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CalcuttaRain

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« #90 : June 12, 2013, 01:51:57 PM »

In 2007, the Commonwealth Fund released a report that compared U.S. health care against several other countries based on a variety of benchmarks. The data were principally derived from statistically random surveys of adult residents and primary care physicians from 2004 to 2006, in the following countries: United States, Canada, New Zealand, United Kingdom, Germany, and the Netherlands. This is what the researchers found:

* Canada had the highest percentage of patients (36%) who had to wait six days or more for an appointment with a doctor, but the United States had the second highest percentage (23%) who reported that they had to wait at least this long. New Zealand, Australia, Germany, and the U.K. all had substantially smaller numbers of people reporting waits of 6 days or longer. Canada and the United States, in that order, also had the lowest percentage of persons who said they could get an appointment with a doctor the same or next day.

* The United States had the largest percentage of persons (61%) who said that getting care on nights, weekends, or holidays, without going to the emergency room, was “very” or “somewhat” difficult. In Canada, it was 54%, and in the U.K, 38%. Germany did the best, with only 22% saying that it was difficult to get after-hours care.

* The United States, though, scored well on physicians’ perceptions of how many patients experience long waits for diagnostic tests. 57% of physicians in the U.K, and 51% of Canadian physicians reported that their patients experienced long waits for diagnostic tests, compared to only 9% of U.S. physicians who reported the same.

* The U.K (60%) and Canada (57%) had the highest numbers of persons who had to wait four weeks or more to get to see a specialist physician. In the U.S., only 23% reported a wait of four weeks or more for specialty care.

* The U.S. also did very well on measures of wait times for non-emergency or elective surgery. Only 8% of surveyed patients in the United States reported a wait time of four months or more for elective surgery, compared to 33% in Canada and 41% in the U.K. Germany scored the best, with only 6% reporting a long wait for elective surgery.

The take-away message is that both the United States and Canada do pretty poorly, compared to most other industrialized countries, on how long patients have to wait to get a regular appointment with a primary care physician or after-hours care, but the U.S. does better than most on having shorter wait times for diagnostic procedures, elective surgery, and specialty care. Each of these countries, though, with the exception of the United States, has universal health insurance coverage, funded and regulated in large part by the government, so it doesn’t seem likely that government-subsidized health care, in itself, is the sole factor in determining how long patients are stuck in The Waiting Place. Other factors, like the numbers of primary care physicians and specialists in each country, may be more important.

http://getbetterhealth.com/wait-times-for-medical-care-how-the-us-actually-measures-up/2010.02.02


Of the countries studied, ONLY Canada and UK have single payer systems. Germany Netherlands, NZ, and the US all have Multi-payer systems that mix govt payments with private insurance plans.

correct and I would defer to others who surely no more, but from my own experience with people living in the UK and Holland, the Dutch system seems to be closest to the way I think thinks might work best.  As I understand it, there is a regualted but still private market layer for some care and free market for other and then even a hybrid level as well.

The question that needs to be resolved -- and maybe it is I am just not aware -- is what preventative care is actually effective and essential to extending life and how do we pay for that.  Private insurance should be able to handle catastrophic care (as long as there is some reform of the current healthcare system in general)

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CBWx2

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« #91 : June 13, 2013, 09:11:20 AM »

HUH???

Where I shop there is a Save-a-Lot across the street from Publix. Save-a-Lot ALWAYS has long lines at their only 2 open registers. While Publix rarely has more than 2 people in a line. When a lines gets 3 deep they open another register.

Now you are saying that the lack of long lines at Publix is NOT because they are more efficient but because more people need Save-a-Lot food than Publix food???

JG?, I'm not suggesting that long lines are never the result of inefficiency. What I said is that they are not a measure of inefficiency, meaning that just because there are long lines doesn't mean that it is always because the place is being run inefficiently. You have to look at more than just wait times. You have to look at patient loads, and what is being done per patient.

For example, a recent study suggested that doctors in the UK are, on average, more familiar with their patients' individual care needs than US doctors are. The reason cited is because US doctors typically aim for a high turn around rate in order to generate more revenue, thus spend less time with their patients, whereas UK doctors get paid on salary, not commission, thus spend more time with their patients. Now if you measure efficiency by simple output, then the US doctor is kicking ass. But if you measure efficiency by useful or quality output, then the US is inferior in that regard.

I don't shop with you, so I can't comment on your experience, but I know that at the Whole Foods I shop at, at peak times, they can have every single register running and still have lines. Now, to me, that doesn't mean that the manager of that Whole Foods is inept at running a business. It just means that perhaps the area could benefit from there being another Whole Foods there.

