Texas Ranks Next To Last in Health Care

[Mr. Peabody]

Hey, DR, I'm still waiting on the stats that support this assertion before I decide there's even a problem with healthcare in America.

Found 'em yet?

I found this article. Maybe these are the stats he is referencing.

U.S. Health Care Most Expensive & Most Error Prone

November 4, 2005
Medical Errors

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• Databases A Possible Culprit In Medication Errors
• Medication Errors Hit 1.5 Million Americans Annually
• Airplanes Safer than Hospitals
• U.S. Health Care Most Expensive & Most Error Prone
• Medication Errors Continue Even in Highly Computerized Hospital
• Study Finds Nearly 200,000 Deaths Annually from Hospital Errors
• Errors Common In Cancer Diagnosis
• Medical "Quality Gaps" Cause 57,000+ Deaths Annually


Not only do Americans pay much more for medical treatment than anyone else in the world, they also bear the brunt of the most medical errors, according to a survey covering the USA, Australia, Canada, Germany, New Zealand and the United Kingdom. Almost 7,000 patients were consulted.

The survey supported by The Commonwealth Fund finds that one-third of U.S. patients with health problems reported experiencing medical mistakes, medication errors, or inaccurate or delayed lab results -- the highest rate of any of the six nations surveyed.

While sicker patients in all countries reported safety risks, poor care coordination, and inadequate chronic care treatment, with no country deemed best or worst overall, the United States stood out for high error rates, inefficient coordination of care, and high out-of-pocket costs resulting in forgone care.

Americans are the most likely to have to pay out-of-pocket expenses over $1,000, and 34 percent of the American patients surveyed said they had encountered either medication errors, wrong test results, late test results or treatment errors.

Nation
Errors

USA
34%

Canada
30%

Australia
27%

New Zealand
25%

Germany
23%

UK
22%

One-third (34%) of U.S. respondents reported at least one of four types of errors: they believed they experienced a medical mistake in treatment or care, were given the wrong medication or dose, were given incorrect test results, or experienced delays in receiving abnormal test results.

Three of 10 (30%) Canadian respondents reported at least one of these errors, as did one-fifth or more of patients in Australia (27%), New Zealand (25%), Germany (23%), and the U.K. (22%).

While patient safety efforts have focused chiefly on hospital settings, most patients (60% or more) said these errors occurred outside the hospital?a signal that safety initiatives should also focus on ambulatory care, said Cathy Schoen, the study's lead author and a senior vice president at The Commonwealth Fund.

Patients receiving complex care may be at even higher risk of medical errors: the incidence of patient-reported errors rose sharply with the number of physicians seen. Despite studies showing patients value discussion about mistakes or errors, most patients (61% to 83%) in each country said the health care providers involved did not tell them about the mistakes.

Communication issues also adversely affect patients' experiences during hospital stays. At least one-fifth of patients (19% to 26%) in the six countries reported communication gaps between themselves and hospital staff, and one-sixth said they would have liked greater involvement in decisions made about their care.

Good transitional care -- helping patients transfer from hospital to home -- also relies on clear communication and coordination. In all six countries, however, at least one-third of patients said they did not receive instructions about symptoms to watch for, did not know whom to contact with questions, or were left without follow-up care arrangements.

German patients had the highest rate of coordination deficiencies when discharged from the hospital, with 60 percent reporting failures to coordinate care. According to the authors, poor transitional care can result in complications and increase the likelihood of hospital readmission, raising concerns about costs as well as quality.

While the U.S. performed better than most countries on the hospital transition measure, it had the highest rate of patients reporting coordination problems during doctor visits.

One-third (33%) of U.S. respondents said that either test results or records were not available at the time of appointments or that doctors duplicated tests. These delays and duplications are a clear sign of inefficient care, the authors said, and waste both physicians' and patients' time and resources. Rates of care coordination problems in the other survey countries were significantly lower, ranging from one-fifth to one-quarter of patients reporting such problems.

As was found in past surveys, the U.S. is an outlier in terms of financial burdens placed on patients. One?half of adults with health problems in the U.S. said they did not see a doctor when sick, did not get recommended treatment, or did not fill a prescription because of cost.

