and work for big pharma etc.

    The results of the labs tie into the work of researchers looking to patent a treatment and to develop a start-up with venture capital. Cambridge, where Hawking is based, is deeply involved in the process.

I have little doubt that Hawking’s outcomes would have been different in the extreme if he were Mister Smith of 7 Back Street Cul-de-sac. Hawking has a disease which usually kills in less than a decade. He has survived about 40 years. In these circumstances, it is very difficult to believe that he receives standard NHS care.

Of course, Hawking is not treated as Sam Sawkins would be - I doubt Sam would have a chance in a million of even obtaining an appointment with some of Hawking’s medics.

I am advising a person with a similar nasty. Already I know more than the first-line neurologist, let alone the general practitioner. And I am still studying hard!

I have access Sam couldn’t, simply because I know more and push harder; and I have paid extra when necessary. There ain’t no equality in the real world, and certainly not for Hawking. So, in that sense he is certainly trimming, if not outright lying. Hawking is not ‘equal’ in the NHS, and he would not be ‘equal’ in the USA. Nor is Ted Kennedy, and nor are congressmen, and nor are the star TV anchors at Fox News.

Any suggestions otherwise are abuse of rational argument.

Maybe it was a mere coincidence that, coincidentally with Stephen Hawking’s endorsement of the NHS, President Obama, somewhat besieged in his attempt to create a public health system in the USA, rushed him a US government medal?

In my view, it is clear that Brown the Clown and Obama are doing the you-scratch-my-back gavotte.click to return

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the ten commandments of business failure - and the nhs

Extracted from a press release.

“Ten Commandments of Business Failure, first drawn up by Donald R. Keough, the past president and former CEO of the Coca-Cola Company.

  1. Stop taking risks. A 2006 study of change capability by the Office of Government Commerce gave the NHS a score of just two out of five points for seven of the nine categories assessed.

  2. Be inflexible. Businesses are hamstrung by state control over factors of production: staff pay is set centrally; capital expenditure is constrained by the DH; the National Programme for IT is a top-down programme; and NICE increasingly decides what treatment can be offered. Local initiative is crowded out

The complete list is at the ten commandments of business failure - and the nhs.

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health reports from the world health organisation and others

For those who care about comparative data on the health services, in contrast to the highly uninformed twittering regarding the British NHS and Obama’s ambitions to take over another swathe of the USA economy.

  • WHO, 1997 figures - see Annex Table 1. I do not know whether there have been any updates. Governments tend to hate comparisons and do not cooperate well. Note carefully the categories, which are almost designed to generate results that please the WHO.

    “Annex Table 1 is designed as a guide for using Annex Tables 5-7, 9 and 10. Each measure of goal attainment and performance - disability-adjusted life expectancy, health equality in terms of child survival, responsiveness level, responsiveness distribution, fairness of financial contribution, performance on level of health, and overall health system performance -is reported as a league table ranked from the highest level of achievement or performance to the lowest level....”

    Plenty of double talk. Many other factors have much greater effects on a nation’s health than do medical services, for instance ‘race’, fatness, illegals, poverty. Thus the WHO report is not a reasonable assessment of a society’s health services. click to return


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Here is Mankiw with sensible comments on health care systems

does a health system have anything much to do with longevity? - mankiw
[dated 2007]

“Americans are also more likely to be obese, leading to heart disease and other medical problems. Among Americans, 31 percent of men and 33 percent of women have a body mass index of at least 30, a definition of obesity, versus 17 percent of men and 19 percent of women in Canada. Japan, which has the longest life expectancy among major nations, has obesity rates of about 3 percent.”

“Infant mortality rates also reflect broader social trends, including the prevalence of infants with low birth weight. The health system in the United States gives low birth-weight babies slightly better survival chances than does Canada’s, but the more pronounced difference is the frequency of these cases. In the United States, 7.5 percent of babies are born weighing less than 2,500 grams (about 5.5 pounds), compared with 5.7 percent in Canada. In both nations, these infants have more than 10 times the mortality rate of larger babies....”