To suggest that queues are the result of inefficiency in a system that affords everyone in the nation with healthcare is ignoring a whole lot of other factors that might be the cause of there being queues. mainly, doctor to patient ratios, and time afforded per patient. And suggesting that we don't have queues in this country simply because our for profit system is more efficient is complete and utter nonsense. We turn patients around far more quickly, and we exclude a huge number of people from being able to see specialists by pricing them out of the process. That tends to cut down on wait times, wouldn't you agree?

when many doctors and many more potential med students leave the single payer country to study or practice in a more market driven country (like the US) because of better opportunities and more career freedom; doesn't that affect that ratio??? Or what if they stay in country but leave the system to service only cash paying que-jumpers?

There have actually been more doctors fleeing the US to practice in Canada than there have been Canadian doctors fleeing there to come here in recent years. I think the notion that our system provides more freedom is an incorrect one. Our system is complicated, hectic, and often times, unrewarding, and studies show that US doctors are far more dissatisfied with the status quo than doctors in almost any other industrialized nation.

http://www.washingtonpost.com/blogs/wonkblog/post/meme-busting-doctors-are-all-leaving-canada-to-practice-in-the-us/2011/06/03/AGVdAuHH_blog.html


CBWx2

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« #92 : June 13, 2013, 09:28:43 AM »

In 2007, the Commonwealth Fund released a report that compared U.S. health care against several other countries based on a variety of benchmarks. The data were principally derived from statistically random surveys of adult residents and primary care physicians from 2004 to 2006, in the following countries: United States, Canada, New Zealand, United Kingdom, Germany, and the Netherlands. This is what the researchers found:

* Canada had the highest percentage of patients (36%) who had to wait six days or more for an appointment with a doctor, but the United States had the second highest percentage (23%) who reported that they had to wait at least this long. New Zealand, Australia, Germany, and the U.K. all had substantially smaller numbers of people reporting waits of 6 days or longer. Canada and the United States, in that order, also had the lowest percentage of persons who said they could get an appointment with a doctor the same or next day.

* The United States had the largest percentage of persons (61%) who said that getting care on nights, weekends, or holidays, without going to the emergency room, was “very” or “somewhat” difficult. In Canada, it was 54%, and in the U.K, 38%. Germany did the best, with only 22% saying that it was difficult to get after-hours care.

* The United States, though, scored well on physicians’ perceptions of how many patients experience long waits for diagnostic tests. 57% of physicians in the U.K, and 51% of Canadian physicians reported that their patients experienced long waits for diagnostic tests, compared to only 9% of U.S. physicians who reported the same.

* The U.K (60%) and Canada (57%) had the highest numbers of persons who had to wait four weeks or more to get to see a specialist physician. In the U.S., only 23% reported a wait of four weeks or more for specialty care.

* The U.S. also did very well on measures of wait times for non-emergency or elective surgery. Only 8% of surveyed patients in the United States reported a wait time of four months or more for elective surgery, compared to 33% in Canada and 41% in the U.K. Germany scored the best, with only 6% reporting a long wait for elective surgery.

The take-away message is that both the United States and Canada do pretty poorly, compared to most other industrialized countries, on how long patients have to wait to get a regular appointment with a primary care physician or after-hours care, but the U.S. does better than most on having shorter wait times for diagnostic procedures, elective surgery, and specialty care. Each of these countries, though, with the exception of the United States, has universal health insurance coverage, funded and regulated in large part by the government, so it doesn’t seem likely that government-subsidized health care, in itself, is the sole factor in determining how long patients are stuck in The Waiting Place. Other factors, like the numbers of primary care physicians and specialists in each country, may be more important.

http://getbetterhealth.com/wait-times-for-medical-care-how-the-us-actually-measures-up/2010.02.02


Of the countries studied, ONLY Canada and UK have single payer systems. Germany Netherlands, NZ, and the US all have Multi-payer systems that mix govt payments with private insurance plans.

In regards to wait times, this is irrelevant. Universal health care means everyone is covered. This is pertinent because the number of eligible patient's affects the doctor/patient ratio. The payer model is irrelevant. In the US, once the PPACA is fully implemented, you will probably see wait times increase to some degree because of the increase in eligible patients, irregardless of the fact that they will mostly be privately insured individuals. Boston, for example, has larger wait times than any US city, mainly because of the MA healthcare mandate. This isn't due to government inefficiency, as all the government does is require that you get insurance. The insurance itself is almost primarily privately managed.
« : June 13, 2013, 09:31:59 AM CBWx2 »


CBWx2

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« #93 : June 13, 2013, 09:39:43 AM »

yeah that single payer NHS system is working soooo well.

http://www.hsj.co.uk/news/two-fifths-of-doctors-consider-leaving-medicine-says-bma/5050553.article

So now it is UK that asks "Where did all the doctors go? ........Who is John Galt?"

