10000 doctors cannot be wrong!

[Just Plain Ruff]

Nice article I came across. Interesting article.

Shows that the UK provides better primary care than the US. So why are so many people under socialized medicine coming to the USA for care?

It's a long read, but the most important parts are in the first couple of paragraphs.

US performs poorly against UK and other developed countries in primary care

From: The British Journal of Healthcare Computing and Information Management | November 05, 2009

The UK has been ranked as having one of the best primary health care systems in the world in a survey by the leading US think tank the Commonwealth Fund and published online today in the journal Health Affairs [1].

The survey queried more than 10,000 primary care physicians in 11 developed countries: Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States).

Fifty-eight percent of primary care doctors in the US report their patients often have difficulty paying for medications and care, and half of US doctors spend substantial time dealing with restrictions insurance companies place on their patients’ care, according to findings from the 2009 Commonwealth Fund International Health Policy Survey published online today in the journal Health Affairs.

The majority (69%) of US doctors report that their practices do not have provisions for after-hours care, forcing patients to seek care in emergency departments (compared to 97% in the Netherlands and 89% in New Zealand and the UK that do have after hours care).

US doctors were also far less likely to use health information technology that helps reduce errors and improve care — only 46% of U.S. doctors use electronic medical records compared to 99% of doctors in the Netherlands and 97% of doctors in New Zealand and Norway.

The NHS was rated highly in a number of key areas including being the only country where the majority of doctors feel the quality of healthcare is improving.

The annual survey of international healthcare comparisons this year polled primary care doctors for their views on their health systems. The UK was rated top in several categories including:

improvements in quality over the past three years;

least likely to report long waiting times for patients referred for specialist care;

managing chronic conditions with specialist teams;

using financial incentives to reward doctors for good patient experience;

the use of patient satisfaction and experience data to improve services; and

the use of comparative data to review doctors’ clinical performance.

Speaking from Washington at the Commonwealth Fund’s 2009 international health symposium, Health Secretary Andy Burnham said: “This is an important moment for the NHS. The journey to overhaul the quality of care over the last ten years has paid off. Clinicians now say they are confident they are treating and caring for patients in ways that match the best healthcare systems in the world. The NHS is not perfect but it has moved from poor to good and I want to see it go from good to great on the next stage of the journey.

“Primary care services are at the heart of the NHS, preventing illness, managing disease and helping people live healthier lives. Most recently our GPs have been doing a fantastic job at the forefront of our response to the swine flu outbreak starting the vaccination programme.

“We will build on these great achievements, and focus on the challenge for the next decade – greater choice, more personalised and high quality care, taking the NHS from good to great.

“I would like today to pay tribute to the hard working NHS staff across the country and congratulate them for this magnificent achievement. This is a proud day for NHS staff and for the millions of patients they look after so well.”

During a three-day visit to Washington the Health Secretary will also be discussing key global health challenges such as the swine flu pandemic, the health effects of climate change and the shared challenge of obesity with his US counterpart and other opposite numbers.

The state of primary care in the US

"We spend far more than any of the other countries in the survey, yet a majority of US primary care doctors say their patients often can’t afford care, and a wide majority of primary care physicians don’t have advanced computer systems to access patient test results, anticipate and avoid medication errors, or support care for chronically ill patients," said Commonwealth Fund Senior Vice President Cathy Schoen, lead author of the article.

"The patient-centered chronic care model originated in the US, yet other countries are moving forward faster to support care teams including nurses, spending time with patients, and assuring access to after-hours. The study underscores the pressing need for national reforms to close the performance gap to improve outcomes and reduce costs."

The survey describes a US primary care system that is under stress and highlights areas where the US can learn from other countries. Notably, the US could look to improve by using financial incentives to improve quality and efficiency, expanding access to health care and simplifying insurance, expanding the use of health information technology to prevent medical errors, and using a medical home approach to primary care where patients have options for care at any time of day or night, teams of health care providers to manage conditions, and continuity of care.

Many of the areas in which the US lags would be addressed by proposed health reform legislation currently under consideration in Congress.

"Access barriers, lack of information, and inadequate financial support for preventive and chronic care undermine primary care doctors' efforts to provide timely, high quality care and put the US far behind what many other countries are able to achieve," said Commonwealth Fund President Karen Davis.

"Our weak primary care system puts patients at risk, and results in poorer health outcomes, and higher costs. The survey provides yet another reminder of the urgent need for reforms that make accessible, high-quality primary care a national priority."

