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It's certainly debatable which countries get the best medical care for the dollar, or which countries distribute it to people in the most fair way, or make it m

It's certainly debatable which countries get the best medical care for the dollar, or which countries distribute it to people in the most fair way, or make it most accessible to the poor. But I don't really think there's debate that the US gives the best medical care if money is no object. My understanding is that, with very few exceptions, the wealthy all over the world come to the US if they have a serious medical condition.

Zigurd 11y ago
Based on data, or based on image and marketing? [EDIT:] Interesting pair of replies: US medicine is envied by those "trapped" in socialized systems that won't give them a private room. AND over-regulation is the cause of quality problems. Now there's a 360 degree defense of market-based medicine!
- bpodgursky 11y ago
  Based on the fact the Mayo clinic does, in fact, attract the richest people in the world.
  - phaemon 11y ago
    So does Harley Street, in London. So what?
  - Zigurd 11y ago
    It's already been pointed out that Lamborghinis don't make Italy the world's best car-making country. And Lamborghinis are not even the world's best cars. The rich are particularly susceptible to irrational decisions about purchases.
maxerickson 11y ago
That effect could be limited to certain health systems within the US though. There's not a single system that provides all the care.
maxxxxx 11y ago
I don't think the fact that wealthy people from all over the world come to the US is an important factor in evaluating the overall health system. The deciding factor should be what the average citizen gets out of it. Otherwise Italy could claim they are building the best cars in the world by having Ferrari and Lamborghini.
- jessriedel 11y ago
  Yours is the first good response. (Thanks!) I agree that on it's own it's not a strongly compelling fact.
XorNot 11y ago
It is highly dubious that this is some feature of the expense of medical care in the US. For example, it's generally recommended that for surgery, you actually want to see a doctor who works in the public system (in Australia, my country) because for routine procedures the guy who does them everyday, all the time, is probably a lot better at it then the guy who can choose his cases. The US has a giant population with first-world levels of funding from the government - it's fairly likely that care quality is simply the intersection of population and experience. But you pay more from the government per person, and get less. Your system and outcomes should be so much better and you all should be angry about that. It's just at some level of size and overall budget, you get a lot despite being inefficient.
- Thriptic 11y ago
  > . For example, it's generally recommended that for surgery, you actually want to see a doctor who works in the public system (in Australia, my country) because for routine procedures the guy who does them everyday, all the time, is probably a lot better at it then the guy who can choose his cases. While I agree that this is the case, the people who are willing to travel for medical care are likely not traveling for routine cases; they are going to see specialists for complex cases. The quality of care varies substantially across the US, and I do think the top tier facilities in the US are some of the best (if not the best) in the world. That says nothing about the average level of care across the country however, and it is typically difficult to get access to these premiere hospitals unless you know someone with connections in medicine or have money.
  - Xylakant 11y ago
    Be careful even in non-routine cases. The specialist in question may select his patients based on qualifiers that are in his interest. One of them is the likelihood of recovery - high likelihood improves their track record and thus their standing as a specialist.
    - Thriptic 11y ago
      This is fair point, but at a hospital-level in the US you do tend to see higher mortality levels at prestigious hospitals due to the increase in average case complexity. People are willing to take on the tougher cases.
dragonwriter 11y ago
> I don't really think there's debate that the US gives the best medical care if money is no object. My understanding is that, with very few exceptions, the wealthy all over the world come to the US if they have a serious medical condition. There's a number of individual places in the US and Europe (and possibly some elsewhere) that attract the rich from all over the world, based on reputation as providing the best care for particular conditions. But the US as a whole does not provide the best overall quality of healthcare (outcomes are about average for the developed world) even before considering overall cost, and has overall cost (whether looked at per GDP or per capita) much higher than the rest of the developed world (per GDP, government spending on healthcare in the US is at a fairly typical level for a developed world country where the vast majority of all health spending is by the government, and private spending on healthcare in the US exceeds government spending.) The inefficiency and wastefulness of US healthcare compared to the rest of the developed world -- most of which have considerably more government involvement in and control of healthcare -- is quite notable.
hackuser 11y ago
> It's certainly debatable which countries get the best medical care for the dollar, or which countries distribute it to people in the most fair way, or make it most accessible to the poor. It's not debatable that the U.S. performs relatively poorly by those measures. > I don't really think there's debate that the US gives the best medical care if money is no object I've heard people repeat that a lot, but I've never seen evidence of it one way or the other.
- jessriedel 11y ago
  > I've heard people repeat that a lot, but I've never seen evidence of it one way or the other. In the absence of me showing you the evidence, what is your honest estimate of the probability that it's true?
  - hackuser 11y ago
    > In the absence of me showing you the evidence, what is your honest estimate of the probability that it's true? I have no reason to think that U.S. healthcare, at the high end, is generally superior to that of other rich countries. My guess is that it depends on the field (some do better in, e.g., oncology and others do better in, e.g., brain surgery); that it might vary by hospital or by doctor more than it varies by country; and that results could depend more on operational issues, such as quality control, than on technology or doctor training.
    - jessriedel 11y ago
      I'd claim (and bet, if we could settle) that a wealthy informed person would rather by randomly dropped into the top X% of hospitals in the US than the top X% of hospitals of any other country, for X < 10. Furthermore, that the top location in the world for 90% of specialities is located in the US. Do you disagree, and if so what would your country/numbers be?
      - chimeracoder 11y ago
        > I'd claim (and bet, if we could settle) that a wealthy informed person would rather by randomly dropped into the top X% of hospitals in the US than the top X% of hospitals of any other country, for X < 10. This isn't an argument that has to take place in the hypothetical. When King Abdullah (Saudi Arabia) had to get open heart surgery, he booked it in the US[0]. This is not an isolated case, just the most famous one. I have a lot of personal stories about this, but I'll just leave it at this. Medical tourism actually runs in both directions. In the US, people often go to other countries for cheap, routine surgeries. Many Middle Eastern countries, on the other hand, are forming partnerships with US hospitals to bring their (American) doctors to the Middle East for effective 'tours of duty', as their solution to equalizing access to health care. (The very wealthy people living in the Gulf already come to the US for their planned treatments, but the middle class[1] can't quite afford it). If you talk to the most prestigious physicians and surgeons[2] at the top hospitals in the US (like the very, very top physicians at Mass General or NewYork-Presbyterian), you'll find that a sizeable number of their patients are foreigners - often living in the Middle East. There is some medical tourism from the Gulf to Europe, but it's nowhere near as widespread, and the general impression in the Gulf is that the US is the pinnacle of care quality, which is why they're chasing US practitioners and practice groups so aggressively. [0] http://pagesix.com/2010/11/30/saudi-king-takes-up-the-entire-vip-wing-at-new-york-hospital/ http://pagesix.com/2010/11/30/saudi-king-takes-up-the-entire... [1] Yes, contrary to popular belief, there is a sizeable middle class in the Gulf.