Single payer means that the payer is singular. The NHS system has an added aspect that has nothing to do with the single payer model, and that is that the doctors and hospitals themselves are, in large part, publicly managed. If the doctors are disgruntled, then it probably has to do with something other than the payer model.


CBWx2

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« #94 : June 13, 2013, 10:38:20 AM »

I would defer to others who surely no more, but from my own experience with people living in the UK and Holland, the Dutch system seems to be closest to the way I think thinks might work best.  As I understand it, there is a regualted but still private market layer for some care and free market for other and then even a hybrid level as well.

The Dutch system is basically a hybrid system with mandatory public insurance covering long-term and catastrophic care, and optional coverage for short term and preventative care that is provided by private insurers. Interestingly enough, the optional short-term coverage is also heavily subsidized. The government not only aids low income earners with their premiums, similarly to how the PPACA does, but it also insures that private companies will cover all citizens regardless of risk factors by compensating them for covering high-risk patients.

It basically functions almost exactly like the PPACA, except for the fact that the compulsory part is publicly ran, and the private coverage is optional, but since it's subsidized anyway, most people take the option. Better than our system for sure. Not all that cost effective though.


CalcuttaRain

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« #95 : June 13, 2013, 11:14:59 AM »

HUH???

Where I shop there is a Save-a-Lot across the street from Publix. Save-a-Lot ALWAYS has long lines at their only 2 open registers. While Publix rarely has more than 2 people in a line. When a lines gets 3 deep they open another register.

Now you are saying that the lack of long lines at Publix is NOT because they are more efficient but because more people need Save-a-Lot food than Publix food???

JG?, I'm not suggesting that long lines are never the result of inefficiency.

O-M-G . . . .  . that is such classic CBW b.s.. backtracking spin . . . . . lmao.  Wartch the spin go FULL CIRCLE.  First . .  long lines have NOTHING to do with inefficiency . . . all the way around to "I am not suggesting long lines are never the result of inefficiency" LMMA.  ..  here we go . .  The orginal comment:

One only need open the many local tabloids to see many adds for "jumping the NHS queue" 

That has nothing to do with inefficiency, Vince.

Later, same thread:

Vince, queue jumping isn't a sign of inefficiency.

Then the shift to  "measure of efficency"

Wait times aren't a measure of inefficiency. They are caused by the fact that EVERYONE CAN RECEIVE CARE THERE.

Notice the CLASSIC CBW SHIFT, now you acknowledge wait times (when you previously said inefficency wasnt the reason people were "queue jumping" -lol) and have switched to what causes the wait times. (Thank you for conceding that people "queue jump" because of wait times -- as close to an "oops, I was wrong" as you will ever get from CBW).


To the current backpedal . . .lmao


JG?, I'm not suggesting that long lines are never the result of inefficiency.
« : June 13, 2013, 11:34:30 AM VinBucFan »

Show the bravest of the brave kids that you have their back.  Go to http://www.childrenscancercenter.org/

Just check out the site or maybe like them on Facebook . .  or Share the site on Facebook, re-tweet one of their tweets.  Not everyone can give money to support this great cause, but its easy to give 10 seconds of your time to help spread the word about The Children\\\\\\\'s Cancer Center

John Galt?

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« #96 : June 13, 2013, 11:33:45 AM »

I would defer to others who surely no more, but from my own experience with people living in the UK and Holland, the Dutch system seems to be closest to the way I think thinks might work best.  As I understand it, there is a regualted but still private market layer for some care and free market for other and then even a hybrid level as well.

The Dutch system is basically a hybrid system with mandatory public insurance covering long-term and catastrophic care, and optional coverage for short term and preventative care that is provided by private insurers. Interestingly enough, the optional short-term coverage is also heavily subsidized. The government not only aids low income earners with their premiums, similarly to how the PPACA does, but it also insures that private companies will cover all citizens regardless of risk factors by compensating them for covering high-risk patients.

It basically functions almost exactly like the PPACA, except for the fact that the compulsory part is publicly ran, and the private coverage is optional, but since it's subsidized anyway, most people take the option. Better than our system for sure. Not all that cost effective though.


The big difference between the Dutch system and the UK is in the Netherlands [corrected per Spartan] the HC providers are not govt. employed salaried but are mostly private.

