6 ms·

US public health infrastructure is less resilient than most of europe, capacity is lower and everything is >10x more expensive. Further the risk of transmissio

• katzgrau 7y ago
  Uh, citations needed.
  • taurath 7y ago
    For which part? All fall under common knowledge for me.
    • Anon1096 7y ago
      > US public health infrastructure is less resilient than most of europe, capacity is lower these parts
      • cmac2992 7y ago
        Europe, in general, has more hospital beds per capita than the US. Hospital beds per capita seems to be a reasonable heuristic. https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hospital_beds https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp...
        • dmoy 7y ago
          Also more physicians per capita. US is around 25 per 10k, most Western European countries are around 35, some up to 50.
          • bpodgursky 7y ago
            In the US, "physicians" might be less numerous, but there are a lot of highly-skilled intermediary roles that fill the gap -- Physician Assistants, Nurse Practitioners, etc, all perform routine treatment performed by "physicians" in other countries. US physician training is honestly excessively long, complicated, and expensive (although there are justifications for making it this way), but it's a simplification to point out that there aren't as many doctors, without noting all the other doctor-esque roles with significant overlap.
            • speedplane 7y ago
              > it's a simplification to point out that there aren't as many doctors, without noting all the other doctor-esque roles with significant overlap. Comparing the number of doctors in the US to other countries is not a good measure of anything. But noting that americans spend more per capita and get worse health outcomes is pretty significant.
              • bpodgursky 7y ago
                I'm definitely not trying to make any greater point, only that the 25 vs 50/10k is not a meaningful measure of healthcare quality or capacity.
        • jariel 7y ago
          This is possibly the worst metric as it can mean so many things. Here [1] we have more numbers. Most importantly the # of beds seems to correlate strongly to the 'average time in hospital' eg. Japan has 3x beds but stays are 3x longer. That stays are shorter is not an indication of poorer quality. The US has fewer doctors, about the same nurses, but 3x more MRIs per capita, and probably similar inventories of other kinds of equipment. As for respirators? Who knows. But The US is a major exporter of medicine, equipment, and they spend considerably more. Just like in every major war there's a 'key weapons system' that wins the day while the underlying economy wins the war ... the US might be in a decent position with enough equipment, and a resilient enough economy and populace to fight coronavirus. Don't be fooled by Trump's shenanigans, Americans are not fools. When they decide to do whatever they do it in a way that few can match. FYI I'm not American. There will be ugly issues for those without insurance but I suggest that states will take over there with emergency solutions or else they'll all be voted out of office instantly and they know it. Even Trump isn't stupid enough to fail to recognize that people dying en masse on TV will make him look, in his own terminology 'really, really, really bad'. Also, thankfully, once again, North America seems to be a tiny bit isolated from the 'rest of the world' and has just enough time to see what's happening in Italy and can possibly act a little sooner on some things. I expect lock-downs and social distancing measures to take effect earlier in America on an per-capita-infected-basis. [1] https://www.healthsystemtracker.org/chart-collection/u-s-health-care-resources-compare-countries/#item-availability-medical-technology-not-always-equate-higher-utilization https://www.healthsystemtracker.org/chart-collection/u-s-hea...
          • E14n 7y ago
            I don't think simple comparisons between Japan and US are meaningful. Japan has a universal health care system so everyone is covered by health insurance. There is little incentive to leave hospitals prematurely. One of our children spent a week in hospital and the out of pocket cost was 500yen (about $5USD)[1] plus food. My mother in law joked that it was cheaper then childcare. Hospitals are also not incentivized to mess around with trying to extract the most from billing because its prescribed. A friend from Australia needed stitches while in Japan and didn't have travel insurance. We went to the local doctor explained the situation and they refereed us to a hospital. They didn't charge us for the consultation because "they didn't do anything, only gave a referral". At the hospital we explained the situation and the bill was less then the excess they would have payed in Australia. My impression is that they didn't feel the need to extract every dollar because they were getting full payment from everyone else. These are exceptional cases and the usually out of pocket is more like $30~$50 for a consultation. 1. Where we are children cost a flat rate of 500yen for a consultation and as the hospital stay was a result of the consultation that was also covered.
