National Health Service bashers make me sick

[AnnaG]

New England Journal of Medicine has an article in it about a model they think the States should go for. They call it the "Prometheus Model". I think it's a good idea and certainly better than what we have going on in BC at the moment. They think it'll be sustainable.

"In the current debate over health care reform, many observers are proposing new delivery structures to move U.S. health care away from fragmentation, poor performance, and dysfunction toward accountability for high-value care. Ideally, these new structures would promote clear accountability for both improving quality and controlling costs and would encourage health care professionals to organize themselves into teams working on behalf of patients. For such structures to be sustainable, however, the payment system must reward professionals for the quality and efficiency of services, rather than the quantity." - Building a Bridge from Fragmentation to Accountability — The Prometheus Payment Model | Health Care Reform 2009

If they can get it going and work out the inevitable bugs, they should end up with a better system than we have.

 

[SirJosephPorter]

Nonsense. Canadians pay health insurance; both public, through taxes, and private, out of pocket. There is a price for everything in Canada. Free is a myth.
BTW, whenever I see my doc, I pay a user fee. We do that in BC.

Anna, in the context of health care, ‘free’ means free at the point of delivery. In my opinion, that is how health care system should be, free at the point of delivery.

And I don’t know about BC, but there are no user fees here in Ontario.

 

[ironsides]

Healthcare in Sweden - Wikipedia, the free encyclopedia
Health care in Singapore - Wikipedia, the free encyclopedia
Two-tier health care - Wikipedia, the free encyclopedia

You can read a bit mroe about the Swedish and Singaporean systems here. The Singaporean model seems to have proven more sucessful overall in that the Swedish model is itself currently undergoing a transition. However, some have criticized certain aspects of the Singaporean model as being not translateable to geographically bigger countries (after all, Singapore is a city state). I don't see why we couldn't pick and choose from the Singaporean model and maybe combine it with some aspects of the current Swedish model to come up with a new system that expoits the strengths of both public and privte health care.

Still not sure that what works for 30 million will work just as well for 300 million. The big difference is that we do not have any real wait times, for anything. Not saying it would never happen, but not so far. Our health care even works good in the real rural areas. The information about Sweden and Singapore is very interesting, I hope who ever researched what ever plan we get has looked into what plans the world has working.

 

[SirJosephPorter]

There is nothing wrong with wait times, ironsides. Pot of money for health care is obviously limited (in USA they seem to think it is bottomless), so there have to be compromises somewhere, and modest wait times for non essential surgeries is not at all harmful.

Where I live, there is about three weeks wait time for cataract surgery. Once cataract is diagnosed, surgery will be booked in three weeks’ time. I don’t see anything wrong with that. I have cataract in both my eyes, so I will have to get it done; it is a question of when, not if.

But for non essential services such as cataract, hip replacement, a modest wait time is not harmful. The flip side is that it keeps the costs down and more money can be spent on essential items of health care. Problem comes when they become excessive.

Not only modest wait times not harmful, but they deliver results, as is evident in high life expectancy, lower infant mortality etc in Canada compared to USA. And Canada delivers it for a much lower cost compared to USA.

 

[TenPenny]

Anna, in the context of health care, ‘free’ means free at the point of delivery. In my opinion, that is how health care system should be, free at the point of delivery.

And I don’t know about BC, but there are no user fees here in Ontario.

That would depend on what health care services you are talking about.

In NB, for example, annual physicals (when the patient doesn't have any medical problems) are not covered by medicare.

There are lots of things that are not covered.

 

[lone wolf]

User fees aren't a benefit lost on governments....

User Fees are Back; But Why? | rabble.ca

 

[SirJosephPorter]

That would depend on what health care services you are talking about.

In NB, for example, annual physicals (when the patient doesn't have any medical problems) are not covered by medicare.

There are lots of things that are not covered.

In Ontario one physical check up every year (called annual health exam) is covered by OHIP. Personally I think it is a good idea. Problems may be uncovered during annual check up for blood pressure, prostrate exam etc., which could save the life of the patient and also save money for the health care system. Not paying for annual health exam is penny wise and dollar foolish.