Survey Highlights

Access and barriers to care

More than half of U.S. physicians (58%) report their patients often have difficulty paying for medications or other out-of-pocket costs, compared to between 5% and 37% in the other countries.

U.S. physicians are also 4 times or more as likely as physicians in some other countries—Australia, Netherlands, Sweden and the U.K.—to report major problems with the time they or their staff spend getting patients needed medication or treatment due to insurance coverage restrictions. About half (48%) of US physicians report this is a major problem, compared to just 6% in the UK.

Twenty-eight percent of US doctors report their patients often face long waits to see a specialist — a rate similar to that reported by Australian (35%) and UK (22%) physicians, the lowest rates in the survey. Three-quarters of Canadian and Italian physicians reported long waits.

After-hours care outside the emergency room

Most US primary care doctors say they have no arrangement for access to care after normal office hours except for directing patients to a hospital emergency room. Just 29% of US doctors report any arrangement for patients to see a doctor or nurse after hours, a drop from 40 percent in the 2006 Commonwealth Fund International Health Policy Survey.

In contrast, nearly all doctors in the Netherlands (97%), and large majorities in New Zealand (89%) and the UK (89%) report after-hours provision, as do more than three of four doctors in France (78%) and Italy (77%).

Health information technology

While nearly half (46%) of U.S. primary care doctors report using electronic medical records (EMRs) — up from 28% in 2006 — US primary care practices, along with Canadian doctors, continue to lag well behind other leading countries. EMRs are nearly universal in the Netherlands (99%), New Zealand (97%), the UK (96%), Australia (95%), Italy (94%), Norway (97%), and Sweden (94%).

In addition to basic EMRs, the survey asked about a range of 13 possible computer functions, including electronic medication prescribing and alerts for medication errors, ordering lab tests and viewing test results, and support and prompts for preventive care and follow-up care with patients.

Here country results varied widely, ranging from nearly all to half of doctors reporting at least nine of 14 possible computerized functions in New Zealand (92%), Australia (91%), the UK (89%), Italy (66%), and the Netherlands (54%), to one fourth or fewer practices in the U.S. (26%), Canada (14%), France (15%), and Norway (19%).

Notably, in the United States, advanced information capacity was concentrated in larger group practices and those affiliated with integrated care systems. In contrast, in the seven countries with near universal use of EMRs, there was little or no difference in advanced health information technology use by practice size. The authors note that in these countries national policies and standards have supported wide adoption of information technology in primary care practices.

Financial incentives to improve quality

Every country in the survey, to some degree, uses financial incentives to improve primary care, preventive care, or disease management. Primary care physicians in the US, however, are among the least likely to report that they receive financial incentives for quality improvement, such as bonuses for achieving high patient satisfaction ratings, increasing preventive care, use of teams, or managing patients with chronic disease or complex needs.

Only one-third of US physicians reported receiving any financial incentives for the six quality improvement measures in the survey. Rates were also low in Sweden and Norway. In contrast, significant majorities of doctors in the UK (89%), the Netherlands (81%), New Zealand (80%), Italy (70%) and Australia (65%) report some type of extra financial incentive or target support to improve primary care capacity.

Use of care teams and systems to care for patients with chronic illness

Teams that include health professionals such as nurses serve an important role in managing care, especially for chronic conditions. The survey results indicate that use of teams is widespread in Sweden (98%), the UK, (98%), the Netherlands (91%), Australia (88%), New Zealand (88%), Germany (73%) and Norway (73%). Use of teams was far less frequent in the United States (59%), Canada (52%), and France (11%) based on primary care physician reports.

Use of evidence-based guidelines for chronic disease was high in all countries for diabetes, asthma, and hypertension but notably lower for depression. Yet, providing written instructions for patients to manage care at home is not yet routine in any country — gaps exist in all. Only in Italy did more than half of physicians (63%) say they routinely provide written instructions to chronically ill patients for managing care at home.

Quality reporting and feedback

Many countries in the survey have also been investing in information on performance to provide incentive and benchmarks. The authors note that "information that peers have met with success is often instrumental to guide and drive innovation."

Asked about comparative information systems, doctors in the U.K. are most likely to routinely receive and review data on clinical outcomes (89%), followed by Sweden (71%), New Zealand (68%), and the Netherlands (65%). Less than half of doctors in other surveyed countries — including the US at 43% — report such reviews.