        • maxerickson 7y ago
          Hospital beds are healthcare infrastructure. Public health isn't quite healthcare. (they overlap, but they are not the same thing)
    • deleted 7y ago
      [deleted]
  • hermitdev 7y ago
    Me. I got fired a year ago January after being out for a month. It took that long with a bad sinus infection and undiagnosed allergies before my doc was willing to prescribe antibiotics due to having previously had c diff, which is a fungus that you apparently cant completely get rid of. C diff also apparently can resurge when on antibiotics. I worked from home during that time, but I was pretty sick. Just as well, my commute sucked (1-2 hours). Our health insurance sucked. $13k deductible, no vision or dental. I had interviews the very next week, 2 offers within 3 weeks. Higher salary, way better insurance and a 15 minute commute. Edit: yes, I'm in the US
    • mrob 7y ago
      Clostridioides difficile is a bacterium, not a fungus: https://en.wikipedia.org/wiki/Clostridioides_difficile_(bacteria) https://en.wikipedia.org/wiki/Clostridioides_difficile_(bact...
      • hermitdev 7y ago
        Then I was misinformed by my doctors...
        • tylerl 7y ago
          Probably just misunderstood; what you said is a mixed up jumble of bits of actual facts. C.diff is something that you always have some of (you'll never be rid of it, nobody is), but it usually gets out-competed by other bacteria. But it's exceptionally hard to kill partly because it can form tough spores that go dormant. So if you take powerful antibiotics, there's a good chance that all that'll be left is the c.diff, which gets problematic when there's a lot of it. Fungus is similar in the sense that bacteria compete with it, so killing the bacteria leaves you vulnerable to fungus as well. This is precisely why you're supposed eat probiotics during certain kinds of treatments. People talk about "healthy gut flora" or whatever like its a new age alternative medicine, but really you just need a ton of different kinds of benign bacteria filling the space so that no particular one strain of pathogen gets enough critical mass to have an effect.
• gwright 7y ago
  I was curious about "capacity" and found https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hospital_beds https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp... I'm not sure how to interpret that table. The range of beds/person is amazing to me. Does that mean that some countries have more demand for beds or that some countries have shorter hospital stays (one bed serves more people per unit time) or that some countries have too few beds with people being turned away. Probably all of the above. So that table just caused me to ask more questions rather than answering any.
  • tuna-piano 7y ago
    I also don't understand that chart, but perhaps the huge range must mean there are some underlying different assumptions, calculations, or methodologies. This study looks at ICU/Critical Care beds, and finds also a large range but quite different ranking as above: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551445/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551445/ Number of ICU/Critical care beds per 100,000 people: US: 20-31.7 Canada: 13.5 Japan: 7.9 UK: 3.5-7.4 China: 2.8-4.6
    • cavisne 7y ago
      The chart in general doesn't make sense (the Czech republic does not have better healthcare than Australia or the UK) backed up by the results here https://en.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare https://en.wikipedia.org/wiki/List_of_countries_by_quality_o... This pandemic specifically requires assistance breathing for a huge amount of people. I'm not sure how closely that correlates to hospital beds, but it could be a big issue in the US where many hospital-like things are dealt with by urgent care.
      • _-___________-_ 7y ago
        > This pandemic specifically requires assistance breathing for a huge amount of people. Most estimates of the ratio of asymptomatic/minor-symptoms people are >=80%.
• GuiA 7y ago
  This is all nice post hoc rationalization, and they may well be factors. But the reality is that North American coastal tech companies are far more progressive when it comes to letting employees manage their own health than most others, especially European companies. In my current Bay Area employment, if I am sick I stay home. If I feel well enough to work I do, otherwise I don't. No questions/justifications asked besides giving my teammates a heads up over text. When I worked for a French company, being sick meant having to go to the doctor (writing a 23 euro check out of pocket that was reimbursed a month or two later) to get an official sick note to justify my absence from work, otherwise I would get penalized. I don't disagree with your hypothesis, but also European paternalism is real.
  • antpls 7y ago
    I could be wrong, but the required note from the doctor isn't paternalism, it's (I think) related to how workplace insurances and the healthcare system work in Europe, requiring proof for everything. With the epidemy, remote consultation with a doctor will be more mainstream, it will be easier to book a quick 20 minutes consultation and get the dematerialized note. In my opinion, requiring people to consult a professional only has benefit. People get help, employers get proof, doctors get work.
    • MandieD 7y ago
      As of a few days ago, we in Bavaria are now able to get sick notes from our primary care doctors (Hausärzte) by phone for absences up to 7 days. My employer, a large manufacturer, usually requires a doctor’s note for illnesses over three days, and I think that’s standard in Germany. Otherwise, think you have a cold? Stay home a day or two and drop the boss an email as soon as you can - no one wants you spreading it around! If I did that more than a few times a year, my boss might start requiring notes, but as long as we don’t seem to be abusing it, they assume we want to do our jobs when we can. As for COVID-19, they’re being even more explicit: if you’ve recently been to Italy or other heavily-impacted place or have any of the symptoms, you must stay away from all company sites for 14 days, doing WFH if your position allows for it, or getting written off sick if you can’t (people actually running the machines or inspecting parts)