Called NED: No Evidence of Disease
“Every seven minutes a woman is diagnosed with a gynecologic cancer.”
NEJM: Sustainability of England’s NHS?
As an oft-cited example of universal health care the NHS has had its performance scrutinized for the last fifty or so years. The article about whether the NHS can sustain itself highlights some issues that other health care systems are also now facing: financial constraints, poor management, and public criticism, especially regarding declining quality of patient care.
“The […]challenge is a lack of managerial capacity, stemming largely from the government’s imposition of a reorganization that had little support from key staff members. This problem has been exacerbated by widespread criticism of managers, […] by members of the public, the media, and politicians. Although criticisms of some clinical and managerial staff were justified, wholesale condemnation was inappropriate and has contributed to the departure of some excellent managers (particularly when generous retirement options were available). The loss of managers is particularly apparent in the commissioning arena, where the effects will be intensified by the shifting of responsibility to GPs [ general care practitioners], most of whom will initially lack appropriate experience and training. Although they will receive technical help, it is unclear whether the initial enthusiasm of those GPs who have opted to take on this role will last. The honeymoon might end when GPs realize how uncomfortable it can be to ration care to patients and reduce funds for their local hospital.”
The NHS is publicly funded, and therefore free at the point of care. Working at a London hospital 3 years ago definitely emphasized for me how well-liked the NHS was, both by providers and patients. But the article brings up ideological support for the NHS as a reason to expect significant improvement. I’m not sure if public appeal is enough to trigger change, improve management ability and financial difficulties fast enough to keep up with increasing demand, or resolve growing frustration among primary care physicians as more of the burden of patient care quality improvement is shifted to GPs.
Read the full article here: “Can England’s NHS survive?” http://www.nejm.org/doi/full/10.1056/NEJMp1305771
NYTimes: American Way of Birth, Costliest in the World
Coupon Specials and Reading Lamps
An old married couple sat next to our table last night at the restaurant we were at. The man pulled out a printed coupon for a Valentine’s Day dinner special. The wife (wearing a red sweater) started to read the menu, but the restaurant’s romantic lighting was too dim for her. Her husband immediately pulled out a pocket reading light and gave it to her. She couldn’t turn it on at first, but the waitress managed to take care of that.
They have been married for such a long time. They still go out, armed with coupons and reading lights.
Seems like the best kind of date night. :)
Rwanda’s Health Care Success Story – NYTimes.com
Rwanda’s Health Care Success Story – NYTimes.com.
With a shocking doctor:patient ratio of 625:11 million, Rwanda’s system highlights how a corps of 53,000 health care workers have been bridging that gap by providing primary care.
A Different Model — Medical Care in Cuba — NEJM
A Different Model — Medical Care in Cuba — NEJM.
This is a fascinating read. We can certainly learn from the Cuban model: if nothing else, the importance of making preventative care a priority. But there problems when we attempt to generalize this on a large scale to the US health care system and the population it serves. (A similar issue arises when a comparison between the Swiss system and US system is made, for example).
Thoughts?
Doctors in the dark
At the E.R., Bearing Witness to Gun Violence – NYTimes.com
Compare and Contrast 2 Health Care Systems
Experts Discuss Similarities, Differences Between U.S., India Health Systems –> http://ht.ly/gaJlX
Both large democracies – India and the U.S. Both have a large population of people who need better health care.
Many, myself included, have pointed out that medical care can be better in India than in the U.S., both in terms of quality and affordability. But can we really compare the two? India is a developing country, the U.S. is reaching its peak (or has already gone over that hump) of growth. The U.S. system has gone through all of the changes that India is going through now, and we are at a point of stagnation now. Rather than comparing the two side-by-side, India should look at the trajectory of the U.S. system in the last century and see if it can shape its own health care system’s progress differently, to avoid the potential pitfalls.
Step 1: Improve public health.
The U.S. arguably has better met its public health needs so far, but there is still a long way to go to maintain a clean, safe environment for all here, particularly in rural and inner city areas. On the other hand, India is severely lacking in this department, and trying to build a stronger health care system without improving public health measures would mean that the country is setting itself up on a shaky foundation.
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