Sunday, May 24, 2009

The Health of Britain, Part III

Last month, commenter "Thai" praised British healthcare:
The UK's NHS NICE is probably the fairest health care system on the planet. I would think conservatives would love it. Brits can always "top up" if they want.
Thai subsequently said good things about my suggested transnational healthcare metric, so I don't want to be too hard on him. But. . .

Isn't it a bit odd to praise NICE's fairness, supporting that two sentences later by arguing that fairness is enhanced by allowing those who find it unfair to pay more? Don't get me wrong--I support an individual's ability to allocate more of his resources for healthcare than the government recommends--not everyone is equally risk adverse. But isn't that an implicit recognition that the U.K.'s National Health under-spends--and under-performs?

And, more substantively, how would Thai counter the personal experience of U.K. oncologist Karol Sikora, who in the May 12th Manchester Union Leader (New Hampshire), counseled Americans to eschew NICE as a template for healthcare reform:
As the government takes increasing control of the health sector with schemes such as Medicare and SCHIP (State Children's Health-care Insurance Program), it is under pressure to control expenditures. Some American health-policy experts have looked favorably at Britain, which uses its National Institute for Clinical Excellence (NICE) to appraise the cost-benefit of new treatments before they can be used in the public system.

If NICE concludes that a new drug gives insufficient bang for the buck, it will not be available through our public National Health Service, which provides care for the majority of Britons.

There is a good reason NICE has attracted interest from U.S. policymakers: It has proved highly effective at keeping expensive new medicines out of the state formulary. Recent research by Sweden's Karolinska Institute shows that Britain uses far fewer innovative cancer drugs than its European neighbors. Compared to France, Britain only uses a tenth of the drugs marketed in the last two years.

Partly as a result of these restrictions on new medicines, British patients die earlier. In Sweden, 60.3 percent of men and 61.7 percent of women survive a cancer diagnosis. In Britain the figure ranges between 40.2 to 48.1 percent for men and 48 to 54.1 percent for women. We are stuck with Soviet-quality care, in spite of the government massively increasing health spending since 2000 to bring the United Kingdom into line with other European countries. . .

In Britain, the reality is that life-and-death decisions are driven by electoral politics rather than clinical need. Diseases with less vocal lobby groups, such as strokes and mental health, get neglected at the expense of those that can shout louder. This is a principle that could soon be exported to America.

Ironically, rationing medicines doesn't help the government's finances in the long run. We are entering a period of rapid scientific progress that will convert previous killers such as heart disease, stroke and cancer into chronic, controllable conditions. In cancer treatment, my specialty, the next generation of medicines could eliminate the need for time-consuming, expensive and unpleasant chemo and radiotherapy. These treatments mean less would have to be spent later on expensive hospitalization and surgery.

The risks of America's move toward British-style drug evaluation are clear: In Britain it has harmed patients. This is one British import Americans should refuse.

See also the May 22nd Daily Mail (U.K.):
A Normandy veteran died after being abandoned on a hospital trolley for 19 hours - on two separate occasions.

Walter Gibson, 86, suffered an agonising death from infected bedsores caused by his ordeal.

Yesterday a coroner condemned the 'gross failings' and 'neglect' that contributed to the great-grandfather's death.

Mr Gibson, who had Parkinson's disease, was admitted to Queen's Hospital in Romford, Essex, in December 2007 with a chest infection.

But the flagship £200million, three-year-old hospital did not have enough beds to accommodate him, an inquest heard.
(via Betsy Newmark, Don Surber)


Assistant Village Idiot said...

Theodore Dalrymple is also eloquent on this score. Writing from his perspective as an inner-city and prison doctor in the UK, he has some cred.

If the government were to admit what was up, I might be persuaded to go along with it: "We're going to provide health care that's five years outdated for everyone." It would at least be truth in advertising.

But they won't, of course. They'll bill it as top-flight, first-class, state o' th' art health care. Lots of people will continue to believe this even when the problems emerge. It will be the doctor's fault, or an administrator's fault, or some bureaucrat's fault - never the fault of the program itself.

Carl said...

Well said--though truth-in-advertising ain't worth dying for.

Carl said...


See also this.

OBloodyHell said...

> If the government were to admit what was up, I might be persuaded to go along with it: "We're going to provide health care that's five years outdated for everyone."

AVI, the real problem here is that the USA, as "the rich bastards" are the ones financing new research.

If WE take stuff "five years out of date", that means the Brits get things "ten years out of date".

When even the "rich bastards" won't pay for it, then what happens to it?

I believe "Duh" suffices, but I believe the general term is "death spiral".