Despite these high rates of forgone care, one-third of U.S. patients spent more than $1,000 out-of-pocket in the past year. In contrast, just 13 percent of U.K. adults reported not getting needed care because of costs, and two-thirds had no out-of-pocket costs.

There were wide and significant variations in access and waiting times on multiple dimensions across the six countries. Respondents in Canada and the U.S. were significantly less likely than those in other countries to report same-day access and more likely to wait six days or longer for an appointment.

At the same time, majorities of patients in New Zealand (58%) and Germany (56%), and nearly half in Australia (49%) and the U.K. (45%), were able to get same-day appointments. Waiting times for elective surgery or specialists were shortest in Germany and the U.S., with the majority of patients in both countries reporting rapid access.

The authors say that no country emerges as a clear winner or loser. All survey countries experience high rates of safety risks, failure to coordinate care during transitions, inadequate communication, and a lack of support for chronically ill patients. These areas of shared concern, they conclude, will likely require policy innovations that transcend current payment and delivery systems.

Facts and Figures:

• More than one of four patients in each country (28% to 32%) said risks were not completely explained during their hospital stay.

• In all countries, sizable majorities of patients said physicians had not always reviewed all their medications during the past year, and one-third or more reported infrequent reviews.

• Across countries, one-sixth to one-fourth of patients said physicians only sometimes, rarely, or never make goals of care and treatment clear or give them clear instructions.

• Relative to the U.S. and Canada, the four countries reporting comparatively rapid access to physicians?Australia, Germany, New Zealand, and the U.K.?also had significantly lower rates of emergency room use.

''What's striking is that we are clearly a world leader in how much we spend on health care," said Cathy Schoen, senior vice president for The Commonwealth Fund, a nonpartisan, nonprofit foundation in New York that commissioned the survey. ''Clearly, we should be doing better."

Other specialists agreed, saying the results offer the most recent evidence that the quality of care delivered by the U.S. healthcare system is seriously eroding even as health care costs skyrocket.

[DarkReign]

Hey, DR, I'm still waiting on the stats that support this assertion before I decide there's even a problem with healthcare in America.

Found 'em yet?

Well balls, no I havent. To be quite honest, I didnt try to look. I get this mild impression you will just discredit the source, site some blog, and we would all be back to square one anyway.

So I decided to cut the bull out and skip to the end of this arrangement.

[Yonivore]

I found this article. Maybe these are the stats he is referencing.

Could be.

A couple of things the article didn't address that I think would be instructive are, what is the longevity of people living in the United States as opposed to the other countries mentioned and how many of the deaths occurred in the age groups of people living beyond those in other countries.

(I don't know that the longevity of Americans is more or less than those in other countries but, if it is, couldn't this explain at least some of the discrepancy.)

Another thing, how many of the deaths -- whether or not due to medical errors -- occurred in people that would not have even survived to be treated in the other countries?

Yes, America has the most expensive health care but, we're also the most innovative and aggressive at treating previously high-mortality illnesses and injuries. Cases in which even a minor mistake could have catastrophic consequences. For instance, premature infants are surviving at a lot earlier age than they were previously...therefore, there is more opportunity for a medical mistake to take their life than them just dying from being born too early.

I think these things should be factored into the equation. But, that's just me.

[Mr. Peabody]

Could be.

A couple of things the article didn't address that I think would be instructive are, what is the longevity of people living in the United States as opposed to the other countries mentioned and how many of the deaths occurred in the age groups of people living beyond those in other countries.

(I don't know that the longevity of Americans is more or less than those in other countries but, if it is, couldn't this explain at least some of the discrepancy.)

Another thing, how many of the deaths -- whether or not due to medical errors -- occurred in people that would not have even survived to be treated in the other countries?

In longevity, we don't fare too well....

