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Apr 052016
 

During a recently on-line rant about anti-abortion terrorists, I happened to trip over some statistics on the rate of mortality during childbirth (the “Maternity Mortality Rate”) from the WHO. And being the kind of person that statistics interest, I spent some time looking into them; indeed I got so interested I transcribed some of the raw figures to generate a pretty graph :-

mmr2

This obviously excludes many countries – what we could call the developing countries. The countries included (which you’ll have to peer closely in order to see – sorry about that) are all rich. At least relatively speaking.

Just look at the USA! Down with the also-rans amongst what could be called the relatively dysfunctional countries at the fringes of being considered “developed”. Now you could argue that there is something special about the reason why the USA doesn’t have a single-digit MMR like the overwhelming majority of developed countries. I can think of a few possibilities myself :-

  1. Perhaps the USA is the only country in the world to tell the truth about it’s actual MMR and all the other countries are lying. Perhaps. I am not going to argue there isn’t a bit of shady practices going on with the figures in some cases, but these figures are produced by statisticians and as an overall group statisticians don’t like lying about numbers. Yes there is the old saw about “lies, dammed lies, and statistics”, but the source of that distrust is the twisting that politicians apply to statistics to support their lies.
  2. Perhaps the USA didn’t read the instructions from the WHO properly about what kind of deaths to include in their returns and they’re including deaths that other countries wouldn’t include. But whilst I’ve not read the instructions from the WHO about this, I have read other instructions on statistics and they usually go into excruciating detail about what should and should not be included. It’s possible that the USA handed this little job over to a complete dumb-arse, but it doesn’t seem very likely.
  3. The WHO is anti-American and decided to inflate the figures. This is just laughable – the WHO isn’t going to risk getting called out by doing something so obvious even if it really was anti-American.

Sometimes the most obvious reason is the real reason – and here the most obvious reason is that the US health care system sucks.

There is additional evidence to show that – the WHO figures cover years other that 2013, and the US figures are consistently bad and getting worse.

But how can this be? The USA is one of the wealthiest countries in the world that spends a ridiculous percentage of it’s annual GDP on health care. It also produces many healthcare innovations and undoubtedly has improved maternal care at some point with some new technique. The really rather obvious (although it really needs to be tested) is that healthcare in the USA is divided into three.

There are those who have full insurance, and this group probably gets pretty good healthcare.

There are those who are covered by government schemes and this group probably gets reasonable healthcare.

And there are those who fall between the cracks – they’re not covered for various reasons – and their care is abysmal and probably limited to emergency care only. Which can sometimes be too late.

But when you come down to it, if you are pregnant it may be worth avoiding the USA until you’ve given birth. And if you’re already in the USA, it may be worth thinking about a long break somewhere where they have a healthcare system that doesn’t suck.

Oct 042009
 

One of the things that comes up online in the debates on the whole US vs UK methods of health care, is the amount of research that takes place. One of the arguments the far right in the US makes is that the US is doing all the research on health care because places with socialist health care systems do not spend much on it.

Well it so happens that I work at a relatively minor University in the UK, and although I do not spend a great deal of time looking around at what the researchers do, I am aware that at least one research group is engaged in research in the health area (specifically looking at developing drugs). So I was curious to look into just how much medical research goes on in a country with a socialist health care system that some claim means spending practically nothing on medical research.

The first thing to bear in mind when it comes to research is that you can come up with a list of gadgets that has “US” down as the inventor, but things are rarely that simple. Often inventions are based on earlier research done by somebody else.

Secondly, whilst the UK health care system is socialistic, the pharmaceutical sector is private and quite healthy. Out of the top 10 pharmaceutical companies (listed by Wikpedia), 4 are US-based, and 6 are European based. Of the European based companies only 1.5 are UK-based (one is listed as “UK/Sweden”). One of the UK-based companies spends in the region of $6 billion per year on research and development; bettered only by one of the US-based companies (although figures for the amount spent is not available for some of the companies).

So lets’s see if we can add up the spending on medical research in the UK :-

Organisation Year(s) Spend
Medical Research Council 2008/9 £704 million
The Wellcome Trust 2008/9 “over £600 million”
BUPA UK (private health care) 2008/9 £1.5 million
Cancer Research UK 2008/9 £355 million
NIHR/PRP (NHS Research) 2008/9 £912 million
UK Pharmaceutical R&D 2008 $12 billion
AMRC members (including Cancer Research UK) 2006/7 £791 million

Whilst looking around for the figures above, I can across an interesting claim by Cancer Research UK – of the top 20 cancer treatment drugs in use around the world, 19 of them came about in whole or partly because of research funded by Cancer Research UK.