UK physicians (65%) were by far the most likely to report they receive data on how they compare to other practices and, along with Sweden and New Zealand doctors, the most likely to have information on patient experiences. Notably, US doctors lagged well behind these leading countries on feedback on both clinical quality and patient experiences.

Tracking medical errors

The study finds that half or more primary care doctors in Canada, France, Germany, Italy and the Netherlands report not yet having a process to identify "adverse events" and take action.

Just one in five U.S. primary care physicians say they have a process that works well to identify risks and take follow up actions; one third said they have no process. At 56 percent, UK physicians were most likely to say they have processes they think work well, followed by Sweden (41%), New Zealand (32%), and Australia (32%).

Looking across survey results, the authors conclude that national policies have been instrumental in the leading countries to achieve round-the-clock access, information systems, and advance primary care teams. They note that "overall, the survey highlights the lack of national policies focused on US primary care. Unless primary care practices are part of more integrated care systems, they are on their own facing multiple payers with uncoordinated policies."

Pressing need for US reforms

Following survey findings that point out lagging US performance, Commonwealth Fund President Karen Davis noted that key national reforms could make a significant difference by:

Covering everyone, with a set of benefits that emphasizes primary care and prevention and which remove financial barriers and support primary care physicians as well as their patients;

Providing financial incentives focused on value and health outcomes;

Supporting primary care practices and their capacity to serve as ― medical homes with 24-hour access, use of teams of health professionals, and continuity of care;

Accelerating the adoption and use of health information technology, including electronic medication prescribing to reduce risks of errors;

Simplifying insurance to reduce complexity and paperwork for doctors and their staff; and

Investing in information systems with quality reporting and feedback to spread improved care and safety.

Reference

1. Cathy Schoen, M.A., Robin Osborn, M.B.A., Michelle M. Doty, Ph.D., David Squires, Jordon Peugh, M.A., and Sandra Applebaum. A Survey of Primary Care Physicians in 11 Countries, 2009: Perspectives on Care, Costs, and Experiences. Health Affairs Web Exclusive, Nov. 4, 2009, w1171–w1183. The full article is available at: http://content.healthaffairs.org/cgi/content/abstract/

hlthaff.28.6.w1171

Further information

Further information on the study from The Commonwealth Fund, including an online charting tool using international health data, is available at:

http://www.commonwealthfund.org/Content/Publications/

In-the-Literature/2009/Nov/A-Survey-of-Primary-Care-Physicians.aspx

[scubanurse]

Great article...but links don't work

[fireflymedic]

But what they fail to mention is they do not have the research dollars nor the depth of specialist there that we have here. Also, I have heard from multiple people the complaints with the Canadian system and how long it can take to achieve an appointment - even for "immediate" specialist appointments. I can't speak to the european system as I've not had much contact with them.

I do know that if I call my doctor with a major concern I can typically get in that day or the next. It is rare I cannot. More larger universities are linking their entire systems to the doctors, hospital, clinics and outside records being forwarded and scanned into main line computers. I am curious though if they are talking a nationwide computer database or simply within the certain system. I think HIPPA essentially goes out the door with a nationwide database. With that many having such easy access - where does privacy go? Don't people have a right to disclose or not disclose certain things of their choice. I see it only as more of big brother watching over us. I am quite opposed to it. I like that people have to ask me before they just go and get my med records. That's a personal thing with me, but I do like privacy.

Also - I have concerns with a socialist medicine system in another aspect. There is no "benefit" for a doctor to be better. In many instances the doctors are paid a flat rate by the government according to their specialty regardless of whether they have multiple malpractice suits against them or are the top of their field. Also - aside from certain states - there isn't capping on malpractice claims (yet). Shouldn't a doctor be required to pay for their mistakes which may have been blatant lack of quality issues that led to a patient's death or injury. They will never be right again - isn't it fair to have them pay for the continue of the care and what they lost? Another great concern of mine is the lack of ability to choose who my physician will be (thus the number 1 reason I DON'T have an HMO). If I have a serious condition I want to be able to choose the doctor most qualified to care for me and that is the best fit in several areas. Right now I have that option at varying levels of coverage, but I can choose whoever I want. Isn't this something you would want to maintain? Since they would be trying to even out the coverage, some might be assigned a great doc and others the bottom of the barrel.