“The 47 million also includes many who could buy insurance but haven’t. The Census Bureau reports that 18 million of the uninsured have annual household income of more than $50,000, which puts them in the top half of the income distribution. About a quarter of the uninsured have been offered employer-provided insurance but declined coverage.”

There is more in the item. Mankiw is one of the few economists who almost invariably talks sense.click to return

health care and poverty

As you can see in the graph above, the USA is listed as spending a considerably larger proportion of their GDP on health services. However, it is very difficult to trust such comparisons as the American health system is so different from nationalised health systems. For example, 10% of the American budget goes on litigation, whereas in Europe it is virtually impossible to receive compensation for medical errors.

It is political rhetoric to go on about 40 or 50 million uninsured. In fact, more than 10 million of these are illegal immigrants, another 10 to 15 million are young people who think they will not become ill, known cynically as “the invulnerables”. And there are 10 to 15 million who genuinely cannot get insurance because of low incomes. However, the uninsured in need of medical services can simply turn up at a free clinic or at A and E (casualty). The over-65s are covered by Medicare, while the seriously poor are covered by Medicaid, but the poor do receive second-class and worry. (To be expanded.)

What is the beef for poor people or those without insurance? Well, sometimes they do have assets and they have chosen not to take out insurance; and then they are saddled with a bad situation, such as an accident and run up very big bills. At which time, they may have their assets taken to pay the bills. For America is far more of a free and self-reliant society. There are also insurance companies that may play fast and loose when faced by a client with large bills.

Around 50% of the population has hardly any bills, so the insurance industry happily rakes in the premiums. By the 80th percentile, the insurance companies become liable for about $3,000 of medical bills. By the 95th percentile, it may well be $12,000, and for the very top 1%, the people with really serious long-term illness, we may be up around $35,000 a year. So it is particularly these very expensive patients where some insurance companies try to wriggle out of their responsibilities. But of course, in Europe it is the same cases where the State is most inclined to ration care by delays and by refusing expensive drugs.

Therefore, you will see that, like some many things, it is swings and roundabouts. Medical services are heavily back-loaded, that means that most of medical costs come at the last couple of years or months of life. Hence in Europe, you will regularly come across cases where very old people are treated with disgusting inhumanity, another form of rationing.

  • Another item concerning the health of the nation that should be considered is GINI (differentials in income) - the greater the GINI value, the lower the health expectation. This is thought to be related to social status. Those of lower status have more ‘illness’ probably related to stress and subservience.

  • “I deeply resent the Americans sneering at our health service: but perhaps that’s because the truth hurts.” [Quoted from dailymail.co.uk] Remarkably well written and accurate article, other than a foolish comment concerning David Cameron.

  • “The UK was found to be one of Europe's worst countries for cancer survival and one of the lowest spending on cancer treatment.”
    [Quoted from bbc.co.uk, 1999]
    Country Health spending as % of GDP Age-standardised cancer deaths per 100,000 people Five-year survival rates
    Colon cancer Breast cancer
    USA 12.7% N/A 60% 82%
    Germany 10.5% 196.7 48% 68%
    Switzerland 9.8% 182.1 51% 76%
    France 9.6% 194.3 45% 72%
    Netherlands 8.6% 206.8 50% 72%
    Italy 7.6% 199.9 42% 72%
    Spain 7.6% 179.8 46% 64%
    Finland 7.5% 163.0 49% 75%
    Sweden 7.2% 161.3 N/A N/A
    UK 6.9% 206.5 36% 63%
    Denmark 6.4% 226.5 38% 69%
    Source: World Health Organisation, 1998; Berrino et al, 1995; Murray 1998; World Bank,1993


  • The state of the UK national health service after 10 years of socialist incompetence [September 2007]
    UK cancer survival rate lowest in Europe
    Country Five-year cancer survival rates between 2000-2002   Country Five-year cancer survival rates between 2000-2002
    Women   Men
    USA 62.9   USA 66.3
    Iceland 61.8   Sweden 60.3
    Sweden 61.7   Iceland 57.7
    Belgium 61.6   Finland 55.9
    Finland 61.1   Austria 55.4
    Switzerland 61.1   Switzerland 54.6
    Spain 59   Belgium 53.2
    England 52.7   England 44.8
    Scotland 48.0   Scotland 40.2
    Quoted from telegraph.co.uk
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health services, value for money - 2009 report from canada

The report’s source is a Canadian ‘think’ tank.

