In a recent survey of Western European nations and the US, dissatisfaction is growing with health care systems, but Americans  top the list of the dissatisfied.  Our take on the survey?  The findings come as no surprise. We pay the most with the worst results. I wonder, however, what the survey answers would be in Canada, Norway, Sweden, Finland, Switzerland or Japan. 

There is no cookie-cutter solution to health care.  Aging populations, technology and chronic diseases push up costs for everyone.   One approach might be to have the World Health Organization or US and European Union nations (plus Switzerland), start a task force on our common health care issues, financing and delivery system approaches.  The question to ask, however, is why the French are the most satisfied? 

Here is a quick glimpse of how we stack up to other health care systems, how they are paid for, managed and the role of government.  We think you will find this of interest.

Cheers and more later.  Kathleen

Today’s blog is from Ken Terry, author of Rx for Health Care Reform.  For more information on Ken and to read his blog, visit A Health Reformer's Online Diary.

It's Time for Deep Reform

Mainstream proposals for reforming health care take a superficial approach to the central role of our care delivery system in driving up costs and obstructing change. But some health policy experts suggest much more radical approaches to reform. These ideas, which collectively might be called “deep reform,” address the need for systemic changes in health care that go far beyond insurance coverage or quality incentives. Recognizing the inadequacy of the financing-focused measures that pass for reform today, these thinkers propose alternative methods of structuring the delivery system and reimbursing providers. While their ideas differ in many important ways, they could form the basis for a grand compromise between the left and the right.

Deep reform encompasses the entire political spectrum. For example, Arnold Relman, MD, former editor of The New England Journal of Medicine and author of the book A Second Opinion: Rescuing America’s Health Care, wants us to switch to a single-payer insurance system in which care is delivered by competing group-model HMOs. He rejects the conservative idea of “consumer-driven health care,” regarding it as a way to shift more costs to consumers while motivating poorer patients to skip necessary care. In contrast, Michael Porter and Elisabeth Olmstead Teisberg, the authors of Redefining Healthcare: Creating Value-Based Competition on Results, favor the consumer-driven approach. In their model, specialized teams of providers would compete on the basis of their outcomes for particular procedures or episodes of care. These teams would be independent business units, rather than part of the large, prepaid multispecialty groups that Relman supports. But like Porter and Teisberg, Relman would have his physician groups vie for patients on the basis of published quality reports.

Continue reading . . .

Let’s hear it for the Tri-Cities Herald!  They have started a civic engagement forum for their community which is a great model for other communities.  We hope to adapt one of their ideas for our use as we move forward. 

Here’s what they do:  Every Sunday they have a Tri-City Forum Page in the newspaper, which links to an open website for comments on virtually any topic.  The newspaper’s opinion page has space for readers’ comments, but the webpage:  www.tricityforum.com is totally devoted to readers’ comments. 

Registered users can start a blog or respond to others comments. 

They have a weekly forum question, and they can comment on the question or start their own conversations.  The letters to the editor require names, but the website discussion can be anonymous with “nicknames.” 

Now they have added an in-person dimension to this ‘conversation.’  They have teamed up with the Benton Franklin Dispute Resolution Center so people can actually sit together and discuss an issue in the same room.  Their next topic is a discussion of the November ballot measure in Washington State on “death with dignity.”

The in-person event is over two evenings so people can reflect on the conversation.  The Dispute Resolution Center focuses on finding common ground among conflicting points of views.  Read more about it here. 

Now this is what we call civic engagement.  

CodeBlueNow! was founded on civic engagement.  Like the Tri-Cities Herald, we have several means of engagement.  We have an online survey tool so people can tell us what they think. We have just started an online discussion forum so people care share their ideas and ‘talk’ with us and each other.  We are just now starting a book group, so we can read a book and comment on its ideas.  These book groups can be virtual or in person.  We also engage the public by partnering with other nonpartisan nonprofits so they can have discussions with us and within their groups.   We also blog and participate and share ideas and comments with other bloggers.  Soon we will be starting an online advocacy campaign.

The point is that the people need to be heard and we have more in common than we are told by the parties and the pundits.  So, our hats are off to the Tri-City Herald for its commitment to civic engagement!

Cheers and more later.  Kathleen

We are starting a series on our blog on what other countries’ health care systems look like.   Significant misinformation exists on other health systems, so we thought we would start by taking a look at a few key countries that operate most like the US.  Anne Kinzel, JD, has been writing about France.  She has one more post on that, but we wanted to start with some other countries as well.  Basically, covering everyone is not rocket science.  It does, however, take political courage and public will.

Before we take a look at these systems, here is what many of them have that we do not:

• One national agency that negotiates rates and defines services
• One standard set of services for everyone
• Employer and individual may add more benefits
• Administrative simplicity
• Standards
• Majority of physicians are primary care
• Private, nonprofit insurance companies
• Mediation prior to litigation for malpractice

The simple act of having one basic set of services for everyone eliminates the vast complexity that drowns our health care system.  If we had one basic set of services that everyone was eligible, we would eliminate probably a third of the cost of our health care system. 

We will look at these issues in greater depth as we move forward.  We invite your comments and insights. 