No, this is NOT an option I care to pursue and I'm with the original poster - if care is so great there, why are so many coming here for it? On a final note, you can make a survey say whatever you want depending on the people you poll. It could easily be reversed to say the exact opposite if you polled a different demographic. It's all in the slant you want to portray. I truly believe there are others out there which say the opposite but they are choosing to promote this side simply to further their agenda of socialized medicine.

Edited November 11, 2009 by fireflymedic

[Mateo_1387]

Shows that the UK provides better primary care than the US. So why are so many people under socialized medicine coming to the USA for care?

Just out of personal curiosity, any idea how many people are coming to the US for medical care when they have socialized care at home? I hear that claim thrown around a lot, but have never had any numbers to explain the claim. I only ask out of curiosity.

Interesting article you posted Ruff. Thanks for sharing.

[Just Plain Ruff]

Just out of personal curiosity, any idea how many people are coming to the US for medical care when they have socialized care at home? I hear that claim thrown around a lot, but have never had any numbers to explain the claim. I only ask out of curiosity.

Interesting article you posted Ruff. Thanks for sharing.

Matt, I've heard figures of 2500 up to 200K a year coming here for treatment.

I have also heard of a large number of pregnant women being transferred from Canadian hospitals for c-sections because they can't get them done in Canada.

like every inflammatory comment or divisive discussion I'm sure the numbers are either trumped up or dumbed down to suit each sides argument as being the right one.

I cannot find any good solid numbers in an exhaustive (30 seconds) search of Google.

[Diazepam618]

Nice article I came across. Interesting article.

Shows that the UK provides better primary care than the US. So why are so many people under socialized medicine coming to the USA for care?

It's a long read, but the most important parts are in the first couple of paragraphs.

US performs poorly against UK and other developed countries in primary care

From: The British Journal of Healthcare Computing and Information Management | November 05, 2009

The UK has been ranked as having one of the best primary health care systems in the world in a survey by the leading US think tank the Commonwealth Fund and published online today in the journal Health Affairs [1].

The survey queried more than 10,000 primary care physicians in 11 developed countries: Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States).

Fifty-eight percent of primary care doctors in the US report their patients often have difficulty paying for medications and care, and half of US doctors spend substantial time dealing with restrictions insurance companies place on their patients’ care, according to findings from the 2009 Commonwealth Fund International Health Policy Survey published online today in the journal Health Affairs.

The majority (69%) of US doctors report that their practices do not have provisions for after-hours care, forcing patients to seek care in emergency departments (compared to 97% in the Netherlands and 89% in New Zealand and the UK that do have after hours care).

US doctors were also far less likely to use health information technology that helps reduce errors and improve care — only 46% of U.S. doctors use electronic medical records compared to 99% of doctors in the Netherlands and 97% of doctors in New Zealand and Norway.

The NHS was rated highly in a number of key areas including being the only country where the majority of doctors feel the quality of healthcare is improving.

The annual survey of international healthcare comparisons this year polled primary care doctors for their views on their health systems. The UK was rated top in several categories including:

improvements in quality over the past three years;

least likely to report long waiting times for patients referred for specialist care;

managing chronic conditions with specialist teams;

using financial incentives to reward doctors for good patient experience;

the use of patient satisfaction and experience data to improve services; and

the use of comparative data to review doctors’ clinical performance.

Speaking from Washington at the Commonwealth Fund’s 2009 international health symposium, Health Secretary Andy Burnham said: “This is an important moment for the NHS. The journey to overhaul the quality of care over the last ten years has paid off. Clinicians now say they are confident they are treating and caring for patients in ways that match the best healthcare systems in the world. The NHS is not perfect but it has moved from poor to good and I want to see it go from good to great on the next stage of the journey.

“Primary care services are at the heart of the NHS, preventing illness, managing disease and helping people live healthier lives. Most recently our GPs have been doing a fantastic job at the forefront of our response to the swine flu outbreak starting the vaccination programme.

“We will build on these great achievements, and focus on the challenge for the next decade – greater choice, more personalised and high quality care, taking the NHS from good to great.

“I would like today to pay tribute to the hard working NHS staff across the country and congratulate them for this magnificent achievement. This is a proud day for NHS staff and for the millions of patients they look after so well.”

During a three-day visit to Washington the Health Secretary will also be discussing key global health challenges such as the swine flu pandemic, the health effects of climate change and the shared challenge of obesity with his US counterpart and other opposite numbers.