Close examination will show that this report is more useful for assessing health services than the WHO report of ten years ago, but it still suffers from confusing tinsel with substance. Total scores put the UK and Canada far down among wealthy countries [p.10].

Separating out the tinsel from the substance [p.15]. It is better to attend to rows 2 and 3 of the table, and to put much less stress on rows 1, 4 and 5. to the right, we reproduce rows 3 and 2. (Row 3 has been re-ordered in score order, countries with the same score are listed alphabetically.)

Again, Britain shows very badly. Canada is bad on waiting times, but considerably better on the vital ‘outcomes’ measure.

This report skips over [omits] the Japanese and USA systems. it does give some idea of ‘money’s worth’. This measure rates Canada and the UK well down among wealthier countries [p. 25].

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Here is an outline of day-to-day experience in the British system, and this from an extreme left-wing source.

“The warning signs of what lay ahead came on our first visit to Great Ormond Street, when there was a young couple who had travelled down from the north-east of England in front of us, their tiny sick baby almost lost in its blankets. "Didn't anyone tell you – your appointment's been cancelled?" the receptionist told them breezily. They looked at each other despairingly.”

“After 10 minutes, we left his consulting room. The waiting area felt tense, with harassed parents, bored children, raised voices and too few seats. This unfortunate doctor had to see more than 50 patients during his two-and-a-half hour clinic – or one patient every three minutes, with no time for reading notes, let alone a break. And we had already ruined his schedule. No wonder people were getting exasperated.”

“For all the rhetoric, this is daily reality in our health service. This is not to denigrate the many fine workers, both on the frontline and behind the scenes. We have come across doctors, nurses, paramedics, therapists and many others who have been supportive, caring and inspirational. Some have gone way beyond the call of duty to help in times of distress or difficulty, such as our palliative care team and the community nurses. But equally, we have come across too many ground down by a sclerotic system that crushes out the idealism or caring nature that presumably made them join the health service.

“Clearly there is systemic failure. And it is a question of management, not money...”

  country outcomes waiting times for treatment
1 Sweden 283 100
2 Denmark 257 150
3 Finland 257 108
4 Netherlands 257 167
5 Austria 243 108
6 Norway 243 133
7 Canada 229 83
8 France 229 167
9 Germany 229 233
10 Ireland 229 133
11 Italy 229 150
12 Luxembourg 229 233
13 Czech Republic 214 183
14 Greece 214 167
15 Spain 214 117
16 Switzerland 214 233
17 Slovenia 200 100
18 United Kingdom 186 117
19 Cyprus 171 150
20 Estonia 171 183
21 Latvia 171 83
22 Belgium 157 217
23 Hungary 157 200
24 Poland 157 133
25 Portugal 157 100
26 Croatia 143 117
27 Lithuania 143 150
28 Malta 143 133
29 Bulgaria 129 167
30 FYR Macedonia 129 117
31 Slovakia 114 167
32 Romania 86 200
  Average 193 153
       

mortalities amenable to health care, by country. From Putting Patients Last/Davies & Gubb
Amenable mortality chart from Putting patients last by Davies and Gubb [publ. Civitas] p.34

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health care: private/public - usa/uk, continuing a comparison

“And so it went. When it came time for my husband to undergo physical rehabilitation, I went to look at the facility offered by the N.H.S. The treatment was first rate, I was told, but the building was dismal: grim, dusty, hot, understaffed, housing 8 to 10 elderly men per ward. The food was inedible. The place reeked of desperation and despair.

