Re: France is healthcare leader, US comes dead last: study --> was RE: Value for health care $

[Guest guest]

,

This is no surprise. What is a surprise is

that we have known we are providing poor care (I think Crossing the Quality

Chasm came out in 2001) and have not done a single thing as a nation to

improve it. Unfortunately, even with the 101,000/year reasons for change (from

the article), the CEO for UHC has 120+ million/year reasons

not to change. How much is a life worth? Apparently not as

much as corporate/personal profits. The real irony is that all this is

happening while the current politicians continue to tout “American/Christian

values†on the stump.

Two physicians in my area just retired and

another went to cash only. In the next 5 years, 25% of primary care docs in my

area will retire. Instead of crossing the Chasm, we are blissfully leaping into

it.

Re:

Value for health care $

No dashboard, but good feedback on how the practice is

doing through " Hows Your Health, " a patient generated survey that

gives feedback in critical areas such as access and efficiency, also gives

quality information on how well patients are educated about their chronic

disease and are managing it.�

The copy of the powerpoint slide below looks at just a

few examples of the data available:

[Guest guest]

I'm no expert on this, but actually, I believe I've heard that the single factor

that relates most closely to improved general health is a more even distribution of

wealth. That means that the countries with stronger " welfare states "

have fewer very poor people, and fewer very rich, so the wealth is more evenly

distributed. Part of that tends to be a government-sponsored/coordinated

health system in most countries of course. So, for example, the USA has an uneven

distribution of wealth so our health data is nearer to Latin American countries

while Western Europe (and Japan perhaps) has a more even distribution of wealth and

their health stats are ahead of us. It's supposedly a much closer relationship

than money spent in health care system for example.To me that speaks to

how little chance there is for a true improvement in our health care system.

Americans believe that our " free-market " makes our lives wonderful and

that we have the potential to move up the ladder in wealth status, even though

studies show that Europe's countries have greater economic mobility for economic

status, and the system is so utterly not " free " but rather weighted to

helping corporate profits (ie- fascist in many ways). That said, no one in the

USA government will have the gall to suggest a " welfare state " that

actually could systematically improve (not perfect, just improve) health in our

society.And the only thing being discussed in presidential campaigns is

how to move around the money of health care SYSTEM. There's no real talk of ways to

improve HEALTH.So, again, I think I'll just take the hours I have in

each day and try to make them benefit my patients and my family and my friends as

much as possible. And I'll play the game as best as possible to get paid and

make a living. (... re--reading this .. I'm actually in great spirits right now,

though this paragraph seems depressing ... in some ways it's quite empowering to be

an IMP because I can be sure my time is spent for family/friends/patients and not to

follow up on " company issues " or hassles other folks have made ...

simplifying life is great!)TimOn Wed, January 9, 2008 11:49 am EST, Locke's in Colorado wrote:

Per our ongoing discussion of healthcare in the

US.

Lots of socialized medicine countries in there.

Is Japan socialized?

Wiki says...

http://en.wikipedia.org/wiki/Health_care_in_Japan

In the Japanese

health care system, healthcare services, including free screening

examinations for particular diseases, prenatal care, and infectious disease control, are provided by

national and local governments. Payment for personal medical services is

offered through a universal health care insurance system that

provides relative equality of access, with fees set by a government committee.

People without insurance through employers can participate in a national health insurance program

administered by local governments. Since 1973, all elderly persons have been

covered by government-sponsored insurance. Patients are free to select physicians or facilities of their choice.

I'm not a big fan of having the gov't run anything in general, but

one has to wonder if all these other countries are just healthier or if it is

because they have socialized medicine and an emphasis on primary care and

access to care...or not.

Locke, MD

=====================================================

France is healthcare

leader, US comes dead last: study

Tue Jan 8, 2:13 PM ET

WASHINGTON (AFP) - France is tops, and the United

States dead last, in providing timely and effective

healthcare to its citizens, according to a survey Tuesday of preventable deaths in 19 industrialized countries.

The study by the Commonwealth Fund and published in

the January/February issue of the journal Health Affairs measured developed

countries' effectiveness at providing timely and effective healthcare.