The state of primary care in the US

"We spend far more than any of the other countries in the survey, yet a majority of US primary care doctors say their patients often can’t afford care, and a wide majority of primary care physicians don’t have advanced computer systems to access patient test results, anticipate and avoid medication errors, or support care for chronically ill patients," said Commonwealth Fund Senior Vice President Cathy Schoen, lead author of the article.

"The patient-centered chronic care model originated in the US, yet other countries are moving forward faster to support care teams including nurses, spending time with patients, and assuring access to after-hours. The study underscores the pressing need for national reforms to close the performance gap to improve outcomes and reduce costs."

The survey describes a US primary care system that is under stress and highlights areas where the US can learn from other countries. Notably, the US could look to improve by using financial incentives to improve quality and efficiency, expanding access to health care and simplifying insurance, expanding the use of health information technology to prevent medical errors, and using a medical home approach to primary care where patients have options for care at any time of day or night, teams of health care providers to manage conditions, and continuity of care.

Many of the areas in which the US lags would be addressed by proposed health reform legislation currently under consideration in Congress.

"Access barriers, lack of information, and inadequate financial support for preventive and chronic care undermine primary care doctors' efforts to provide timely, high quality care and put the US far behind what many other countries are able to achieve," said Commonwealth Fund President Karen Davis.

"Our weak primary care system puts patients at risk, and results in poorer health outcomes, and higher costs. The survey provides yet another reminder of the urgent need for reforms that make accessible, high-quality primary care a national priority."

Survey Highlights

Access and barriers to care

More than half of U.S. physicians (58%) report their patients often have difficulty paying for medications or other out-of-pocket costs, compared to between 5% and 37% in the other countries.

U.S. physicians are also 4 times or more as likely as physicians in some other countries—Australia, Netherlands, Sweden and the U.K.—to report major problems with the time they or their staff spend getting patients needed medication or treatment due to insurance coverage restrictions. About half (48%) of US physicians report this is a major problem, compared to just 6% in the UK.

Twenty-eight percent of US doctors report their patients often face long waits to see a specialist — a rate similar to that reported by Australian (35%) and UK (22%) physicians, the lowest rates in the survey. Three-quarters of Canadian and Italian physicians reported long waits.

After-hours care outside the emergency room

Most US primary care doctors say they have no arrangement for access to care after normal office hours except for directing patients to a hospital emergency room. Just 29% of US doctors report any arrangement for patients to see a doctor or nurse after hours, a drop from 40 percent in the 2006 Commonwealth Fund International Health Policy Survey.

In contrast, nearly all doctors in the Netherlands (97%), and large majorities in New Zealand (89%) and the UK (89%) report after-hours provision, as do more than three of four doctors in France (78%) and Italy (77%).

Health information technology

While nearly half (46%) of U.S. primary care doctors report using electronic medical records (EMRs) — up from 28% in 2006 — US primary care practices, along with Canadian doctors, continue to lag well behind other leading countries. EMRs are nearly universal in the Netherlands (99%), New Zealand (97%), the UK (96%), Australia (95%), Italy (94%), Norway (97%), and Sweden (94%).

In addition to basic EMRs, the survey asked about a range of 13 possible computer functions, including electronic medication prescribing and alerts for medication errors, ordering lab tests and viewing test results, and support and prompts for preventive care and follow-up care with patients.

Here country results varied widely, ranging from nearly all to half of doctors reporting at least nine of 14 possible computerized functions in New Zealand (92%), Australia (91%), the UK (89%), Italy (66%), and the Netherlands (54%), to one fourth or fewer practices in the U.S. (26%), Canada (14%), France (15%), and Norway (19%).

Notably, in the United States, advanced information capacity was concentrated in larger group practices and those affiliated with integrated care systems. In contrast, in the seven countries with near universal use of EMRs, there was little or no difference in advanced health information technology use by practice size. The authors note that in these countries national policies and standards have supported wide adoption of information technology in primary care practices.

Financial incentives to improve quality

Every country in the survey, to some degree, uses financial incentives to improve primary care, preventive care, or disease management. Primary care physicians in the US, however, are among the least likely to report that they receive financial incentives for quality improvement, such as bonuses for achieving high patient satisfaction ratings, increasing preventive care, use of teams, or managing patients with chronic disease or complex needs.

Only one-third of US physicians reported receiving any financial incentives for the six quality improvement measures in the survey. Rates were also low in Sweden and Norway. In contrast, significant majorities of doctors in the UK (89%), the Netherlands (81%), New Zealand (80%), Italy (70%) and Australia (65%) report some type of extra financial incentive or target support to improve primary care capacity.

