Tuesday, October 14, 2008

Sick Around the World

Last night I had a chance to view Sick Around the World, a Frontline production (public broadcasting), at a local Unitarian Church. Prior to the movie, there was a short talk about what Oregon is doing to attempt to get health insurance for all of its residents. As a self-employed individual whose COBRA will run out next year who has pre-existing conditions, I have a keen interest in both local and national attempts to right an increasingly broken healthcare system in America. 

The astonishing number to me was that 75% of the money spent on health care goes for chronic care. More and more I believe that not only should our health insurance be focused on wellness and prevention, but our health technology needs to help intervene before we are so ill that we have a condition for the rest of our lives. The work I was doing previously and the work Intel continues to do in telemedicine may also reduce this burden, allowing technology to more closely monitor chronic conditions and keep people healthier, longer. 

Sick Around the World features a journalist, T.R. Reid who visits the UK, Taiwan, Japan, Germany and Switzerland to see what the U.S. can learn about health care. 

This review will surely be an oversimplification of an oversimplification, but worth looking at nevertheless. 

In the U.K., the government is too involved in health care. A general practitioner is the gatekeeper and you cannot see a specialist until you see the GP.  Waiting time is long for surgery and specialists. When doing my own research on the ground there, I also heard that the doctors felt very stretched - seeing patients only for a few minutes to meet the NHS goals of patients per hour. Their pharmacists were starting to do interesting work, scheduling long visits with patients in order to help manage all of their medications. This is also starting to happen in the U.S. and is reimbursed by insurance. 

In Japan, the country regulates what doctors can charge for various services. There is a fee book  that all doctors use(MRIs are $98 and an overnight stay in the hospital is....$10!). The hospitals are going broke (though it's nice not to see patient's going broke as in the U.S.) There is no wait time to see a doctor and  you can go as often as you would like. 

In Germany, doctors are not allowed to make a profit. They have a "sickness fund". Some doctors feel undervalued and underpaid. However, malpractice insurance is very low and they don't have loans when leaving med school. Again, the government sets the prices. 

Taiwan has mandatory insurance, there is no opt out position. There is also no gatekeeper and you can see any specialist you like. They have a wonderful smart card with all of your health information - imagine no more papers in triplicate every time you visit a new provider! Taiwan also has the lowest administration costs in the world. Again, they aren't bringing in enough money to cover services provided. 

Finally, Switzerland, who switched in 1994 from a system similar to what we currently have to mandatory/national coverage.  Employed persons are covered by their employer. The poor and individuals are covered by the government (so specifics on self-employment). Some still buy supplemental insurance, but everyone is covered in some form or fashion. The pharmaceutical industry was hit by having to decrease their costs, saying they wouldn't have money for research. Fortunately, Americans still pay painfully high prices for drugs and they are able to continue researching thanks to sick, bankrupt Americans who need medication. 

So what's the answer? Likely some combination of the above. The real answer is that what we have is NOT working and something needs to be done. The economic downturn hits the sick even harder. People cannot afford their chemotherapy, insurance only covers the employed and the healthy. The system is very broken. Let's hope a new administration can fix it.