Double for nothing?

Paul Levy, CEO of BIDMC and author of Running a Hospital, takes a look at the recent Commonwealth Fund-sponsored indictment of the US health care system (which I also mentioned earlier) and asks:

…whether there is broad political support in the US for a major change. Notwithstanding similar data for years and lots of speeches on the subject, there has not been movement along these lines. Why have there not been votes for passage?

Hidden away in these charts might be indications of why the national health plan idea has been politically unpopular in the United States. Chart #60 shows the percentage of “sicker adults” who had to wait more than four weeks to see a specialist: Germany 22; US 23; NZ 40; Australia 46; Canada 57; UK 60. Chart #61 shows the percent of physicians who feel that their patients often have long waits for diagnostic tests: Australia 6; Germany 8; US 9; Netherlands 26; NZ 28; Canada 51; UK 57. And chart #62 shows the percentage of people who waited four weeks or more for needed non-emergency or elective surgery: Germany 6; US 8; Australia 19; NZ 20; Canada 33; UK 41.

But if the the barrier to major change in the US is the argument that universal health coverage will result in waiting lists, it should be pretty easy to surmount. After all, using the same charts it’s evident that:

  • We already have waiting lists in the US, and they’re worse than in socialized Germany (#60, 61, 62)
  • Other countries, including those outperforming the US on almost every measure including waiting times, spend half or less per capita of what’s spent in the US (#53)

Imagine what kind of performance these other systems could enjoy if they spent at US levels. For example, in Quebec physicians’ salaries are capped. Some docs I know there practice only three days a week as a result. Do you think access would improve if they were allowed to double their incomes?
Waiting lists in the US aren’t limited to the uninsured, ignorant, or rural dwellers. Waiting lists are long in Boston for specialists.

It’s also true for generalists as my experience today illustrates. I had a routine physical scheduled with my physician of 20 years for June 4. I just found out I have to travel that day and when I called to change my appointment the first date they could offer was July 16. (Incidentally my doc is part of BIDMC.) Sure, I could get in sooner for something serious, but this is worse access than I have for any other professional or personal service.

I’m not advocating a shift to a Canadian or German system, but as we examine our own system we’d be wise to understand how other countries do more with so much less.

May 23, 2007

3 thoughts on “Double for nothing?”

  1. A major difference between the US and European systems is that there is systematic measurement of waiting times in several of the European systems, especially in the UK. Waiting time from GP referral to seeing a specialist is tracked by medical specialty by region of the UK and used to assess the purchasing effectiveness of primary care trusts. Neiher employers, Medicaid, nor Medicare systematically collect similar data on the delay from PCP referral to seeing a specialist in HMO or PPO networks in the USA and use them to evluate the plans. Have you tried to obtain an appointment for an assessment of Alzheimer’s disease in a 90-year old in the U.S.? Or plastic surgery for a major burn scar? Anecdotal evidence suggests that waiting times in many parts of the USA are not significantly less than in many parts of Europe. I am increasingly suspicious of the claims of American system superiority in waiting times for those who are enrolled in HMOs and PPOs – which are the plans offered for most insured Americans.

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