Rank Countries Amount (top to bottom)
#1 Andorra: 83.52 years
#2 Macau: 82.27 years
#3 Japan: 82.02 years
#4 San Marino: 81.8 years
#5 Singapore: 81.8 years
#6 Hong Kong: 81.68 years
#7 Sweden: 80.63 years
#8 Switzerland: 80.62 years
#9 Australia: 80.62 years
#10 France: 80.59 years
#11 Guernsey: 80.53 years
#12 Iceland: 80.43 years
#13 Canada: 80.34 years
#14 Cayman Islands: 80.2 years
#15 Italy: 79.94 years
#16 Gibraltar: 79.93 years
#17 Monaco: 79.82 years
#18 Liechtenstein: 79.81 years
#19 Spain: 79.78 years
#20 Norway: 79.67 years
#21 Israel: 79.59 years
#22 Jersey: 79.51 years
#23 Faroe Islands: 79.49 years
#24 Greece: 79.38 years
#25 Austria: 79.21 years
#26 Virgin Islands: 79.2 years
#27 Malta: 79.15 years
#28 Netherlands: 79.11 years
#29 Luxembourg: 79.03 years
#30 Montserrat: 79 years
#31 New Zealand: 78.96 years
#32 Germany: 78.95 years
#33 Belgium: 78.92 years
#34 Saint Pierre and Miquelon: 78.76 years
#35 Guam: 78.76 years
#36 United Kingdom: 78.7 years
#37 Finland: 78.66 years
#38 Man, Isle of: 78.64 years
#39 Jordan: 78.55 years
#40 Puerto Rico: 78.54 years
#41 Bosnia and Herzegovina: 78.17 years
#42 Bermuda: 78.13 years
#43 Saint Helena: 78.09 years
#44 United States: 78 years

[Mr. Peabody]

Yes, America has the most expensive health care but, we're also the most innovative and aggressive at treating previously high-mortality illnesses and injuries. Cases in which even a minor mistake could have catastrophic consequences. For instance, premature infants are surviving at a lot earlier age than they were previously...therefore, there is more opportunity for a medical mistake to take their life than them just dying from being born too early.

I think these things should be factored into the equation. But, that's just me.

I do agree with you that we are more innovative here in the U.S. in terms of developing new treatments and a big factor in that innovation is the potential for profit. However, it's hard for me to agree with the argument that we should allow our healthcare industry to maintain status quo as the most expensive in the world just so that we can be the most innovative. There has to be a different approach we can take to bring down healthcare costs without sacrificing the development of new treatments for disease.

[Yonivore]

I do agree with you that we are more innovative here in the U.S. in terms of developing new treatments and a big factor in that innovation is the potential for profit. However, it's hard for me to agree with the argument that we should allow our healthcare industry to maintain status quo as the most expensive in the world just so that we can be the most innovative. There has to be a different approach we can take to bring down healthcare costs without sacrificing the development of new treatments for disease.

I do think the other side of that coin could be that health care costs are lower in the other countries because of how they benefit from the innovation of our medical industry.

[Yonivore]

In longevity, we don't fare too well....

Okay, that question is answered but, being as the highest ranking "other" country mentioned (Australia) is only 2.62 years ahead doesn't necessarily negate the point I was making. It does, however, eliminate my using our longevity as evidence of such.

Do you think Andorra has a better healthcare system than Australia?

[boutons_]

Foreign countries (single-buyers) also pay a lot less to US Big Pharma than Americans do. That's why buying US drugs from Canada has exploded into a huge industry.

In ridiculous contrast, the Repugs FORBID the US govt from negotiating for lower prices with Big Pharma.

My doctor says there are plenty of foreign medical innovations, even improvements on US ideas, that flow back into US. He says foreign medical, drug, equipment researchers are on the same level as US people.

(eg, retropublic laparoscopic prostatectomy developed in the US didn't really take off (too long to learn and to master) until French doctors re-thought the entire process. When the French procedures came back to the USA, that kind of surgery finally became widely adopted,

As usual, Yoni's xenophobia and chauvinism have no basis in fact, just ideological bull .

[Mr. Peabody]

Do you think Andorra has a better healthcare system than Australia?