 

[lone wolf]

What good are annual health exams if you don't have a doctor to keep track of them? Our Health Care system works fine ... in emergencies and for healthy people.

 

[Machjo]

Still not sure that what works for 30 million will work just as well for 300 million. The big difference is that we do not have any real wait times, for anything. Not saying it would never happen, but not so far. Our health care even works good in the real rural areas. The information about Sweden and Singapore is very interesting, I hope who ever researched what ever plan we get has looked into what plans the world has working.

I don't see what numbers have to do with it. If it's a larger population, you'd just need a decentralized administrative system with local branches.

As for wait times, it's natural that you won't have them under such a private system because those who pay pay well to ensure sufficient staff, while the rest are denied healthcare except maybe in exceptional circumstances as you'd mentioned above. That is a strength of the US system. Universal access is a strength of the Canadian system. The real issue is how to exploit both strengths.

 

[Machjo]

New England Journal of Medicine has an article in it about a model they think the States should go for. They call it the "Prometheus Model". I think it's a good idea and certainly better than what we have going on in BC at the moment. They think it'll be sustainable.

"In the current debate over health care reform, many observers are proposing new delivery structures to move U.S. health care away from fragmentation, poor performance, and dysfunction toward accountability for high-value care. Ideally, these new structures would promote clear accountability for both improving quality and controlling costs and would encourage health care professionals to organize themselves into teams working on behalf of patients. For such structures to be sustainable, however, the payment system must reward professionals for the quality and efficiency of services, rather than the quantity." - Building a Bridge from Fragmentation to Accountability — The Prometheus Payment Model | Health Care Reform 2009

If they can get it going and work out the inevitable bugs, they should end up with a better system than we have.

That link brings up some valid points and seems to be a valid payment model.

 

[Machjo]

There is nothing wrong with wait times, ironsides. Pot of money for health care is obviously limited (in USA they seem to think it is bottomless), so there have to be compromises somewhere, and modest wait times for non essential surgeries is not at all harmful.

Where I live, there is about three weeks wait time for cataract surgery. Once cataract is diagnosed, surgery will be booked in three weeks’ time. I don’t see anything wrong with that. I have cataract in both my eyes, so I will have to get it done; it is a question of when, not if.

But for non essential services such as cataract, hip replacement, a modest wait time is not harmful. The flip side is that it keeps the costs down and more money can be spent on essential items of health care. Problem comes when they become excessive.

Not only modest wait times not harmful, but they deliver results, as is evident in high life expectancy, lower infant mortality etc in Canada compared to USA. And Canada delivers it for a much lower cost compared to USA.

I can agree to this to some degree, but still believe that reasonable efforts to curtail wait times aught to be attempted. For instance, excessive restrictions on private payment for health care exacerbates wait times, whereas allowing for a two-tier system could allow some to opt out of line so as to shorten the line for the rest. This was a benefit of Sweden allowing for more private involvment. And from what I can see of the Singaporean model, it's not likely to have serious wait times for emergencies either owing to its allowing people there to pay to skip the line too if they wish.

 

[Machjo]

Anna, in the context of health care, ‘free’ means free at the point of delivery. In my opinion, that is how health care system should be, free at the point of delivery.

And I don’t know about BC, but there are no user fees here in Ontario.

interestingly enough, both Sweden and Singapore require at least a small fee for service for all non-essential services so as to discourage abuse of the system. Keeping costs down so as to make it accessible to all makes sense. Making it 100% free might not make sense. A small fee coudl help people to think twice before using the service. If a person is on social assistance, I'm sure the government would take that into account by raising the social assistance premiums enough to compensate, while still making the recipients think twice before going for any silly thing.

In some ways, it's the same principle as a carbon tax. It does raise costs for the poor, but the government can compensate by raising the poverty line, while still creating an insentive to not abuse our resources.

 

[Machjo]

User fees aren't a benefit lost on governments....

User Fees are Back; But Why? | rabble.ca

I see nothing wrong with moderate user fees. A simple solution for the poor is for the government to just raise the poverty line to help them if they need help. A small reasonable user fee can help to discourage abuse of the system. As long as the fee is low enough that even the poorest person could afford it, I would still consider it universal.