Cheers and more later.  Kathleen

While Anne is preparing to finalize her blogging on the French health care system, we are taking a side trip and looking at how other countries deal with malpractice.  We will be featuring an upcoming series on health care in other countries that is pretty much going to dispel the myth that if it ain’t American it is socialized. 

There are many ah ha moments here for how other countries handle their malpractice claims. 

United States
In the US, medical malpractice law traditionally has been under the authority of the states, not the federal government, as it is in many other countries.  To win compensation, the injured person needs to prove that they received substandard medical care that caused their injury.  This must be done within a legally prescribed period, called a “statute of limitation.”  Once the injured person has proved negligence that led to injury, the court establishes how much “damages” will be paid in compensation.  These take into account both actual economic loss (lost wages and cost of future medical care) and non-economic losses (pain and suffering).  Physicians generally must have malpractice insurance to protect themselves and their patients in case of medical negligence and unintentional injury.

United Kingdom
Similar to the United States, the UK relies on the court system to settle patient complaints.  90% of doctors in the UK are insured by the NHS, which handles all the legal and business aspects of medicine.  Doctors are not personally liable for malpractice claims, nor must they purchase malpractice insurance on their own.  While jury trials are less common in the UK, the legal handling of malpractice claims are much like the US’s.  Funds for the NHS indemnity come from the government’s general fund.

France
Up until 2002, France’s malpractice system looked similar to the United States’.  Patients brought their cases to court and then either settled or received an award.  The two main differences between France and the United States’ practices are that first, France had no caps on malpractice awards, and second, there were several rules that made it more difficult for patients to win a case. 

However, since 2002 things work differently in France.  France has moved to a out-of-court, no-fault system in which wronged patients bring claims before their regions’ government-appointed review board which is responsible for determining whether or not compensation is in order, and if so, how much.  Money for patient relief comes from a national compensation fund which gets its funds from insurance premiums placed on doctors and hospitals or from general fund revenues. 

Germany
In Germany, initial malpractice claims are referred to mediation boards and expert panels set up by the Physicians’ guild.  Patients may reject the result of mediation and take their case to court, where the system is similar to the United States’.   

Sweden, Finland, Denmark and Norway
These Nordic countries operate out-of-court, no-fault systems for medical malpractice.  The systems are based on the principle of compensating patients for injuries they suffer from medical care that involved avoidable risk and complications.  The systems also compensate patients for injury caused by defective equipment, the misuse of equipment, incorrect diagnoses, and infection contracted during treatment. 

Japan
All members of the Japanese Medical Association  – which accounts for 43.5% of Japan’s doctors – have a collective insurance pool.  Private doctors and hospital employees can buy insurance through the private market, though it is not required by law.  The professional liability program offers an out-of-court review of claims that is faster and less expensive than in-court reviews, but the way is set up is biased in favor of doctors over patients.  The review board’s decisions are binding, but if the patient is dissatisfied he or she may sue in court.

In Japan, injury or death due to medical error is often treated as a criminal matter – arrests and prosecutorial decisions are based on results of investigations.  This is in contrast to the United States, which almost always treats medical errors as a civil matter, not criminal.

Canada
Canada’s malpractice system is similar to the UK and the US, except there are far fewer claims filed and more money is paid out in compensation on average that in the US.  One reason there are fewer claims filed in Canada can be attributed to the increasing use of alternative, informal interventions that address patient concerns more quickly the formal system.  In Canada, most doctors receive malpractice protection from the Canadian Medical Protective Association.

Many thanks to our Projects Assistant who did the research!

Cheers, Kathleen.

Sources:
• Medical Malpractice Law in the United States.  Kaiser Family Foundation. May 2005. • International Medical Liability Systems – A comparative view.  The Canadian Medical Protective Association. June 2006.
• Health Spending in the United States and the Rest of the Industrialized World.  The Commonwealth Fund.  July 2005.
• Mythbusters: Medical malpractice lawsuits plague Canada.  Canadian Health Services Research Foundation.  March 2006.
• Malpractice ‘Round the World.  Nick Beaudrot.  July 2005. 
• "Medical malpractice." Wikipedia, The Free Encyclopedia. 6 May 2008, 00:32 UTC. Wikimedia Foundation, Inc. 7 May 2008

When I was the marketing director for a Medicare HMO in the late 80’s, we used to hear from seniors at that time:  “I’m healthy as a horse. I have never had to see a doctor my entire life.”   Well that culture has changed.   Earlier this week, the Blue Cross Blue Shield Association released a story about the Top Ten Drugs used in New York State, and their annual costs.

Just look at the costs of these drugs:  $241,520,000 on Lipitor alone—the number one best seller.  Next was for Asthma—Advair at $116,280,000.

This is only from one state (New York). 

In most of these cases, generics were available. In the case of asthma, it would be interesting to know how much of this was for children.   Here in Seattle, at a low income housing development, ER room visits dropped from 61.8 visits to 20 over a 3 month period, just by adding an air cleaning system in some of the homes. 

We are being sold sickness and we are not the healthier for it. (Read: Selling Sickness: How the World’s Largest Pharmaceutical Companies are Turning Us All into Patients).

Our costs are outrageous—twice as much as any other country—yet we do not live as long (30th for life expectancy) and we have shameful outcomes—27th in Infant Mortality and 37th for overall health outcomes. 

Which is why we all need to get involved to change our system. It is not working! 

Cheers and more later.  Kathleen