[pickledpepperRN]

Originally Posted by Jolie

Is a 25% difference insignificant to you?

According to your graph, 47% of Americans were able to receive same-day or next-day services, while only 36% of Canadians were seen the same or next day.

Almost 25% more Americans than Canadians were seen within a day of requesting services. That is not "very little difference".

Um, tell me if I'm wrong. It seems to me the difference between 47% and 36% is an 11% difference.

In both countries less than half of the people can see a doctor.
Does the US figure include the uninsured?

How does Canada care for people needing mental health care?

[Jolie]

Originally Posted by spacenurse

Um, tell me if I'm wrong. It seems to me the difference between 47% and 36% is an 11% difference.

To simplify the problem, allow me to use the figures 48% and 36%.

If I am 48 years old, and you are 36 years old, I am 12 years older than you, but my age is actually 25% greater than yours.

In Viking's example, 48 Americans were seen within a day, and 36 Canadians. That is a difference of 12 people, which constitutes a 25% difference in the number of people seen within each system.

[HM2Viking]

I actually don't advocate for adopting a Canadian style system. I think we would be far better served by looking at the countries that do better on average across quality dimensions for ideas on how to i,prove our system. THis means looking at the countries to our left on the graph as well as those in the following graphic.

While many U.S. hospitals and health systems are dedicated to improving the process of care to achieve better safety and quality, the U.S. can also learn from innovations in other countries—including public reporting of quality data, payment systems that reward high-quality care, and a team approach to management of chronic conditions. Based on these patient and physician reports, the U.S. could improve the delivery, coordination, and equity of the health care system by drawing from best practices both within the U.S. and around the world.

Citation

K. Davis, C. Schoen, S. C. Schoenbaum, M. M. Doty, A. L. Holmgren, J. L. Kriss, and K. K. Shea, Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care, The Commonwealth Fund, May 2007

[whaley]

What an intersting debate. I work in England, but have always been quite interested in the US health system as it always seemed quite elitist. At the beginning of this debate some people were worried about how it would affect their pay and the pt/nursing ratio. Well in the NHS in England, nurses in the private sector don't get paid much more than NHS nurses. However the pt/nurse ratio can be quite high, I often have 15 patients to look after. I don't know what it's like in the US, but I do work on quite an underfunded ward, so it's not usually that high.
At the moment our government is trying to reduce the number of pts that need to be in hospital, so it putting more money into the community rather than hospitals, so people with chronic diseases can be treated and managed better, and therefore in theory need less hospital admissions.
The NHS does have to be careful with resources, for example certain drugs like cancer drugs aren't available to everyone, which has recently caused quite a lot of controversy.
The perfect sysytem would be that everyone could have free health care and there would be no money issues or waiting lists, however that's not going to happen, but I do believe that everyone has a right to good quality free health care.

[KayMichelle]

The example of how universal healthcare would be beneficial is unsound.

The poster used the example of diabetes, stating that if a person had healthcare he/she would use it before becoming very sick (ie getting renal failure, amputations, etc.) and this would save the system a great deal of money.

Now, I think we all know from personal experience that these folks who do not treat their DMII fail to do so because of lack of discipline, and refusal to accept lifestyle changes, not because they do not have health insurance.

Please, let's not use emotional arguments. Let's live in the real world. These issues are very important to us, especially the quality of care issues, the shortage issues, the salary issues.

[KayMichelle]

Originally Posted by whaley

What an intersting debate. I work in England, but have always been quite interested in the US health system as it always seemed quite elitist. At the beginning of this debate some people were worried about how it would affect their pay and the pt/nursing ratio. Well in the NHS in England, nurses in the private sector don't get paid much more than NHS nurses. However the pt/nurse ratio can be quite high, I often have 15 patients to look after. I don't know what it's like in the US, but I do work on quite an underfunded ward, so it's not usually that high.
At the moment our government is trying to reduce the number of pts that need to be in hospital, so it putting more money into the community rather than hospitals, so people with chronic diseases can be treated and managed better, and therefore in theory need less hospital admissions.
The NHS does have to be careful with resources, for example certain drugs like cancer drugs aren't available to everyone, which has recently caused quite a lot of controversy.
The perfect sysytem would be that everyone could have free health care and there would be no money issues or waiting lists, however that's not going to happen, but I do believe that everyone has a right to good quality free health care.

