6 ms·

The NHS has gone the other way and wont run diagnostic tests it really needs to. The end result is growing legal action over failure to diagnose conditions. Lon

The NHS has gone the other way and wont run diagnostic tests it really needs to. The end result is growing legal action over failure to diagnose conditions. Long covid is diagnosed in just 28,000 patients and yet the office for national statistics says by the symptom studies 1.8 million have it. There is no where I know of, certainly not on the NHS, where you can get a test for microclots, a condition found in the bulk of Long Covid cases and easily treatable but doesn't show up in normal clotting tests. You can get micro clot tests throughout a lot of Africa but such is the reluctance to run tests in the UK no labs have bothered. Its something we have known can be tested and treated for 17 months at least. Be careful about reducing the testing just because it drives over treatment because under treatment is quite deadly, cheaper maybe but also has a serious impact of life expectancy and disease burden. Life expectancy is dropping in the UK and disease burden is one of the highest in the western world and growing. The grass isn't greener on the low test and treatment side, health care is still increasingly expensive and the results are worse.

refurb 4y ago
But this is how population medicine works. You’re willing to trade off a few extra deaths if you can save a certain amount of money. Hell NICE in the UK put a very firm GBP figure on the value of a life-year. It works great at a population level since you maximize outcomes and keep costs low. But that isn’t that comforting when you’re the poor bloke who dies from lung cancer that could have been detected early but NICE said the 50GBP test isn’t cost-effective.
- hammock 4y ago
  > But this is how population medicine works. You’re willing to trade off a few extra deaths if you can save a certain amount of money. Or even make a certain amount of money: https://www.openthebooks.com/substack-investigation-faucis-royalties-and-the-350-million-royalty-payment-stream-hidden-by-nih/ https://www.openthebooks.com/substack-investigation-faucis-r...
- pfortuny 4y ago
  That is why population “medicine” is anything but “medicine”. The State is not a physician. But turns out that it IS.
  - refurb 4y ago
    People point to the US, but every country in the world is struggling with healthcare costs and how to contain them. As technologies develop, costs will only continue to rise - the question is how to control costs and get the maximum benefit. From my own experience it's typically done a few ways: 1) the government decides what treatment will be paid for and which ones won't [this works pretty well since patients don't know what they're missing], 2) the government simply caps a budget and pushes treatment decision down - doctors and hospital are forced to make trade-offs. Countries that do #2 often have long wait times for elective procedures - that's the cost control mechanism. The US does neither one of these very well (but does them to some extent, but it's unevenly applied), so costs are very high (in addition to other factors). But if one wants universal care and a manageable healthcare budget, you need to say "no" to some things that would otherwise still benefit the patient.
- tuukkah 4y ago
  > dies from lung cancer that could have been detected early but NICE said the 50GBP test isn’t cost-effective. It would be awesome if in cases like this, the doctor would suggest the patient to pay this 50GBP out of their own pocket.
- starkd 4y ago
  And yet I seem to remember we were told government would not be making vital healthcare decisions like the greedy private sector corporations. That was supposedly a chief selling point to government managed care.
  - lupire 4y ago
    Private medicine is legal in UK.
    - refurb 4y ago
      To be honest, this seems to be the best approach. The public system provides a baseline level of care based on a set budget. Individuals are free to seek additional care at their own expense.
- axg11 4y ago
  Compare the UK vs. US [0]: life expectancy is higher in the UK _and_ expenditure is lower. As much as people love to dunk on the NHS, population-level optimization works. [0] - https://ourworldindata.org/grapher/life-expectancy-vs-health-expenditure?country=GBR~USA~CAN~DEU https://ourworldindata.org/grapher/life-expectancy-vs-health...
  - refurb 4y ago
    I’d be very cautious assuming 100% of life expectancy differences are due to healthcare system alone.
    - nradov 4y ago
      The UK has a lower obesity rate than the USA (although still relatively high compared to other developed countries).
      - refurb 4y ago
        Indeed, not to mention traffic deaths, drug overdoses, differences in life span across ethnic groups, cancer rates, prenatal and post-natal care, etc. There are a million factors that go into life expectancy other than just the healthcare system.

refurb 4y ago

But this is how population medicine works. You’re willing to trade off a few extra deaths if you can save a certain amount of money. Hell NICE in the UK put a very firm GBP figure on the value of a life-year. It works great at a population level since you maximize outcomes and keep costs low. But that isn’t that comforting when you’re the poor bloke who dies from lung cancer that could have been detected early but NICE said the 50GBP test isn’t cost-effective.

hammock 4y ago
> But this is how population medicine works. You’re willing to trade off a few extra deaths if you can save a certain amount of money. Or even make a certain amount of money: https://www.openthebooks.com/substack-investigation-faucis-royalties-and-the-350-million-royalty-payment-stream-hidden-by-nih/ https://www.openthebooks.com/substack-investigation-faucis-r...
pfortuny 4y ago
That is why population “medicine” is anything but “medicine”. The State is not a physician. But turns out that it IS.
- refurb 4y ago
  People point to the US, but every country in the world is struggling with healthcare costs and how to contain them. As technologies develop, costs will only continue to rise - the question is how to control costs and get the maximum benefit. From my own experience it's typically done a few ways: 1) the government decides what treatment will be paid for and which ones won't [this works pretty well since patients don't know what they're missing], 2) the government simply caps a budget and pushes treatment decision down - doctors and hospital are forced to make trade-offs. Countries that do #2 often have long wait times for elective procedures - that's the cost control mechanism. The US does neither one of these very well (but does them to some extent, but it's unevenly applied), so costs are very high (in addition to other factors). But if one wants universal care and a manageable healthcare budget, you need to say "no" to some things that would otherwise still benefit the patient.
tuukkah 4y ago
> dies from lung cancer that could have been detected early but NICE said the 50GBP test isn’t cost-effective. It would be awesome if in cases like this, the doctor would suggest the patient to pay this 50GBP out of their own pocket.
starkd 4y ago
And yet I seem to remember we were told government would not be making vital healthcare decisions like the greedy private sector corporations. That was supposedly a chief selling point to government managed care.
- lupire 4y ago
  Private medicine is legal in UK.
  - refurb 4y ago
    To be honest, this seems to be the best approach. The public system provides a baseline level of care based on a set budget. Individuals are free to seek additional care at their own expense.
axg11 4y ago
Compare the UK vs. US [0]: life expectancy is higher in the UK _and_ expenditure is lower. As much as people love to dunk on the NHS, population-level optimization works. [0] - https://ourworldindata.org/grapher/life-expectancy-vs-health-expenditure?country=GBR~USA~CAN~DEU https://ourworldindata.org/grapher/life-expectancy-vs-health...
- refurb 4y ago
  I’d be very cautious assuming 100% of life expectancy differences are due to healthcare system alone.
  - nradov 4y ago
    The UK has a lower obesity rate than the USA (although still relatively high compared to other developed countries).
    - refurb 4y ago
      Indeed, not to mention traffic deaths, drug overdoses, differences in life span across ethnic groups, cancer rates, prenatal and post-natal care, etc. There are a million factors that go into life expectancy other than just the healthcare system.