Monday, June 20, 2005


Courtesy of The Economist

I'm so puzzled at how it is we spend so much in this country, but yet we seem to get so little for what we spend. Many of these countries have universal healthcare, yet we're still outspending them per person. Something just ain't right.


Blogger she falters to rise said...

A fellow student of mine is from Korea. When she needs medical or dental care, she flies back to Korea to get it. This practice is so common that the Korean Student Association here has several jokes about this issue. It is, in general, cheaper for them to pay for the plane ticket and the Korean medical prices than to get treated here. That is sad.

4:16 PM  
Blogger James said...

I'm actually somewhat stunned by this --- my wife's insurance, for both of us, comes in at about $70/month. Over the course of a year that's only $840, which has to be comprable to the cost of a plane ticket to and from Korea. We haven't had any real problem with getting medical treatment here, in fact the appointments have been fairly easy to make and there's only a $5 co-pay. So I'm wondering if the medical insurance in this case is covering things adequately.

That said, we pay a comprable amount for dental care, and keep in mind that the chart above is not addressing dental care. Dental insurance comes no where near close to covering what medical insurance does, and when you get into periodontal work and crowns (the insurance company covers 50% on crowns) it can get very expensive.

However I look at it, the cost of things here makes no sense relative to what we get for our money as compared to people in other countries, and I can't see the reason why.

4:39 PM  
Blogger she falters to rise said...

Part of the problem is an issue of medical and/or dental insurance as our student health insurance covers the bare minimum. You and your wife seem to have a very nice insurance package, however, because my husband and I have never been able to get under $120/month and we pay a $20-30 copay. We also only have 70% coverage on out of network providers. Even though we always go to network providers, many tests that they run are outsourced and, thus, out of network. If you have a chronic medical condition, things really add up. That's a different issue, though.

It's hard to figure out what's going on using this graph because it doesn't give you a breakdown on how much is going towards specialist care, mental health care, drug costs, etc. Since all countries handle these things differently, they could account for some of the disparity. I don't know.

6:27 PM  
Blogger James said...

You caused me to take a look at one of Feri's pay stubs to see what's there so I was sure of the numbers. For medical we're paying $80/month, with a $5 co-pay. I'm once again stunned with the out-of-network test thing, but maybe that's because we're not running into anything exceptional with regard to testing, I don't know. The physicians we see are affiliated with the local large hospital, which has a tie-in with the university's medical school, and it seems that pretty much anything they could want to do is pretty much in-house. If it's just you and your husband, i.e. no kids, then I'm surprised at how much you're having to pay, or maybe Feri's package really is that much better than the norm.

We're also paying about $40/month for dental, and while this hardly covers everything we've already come out ahead on this deal for this year and likely into the next.

You're right about the charts, you can't really get anything out of them other than an overall macro sense of what's happening on a per person basis for cost. While I agree that all the countries do things differently, given the relative economic parity amongst all the countries represented I'd assume (of course this is where I'd get into trouble, but then to a degree I think it's a reasonable thing to do) that what patients and physicians expect to be done should, on the whole, be similar in Europe as here which is why the comparison to begin with, but then it does beg an answer as to why in the world there's such a difference. What I'd like to also see is a chart of customer satisfaction of the various countries --- I'm sure that would be telling, too.

9:04 PM  
Blogger : Joseph j7uy5 said...

Almost certainly, your wife is payting only a fraction of the health insurance cost. Her employer is picking up the rest. I'm guessing that she is employed by the same university that runs the hospital that you go to. Thus, the university is paying into an insurance fund, the insurance company takes a cut, then gives the money back to the university. The money gets shuffled from one account to another, then ends up right where it started. Every shuffle burns a part of the money. Studies have shown that we waste about one-third of our health care dollars this way.

Medicare, by the way, has an overhead of only a few percent. I forget the exact numbers, but they were published in NEJM a while back. The VA health system, for all its faults, is also a very efficient system. (Even a very efficient system can't do its job if it is grossly underfunded.) That is why so many people think a single-payer system would make so much sense. There are hundreds of insurance companies, and all of them duplicate the same services.

11:36 PM  
Blogger Africanuck said...

I'm wondering if the cost of medications is covered in this chart. That might go a long way to explaining the difference, since they are considerably more expensive in the States than anywhere else.

It would also be interesting to compare a chart of obesity rates with this. If a larger section of the population is suffering from preventable conditions and diseases caused by obesity, some of this discrepancy might be explained by the fact that other governments put into place campaigns to get their people moving (or that it is already normal in certain countries).

Canada is a good example of this, about 30 years ago they did a study which showed that a 30 year old Canadian was in the same physical shape as a 60 year old Swede. Thus was born "Participaction" and a lowkey but ongoing advertising campaign to get people out walking, biking or moving any way that they liked every day. The government realized back then that with a national health care system, prevention was much less expensive than having to pay for a "cure" later on.

I think that now the ratio Canadian to Swede is at something like 50 year old Canadian = 60 year old Swede. It's been effective, and has no doubt had a big effect on health care spending, since the people are healthier.

Another possibility that comes to mind is that in countries that have universal or inexpensive health care, people tend to go to the doctor much sooner, rather than waiting "to see if it will go away", and this probably leads to earlier diagnosis of problems which can then be dealt with before they requires major, aggresive and costly interventions.

3:52 AM  
Blogger James said...

Joseph: Thank you very much for your insights on this. I'll be honest, my head is still spinning with trying to track the simple shuffle you're talking about here with the insurance system my wife and I are using. I suppose I shouldn't be surprised that we're wasting a lot of money on transfers of cash back and forth, I just have a hard time understanding why it's allowed to continue like this.

Another point to add to the discussion: I was referred by my internist to two other doctors to look at two separate (though thankfully, relatively minor) problems. They're all in the same "system", but each of them wanted me to duplicate the same information to get into their individual offices. How much are we wasting by not consolidating certain records and making it easy to share? Hmmmmm ...

Your comment about the VA system is something I can atest to. I was stationed for a while in a place where standard military medicine wasn't avaiable to me and I had to rely on the local VA hospital, with which we had a contract, for medical care. Initially I was very leery about this given all the horror stories I'd heard about the system, but one visit put those fears to rest and I have to say that I was never disappointed with the service or the professionalism of the people I dealt with. That said, it was in a relatively rural area and likely better funded than most --- I'd hate to think how a VA hospital which was poorly funded would fair with the average clientele such places tend to attract, i.e. they don't see the healthiest sick people (:::chuckling::: I hadn't intended to say it that way, but I think you know what I mean.)

Africanuck: As to be expected, given your vast experience, you'd have a very different take on this and it's also food for thought. My guess is that the numbers we're seeing here in fact do cover medicine, and that would be partly the reason for the problem but even there I don't think it accounts for the larger percentage. To be honest I'm getting more and more the impression that this is very much the result of a congregation of many small cuts bleeding the system.

As for prevention, there's no question of the value there. But it seems here we have a problem with figuring out what's the right thing to do and then conveying it to the average citizen --- I offer up the latest U.S. Govt food pyramid as a case in point. I have no idea why there's not more of a focus on prevention here, though I sense that it's becoming more and more a part of the average person's thinking as we learn more about the disease and people have more ready access to information to do something about it. That said, we're not very nearly the chubbiest nation without good reason.

10:05 AM  

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