Excluding the rest of the AMRC members (for which I only have 2006/7 figures), the total here is some £2572 million in one year. This amounts to £42 per person per year. Or $67 according to today’s exchange rate. Plus added to that is the total spent by UK pharmaceutical companies which amounts to $12 billion a year – increasing our per person spend to $267. Of course we’re also not including the percentage of funding that US pharmaceutical companies make that is due to the drugs purchased by the NHS – doesn’t that also count as spending by the UK on medical research ?

The US overall apparently spends $95 billion on medical research which comes out at about $316 per person per year. Quite a bit more than the UK spends. But the US is richer, and we’re underestimating the UK spend on medical research and not counting European research at all which is partly funded by the UK.

Even if the UK does spend significantly less than the US, it certainly does spend a lot on medical research so the idea that a socialist health care system will cause spending on research to practically cease is wrong. Besides none of this number crunching tells us anything about how effective the spending is.

Aug 142009
 

I am taking the unusual step of explicitly reserving the right to update this post – in case someone comments and I update the post to reflect their comments

According to the news, the health care debate in the US brought about by Obama’s attempt to reform the health care system is hot and furious. In particular the UK’s NHS is being targeted as an example of how horrendous socialist health care can be – including one ridiculous comment that Stephen Hawking would be dead if he had been British (he is British, and most of his health care is provided by the NHS).

The big concern about the NHS is the length of time it takes to wait for treatment because of health care “rationing”. It is implied that UK health care is rationed whereas US health care is not – nothing could be further from the truth! At a simplistic level, UK health care is rationed by need, and US health care is rationed by ability to pay.

Looking a little deeper, US rationing is mostly controlled by the insurance companies. Now sometimes (perhaps even the majority of times) this is done with the patient’s best interest in mind. But sometimes less scrupulous insurance companies will restrict access to more expensive treatments; particularly those who have pre-existing chronic conditions such as diabetes, or MS.

Looking around I can see there is particular concern with something called “co-pay” where the insurance company pays 80% of the cost of treatment, and the patient pays 20% (undoubtedly this varies between different providers). Sounds like a not unreasonable way from preventing people signing up for unnecessary treatments? Well perhaps, but 20% of many medical procedures is a lot of money and many people will find it difficult or impossible to fund a sudden large bill that might occur because of a medical emergency.

Apparently there are ways to get assistance with paying the 20%, but that involves scrabbling around looking for people to help. This is probably not the sort of thing that is helpful in a medical emergency!

The NHS provides treatment free at the point of delivery with the exception of Dentistry. Prescriptions are also subject to a flat £7 fee in England, although they are free in Scotland and Wales. In other words, you will not suddenly find yourself paying a huge bill.

The real truth is that most people who need it can get treated whether they are in the US or the UK. Although if you are poor and in the US, your access is likely to be not quite so easy. Are there millions of people in the US who have no access to medical care ? Probably not, but there are enough indications out there that a significant number of the US poor find access to medical care difficult. If you read this article it would seem that the uninsured get medical treatment in circumstances that look suspiciously like a field hospital in a third world country!

As for waiting times, it is easy to pick particularly bad examples of NHS waiting times and wave them around as examples of how bad socialist medicine is. Now the NHS did used to have a problem with waiting times and some people did die as a result of not getting the treatment that they needed. This was indeed a scandal, and was a direct result of a long period of chronic underfunding by the Conservative governments (1979-1997).  The situation now is much improved and people do not have to wait so long for treatments.

In fact the NHS this year reached their target of having no patients wait more than 18 weeks (or more explicitly 18 weeks from referral to when treatments start). This is a bit on the high side, but the average wait for ‘inpatients’ is 8.6 weeks and 4.6 weeks for ‘outpatients’. Still too long, but this is far cry from claims of 18 month waits. And these statistics conceal something – for urgent treatment a certain amount of queue jumping goes on including going to non-local hospitals for treatment. The full details can be found here. Reducing waiting times would be a simple matter of increasing the amount of money invested in the NHS – and we pay a lot less than people in the US do – more on that later.

As a little personal example, my grandmother recently had to wait several weeks to be moved from a hospital to a rehabilitation clinic (for physiotherapy), but my Aunt (with cancer) was seen the same week by a specialist after her initial diagnosis.

Another story going around is that the treatment in the UK is very much worse than that in the US. One of the areas that people target is the cancer survival rates. Indeed the UK’s record of treating cancer is not ideal, but this is just one area. And sometimes simple comparisons can be deceptive. A little story from the US media about prostate cancer – the US has a much better rate of long term survival rate than the UK, but prostate specialists point out that the US does more testing for prostate cancer than anyone else.

That would be good except that once prostate cancer is found in the US, it gets treated despite the fact that many prostate cancers are slow and unlikely to cause death in many patients. The US system inflicts painful and uncomfortable treatment on patients who do not need it, and as a result they boost their long-term survival rates (see here). This illustrates the dangers of doing a naive comparison of health care statistics … which is what I’m just about to do!