“Then I toured the other option, a private rehabilitation hospital with air-conditioned rooms, private bathrooms and cable televisions, a state-of-the-art gym, passably tasty food and cheery nurses who made a cup of cocoa for my husband every night before bed.

“We chose the private hospital, where the bills would be paid in their entirety by insurance. My husband lived there for nearly two months. We saw the other patients only when they were in the gym for treatment when my husband was. Most of them seemed to be from rich countries in the Middle East. Perhaps they were the only ones who could afford to pay.” [Quoted from nytimes.com]

There are also some positive comments.click to return

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and interminable socialist ‘New’ Labour lies:

“The figures, published by the Lib Dems, show that 236,316 people are currently waiting more than 18 weeks for a range of treatments including oral surgery, rheumatology and geriatric medicine.

“This means that nearly 10 per cent of patients are not being treated within the government's waiting list target.

“It stands in contrast to comments made by Mr Burnham on Tuesday that Labour had wiped out all waiting lists on the NHS.”

“ The Department of Health said the NHS had met targets for the first time last summer for 90 per cent of admitted and 95 per cent of non-admitted patients to receive treatment within 18 weeks.”

What is interesting to me is this sort of statement is presented as ‘success’. Even if it were not for the widespread fudging of government stats, it would come nowhere near the results for any high-street supplier - even the worst of them.click to return


a lightweight outline of what the serious right actually want in healthcare

This proposal amounts to a voucher, or citizen’s wage, for healthcare.

For those who still read books, the proposal is better laid out, and in greater detail, by Charles Murray in In Our Hands: A Plan to Replace the Welfare State.

health costs in society


48:00 mins

This video is fascinating and well worth watching, as long as you have ample pinches of salt. It is propaganda, classy propaganda, but still propaganda. It is not analysis.

The UK’s NHS is one of the biggest employers in the world. Not like the French system with approximately similar population, not like the German system with considerably higher population. Why does it that such a huge monolithic organisation in the UK? How much resources are wasted by these health systems? Maybe the NHS is cheaper because of low wages, but that also must mean there are less road sweepers or church fabric restorers!

Meanwhile, the users of the USA system make far more of the choices, and they choose, as a society, to pay more. And further, the USA is a much richer society than Europe.

I keep asking what the situation would be in Europe if the public chose their level of expenditures on health, rather than being captive to a government cartel.

The higher costs in America could easily reflect the higher level of discretionary income available to the average American and a widespread choice to spend a good proportion of that on medical services, rather than any argument about ‘waste’ or ‘too high’ health care costs. There is a great deal of disinformation about the American health system. Almost everybody does, in fact, have health care. In fact, about 45% of American health care is paid for by the government under the headings of Medicare and Medicaid. Medicare is essentially for the over sixty-fives and Medicaid for those on low incomes. There is also a system for veterans (ex-military).

It is difficult to compare American costs with those of the UK and Europe. In particular, legal liability for medical errors is widely enforceable in the USA, whereas in Europe it is very hard to enforce recompense. Legal liability is estimated at about 10% of the American medical costs, but I think it may very well be higher in view of all the insurance and legal services implications. It is also claimed that drug bills are about 10% of medical costs and that higher charges are made for drugs in the USA.

In the USA, able citizens in good standing are expected to shift for themselves and take out appropriate health insurance. Three groups tend to under-insure themselves: illegal immigrants (maybe 10 million+ people), young workers, often referred to as the Invincibles because they believe nothing will happen to them (maybe 15 million people), and those poor but not poor enough to qualify for Medicaid (perhaps another 15 million people). But even these groups can turn up at A & E (accident and emergency, or casualty in the UK) and it is illegal not to treat them.

Note the surprisingly low contribution of health (medical) costs to a nation’s welfare, despite the high levels of agonising about health services, both private and political.

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twitter and iran - This makes an interesting contrast, because in the main, the NHS twittering is uniformed, full of emotion, while being generally bereft of information.

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