Zigurd 11y ago

Based on data, or based on image and marketing? [EDIT:] Interesting pair of replies: US medicine is envied by those "trapped" in socialized systems that won't give them a private room. AND over-regulation is the cause of quality problems. Now there's a 360 degree defense of market-based medicine!

bpodgursky 11y ago
Based on the fact the Mayo clinic does, in fact, attract the richest people in the world.
- phaemon 11y ago
  So does Harley Street, in London. So what?
- Zigurd 11y ago
  It's already been pointed out that Lamborghinis don't make Italy the world's best car-making country. And Lamborghinis are not even the world's best cars. The rich are particularly susceptible to irrational decisions about purchases.

maxerickson 11y ago

That effect could be limited to certain health systems within the US though. There's not a single system that provides all the care.

maxxxxx 11y ago

I don't think the fact that wealthy people from all over the world come to the US is an important factor in evaluating the overall health system. The deciding factor should be what the average citizen gets out of it. Otherwise Italy could claim they are building the best cars in the world by having Ferrari and Lamborghini.

jessriedel 11y ago
Yours is the first good response. (Thanks!) I agree that on it's own it's not a strongly compelling fact.

XorNot 11y ago

It is highly dubious that this is some feature of the expense of medical care in the US. For example, it's generally recommended that for surgery, you actually want to see a doctor who works in the public system (in Australia, my country) because for routine procedures the guy who does them everyday, all the time, is probably a lot better at it then the guy who can choose his cases. The US has a giant population with first-world levels of funding from the government - it's fairly likely that care quality is simply the intersection of population and experience. But you pay more from the government per person, and get less. Your system and outcomes should be so much better and you all should be angry about that. It's just at some level of size and overall budget, you get a lot despite being inefficient.

