5 ms·

Ok but why focusing on the insurance systems that are still sub-par compared to Italy, UK and Spain where the single payer system yields even better results fo

Ok but why focusing on the insurance systems that are still sub-par compared to Italy, UK and Spain where the single payer system yields even better results for less money?

DennisP 8y ago
The book did cover the UK and Canada, and found they did not get better results for less money. The author didn't visit Italy or Spain. For quality results, the book used rankings by international organizations, based on statistics like "cure rate after diagnosis of major disease." For cost, it used percentage of GDP and cost per capita. Germany, France, and Japan were tops in quality, and Japan was also the cheapest at 5% GDP. Germany spent 13% GDP but with expansive coverage. Incidentally, the UK is not single payer like we're talking about in the U.S. It's also single provider. All doctors in the system are employees of the NHS, much like the VA in the U.S.
- DanBC 8y ago
  > It's also single provider. For England that's completely incorrect. Services are commissioned mostly by local clinical commissioning groups (There are about 195 of these across England), but sometimes centrally by NHS England, but they are provided by a range of different organisations. Some of these are NHS organisations, but they don't have to be. It's possible that NHSEngland and CCGS commission NHS services from non-NHS providers. Doctors (and all other healthcare staff, and all manager, and all admin staff) are employed by NHS Trusts, or by other provider organisations. Some examples of non-NHS providers who are commissioned to provide NHS services might be- Livewell South West, a large community interest company that provides a range of in-patient and outpatient treatment. https://www.livewellsouthwest.co.uk/ https://www.livewellsouthwest.co.uk/ Priory Group, a large private provider that also provides some in-patient NHS treatment, especially around in-patient eating disorder treatment or inpatient learning disability "care". https://www.priorygroup.com/ https://www.priorygroup.com/ (Note that LiveWellSW are pretty good, and Priory Group are piss-poor and often abusive.) Even NHS Trusts aren't single provider. They are their own organisation, with their own executive boards and accounts, working independantly from other NHS Trusts. If they're a foundation trust they have a bit more freedom with their budgets and staffing. Here's a nice description of what the NHS is and how it works: https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-england-work https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-eng...
- foldr 8y ago
  GPs are not really employed directly by the NHS.
- _benedict 8y ago
  I'm not sure what statistic you are referring to, but for cancer at least the definition of 'cure' is typically a number of years of life after detection (e.g. 5). In jurisdictions with less aggressive testing, this can give a worse measurement of cancer survival rates than the reality, since earlier detection by definition gives a higher chance of surviving to a time X years after detection. https://www.bmj.com/bmj/section-pdf/187734?path=/bmj/346/7893/Observations.full.pdf https://www.bmj.com/bmj/section-pdf/187734?path=/bmj/346/789...

Ok but why focusing on the insurance systems that are still sub-par compared to Italy, UK and Spain where the single payer system yields even better results for less money?

DennisP 8y ago

The book did cover the UK and Canada, and found they did not get better results for less money. The author didn't visit Italy or Spain. For quality results, the book used rankings by international organizations, based on statistics like "cure rate after diagnosis of major disease." For cost, it used percentage of GDP and cost per capita. Germany, France, and Japan were tops in quality, and Japan was also the cheapest at 5% GDP. Germany spent 13% GDP but with expansive coverage. Incidentally, the UK is not single payer like we're talking about in the U.S. It's also single provider. All doctors in the system are employees of the NHS, much like the VA in the U.S.

DanBC 8y ago
> It's also single provider. For England that's completely incorrect. Services are commissioned mostly by local clinical commissioning groups (There are about 195 of these across England), but sometimes centrally by NHS England, but they are provided by a range of different organisations. Some of these are NHS organisations, but they don't have to be. It's possible that NHSEngland and CCGS commission NHS services from non-NHS providers. Doctors (and all other healthcare staff, and all manager, and all admin staff) are employed by NHS Trusts, or by other provider organisations. Some examples of non-NHS providers who are commissioned to provide NHS services might be- Livewell South West, a large community interest company that provides a range of in-patient and outpatient treatment. https://www.livewellsouthwest.co.uk/ https://www.livewellsouthwest.co.uk/ Priory Group, a large private provider that also provides some in-patient NHS treatment, especially around in-patient eating disorder treatment or inpatient learning disability "care". https://www.priorygroup.com/ https://www.priorygroup.com/ (Note that LiveWellSW are pretty good, and Priory Group are piss-poor and often abusive.) Even NHS Trusts aren't single provider. They are their own organisation, with their own executive boards and accounts, working independantly from other NHS Trusts. If they're a foundation trust they have a bit more freedom with their budgets and staffing. Here's a nice description of what the NHS is and how it works: https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-england-work https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-eng...
foldr 8y ago
GPs are not really employed directly by the NHS.
_benedict 8y ago
I'm not sure what statistic you are referring to, but for cancer at least the definition of 'cure' is typically a number of years of life after detection (e.g. 5). In jurisdictions with less aggressive testing, this can give a worse measurement of cancer survival rates than the reality, since earlier detection by definition gives a higher chance of surviving to a time X years after detection. https://www.bmj.com/bmj/section-pdf/187734?path=/bmj/346/7893/Observations.full.pdf https://www.bmj.com/bmj/section-pdf/187734?path=/bmj/346/789...