The big difference between the Dutch (and French and Swiss) system and Obamacare is those European systems have a "cost control mechanism". In Switzerland, the insurers and the HC providers negotiate set fees for drugs, procedures, and devices. In Netherlands and France, the govt., private insurers, and medical unions all meet yearly to negotiate maximum costs for drugs, devices, procedures, etc. This eliminates the $30 aspirin and the MRI which costs $20k if you are on Medicare, $10k if on private insurance, or $4k if paying cash.
« : June 13, 2013, 01:29:28 PM John Galt? »


CalcuttaRain

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« #97 : June 13, 2013, 11:35:23 AM »

I would defer to others who surely no more, but from my own experience with people living in the UK and Holland, the Dutch system seems to be closest to the way I think thinks might work best.  As I understand it, there is a regualted but still private market layer for some care and free market for other and then even a hybrid level as well.

The Dutch system is basically a hybrid system with mandatory public insurance covering long-term and catastrophic care, and optional coverage for short term and preventative care that is provided by private insurers. Interestingly enough, the optional short-term coverage is also heavily subsidized. The government not only aids low income earners with their premiums, similarly to how the PPACA does, but it also insures that private companies will cover all citizens regardless of risk factors by compensating them for covering high-risk patients.

It basically functions almost exactly like the PPACA, except for the fact that the compulsory part is publicly ran, and the private coverage is optional, but since it's subsidized anyway, most people take the option. Better than our system for sure. Not all that cost effective though.


The big difference between the Dutch system and the UK is in France the HC providers are not govt. employed salaried but are mostly private.

The big difference between the Dutch (and French and Swiss) system and Obamacare is those European systems have a "cost control mechanism". In Switzerland, the insurers and the HC providers negotiate set fees for drugs, procedures, and devices. In Netherlands and France, the govt., private insurers, and medical unions all meet yearly to negotiate maximum costs for drugs, devices, procedures, etc. This eliminates the $30 aspirin and the MRI which costs $20k if you are on Medicare, $10k if on private insurance, or $4k if paying cash.

Show the bravest of the brave kids that you have their back.  Go to http://www.childrenscancercenter.org/

Just check out the site or maybe like them on Facebook . .  or Share the site on Facebook, re-tweet one of their tweets.  Not everyone can give money to support this great cause, but its easy to give 10 seconds of your time to help spread the word about The Children\\\\\\\'s Cancer Center

spartan

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« #98 : June 13, 2013, 12:48:06 PM »



The big difference between the Dutch system and the UK is in France the HC providers are not govt. employed salaried but are mostly private.


The difference between the Dutch and the UK systems is that the French do it differently?

Huh?

What?

John Galt?

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« #99 : June 13, 2013, 01:34:02 PM »



The big difference between the Dutch system and the UK is in France the HC providers are not govt. employed salaried but are mostly private.


The difference between the Dutch and the UK systems is that the French do it differently?

Huh?

What?


Oops, I guess I effed that up. Should be Netherlands. I was thinking way ahead of what I was typing.



Or I could go CBW and deny the error, post 9 articles that prove that "French" correctly means "Dutch" in Swahili ;)


CalcuttaRain

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« #100 : June 13, 2013, 02:05:34 PM »

Or I could go CBW and deny the error, post 9 articles that prove that "French" correctly means "Dutch" in Swahili ;)

:-)

Show the bravest of the brave kids that you have their back.  Go to http://www.childrenscancercenter.org/

Just check out the site or maybe like them on Facebook . .  or Share the site on Facebook, re-tweet one of their tweets.  Not everyone can give money to support this great cause, but its easy to give 10 seconds of your time to help spread the word about The Children\\\\\\\'s Cancer Center

Dolorous Jason

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« #101 : June 13, 2013, 02:57:29 PM »

I could totally see Comrade doing that,  lol.

What is your point? I was wrong? Ok. You win. I was wrong.

           

CBWx2

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« #102 : June 13, 2013, 04:18:20 PM »

HUH???

Where I shop there is a Save-a-Lot across the street from Publix. Save-a-Lot ALWAYS has long lines at their only 2 open registers. While Publix rarely has more than 2 people in a line. When a lines gets 3 deep they open another register.

Now you are saying that the lack of long lines at Publix is NOT because they are more efficient but because more people need Save-a-Lot food than Publix food???

JG?, I'm not suggesting that long lines are never the result of inefficiency.

O-M-G . . . .  . that is such classic CBW b.s.. backtracking spin . . . . . lmao.  Wartch the spin go FULL CIRCLE.  First . .  long lines have NOTHING to do with inefficiency . . . all the way around to "I am not suggesting long lines are never the result of inefficiency" LMMA.  ..  here we go . .  The orginal comment:

One only need open the many local tabloids to see many adds for "jumping the NHS queue" 

That has nothing to do with inefficiency, Vince.