No, I don't think you can necessarily use expected lifespans as proof of quality healthcare. There are other factors which undoubtedly play a role in determining average lifespan (lifestyle, environment, genetics, etc.). I only posted those stats in response to your post which questioned whether our longer lifespans could be an explanation for the gap in healthcare.

I would say though, Yoni, that at some point the evidence does seem to indicate the possibility that our healthcare system is not the best in the world.

[Mr. Peabody]

Foreign countries (single-buyers) also pay a lot less to US Big Pharma than Americans do. That's why buying US drugs from Canada has exploded into a huge industry.

In ridiculous contrast, the Repugs FORBID the US govt from negotiating for lower prices with Big Pharma.

Right, but you would have to agree that Big Pharma is a business and is only going to put effort into creating new drugs to realize a profit. If you start artificially capping the amount of profit, don't you also take away the incentive to invest in the creation of new drugs?

[Yonivore]

No, I don't think you can necessarily use expected lifespans as proof of quality healthcare. There are other factors which undoubtedly play a role in determining average lifespan (lifestyle, environment, genetics, etc.). I only posted those stats in response to your post which questioned whether our longer lifespans could be an explanation for the gap in healthcare.

I understood that and I was more pointing to my folly in even mentioning it than suggesting you posted it as some refutation of my point.

I would say though, Yoni, that at some point the evidence does seem to indicate the possibility that our healthcare system is not the best in the world.

Could be.

The evidence could also indicate we're a more unhealthy society than the others -- due to lifestyle choices and not medical care -- or that we have a riskier healthcare system due to our propensity to be aggressive in the name of innovation in cure-seeking.

I think the cost is clearly a function of innovation (and the inherent waste and fraud of bureaucracy). None of the other countries expend as much because they merely take what we've invented and apply it there.

[boutons_]

"If you start artificially capping the amount of profit, don't you also take away the incentive to invest in the creation of new drugs?"

One proposal I saw was that US govt would buy drug patents from drug development companies (perhaps $Bs per patent in some cases) and make them generic. This would take the $Bs in profits away from Big Pharma over the life of the patents that now cost the US so much money and put so many drugs out of reach.

Then generic manufacturers could get on with producing the drugs for reasonable mfr-ing profits, often at pennies per dose to manufacture.

The savings in drug costs for Medicare/Medicaid/univseral-health-care/VetAdmin would offset the costs of buying the patents.

This would prevent drug development companies from reformulating their expired patent drugs with little or no improvement, just so they could get a new 17-year patent and then market their new no-better-than-generic drug as much superior to generic drugs.

Since the whole planet benefits from drugs, the whole planet can play the drug development game. They make profits from development, but not from manufacturing. ie, no-profit drugs, instead of the exorbitant profits, just part of the overall approach to no-profit health care.

[PixelPusher]

Right, but you would have to agree that Big Pharma is a business and is only going to put effort into creating new drugs to realize a profit. If you start artificially capping the amount of profit, don't you also take away the incentive to invest in the creation of new drugs?

How is having the ability to negoiate on prices (you know...bargaining?) an "artificial cap"? When I post the winning bid on an item on eBay, and it (inevitably) ends up being less than what the seller was hoping to sell it for, am I "artificially capping" his profit margin? Where's the "artifice"?

[Extra Stout]

USA health care costs, 2005: $2 trillion
USA health care R&D costs, 2005: $111 billion
USA health care R&D costs, funded by private industry: $61 billion.

There is a lot of room to cut health care costs without touching R&D. Don't touch R&D.

[Yonivore]

USA health care costs, 2005: $2 trillion
USA health care R&D costs, 2005: $111 billion
USA health care R&D costs, funded by private industry: $61 billion.

There is a lot of room to cut health care costs without touching R&D. Don't touch R&D.

Yep. You could cut healthcare costs substantially by completely privatizing it and removing government price controls enforced through Medicare and Medicaid. Compe ion is the best medicine.

Not to mention all the fraud and waste that would go away with the bureaucracy.

Oh yeah, and Tort reform. Doctor's don't need to be afraid of getting their licenses sued out from under them.

Government has beat altruism right out of the medical field.

