Wednesday, June 08, 2005

A View of the British Health Service

David Asman, an anchor for Fox News, has an exceptional piece in OpinionJournal today (click title) on the UK Health Service. His wife, unfortunately, suffered a severe stroke while in the UK and he got a look first hand at the UK system compared with ours.

[New York Times: PLEASE TAKE NOTE. This is good journalism. It's personal, insightful, with facts and opinions freely and clearly expressed and FAIR.]

Asman has high praise for UK health care workers from front to back:

The emergency workers who came within five minutes were wonderful. The two young East Enders looked and sounded for all the world like a couple of skinhead soccer fans, cockney accents and all. But their professionalism in immediately stabilizing my wife and taking her vitals was matched with exceptional kindness. I was moved to tears to see how comforting they were both to my wife and to me. As I was to discover time and again in the British health system, despite the often deplorable conditions of a bankrupt infrastructure, British caregivers--whether nurses, doctors, or ambulance drivers--are extraordinarily kind and hardworking. Since there's no real money to be made in the system, those who get into public medicine do so as a pure vocation. And they show it.
As for the caliber of medicine practiced at Queen's Square, we were quite impressed at the collegiality of the doctors and the tendency to make medical judgments based on group consultations. There is much better teamwork among doctors, nurses and physical therapists in Britain. In fact, once a week at Queen's Square, all the hospital's health workers--from high to low--would assemble for an open forum on each patient in the ward. That way each level knows what the other level is up to, something glaringly absent from U.S. hospital management. Also, British nurses have far more direct managerial control over how the hospital wards are run. This may somewhat compensate for their meager wages--which averaged about £20,000 ($36,000) a year (in a city where almost everything costs twice as much as it does in Manhattan!).

There is also much less of a tendency in British medicine to make decisions on the basis of whether one will be sued for that decision. This can lead to a much healthier period of recuperation.

However, the infrastructure itself is antiquated and dangerous:

When I covered Latin America for The Wall Street Journal, I'd visit hospitals, prisons and schools as barometers of public services in the country. Based on my Latin American scale, Queen's Square would rate somewhere in the middle. It certainly wasn't as bad as public hospitals in El Salvador, where patients often share beds. But it wasn't as nice as some of the hospitals I've seen in Buenos Aires or southern Brazil. And compared with virtually any hospital ward in the U.S., Queen's Square would fall short by a mile.

The equipment wasn't ancient, but it was often quite old. On occasion my wife and I would giggle at heart and blood-pressure monitors that were literally taped together and would come apart as they were being moved into place. The nurses and hospital technicians had become expert at jerry-rigging temporary fixes for a lot of the damaged equipment.
In fact, cleaning was my main occupation for the month we were at Queen's Square. Infections in hospitals are, of course, a problem everywhere. But in Britain, hospital-borne infections are getting out of control. At least 100,000 British patients a year are hit by hospital-acquired infections, including the penicillin-resistant "superbug" MRSA. A new study carried out by the British Health Protection Agency says that MRSA plays a part in the deaths of up to 32,000 patients every year. But even at lower numbers, Britain has the worst MRSA infection rates in Europe.

It's cheap:

When I received the bill for my wife's one-month stay at Queen's Square, I thought there was a mistake. The bill included all doctors' costs, two MRI scans, more than a dozen physical therapy sessions, numerous blood and pathology tests, and of course room and board in the hospital for a month. And perhaps most important, it included the loving care of the finest nurses we'd encountered anywhere. The total cost: $25,752. That ain't chump change. But to put this in context, the cost of just 10 physical therapy sessions at New York's Cornell University Hospital came to $27,000--greater than the entire bill from British Health Service!

but is it really?

"Free health care" is a mantra that one hears all the time from advocates of the British system. But British health care is not "free." I mentioned the cost of living in London, which is twice as high for almost any good or service as prices in Manhattan. Folks like to blame an overvalued pound (or undervalued dollar). But that only explains about 30% of the extra cost. A far larger part of those extra costs come in the hidden value-added taxes--which can add up to 40% when you combine costs to consumers and producers. And with salaries tending to be about 20% lower in England than they are here, the purchasing power of Brits must be close to what we would define as the poverty level. The enormous costs of socialized medicine explain at least some of this disparity in the standard of living.

In short,

As for the quality of British health care, advocates of socialized medicine point out that while the British system may not be as rich as U.S. heath care, no patient is turned away. To which I would respond that my wife's one roommate at Cornell University Hospital in New York was an uninsured homeless woman, who shared the same spectacular view of the East River and was receiving about the same quality of health care as my wife. Uninsured Americans are not left on the street to die.

Where do you get better care?

...One can tell that the edge has disappeared in treatment in Britain. For example, when we returned to the U.S. we discovered that treatment exists for thwarting the effects of blood clots in the brain if administered shortly after a stroke. Such treatment was never mentioned, even after we were admitted to the neurology hospital. Indeed, the only medication my wife was given for a severe stroke was a daily dose of aspirin. Now, treating stroke victims is tricky business. My wife had a low hemoglobin count, so with all the medications in the world, she still might have been better off with just aspirin. But consultations with doctors never brought up the possibilities of alternative drug therapies. (Of course, U.S. doctors tend to be pill pushers, but that's a different discussion.)

Then there was the condition of Queen's Square compared with the physical plant of the New York hospitals. As I mentioned, the cleanliness of U.S. hospitals is immediately apparent to all the senses. But Cornell and New York University hospitals (both of which my wife has been using since we returned) have ready access to technical equipment that is either hard to find or nonexistent in Britain. This includes both diagnostic equipment and state-of-the-art equipment used for physical therapy.

Read it all, it's worth your time.

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