December 12, 2009
Healthcare Access Better Overseas?By Linda Halderman, MD
European health care systems are often portrayed by their advocates as superior in quality and delivery of care to that of the United States. Proponents of radical health care reform who condemn the U.S. system cite great achievements in access and affordability in other nations.
As the debate over U.S. health care reform continues, these assertions should be examined.
Worldwide, true single-payers system are found in only two countries: Canada and North Korea. In both countries, health care is delivered only via government provision. All other systems involving government-provided care are multi-tiered, allowing some combination of public and private care.
The Greek Way
I met 22-year-old Helena while traveling. A native of Santorini, Greece, she was fascinated by American culture but proud of her own country. She asked many questions and was eager to answer mine, most of which dealt with the system of health care delivery in Greece.
"We are glad we offer what your country does not," she said. "Everyone here can go to the doctor. Of course, it is not perfect. But it is Greek and it will not change."
"Not perfect?" I asked.
"Well, I give you my father. He had stomach problems for a long time. The doctor said he needed surgery on the gallbladder. But we are not rich, so we go to the public hospital. They told him he would have to wait two years for the surgery. But he had much pain."
"What did he do?"
"Of course he gave money to the doctor to make the wait shorter," she reported matter-of-factly. "He's feeling much better now."
During a taxi ride through Athens, I asked the driver about a beautiful modern building we passed. It appeared new.
"That is the public hospital," he answered. "It is very nice. But it is not so good if you have the emergency."
"Why?" I asked. "Aren't there very good doctors in Athens?"
"Yes, of course. But they won't work there. My friend Christos drives a cab now, like me. But before this he was an emergency doctor; he told me he had to see about two hundred patients each night. For this, the government pay him 1,300 Euros a month...something like 2,000 American dollars, yes?"
In both Greece and Japan, expensive "gifts" are commonly paid to doctors and hospitals for expedited treatment within the government-subsidized system. In Sweden, the waiting time for heart surgery is twenty-five weeks. This led to recent privatization efforts in which the government will contract out some 80% of Stockholm's primary care and 40% of total health services, including Stockholm's largest hospital.
In 1993, Germany attempted to address the high cost of prescription drugs by fixing prices. The result was that research and development halted. Drug shortages led to an increase in patient dissatisfaction, and job losses in the pharmaceutical industry increased the country's unemployment rates.
Germany has since enhanced insurance competition and turned state enterprises -- including most public hospitals -- over to the private sector.
Vive la France?
The French system, though two-tiered, is based on Marxist theory: "You pay according to your means, and you receive according to your needs."
The State decides what care is covered and how much it pays. It defines the responsibilities of patients and doctors.
The State is responsible for safety within the health system.
Unfortunately, policy failures led to a 1980s health disaster. For economic expediency and with government approval, units of blood contaminated with HIV were transfused into over 4,400 patients, who were later confirmed to develop AIDS.
Ignoring French and international medical evidence that HIV-infected blood leads to infection in transfused patients, the French government even initiated a blood-donation drive among prisoners -- one of the highest known risk groups for HIV.
A cover-up was eventually revealed, and new agencies were created to oversee safety measures concerning the nation's blood supply, organ donor programs, food, medical goods, and services.
French Technology, Planning, and Government Oversight
The State decides on the size and number of hospitals, as well as the distribution of highly technical equipment like MRI and CAT scanners.
Since 1999, health care workers and doctors have warned of the decay-related inadequacy of the health system and the dangerous consequences for French citizens. Medical personnel shortages, poor training and equipment, widespread hospital closures, and the high cost of care are subjects of public protest.
This attracted international attention when the French government admitted that over 11,000 people died during the two weeks of France's August 2003 104-degree heat wave.
The overburdened, ill-equipped health care system -- particularly for elderly victims -- was blamed in part for this tragedy.
During a one-week period, a crisis occurred when hospitals were unable to cope with the vast numbers of people suffering from dehydration and heat-related illnesses who were brought in by emergency workers. Most of these were frail or elderly with chronic illnesses.
Overwhelmed hospitals stopped admitting patients. Ambulance services told patients to cope wherever they were. French citizens died in hotels, in apartments, and in nursing homes. Some died on the street.
80% of those who died were over 75 years of age.
France's Healthcare's Future
Recently, and particularly since the revelation of government's involvement in the blood-bank-HIV catastrophe, more and more policy-making is undertaken regionally. This is likely to continue in the coming years.
In addition, a new French private health market is rapidly expanding, including the listing of some private companies on the Paris stock exchange.
Cuba: Not for the Sick
The Cuban health care delivery system received a great deal of attention after the release of Michael Moore's Sicko.
However, Moore reported to interviewers that he personally rejected the Cuban system as a good model for the U.S. to follow, referring to the country as a "prison nation" and admitting that he simply highlighted the socialist system for "ironic purposes."
The multi-tiered system of health care delivery and funding in Cuba includes the following, none of which is mentioned in "Sicko":
Though the grass may appear greener from across the Atlantic Ocean -- or even ninety miles off Key West -- it may, in fact, need new sod.
Dr. Linda Halderman is a General Surgeon and policy advisor in the California State Senate. Since the September 29, 2009 earthquake and tsunami that devastated the South Pacific, she has been providing medical relief on American Samoa.