[boutons_]

"Compe ion is the best medicine."

yoni's funny. Go back and read where that last Repug Medicare bill FORBIDS the US govt from negotiating for lower drug prices. That type of govt regulation, that stuffs corporate welfare $Bs into Big Pharma pockets, doesn't bother yoni and the conservatives one little bit.

There is NO compe ion when a drug company has patent on a drug. It's monopoly supplier, and all unregulated monopolies are abusive.

There's no compe ion in healthcare, and it's not because of govt regulations. Health care orgs join networks run by insurance companies that set the prices they will pay, and IF they will pay. This is completely private, commercial, "free market", NOT govt regulation.

You ers don't have a clue when you worship free markets, which are great in text books, but in practice, most markets are cartelized, centralized, controlled by a few dominant players who don't compete on price and buy enough politicians to protect their racket.

[Extra Stout]

Yep. You could cut healthcare costs substantially by completely privatizing it and removing government price controls enforced through Medicare and Medicaid. Compe ion is the best medicine.

Not to mention all the fraud and waste that would go away with the bureaucracy.

Oh yeah, and Tort reform. Doctor's don't need to be afraid of getting their licenses sued out from under them.

Government has beat altruism right out of the medical field.

Yes, completely privatizing medicine will significantly reduce costs. As mentioned previously in the thread, this is how Chile does it, and AEI/Heritage Foundation types tend to applaud Chile's economic freedom.

The only thing you give up with the complete privatization is the ability of the poor of get medical care. The Chilean solution is to let them die. Simply not treating sick people reduces the cost of their care to nearly zero (sometimes, the state has to dispose of the untended corpses if the family does not).

The thing that we get hung up on is this idea that people should not die of readily treatable diseases simply for lack of means. If we can disabuse ourselves of this notion, the issues get a lot simpler.

[Yonivore]

Yes, completely privatizing medicine will significantly reduce costs. As mentioned previously in the thread, this is how Chile does it, and AEI/Heritage Foundation types tend to applaud Chile's economic freedom.

The only thing you give up with the complete privatization is the ability of the poor of get medical care. The Chilean solution is to let them die. Simply not treating sick people reduces the cost of their care to nearly zero (sometimes, the state has to dispose of the untended corpses if the family does not).

The thing that we get hung up on is this idea that people should not die of readily treatable diseases simply for lack of means. If we can disabuse ourselves of this notion, the issues get a lot simpler.

There's a lot more wealth in American than Chile. I have trouble believing our wealthy and our doctors wouldn't be able to pull together enough free clinics to treat the indigent.

And, I think they'd do it a lot better than government.

[Extra Stout]

You ers don't have a clue when you worship free markets, which are great in text books, but in practice, most markets are cartelized, centralized, controlled by a few dominant players who don't compete on price and buy enough politicians to protect their racket.

I have to agree with boutons on thsi one. Corporations' extolling of free market principles is just lip service. They want rigged markets that protect their own interests.

[Extra Stout]

There's a lot more wealth in American than Chile. I have trouble believing our wealthy and our doctors wouldn't be able to pull together enough free clinics to treat the indigent.

And, I think they'd do it a lot better than government.

I think you have an utterly misplaced faith in the philanthropy and altruism of the wealthy in this country.

For every Bill Gates or Warren Buffet out there, there are 100 tycoons who will step on your throat, as you lay bleeding on the pavement, to bend down and pick up a dime.

[Yonivore]

I think you have an utterly misplaced faith in the philanthropy and altruism of the wealthy in this country.

For every Bill Gates or Warren Buffet out there, there are 100 tycoons who will step on your throat, as you lay bleeding on the pavement, to bend down and pick up a dime.

It doesn't take them all. There are enough Bill Gates' and Warrent Buffets out there who will step up to the plate.

Our society is fairly well integrated where the wealthy depend fairly heavily on the labor of poor. This isn't the middle ages -- or, Chile, for example -- where the rich can just use someone until they die and have them replaced with the next future corpse. Much of our national industry depends on a healthy and intelligence work force.