Later, same thread:

Vince, queue jumping isn't a sign of inefficiency.

Then the shift to  "measure of efficency"

Wait times aren't a measure of inefficiency. They are caused by the fact that EVERYONE CAN RECEIVE CARE THERE.

Notice the CLASSIC CBW SHIFT, now you acknowledge wait times (when you previously said inefficency wasnt the reason people were "queue jumping" -lol) and have switched to what causes the wait times. (Thank you for conceding that people "queue jump" because of wait times -- as close to an "oops, I was wrong" as you will ever get from CBW).


To the current backpedal . . .lmao


JG?, I'm not suggesting that long lines are never the result of inefficiency.

Long lines are never the result of inefficiency. Long lines aren't always the result on inefficiency. I can see how you can suggest that those two statements mean the same thing.  ::)

To reiterate, long lines in a system with Universal Coverage is not a sign of inefficiency. Not in the UK, not in the US. There are a **CENSORED** ton of other factors that you are ignoring by making that characterization. Now go ahead and pretend that you don't understand what I'm saying. I know you do, and if you were operating under a shred of honesty you would acknowledge it.


CBWx2

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« #103 : June 13, 2013, 05:22:58 PM »

I would defer to others who surely no more, but from my own experience with people living in the UK and Holland, the Dutch system seems to be closest to the way I think thinks might work best.  As I understand it, there is a regualted but still private market layer for some care and free market for other and then even a hybrid level as well.

The Dutch system is basically a hybrid system with mandatory public insurance covering long-term and catastrophic care, and optional coverage for short term and preventative care that is provided by private insurers. Interestingly enough, the optional short-term coverage is also heavily subsidized. The government not only aids low income earners with their premiums, similarly to how the PPACA does, but it also insures that private companies will cover all citizens regardless of risk factors by compensating them for covering high-risk patients.

It basically functions almost exactly like the PPACA, except for the fact that the compulsory part is publicly ran, and the private coverage is optional, but since it's subsidized anyway, most people take the option. Better than our system for sure. Not all that cost effective though.


The big difference between the Dutch system and the UK is in the Netherlands [corrected per Spartan] the HC providers are not govt. employed salaried but are mostly private.

Doctors in Canada aren't salaried, public employees either.

The big difference between the Dutch (and French and Swiss) system and Obamacare is those European systems have a "cost control mechanism". In Switzerland, the insurers and the HC providers negotiate set fees for drugs, procedures, and devices. In Netherlands and France, the govt., private insurers, and medical unions all meet yearly to negotiate maximum costs for drugs, devices, procedures, etc. This eliminates the $30 aspirin and the MRI which costs $20k if you are on Medicare, $10k if on private insurance, or $4k if paying cash.

Just to focus on that last comment, you have it backwards. Generally, the cost of those procedures are not more for Medicare than they are for private insurers, they are less, because contrary to your suggestion, Medicare does actually implement some cost control measures, albeit not as much as it should. The main flaw is that Medicare does not negotiate for lower prescription drug costs, but this is mainly due to legislation being blocked in congress to allow it to, thanks to an effective Big Pharma lobby.

I agree with you on your criticism of the PPACA for lacking effective price control mechanisms. I think it's foolish that it doesn't. Interestingly enough, however, the call for government implemented price control measures seems to be working at odds with the notion that competitive, for profit care is, in and of itself, capable of keeping costs down. If this was the case, then why would publicly imposed price control mechanisms be necessary? If anything, this is further proof that the profit motive is counter productive towards keeping costs down.

What provides the government the ability  to negotiate for cheaper costs in universal systems is the fact that they represent a large patient pool. The larger the pool of potential customers an entity represents, the more effectively they can negotiate for cheaper costs. There is no larger a pool than a single payer system, which is why costs are so much more significantly lower in those systems than they are here, and even in places like the Netherlands.
« : June 13, 2013, 05:26:46 PM CBWx2 »


spartan

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« #104 : June 13, 2013, 06:00:05 PM »

 :P


The big difference between the Dutch system and the UK is in France the HC providers are not govt. employed salaried but are mostly private.


The difference between the Dutch and the UK systems is that the French do it differently?

Huh?

What?


Oops, I guess I effed that up. Should be Netherlands. I was thinking way ahead of what I was typing.



Or I could go CBW and deny the error, post 9 articles that prove that "French" correctly means "Dutch" in Swahili ;)

 ;D
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