 

[Machjo]

I think though that the Canadian, British, Swedish and Singaporean systems would likely find it easier to borrow ideas from one another since they all ahve at least one thing in common: they're all universal systems. So even the jump from, let's say, a Canadian to a Swedish or even Singaporean system would likely not be as difficult as it would to go from a US system to even just a Singaporean system, since then you'd be making a giant leap from user-pay to universal. The Singaporean system likewise would probably find it easier to go to the Canadian system than the US one, for similar reasons but in reverse.

 

[#juan]

quoting ironsides
I know I am reading articles about the worst of Canadian healthcare, but are they wrong? Why is there a waiting period of over a week or two for any kind of surgery? In the U.S. you need cosmetic surgery, you just make an appointment thru your doctor and get it. Emergency surgery is done immediately like yours without delay.

You forgot the other step: Take out a second mortgage....;-)

 

[ironsides]

SirJosephPorter:
There is nothing wrong with wait times, ironsides. Pot of money for health care is obviously limited (in USA they seem to think it is bottomless), so there have to be compromises somewhere, and modest wait times for non essential surgeries is not at all harmful.

Where I live, there is about three weeks wait time for cataract surgery. Once cataract is diagnosed, surgery will be booked in three weeks’ time. I don’t see anything wrong with that. I have cataract in both my eyes, so I will have to get it done; it is a question of when, not if.

If I was diagnosed on a Monday needing cataract surgery it could be done by Friday and I would be home Friday afternoon. (Happened to a friend of mine.)


But for non essential services such as cataract, hip replacement, a modest wait time is not harmful. The flip side is that it keeps the costs down and more money can be spent on essential items of health care. Problem comes when they become excessive.

Both cataract and a hip replacement I would not consider cosmetic surgery, they are done ASAP here. There is a so called waiting list, but nothing like you have up there. As soon as the operating room is available you go in. Wait times do not make a operation any easier or better, just causes more anxiety and tension to the patient. Tell the patient that it is good that their operation is being done at a cheaper price.

 

[ironsides]

You forgot the other step: Take out a second mortgage....;-)

They made the term Second Mortgage sound better by calling it a Home Equity Loan. They were practically give second and third loans away. Being sick, had nothing to do with it, need a boat, need a new car, extension on your home, or for that matter get a vacation home get a loan and pay it off for 15 or so years. So many people made that mistake, and now want us to get them out of trouble.

 

[gopher]

washingtonpost.com


5 Myths About Health Care Around the World



''As Americans search for the cure to what ails our health-care system, we've overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they've found ways to cover everybody -- and still spend far less than we do.''

It works every where else. It can work just as easily here.
​

 

[AnnaG]

Anna, in the context of health care, ‘free’ means free at the point of delivery. In my opinion, that is how health care system should be, free at the point of delivery.

And I don’t know about BC, but there are no user fees here in Ontario.

You mean in YOUR context of healthcare "free" means "free at the point of delivery". Either way, you should specify it somewhere near the beginning of your posts. You didn't.
I just told you about BC so now you DO know.

 

[AnnaG]

I can agree to this to some degree, but still believe that reasonable efforts to curtail wait times aught to be attempted. For instance, excessive restrictions on private payment for health care exacerbates wait times, whereas allowing for a two-tier system could allow some to opt out of line so as to shorten the line for the rest. This was a benefit of Sweden allowing for more private involvment. And from what I can see of the Singaporean model, it's not likely to have serious wait times for emergencies either owing to its allowing people there to pay to skip the line too if they wish.

I can agree to a point, also. I wouldn't exactly call a hip replacement non-essential in all circumstances, though. Being in acute pain for 4 months and not being able to move much because of it isn't exactly what I would call "Not harmful" to put it in Sir Potty's terms. One can only take so many drugs for pain.
If physicians were rewarded for keeping return visits to a minimum, I think that would provide incentive to providing a higher quality care. As it is, the gov'ts seem to be attacking the problem on a quantitative basis. As the population grows and the baby boomers hit old age, it'll get worse. The last projection I saw was that the feds would be spending about 70% of the budget on healthcare within the next 2 or 3 decades.
What has worked BEFORE is failing NOW and will likely get worse unless things change.