If for no other reason than keeping productivity up, they'll figure out a way to replace government medical care.

And, I guarantee it'll be more efficient than Medicare and Medicaid.

[Extra Stout]

It doesn't take them all. There are enough Bill Gates' and Warrent Buffets out there who will step up to the plate.

Our society is fairly well integrated where the wealthy depend fairly heavily on the labor of poor. This isn't the middle ages -- or, Chile, for example -- where the rich can just use someone until they die and have them replaced with the next future corpse. Much of our national industry depends on a healthy and intelligence work force.

If for no other reason than keeping productivity up, they'll figure out a way to replace government medical care.

And, I guarantee it'll be more efficient than Medicare and Medicaid.

I think you have an utterly misplaced faith in the concern of the wealthy in America for the long-term compe iveness of the U.S. economy.

[Yonivore]

I think you have an utterly misplaced faith in the concern of the wealthy in America for the long-term compe iveness of the U.S. economy.

Well, we just disagree. I believe there are more Gates's and Dells and Buffetts than there are Rockefellers and Hearsts and...pick your villain.

[Extra Stout]

Well, we just disagree. I believe there are more Gates's and Dells and Buffetts than there are Rockefellers and Hearsts and...pick your villain.

The disdain for ordinary Americans among the old-money set is unmistakeable. They are the grandchildren of people in the 1930's who thought the Great Depression represented what the natural order of things should be, and who tried to overthrow FDR and install a fascist dictatorship. They haven't forgotten those values.

You should read and find out what America actually was like for the middle and working classes during the Gilded Age. The reason things changed was that people got sick of it and started killing the wealthy, and the wealthy got scared and gave concessions.

And America was more altruistic then than it is now.

These are the people who actually are quoted as saying that they alone are responsible for 100% of the American economy and should therefore control 100% of the wealth, and that an American worker is no different from a peasant in Indonesia and shouldn't be paid any more.

The default situation for humanity throughout history is that everyone is selfish, and will gladly screw over everybody else to benefit themselves and their families. Capitalism, in principle, counts upon this (which is why it works while utopian systems fail miserably), but if not refereed to protect free markets, laspses into economic oligarchy.

There are rare cases when a society will develop elites who actually are concerned about something besides their own enrichment at the expense of the country. We have had two such periods when that was true: the founding of the nation, and the aftermath of World War II. Nations become great when that happens. It is NOT true today.

I think a lot of your ideas could work in a society where there were no multinational corporations with the power of nation-states, with a drastically diminished state that lacked the ability to control the population. Free markets will work only when the elites lack the ability to manipulate them, or where there is sufficient fear of violent consequences to prevent the rich from doing so.

[Yonivore]

The disdain for ordinary Americans among the old-money set is unmistakeable. They are the grandchildren of people in the 1930's who thought the Great Depression represented what the natural order of things should be, and who tried to overthrow FDR and install a fascist dictatorship. They haven't forgotten those values.

You should read and find out what America actually was like for the middle and working classes during the Gilded Age. The reason things changed was that people got sick of it and started killing the wealthy, and the wealthy got scared and gave concessions.

And America was more altruistic then than it is now.

These are the people who actually are quoted as saying that they alone are responsible for 100% of the American economy and should therefore control 100% of the wealth, and that an American worker is no different from a peasant in Indonesia and shouldn't be paid any more.

The default situation for humanity throughout history is that everyone is selfish, and will gladly screw over everybody else to benefit themselves and their families. Capitalism, in principle, counts upon this (which is why it works while utopian systems fail miserably), but if not refereed to protect free markets, laspses into economic oligarchy.

There are rare cases when a society will develop elites who actually are concerned about something besides their own enrichment at the expense of the country. We have had two such periods when that was true: the founding of the nation, and the aftermath of World War II. Nations become great when that happens. It is NOT true today.

I think a lot of your ideas could work in a society where there were no multinational corporations with the power of nation-states, with a drastically diminished state that lacked the ability to control the population. Free markets will work only when the elites lack the ability to manipulate them, or where there is sufficient fear of violent consequences to prevent the rich from doing so.

Okay.