Use of care teams and systems to care for patients with chronic illness

Teams that include health professionals such as nurses serve an important role in managing care, especially for chronic conditions. The survey results indicate that use of teams is widespread in Sweden (98%), the UK, (98%), the Netherlands (91%), Australia (88%), New Zealand (88%), Germany (73%) and Norway (73%). Use of teams was far less frequent in the United States (59%), Canada (52%), and France (11%) based on primary care physician reports.

Use of evidence-based guidelines for chronic disease was high in all countries for diabetes, asthma, and hypertension but notably lower for depression. Yet, providing written instructions for patients to manage care at home is not yet routine in any country — gaps exist in all. Only in Italy did more than half of physicians (63%) say they routinely provide written instructions to chronically ill patients for managing care at home.

Quality reporting and feedback

Many countries in the survey have also been investing in information on performance to provide incentive and benchmarks. The authors note that "information that peers have met with success is often instrumental to guide and drive innovation."

Asked about comparative information systems, doctors in the U.K. are most likely to routinely receive and review data on clinical outcomes (89%), followed by Sweden (71%), New Zealand (68%), and the Netherlands (65%). Less than half of doctors in other surveyed countries — including the US at 43% — report such reviews.

UK physicians (65%) were by far the most likely to report they receive data on how they compare to other practices and, along with Sweden and New Zealand doctors, the most likely to have information on patient experiences. Notably, US doctors lagged well behind these leading countries on feedback on both clinical quality and patient experiences.

Tracking medical errors

The study finds that half or more primary care doctors in Canada, France, Germany, Italy and the Netherlands report not yet having a process to identify "adverse events" and take action.

Just one in five U.S. primary care physicians say they have a process that works well to identify risks and take follow up actions; one third said they have no process. At 56 percent, UK physicians were most likely to say they have processes they think work well, followed by Sweden (41%), New Zealand (32%), and Australia (32%).

Looking across survey results, the authors conclude that national policies have been instrumental in the leading countries to achieve round-the-clock access, information systems, and advance primary care teams. They note that "overall, the survey highlights the lack of national policies focused on US primary care. Unless primary care practices are part of more integrated care systems, they are on their own facing multiple payers with uncoordinated policies."

Pressing need for US reforms

Following survey findings that point out lagging US performance, Commonwealth Fund President Karen Davis noted that key national reforms could make a significant difference by:

Covering everyone, with a set of benefits that emphasizes primary care and prevention and which remove financial barriers and support primary care physicians as well as their patients;

Providing financial incentives focused on value and health outcomes;

Supporting primary care practices and their capacity to serve as ― medical homes with 24-hour access, use of teams of health professionals, and continuity of care;

Accelerating the adoption and use of health information technology, including electronic medication prescribing to reduce risks of errors;

Simplifying insurance to reduce complexity and paperwork for doctors and their staff; and

Investing in information systems with quality reporting and feedback to spread improved care and safety.

Reference

1. Cathy Schoen, M.A., Robin Osborn, M.B.A., Michelle M. Doty, Ph.D., David Squires, Jordon Peugh, M.A., and Sandra Applebaum. A Survey of Primary Care Physicians in 11 Countries, 2009: Perspectives on Care, Costs, and Experiences. Health Affairs Web Exclusive, Nov. 4, 2009, w1171–w1183. The full article is available at: http://content.healthaffairs.org/cgi/content/abstract/

hlthaff.28.6.w1171

Further information

Further information on the study from The Commonwealth Fund, including an online charting tool using international health data, is available at:

http://www.commonwealthfund.org/Content/Publications/

In-the-Literature/2009/Nov/A-Survey-of-Primary-Care-Physicians.aspx

Well their not coming here to the US for medical care , as they are for the American Dream type of thing would be my guess.

[Just Plain Ruff]

Well their not coming here to the US for medical care , as they are for the American Dream type of thing would be my guess.

What?

I believe that they are indeed coming to the US for the medical care. For some people in the socialized medicine countries, the only way to get a operation or procedure done in a timely manner is to come to the US. Once the procedure is done, then they go back to their country.

[VentMedic]

Matt, I've heard figures of 2500 up to 200K a year coming here for treatment.

