Sunday, 9 September 2007

Sicko and State run Healthcare Systems

Dear Bloggers

I recently saw the new film Sicko which is a real-life compilation of different peoples stories about how the American health system has failed them because of the insurance run practices that exist in the United States.

Some of the stories are shocking and reveal how some insurance companies refuse to pay out on the medical bills because of their own corporate decisions, rather than the advice of the treating physicians, that the treatment is not necessary or considered experimental.

Despite the first world American leading in medical advancements, or at least that is what we are led to believe, still some 50 million Americans have no healthcare insurance and as such, if they get sick, then they have a problem ! Sick-O-No!

Then there is a comparison to state run health care systems that are described as 'Socialist' run systems, which are in fact, State runs and which exist in Canada, France, UK and Cuba !

These State run health care systems are funded by Taxation from the working population that is then FREE at source for ALL members of the society. These systems work very effectively by cutting down on unnecessary costs, inpatient stays, increased outpatients procedures, scrutinisation and implementation of evidence based practices and cost to benefit for particular treatments and use of generic drugs to keep down the costs of overall expenditure. This is at least the way it carried out in the UK system.

The Author of the film was amazed when speaking to the various doctors in the four different countries with State run systems that the Health care systems actually do WORK. He was also amazed that there was no payment desk in ANY UK hospital as patients DO NOT pay anything for their hospital stay as it is paid totally through the high taxation.

I am sure the Film was certainly an 'eye opener' for most Americans who have seen it, but for me, who has come from the UK where health care is free at source, I feel saddened that people without insurance will not benefit from the best medical intervention.

Does this have implications for Japan?

Well, the Japanese system sits somewhere between the British and American systems. There is an insurance system plus state cover for expenses. Despite the large part of the expenses being covered by the Government, there is still some 30% or so that will need to be paid by the patient or the patient's family unless, this is covered by the particular insurance programme.

Of course, if the patient has no family to foot the bill and no personal insurance, then it leaves a financial problem for the patient, who should not be worried about health costs when they are sick and moreover, a financial problem for the hospital.

How can this problem be solved??

Could a Government run medical system funded by taxation alone work here in Japan? This would mean a higher taxation on the working population to support an ever growing elderly population.

However, in doing so, the Government would have the ability introduce legislation to cut costs on medical expenditure such as having effective antibiotic and drug protocols to provide effective medical therapy but at a cost to benefit sliding scale. No one would ever be worried about accessing medical treatment and all medical expenses would be free in the time of need....sounds good !

However, from my experience of the UK medical system, there are delays in treatment directly as a result of this State run service.

In the UK, hospitals are provided with their annual money and they then need to manage their finances effectively by juggling services to try and stay within their financial provision. However, some treatments which are expensive, e.g. new cancer drugs with limited evidence, may be refused to patient (see UK National Institute of Clinical Excellence [NICE] Guidelines ). Moreover, some planned surgical lists may be postponed because the funds are not available to pay for the surgery. Waiting lists for outpatient surgery can be several months although emergency surgery and cancer surgery tend to be very fast.

Patient awaiting a new hip, of which there are many in the UK, sometimes have to wait for a year before they are operated on. It has been known, that some patients have travelled to France or Germany for their operation and the National Health Service (NHS) reimburses those foreign hospitals. The system clearly has some problems.

To get an outpatient appointment at a hospital to see a specialist in the UK is not like in Japan. You cannot just walk into a hospital and see who you want. You must first see your General Practitioner (GP) in the local community who then has to refer you by letter to the hospital in the locality. The GP practice usually will use only one hospital as it is that hospital from which it purchases the services for their patients. Hence, there is no choice of where you can be referred. The wait to actually be seen can be several months for non-urgent conditions and from my experience, the same day or the same week for more urgent conditions e.g. deterioration in diabetes control.

So, there is no ability to choose the hospital of choice....the UK are trying to now change this, which seems logical. The Canadian system is also paid by taxes, but you have the ability to choose whichever hospital you want to receive a consultation or treatment. Again, it is free! :)

As with any system, there are good and bad perspectives. There is a trade off for having a free system such as reduction in expenditure, generic drug usage, evidence based practice which drives down expenditure, more use of clinical skills such as history and examination with less reliance on radiological services unless deemed necessary BUT longer waits to see doctors in outpatients and longer waits for non-urgent surgery.

However, the Emergency treatment is rapid e.g. stroke, AMI. Even ER waiting times are not too long. Non urgent conditions can be seen within a few hours and more urgent conditions more rapidly. In the UK system, new legislation means that no patients wait more than 4 hours in the ER department before being moved to a ward. Hence, this means that the patient are seen within 4 hours, treatment is commenced and they are moved to a ward where therapy can be continued.

From my experience, the Japanese medical system works well but in my opinion, it could be enhanced in many ways.

I would hope that in the future, Japan can learn many things from these State run medical systems in order to help Japan reduce expenditure its health care system, provide cover for all which is free to utilise at source and so to therefore avoid what has happened to the American medical system so that 'Sicko' does not occur here.

DISCLAIMER: These comments are my own personal perspective on the health care systems within which I have worked and are not in any way endorsed by my hospital or anyone else.

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