In fact if you look at a more widespread selection of conditions, the UK does not look quite as bad. Unfortunately the WHO statistics available are a little dated, but can be used to do a naive comparison.

Lets have a look at the mortality rates for all cancers – in 2002, the US had 134 deaths per 100,000 and the UK had 143. It is quite possible that the US rate has improved since then, but if so the UK is likely to have improved more – the NHS was asked to concentrate in this area because of the UK’s poor record here. Still even with the 2002 figures, the UK isn’t that much worse!

Now lets have a look at mortality rates for cardiovascular diseases – in 2002, the US had 188 deaths per 100,000, and the UK had 182. What’s this ? A country with a socialist health care system does better than the US? Obviously I am excluding lifestyle differences, but even so this does not look like the UK has a chronically bad health care system.

And now let’s have a look at mortality rates from injuries – in 2002, the US had 47 deaths per 100,000, and the UK had 26. That’s quite a big difference! The rates for deaths from non-communicable diseases were 460 (for the US) and 434 (for the UK). Again we have the UK apparently doing better.

If we look at more recent figures (2006) for rates of infant mortality, we see the US had 7 per 100,000 and the UK 5. Again the UK looks better!

I would rather like to include some more finely tuned statistics here such as more recent figures for how many people with a set of conditions are successfully treated, and will indeed update this post if I find some.

Because of the lack of recent figures I am not going to say the UK health care system is better at keeping people alive than the US system … or visa-versa. But it should be clear that the UK system is not dramatically worse (or better) than the US system at actually treating people.

What does become obvious when looking at health care statistics, is just how much more the US spends on health care than the UK. The UK spends about 8.4% of GDP on health care and the US spends 16%. That is dramatically more. For that much more, you wonder why the US health care system is not dramatically better than the UK health care system, because it should be! Let’s have a look at some more statistics (sorry, but facts are needed when comparing two systems) … a table from the UK newpaper The Guardian (specifically their “Datablog”) :-

Country

United States

$ per person

6719

Doctors

(per 10,000)

26

Nurses

and Midwives

94

Hospital

Beds

31

Life

Expectancy

78

United Kingdom 2815 23 128 39 80

With only one exception (the number of doctors), the US does worse than the UK in terms of number of health care personnel. Of course this by itself does not show anything about the quality of what is provided (although we covered that earlier). The question seems to be what does the US get for all that money they spend on health care ? Looking at the full table in the relevant Guardian article, we see that the US spend far and away the highest per capita cost on health care than any other country in the table.

For the amount that the US spends, it should have a health care system by far and away better than any other developed nation. It doesn’t. It certainly does better in some areas (cancer) than the UK, but it does not do better in all areas. Is the UK health care system as good as that in the US ? Well I don’t have accurate enough figures to say so, but I think I do have the figures to say that it is not immensely worse to the level that US right-wing politicians with an axe to grind are portraying. I have no wish to try and tell Americans what kind of health care they should have, but they should be aware of the facts when considering health care reform.

One thing to be wary of are anecdotal stories of how bad the UK health system is. Undoubtedly many (if not most) are true, but are frequently very dated. And don’t you think that we could come up with very many similar stories about the problems with the US health care system ? I’m sure there’s a number of stories from people who “fall between the cracks” in the US, and essentially get little or no health care.

On the subject of anecdotal stories, apparently there are short videos circulating in the US (adverts?) detailing NHS horror stories. Interestingly enough those same people have been interviewed recently in the British media to indicate that they are disgusted that their stories are being used in this way, and that they fully support the NHS – they just want more money for the NHS!

I very much doubt that Obama is planning on setting up anything that would come anywhere near the socialism of the NHS. The right-whingers (spelling mistake intentional) over there are spreading disinformation – not only in how bad the NHS is, but in what Obama is planning. Please just find out the facts for yourself and don’t count on so-called “facts” provided by people who have a vested interest in the status quo.

The lies about health care by the NHS are grossly offensive to people in the UK. However if I were a US citizen I would also be grossly offended by the spread of disinformation being spread in this campaign. For more information about the lies and how false they are, there are a number of links to further information :-

And as for the UK people, well we moan about the NHS amongst ourselves but as has been shown in the last week we certainly defend the NHS when it comes to outside attack. One way of judging the success of the NHS is that no sane political party would attempt to dismantle it – if they managed it, they would probably never be elected again. If you watch US media, you will probably be familiar with a certain Conservative politician (Daniel Hannan) who does attack the NHS. He belongs (at present – his future is quite possibly in doubt) to the lunatic fringe of the Conservative party and the party leaders have dismissed his views.

Whilst most people in the UK would greatly like to see the NHS improved by the investment of more money, there is no way that they would trade the system they have for the system in the US.

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