Saturday, March 18, 2006


Yes. It is that awful dog-eat-dog capitalistic USA that has achieved equal medical care for all. The prestigious (and distinctly Leftist) "New England Journal of Medicine" says so. They report research findings that say that the poor get roughly the same care as the rich. That does not happen in Canada or Britain. There the rich get prompt treatment while the poor get put on waiting lists for years. The academics who did the study below were mightly miffed at such pesky findings and tried to play them down by noting that very few people got cared for according to a theoretical ideal. That being put on a waiting list for years is REALLY non-ideal care is however obvious. If the poor get roughly the same treatment as the rich in the USA, they get very good care indeed.

"Startling research from the biggest study ever of U.S. health care quality suggests that Americans - rich, poor, black, white - get roughly equal treatment, but it's woefully mediocre for all. "This study shows that health care has equal-opportunity defects," said Dr. Donald Berwick, who runs the nonprofit Institute for Healthcare Improvement in Cambridge, Mass.

The survey of nearly 7,000 patients, reported Thursday in the New England Journal of Medicine, considered only urban-area dwellers who sought treatment, but it still challenged some stereotypes: These blacks and Hispanics actually got slightly better medical treatment than whites.

While the researchers acknowledged separate evidence that minorities fare worse in some areas of expensive care and suffer more from some conditions than whites, their study found that once in treatment, minorities' overall care appears similar to that of whites. "It doesn't matter who you are. It doesn't matter whether you're rich or poor, white or black, insured or uninsured," said chief author Dr. Steven Asch, at the Rand Health research institute, in Santa Monica, Calif. "We all get equally mediocre care."

The researchers, who included U.S. Veterans Affairs personnel, first published their findings for the general population in June 2003. They reported the breakdown by racial, income, and other social groups on Thursday. They examined medical records and phone interviews from 6,712 randomly picked patients who visited a medical office within a two-year period in 12 metropolitan areas from Boston to Miami to Seattle. The group was not nationally representative but does convey a broad picture of the country's health care practices. The survey examined whether people got the highest standard of treatment for 439 measures ranging across common chronic and acute conditions and disease prevention. It looked at whether they got the right tests, drugs and treatments.

Overall, patients received only 55 percent of recommended steps for top-quality care - and no group did much better or worse than that. Blacks and Hispanics as a group each got 58 percent of the best care, compared to 54 percent for whites. Those with annual household income over $50,000 got 57 percent, 4 points more than people from households of less than $15,000. Patients without insurance got 54 percent of recommended steps, just one point less than those with managed care. As to gender, women came out slightly ahead with 57 percent, compared to 52 percent for men. Young adults did slightly better than the elderly. There were narrow snapshots of inequality: An insured white woman, for example, got 57 percent of the best standard of care, while an uninsured black man got just 51 percent. "Though we are improving, disparities in health care still exist," said Dr. Garth Graham, director of the U.S. Office of Minority Health. Graham, who is black, pointed to other data showing enduring inequality in care, including a large federal study last year. He also said minorities go without treatment more often than whites, and such people are missed entirely by this survey.

Some experts took heart in the relative equality within the survey. "The study did find some reassuring things," said Dr. Tim Carey, who runs a health service research center at the University of North Carolina-Chapel Hill. But all health experts interviewed fretted about the uniformly low standard. "Regardless of who you are or what group you're in, there is a significant gap between the care you deserve and the care you receive," said Dr. Reed Tuckson, who is black and a vice president of United HealthGroup, which runs health plans and sells medical data.

Health experts blame the overall poor care on an overburdened, fragmented system that fails to keep close track of patients with an increasing number of multiple conditions. Quality specialists said improvements can come with more public reporting of performance, more uniform training, more computerized checks and more coordination by patients themselves."


More on the corrupt, wasteful and and secretive inner workings of a long-established socialized medicine bureaucracy

A Queensland Health employee yesterday gave secret "in-camera" evidence to a federal health inquiry alleging the State Government has been illegally taking money from Medicare. The former head of the controversial health inquiry into surgeon Jayant Patel, Tony Morris, QC, yesterday told a federal House of Representatives Health and Ageing Committee hearing the concerned QH employee made the claims to him earlier this week. Mr Morris told the hearing the anonymous QH staffer was so concerned she wanted to expose how the department was "cost shifting" Medicare funds by bulk-billing patients without referrals and deliberately overcharging for health services. "(This is) the most scandalous stuff and, fortunately, I was able to tell that particular whistleblower about the existence of this committee," Mr Morris said.

