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What are countries with more functional healthcare systems doing differently? When it comes to comparisons with other countries, much of the dialogue in the US

What are countries with more functional healthcare systems doing differently? When it comes to comparisons with other countries, much of the dialogue in the US is centered on insurance coverage. That said, I'm curious if other countries have found better solutions to similarly fundamental issues, such as doctors working long hours, doctors being forced to maximize the number of patients, continued medical education, and patient education about the doctor-patient relationship.

oblvious-earth 5y ago
Aaron Carroll did a Youtube Series back in 2014 on the topic, even if you don't want to watch the videos there's a lot of good links in the description of each one: https://www.youtube.com/watch?v=yN-MkRcOJjY&list=PLkfBg8ML-gIngk82SUbTp6Og_KkYfJ6oF https://www.youtube.com/watch?v=yN-MkRcOJjY&list=PLkfBg8ML-g... From what I remember: Insurance is one reason, Hospitals not engaging in collective bargaining (e.g. vs. NHS in England which makes decisions about what to spend money on and makes companies bid on contracts for the whole country), wasteful premium care that adds little to patient outcomes (e.g. vs Singapore which has a privatised tiered healthcare system but heavily regulates healthcare so this doesn't happen), and simply paying Doctors far more money.
wswope 5y ago
Career healthtech worker; opinions are my own; focusing only on the provider-specific questions you're asking: Biggest problem (w.r.t. provider overwork and availability) is regulatory capture by AMA and hospital groups. The AMA has for decades induced an artificial shortage of MDs by limiting the number of available residency slots. In particular, there's an acute shortage of slots for primary care providers (gen practice, family med, internal medicine, OBGYN) - which combined with financial incentive, leads to an oversupply of specialists. AMA is also very assertive about keeping alternative providers (e.g. nurse practitioners) from having the rights to perform certain procedures - again as a form of financial protectionism. I'm picking the worst possible example, because it goes wrong all the time, but in many LatAm countries for example, routine x-rays and ultrasounds are often read by technologists rather than radiologists. Broadly speaking, there's a chilling effect of provider liability, in that your PCP may not be a dermatologist, so instead of doing a mole screen themselves during your annual office visit, they send you for a specialist visit instead of doing it in house (to avoid the unlikely chance they miss something subtle the derm might've caught) - costing more money, fueling the oversupply of specialty care, and letting the "general" skills of GPs atrophy even further. TLDR: The American Medical Association kills people.
- kvathupo 5y ago
  I initially thought this was a fringe comment, but I was surprised to learn that your criticisms have basis, with adherents like Milton Friedman [1]. It certainly toppled my presumptive association of the AMA with putting patient care first. P.S. I found this tidbit on tobacco particularly troublesome [2]. [1] - https://en.wikipedia.org/wiki/American_Medical_Association#Criticism https://en.wikipedia.org/wiki/American_Medical_Association#C... [2] - https://www.sourcewatch.org/index.php/American_Medical_Association#AMA_.26_tobacco https://www.sourcewatch.org/index.php/American_Medical_Assoc...

oblvious-earth 5y ago

Aaron Carroll did a Youtube Series back in 2014 on the topic, even if you don't want to watch the videos there's a lot of good links in the description of each one: https://www.youtube.com/watch?v=yN-MkRcOJjY&list=PLkfBg8ML-gIngk82SUbTp6Og_KkYfJ6oF https://www.youtube.com/watch?v=yN-MkRcOJjY&list=PLkfBg8ML-g... From what I remember: Insurance is one reason, Hospitals not engaging in collective bargaining (e.g. vs. NHS in England which makes decisions about what to spend money on and makes companies bid on contracts for the whole country), wasteful premium care that adds little to patient outcomes (e.g. vs Singapore which has a privatised tiered healthcare system but heavily regulates healthcare so this doesn't happen), and simply paying Doctors far more money.

wswope 5y ago

Career healthtech worker; opinions are my own; focusing only on the provider-specific questions you're asking: Biggest problem (w.r.t. provider overwork and availability) is regulatory capture by AMA and hospital groups. The AMA has for decades induced an artificial shortage of MDs by limiting the number of available residency slots. In particular, there's an acute shortage of slots for primary care providers (gen practice, family med, internal medicine, OBGYN) - which combined with financial incentive, leads to an oversupply of specialists. AMA is also very assertive about keeping alternative providers (e.g. nurse practitioners) from having the rights to perform certain procedures - again as a form of financial protectionism. I'm picking the worst possible example, because it goes wrong all the time, but in many LatAm countries for example, routine x-rays and ultrasounds are often read by technologists rather than radiologists. Broadly speaking, there's a chilling effect of provider liability, in that your PCP may not be a dermatologist, so instead of doing a mole screen themselves during your annual office visit, they send you for a specialist visit instead of doing it in house (to avoid the unlikely chance they miss something subtle the derm might've caught) - costing more money, fueling the oversupply of specialty care, and letting the "general" skills of GPs atrophy even further. TLDR: The American Medical Association kills people.

kvathupo 5y ago
I initially thought this was a fringe comment, but I was surprised to learn that your criticisms have basis, with adherents like Milton Friedman [1]. It certainly toppled my presumptive association of the AMA with putting patient care first. P.S. I found this tidbit on tobacco particularly troublesome [2]. [1] - https://en.wikipedia.org/wiki/American_Medical_Association#Criticism https://en.wikipedia.org/wiki/American_Medical_Association#C... [2] - https://www.sourcewatch.org/index.php/American_Medical_Association#AMA_.26_tobacco https://www.sourcewatch.org/index.php/American_Medical_Assoc...