Thursday, 15 March 2012

Medical care in the United States

If you live in the United States, and have MS, the following article is a must read. It is particularly relevant to the management of chronic diseases.

Harvey V. Fineberg. A Successful and Sustainable Health System - How to Get There from Here. N Engl J Med 2012; 366:1020-1027March 15, 2012.

Some brief extracts:

"In 1960, life expectancy at birth in the United States was 69.8 years — putting us in the middle of the pack of countries in the Organisation for Economic Co-operation and Development (OECD), 12 of which had a longer life expectancy and 13 of which had the same life expectancy or a shorter one. By 2009, 26 countries had longer life expectancies and 7 had shorter ones."

"When assessed on the basis of various aspects of performance, including quality, access, efficiency, and equity, the United States came in last overall in 2010; in no category did we excel."

"One health system measure on which we far exceed all other countries is health expenditures. Back in 1960, when the United States spent 5.1% of its gross domestic product (GDP) on health, Canada spent 5.4% of its GDP. By 2009, however, Canada's spending as a fraction of GDP had more than doubled, to 11.4%, while ours had more than tripled, to 17.4%. Today, however, no one rivals the United States in per capita health expenditures."


"Why is this important? I get a several emails a week from MS'ers in the US explaining the difficulties they are having with access to DMTs or specialized care. Most of the time it revolves around lack of insurance and finance. This is something I am not used to. I was surprised by the facts in this paper; in fact shocked. I was under the impression that the US had one of the best healthcare systems in the world."

3 comments:

  1. Oh Prof G as a Brit who has lived in the US let me tell you the US system is great if you have a job and therefore insurance AND can afford to pay the percentage you have to contribute (insurance doesn't cover 100% of the (enormous) costs...) need I say more? The amount spent on health in the US has to include a profit for the insurance companies, and all the admin associated with running such a system. It is very inefficient in % GDP terms - and also excludes the most vulnerable people in society. People may criticise the NHS but in my book it is brilliant.

    Yes I had very good care while I was living in America but I was lucky in that 100% of my medical costs wee covered, which was quite unusual.

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  2. Of course I meant were!

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  3. I used to go on a US leukaemia website board and lots of people there had to get ok's from their insurers for certain hospitals or treatments- it wasn't just what their clinicians thought was the best treatment for them. Also quite often they'd have chemo that would knock out their immune system and then be sent home to wait for it to rebuild itself, only having to be re-admitted as emergency cases when they developed neutropenic (no immune system) fevers

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