There is no such thing as "free". Unless of course, you are a volunteer nurse, drugs cost nothing, and there is no need for research and development.

This is the big problem with universal healthcare. It is not "universal". As you say, cancer drugs aren't available to "everyone", so who decides who gets them? The Queen? The Archbishop? Just curious. In America, we really don't accept that kind of authoritarian system. That is why we fought the Revolutionary War, you see!

Another statement that is an oxymoron: "Everyone has a right to good quality free health care..." But, realistically, care that has made you wait is not quality at all.

It is neither free, fair or of high quality.

The true answer is tort reform.

[BlueRidgeHomeRN]

Originally Posted by whaley

What an intersting debate. I work in England, but have always been quite interested in the US health system as it always seemed quite elitist. At the beginning of this debate some people were worried about how it would affect their pay and the pt/nursing ratio. Well in the NHS in England, nurses in the private sector don't get paid much more than NHS nurses. However the pt/nurse ratio can be quite high, I often have 15 patients to look after. I don't know what it's like in the US, but I do work on quite an underfunded ward, so it's not usually that high.
At the moment our government is trying to reduce the number of pts that need to be in hospital, so it putting more money into the community rather than hospitals, so people with chronic diseases can be treated and managed better, and therefore in theory need less hospital admissions.
The NHS does have to be careful with resources, for example certain drugs like cancer drugs aren't available to everyone, which has recently caused quite a lot of controversy.
The perfect sysytem would be that everyone could have free health care and there would be no money issues or waiting lists, however that's not going to happen, but I do believe that everyone has a right to good quality free health care.

Thanks for the info and observations from the other side of the pond!

[ZippyGBR]

Originally Posted by KayMichelle

The example of how universal healthcare would be beneficial is unsound.

The poster used the example of diabetes, stating that if a person had healthcare he/she would use it before becoming very sick (ie getting renal failure, amputations, etc.) and this would save the system a great deal of money.

if money is tight are you going to pay the true price for a drug regime including newer agents?

if you are going to be charged for your retinal screening - are you going to go ?

how often are you going to go and get U+Es and HBA1C taken if you are charged for it ?

Now, I think we all know from personal experience that these folks who do not treat their DMII fail to do so because of lack of discipline, and refusal to accept lifestyle changes, not because they do not have health insurance.

blame the 'victim' why don't you

case management in the USA is about maximising profit, case management in the Uk is about optimising resource use...

[jjjoy]

Originally Posted by KayMichelle

Now, I think we all know from personal experience that these folks who do not treat their DMII fail to do so because of lack of discipline

If that's truly the case, how is it helpful when health care is more expensive to access? A national plan should include case management (as most health insurance companies do in order to reduce costs) which can follow up with patients, educating them and encouraging them to do the right thing. It's true that a number of people won't change their ways. But it's even less likely they'll change their ways if they fear how much it will cost to seek care. It can be quite intimidating to speculate on health care costs and I don't think we can expect people to be rational 100% of the time. Insurance with questionable cover will cost several hundreds of dollars a month, more with pre-existing conditions. A primary care doctor's visit might cost $75 out of pocket, tests could run in the hundreds, medications can run in the hundreds every month, and a hospitalization could mean complete financial ruin. Putting one's head in the sand and simply not renewing that expensive prescription or always putting off scheduling an appointment for that sore on one's foot are actually pretty normal human responses, albeit not benefitial for their physical health.

[ZippyGBR]

Originally Posted by KayMichelle

<snip>

This is the big problem with universal healthcare. It is not "universal". As you say, cancer drugs aren't available to "everyone", so who decides who gets them? The Queen? The Archbishop? Just curious. In America, we really don't accept that kind of authoritarian system. That is why we fought the Revolutionary War, you see!

.

Lets see,
NICE http://www.nice.org.uk/

clinicians,

PCT management when money is short...

the issues are over cancer drugs which don't have NICE approval or have nice approval only for their licenced indication although there is limited evidence for their use outisde their licence

there is the issue if at what point does 'life prolonging' palliative treatment actually provide a meaningful return...