Thriptic 11y ago
> . For example, it's generally recommended that for surgery, you actually want to see a doctor who works in the public system (in Australia, my country) because for routine procedures the guy who does them everyday, all the time, is probably a lot better at it then the guy who can choose his cases. While I agree that this is the case, the people who are willing to travel for medical care are likely not traveling for routine cases; they are going to see specialists for complex cases. The quality of care varies substantially across the US, and I do think the top tier facilities in the US are some of the best (if not the best) in the world. That says nothing about the average level of care across the country however, and it is typically difficult to get access to these premiere hospitals unless you know someone with connections in medicine or have money.
- Xylakant 11y ago
  Be careful even in non-routine cases. The specialist in question may select his patients based on qualifiers that are in his interest. One of them is the likelihood of recovery - high likelihood improves their track record and thus their standing as a specialist.
  - Thriptic 11y ago
    This is fair point, but at a hospital-level in the US you do tend to see higher mortality levels at prestigious hospitals due to the increase in average case complexity. People are willing to take on the tougher cases.

dragonwriter 11y ago

> I don't really think there's debate that the US gives the best medical care if money is no object. My understanding is that, with very few exceptions, the wealthy all over the world come to the US if they have a serious medical condition. There's a number of individual places in the US and Europe (and possibly some elsewhere) that attract the rich from all over the world, based on reputation as providing the best care for particular conditions. But the US as a whole does not provide the best overall quality of healthcare (outcomes are about average for the developed world) even before considering overall cost, and has overall cost (whether looked at per GDP or per capita) much higher than the rest of the developed world (per GDP, government spending on healthcare in the US is at a fairly typical level for a developed world country where the vast majority of all health spending is by the government, and private spending on healthcare in the US exceeds government spending.) The inefficiency and wastefulness of US healthcare compared to the rest of the developed world -- most of which have considerably more government involvement in and control of healthcare -- is quite notable.

hackuser 11y ago

> It's certainly debatable which countries get the best medical care for the dollar, or which countries distribute it to people in the most fair way, or make it most accessible to the poor. It's not debatable that the U.S. performs relatively poorly by those measures. > I don't really think there's debate that the US gives the best medical care if money is no object I've heard people repeat that a lot, but I've never seen evidence of it one way or the other.

jessriedel 11y ago
> I've heard people repeat that a lot, but I've never seen evidence of it one way or the other. In the absence of me showing you the evidence, what is your honest estimate of the probability that it's true?
- hackuser 11y ago
  > In the absence of me showing you the evidence, what is your honest estimate of the probability that it's true? I have no reason to think that U.S. healthcare, at the high end, is generally superior to that of other rich countries. My guess is that it depends on the field (some do better in, e.g., oncology and others do better in, e.g., brain surgery); that it might vary by hospital or by doctor more than it varies by country; and that results could depend more on operational issues, such as quality control, than on technology or doctor training.
  - jessriedel 11y ago
    I'd claim (and bet, if we could settle) that a wealthy informed person would rather by randomly dropped into the top X% of hospitals in the US than the top X% of hospitals of any other country, for X < 10. Furthermore, that the top location in the world for 90% of specialities is located in the US. Do you disagree, and if so what would your country/numbers be?
    - chimeracoder 11y ago
      > I'd claim (and bet, if we could settle) that a wealthy informed person would rather by randomly dropped into the top X% of hospitals in the US than the top X% of hospitals of any other country, for X < 10. This isn't an argument that has to take place in the hypothetical. When King Abdullah (Saudi Arabia) had to get open heart surgery, he booked it in the US[0]. This is not an isolated case, just the most famous one. I have a lot of personal stories about this, but I'll just leave it at this. Medical tourism actually runs in both directions. In the US, people often go to other countries for cheap, routine surgeries. Many Middle Eastern countries, on the other hand, are forming partnerships with US hospitals to bring their (American) doctors to the Middle East for effective 'tours of duty', as their solution to equalizing access to health care. (The very wealthy people living in the Gulf already come to the US for their planned treatments, but the middle class[1] can't quite afford it). If you talk to the most prestigious physicians and surgeons[2] at the top hospitals in the US (like the very, very top physicians at Mass General or NewYork-Presbyterian), you'll find that a sizeable number of their patients are foreigners - often living in the Middle East. There is some medical tourism from the Gulf to Europe, but it's nowhere near as widespread, and the general impression in the Gulf is that the US is the pinnacle of care quality, which is why they're chasing US practitioners and practice groups so aggressively. [0] http://pagesix.com/2010/11/30/saudi-king-takes-up-the-entire-vip-wing-at-new-york-hospital/ http://pagesix.com/2010/11/30/saudi-king-takes-up-the-entire... [1] Yes, contrary to popular belief, there is a sizeable middle class in the Gulf.