Saturday, November 15, 2008

Britain's health service is now worse than Estonia's

Healthcare in Britain is worse than in Estonia even though we spend four times as much on each person, according to a Europe-wide league table. And despite the billions poured into the NHS by Labour, the standard of care is on a par with the former Communist states of the Czech Republic and Hungary, which spend far less on health.

Long waiting times and slow access to new cancer drugs were highlighted as major reasons for Britain's `mediocre' placing of 13th out of 31 countries. Britain came out near the bottom on cancer survival rates, waiting times, MRSA infections and the speed of access to new drugs. The Euro Health Consumer Index report found that when the cost-efficiency of the health service was taken into account, the UK came 17th.

Johan Hjertqvist, of the Health Consumer Powerhouse think-tank which compiled the report, said Britain had improved since last year on patients' rights and providing patients with information on their health. `However access for both waiting times for treatment and uptake of modern drugs, remains a problem,' he added. The report concludes: `The NHS shares some fundamental problems with other centrally planned healthcare systems. It would require some really top class management for that giant system. Superbug problems are improving, but they are still bad.'

Government health spending has doubled since 2002. This year, 96billion pounds is going into the NHS - almost four times 'the amount spent in the former Soviet republic of Estonia per head of population. The report backs up a recent Italian study, which put Britain near the bottom of a European table for the chances of its patients still being alive five years after being diagnosed with cancer.

Matthew Sinclair, of the TaxPayers' Alliance, said: `For all the central initiatives and health drives launched in Whitehall, we are still lagging behind much poorer countries like Estonia. `That should teach the politicians that this centralised, micromanaged and monopolistic approach does not work.'

The index rates healthcare systems on 34 indicators before working out a total score out of 1,000. The UK scored 650 points, way behind the Netherlands in first place on 839 points. Britain was rated `poor' on nine indicators, including direct access to a specialist, quick access to operations and MRI scans, five-year cancer survival rates, MRSA infections and quick access to cancer drugs. It was rated `intermediate' on 16 indicators, such as the ability to see GPs on the same day, quick access to cancer therapy and heart attack survival rates. Only on the remaining nine indicators was it rated `good'. These include NHS Direct, the quality of hospital rating systems and IT.

The study concluded that countries with a social insurance system, in which patients take out cover with companies but receive healthcare from separate bodies, fared better than those with centrally driven systems such as the UK.

LibDem health spokesman Norman Lamb said: `We have got to attack the waste and bureaucracy that drives clinicians and the public crazy. We need to make sure that all available resources are focused on patient care.' Tory health spokesman Stephen O'Brien said: `This is further evidence of the incompetence of ministers when it comes to running the NHS.'

Health Secretary Alan Johnson said: `The European Health Consumer Index report is not anchored in any reputable academic or international organisation. It uses flawed methodology and old data.'


Doctor held liable for punitives even though he treated the patient competently

Sounds like someone gaming the system

I don't usually post about trial court decisions -- they have a high variance, that is typically narrowed on appeal. They are often the fodder for demagogic politicians of every stripe. I usually take them with multiple grains of salt.

But this New Jersey Law Journal report is, I think, worthy of larger notice. It describes a jury verdict from Hudson County, for $400,000, against a physician who treated his patient competently. His failing was to refuse to hire, at his own expense, an interpreter so that he could adequately communicate with his deaf patient. Why didn't the patient come with her own interpreter (hired at her own expense)? Because she doesn't have to, according to federal law as interpreted by the courts. Her lack of verbal skills is a disability that others must palliate at their expense.

More obscene still is that the defendant's malpractice liability insurance does not usually cover such liability, because the care actually given to the patient was quite appropriate.

The plaintiff claimed that she repeatedly asked her Jersey City rheumatologist to hire an American Sign Language interpreter. The doctor responded that as a solo practitioner, he couldn't afford the estimated $150 to $200 per visit an interpreter would cost, given that Medicare paid him $49 for each visit. He treated his patient (who declined to visit another rheumatologist, perhaps one who knew American sign language) for lupus for about 20 visits, stretched out over 20 months, occasionally exchanging written words with the patient's civil union partner [wait: if they were lovers, how come the partner didn't understand and use American sign language?] or verbal instructions via the "couple's" 9-year-old daughter (who apparently couldn't use sign language either -- it just gets stranger and stranger).

But the patient claimed she never really understood the side-effects (swelling of her treatment), and that when she insisted the doctor was obliged to pay for an interpreter (she had an interpreter phone the doctor, self-serving legal advice if ever any has been dispensed), the doctor became angry and insulted her, forcing her to seek treatment elsewhere. Her next doctor was able to communicate with her, and ceased the treatment, since it turned out that the patient didn't want the swelling and preferred a different treatment. Essentially her lawsuit sounds in battery (touching of a patient despite the lack of informed consent) -- fine, except that the patient apparently was advised to seek out other providers and insisted on returning time and again to this one. I'm not excusing poor bedside manner or countenancing insults (though I have no evidence that any insults were uttered) --

During a three-week trial (!), the rheumatologist's argument that it would have been an undue hardship to pay an interpreter who cost more than the income he received for each visit was apparently undercut by the fact that the doctor's tax returns showed he earned over $400,000 a year. Sorry, but how did this evidence get in? Unless the doctor is obliged to treat handicapped people at a loss, why is his personal wealth relevant here?

The jury obviously doesn't share my disbelief. Fully half of the $400,000 verdict against the doctor was for punitive damages. To repeat, the sum is not insurable, apparently.

So, notice to all professionals out there: don't get wealthy, or you may be obliged to "share the wealth" with a disabled person. Can't professionals post a sign in their office that reads "Sorry, we decline to treat you if we must spend more money on your visit than you or your agents will pay us"? Apparently the answer is "Yes, such a sign is OK if the patient speaks only Slovak (since that is not a "disability", at least not yet), but not if the patient is blind or deaf.


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