One would have to differientate between the illegals (from all countries and not just one), those who can qualify for government assisted programs legally(Cubans), tourists and Snowbirds who may need medical care during their stay be it ongoing or emergent. For the tourists and the snowbirds, just coming to the U.S. for medical care may not have been their intent.

However, there are now many companies in the U.S. that specialize in getting Americans medical care in other countries. It is estimated that roughly 6 million people go to another country for their medical care. That number might be lower since it is difficult to track those that go to Cuba which is also considered by Europeans a more popular spot than the U.S. for medical care.

Then there are the large numbers of U.S. citizens, especially the senior citizens, who get their prescriptions fill somewhere other than the U.S.

For Europeans to get nonemergent medical care here, they must have an insurance that is agreed upon and accepted in the U.S. or they must pay cash.

I have also heard of a large number of pregnant women being transferred from Canadian hospitals for c-sections because they can't get them done in Canada.

That would depend on them being emergent, a medical necessary or elective. Some American women get upset also when their doctors refuse to work around the mother to be's personal agenda to have a baby born on her time and her way. That also goes for the doctors that scheduled C-Sect day on Thursday so they could have a 3 day weekend.

Edited November 11, 2009 by VentMedic

[fireflymedic]

On the topic of C sections - I've not heard of the issues with that. However, I have heard of a significant number of NICU qualifying babies being sent to the US for care as there is a significant lack of appropriate facilities in Canada. From the report I saw (granted was two years ago, but I doubt has changed significantly up to this time though it may have) that Seattle and Boston are absorbing the largest amount of these babies. If anyone recalls the show that was on TLC a couple years ago featuring the one Boston firehouse, they had that kid that they said they had adopted and he came to the station every time he was in the US for treatment which was frequently about every 3 months or so. What I am curious though - does the canadian government absorb the cost of the treatment? Is it done on US charity? Is it a private pay for care?

What I believe Vent is speaking of is the "medical tourism". They have had several features and articles on people who choose to go to another country for medical care (India and Thailand seem to be two of the biggest) due to reduced costs. They have their entire recovery period post surgery there, though some choose to return home more quickly and is combined with a vacation of sorts. The initial care is evidently as much as half the price in some cases depending on procedure. Also, there are options for care there that aren't available in the US. The downside to this is if there is a complication once you have returned home, you will be referred to a local specialist which you most likely would have been referred to initially. There is the potential that standard US products may not have been used in the surgery making it more difficult to correct if there is a problem. I understand South Africa is another country growing with this option, especially in the field of plastic surgery. It seems to be a growing industry as the cost of US healthcare increases and the amount of insured decreases they look for the least expensive way to receive their care.

I have no objection to us caring for those who are here visiting or as vent discussed the snowbirds. You can't help when and where you get sick - no different than if you were in another country and became ill. However, those who choose to come to the US for care should be responsible for the full cost of care, same as an uninsured US citizen. It should be either a personal payment or paid for by the socialized medicine country referring them. I do not agree under any terms should it be a charity case. I know it sounds hard and calloused but with so many americans unable to afford the care they desperately need and unable to get assistance because they fall in that middle bracket (not poor enough for charity, not rich enough to afford it) - they are the ones which should have priority for charity, not bringing in people from another country for treatment US doctors are unwilling to provide for free to their own citizens. I do feel quite strongly on this point and if all our own were cared for, yes, I would be completely unopposed to treating others - I would welcome it. But care for your own first, then be willing to extend out to other areas.

[scott33]

Can't speak for Canada, but I would be surprised if any significant numbers in the UK had come to the US for healthcare. I am not saying it hasn't happened (just like there has probably been many non-insured US citizens go to Canada, the UK, or Continental Europe for their healthcare needs), I just think it is a crazy notion.

Why? Because private healthcare has been freely available in the UK for many, many years. Apparently though, it still seems to be one of the UK's biggest secrets, and people from outside the UK still think the NHS is the only option.

The home grown private options would be considerably cheaper than jumping on a plane getting treatment in the US.

http://www.bupa.co.uk/

http://www.axappphealthcare.co.uk/personal/private-medical-insurance

http://www.spirehealthcare.com/Templates/Pages/corporate_lower.aspx?id=46825

http://www.bmihealthcare.co.uk/

http://www.ramsayhealth.co.uk/premium_care/premium_care_patients.aspx

http://www.hcainternational.com/about-hca.asp

I too would also like to see some concrete figures, to back up what I believe to be a long-standing myth.

Edited November 12, 2009 by scott33