Committee chairman Alex Somylay, a federal liberal backbencher, later confirmed the QH employee would be afforded protection by being allowed to give her evidence during a closed hearing. "We know that cost shifting is rampant, just the same as blame shifting is rampant between the Commonwealth and the state (governments)," Mr Somylay said. He also launched an attack on Queensland Premier Peter Beattie for the State Government's unwillingness to take part in the hearing or even allow QH staff to give evidence.

Mr Morris said it was sad that after last year's three health inquiries that QH staff were still too scared to blow the whistle on on-going systemic departmental problems for fear of retribution.

The hearing was also told that in Queensland only 20c out of every dollar was actually spent providing care to patients and that there were more bureaucrats working for QH than there were beds in public hospitals.

Mr Morris said the culture within QH would not change unless clinicians started running hospitals and not "bean counters" who had yet to pass a "St John's Ambulance" first-aid course. "The only patients at (QH's head office in) Charlotte St (in Brisbane's CBD) are the odd public servant who scalds himself on the tea trolley," Mr Morris said. He was also critical of the "band-aid" approach taken by the State Government to fix the doctor shortage crisis at Caboolture, saying it was simply a reaction to help save political face. "(It) is a quick fix solution that will help the people in Caboolture (in the short term)," he said. "It's a very expensive band-aid (solution), but a band-aid solution none the less," he said.

It was not all bad news for Mr Beattie, however, with Mr Morris praising him for his success in securing an additional 80 placements at universities for medical students. However, he said that based on the current need for locally trained doctors in Queensland, exposed during his inquiry, the current need to fill public hospitals with home-grown clinicians would not occur before 2038.


More secrecy about a tragic public medicine failure in the same health system

But plenty of "spin" now the matter has come to light

A secret investigation is under way to determine whether infants are dying unnecessarily because of inferior pediatric cardiac services in Queensland. The inquiry by an independent team of interstate and overseas medicos follows complaints that services have for years been poorly funded and fragmented. Up to eight babies died from one procedure which has now been stopped.

The team is due to complete its report by Monday. It threatens to be another political bomb for the Beattie Government which was warned at least five years ago of dangerous pitfalls in the system.

Much of the probe centred on Chermside's Prince Charles Hospital pediatric intensive care unit following the deaths of several children there, and other Brisbane hospitals. The investigators examined concerns raised by three leading specialists: Dr Tony Slater, Dr Rob Justo and Dr Cameron Ward. The director of the pediatric intensive care unit at Prince Charles, Dr Nikolaus Haas, resigned after the inquiry began. Dr Michael Cleary, director of medical services at Prince Charles, said: "Because of the confidential nature of the inquiry, I can't comment on Dr Haas." Later, he phoned back and said: "Dr Haas has resigned from Prince Charles as the director of pediatric intensive care. "He has been discussing a possible change for about a year. His resignation is in no way linked to the inquiry." The German-born Dr Haas did not return calls.

The investigating team of Professor Tim Cartmill and Professor Craig Mellis from Sydney and Professor Frank Shann from Melbourne has been joined by New Zealand's leading pediatric cardiologist, Dr Tom Gentles. They enlisted University of Queensland mathematician, Professor Annette Dobson, who was asked to examine mortality statistics "benchmarked against data from other national and international centres".

Between 300 and 400 children are born each year in Queensland with congenital heart disease requiring surgery. All but minor operations are conducted at Prince Charles Hospital. "A vast majority of these children do well and survive with good life expectancy," said Dr Tony Slater, whose work spans the Royal Children's, Prince Charles and the Mater Children's hospitals. "This is very sensitive, delicate stuff. "There are a number of people from different disciplines who thought we would benefit from outside advice. The individuals at Prince Charles have done a very good job. The question now is: Is this the right system for the future?"

More here


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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