The study, entitled " Measuring the Health of Nations: Updating an Earlier

Analysis, " was written by researchers from the London School of Hygiene

and Tropical Medicine. It looked at death rates in

subjects younger than 75 that could have been prevented by timely and

effective medical care.

The researchers found that while most countries surveyed saw preventable deaths decline by an average of 16 percent, the United States saw only a four percent dip.

The non-profit Commonwealth Fund, which financed the study, expressed alarm at the findings.

" It is startling to see the US falling even farther behind on this crucial

indicator of health system performance, " said Commonwealth Fund Senior

Vice President Schoen, who noted that " other countries are reducing

these preventable deaths more rapidly, yet spending far less. "

The 19 countries, in order of best to worst, were: France, Japan, Australia, Austria, Canada, Denmark, Finland, Germany, Greece, Ireland, Italy, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden,

the United Kingdom and the United

States.

Some countries showed dramatic improvement in the periods studied -- 1997 and 1998 and again between 2002 and 2003 -- outpacing the United States, which showed only slight improvement.

White the United States ranked 15th of 19 between 1997-98, by 2002-03 it had fallen to last place.

" It is notable that all countries have improved substantially except the

US, " said Ellen Nolte, lead author of the study.

Had the United States performed as well as any of the top three industrialized countries, there would have been 101,000 fewer deaths per year, the researchers said.

From:

[mailto: ] On Behalf Of

GuinnSent: Wednesday, January 09, 2008 8:15 AMTo: Subject: Re: Value for health care

$

No dashboard, but good feedback on how the practice is doing through " Hows Your Health, " a patient generated survey that gives feedback in

critical areas such as access and efficiency, also gives quality information

on how well patients are educated about their chronic disease and are managing

it.�

The copy of the powerpoint slide below looks at just a few examples of the data available:

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.----------------------------------------

[Guest guest]

As I mentioned before in another thread, this is a result of the

habitat destruction of the US medical scenery.

The trees ( primary care docs ) are being cut down thru loss of

income, retirement etc, and too few trees are being grown to replace

them. Instead, more exotic and less useful trees ( sub specialists )

which require more care ($$$) are being grown in their place.

The persons in a position to change this won't because of their self

interests ( income, shareholders etc, treatment of patient populations

as a common green ), and so change has to occur at the grass roots, or

tree roots in this analogy.

>

>

>

>

>

>

> I'm no expert on this, but actually, I believe I've heard that the single

> factor that relates most closely to improved general health is a more even

> distribution of wealth. That means that the countries with stronger

> " welfare states " have fewer very poor people, and fewer very rich, so the

> wealth is more evenly distributed. Part of that tends to be a

> government-sponsored/coordinated health system in most countries of course.

> So, for example, the USA has an uneven distribution of wealth so our health

> data is nearer to Latin American countries while Western Europe (and Japan

> perhaps) has a more even distribution of wealth and their health stats are

> ahead of us. It's supposedly a much closer relationship than money spent in

> health care system for example.

>

> To me that speaks to how little chance there is for a true improvement in

> our health care system. Americans believe that our " free-market " makes our

> lives wonderful and that we have the potential to move up the ladder in

> wealth status, even though studies show that Europe's countries have greater

> economic mobility for economic status, and the system is so utterly not

> " free " but rather weighted to helping corporate profits (ie- fascist in many

> ways). That said, no one in the USA government will have the gall to

> suggest a " welfare state " that actually could systematically improve (not

> perfect, just improve) health in our society.

>

> And the only thing being discussed in presidential campaigns is how to move

> around the money of health care SYSTEM. There's no real talk of ways to

> improve HEALTH.

>

> So, again, I think I'll just take the hours I have in each day and try to

> make them benefit my patients and my family and my friends as much as

> possible. And I'll play the game as best as possible to get paid and make a

> living. (... re--reading this .. I'm actually in great spirits right now,

> though this paragraph seems depressing ... in some ways it's quite

> empowering to be an IMP because I can be sure my time is spent for

> family/friends/patients and not to follow up on " company issues " or hassles

> other folks have made ... simplifying life is great!)

>

> Tim

>

>

>

> On Wed, January 9, 2008 11:49 am EST, Locke's in Colorado wrote:

>

>

>

>

>

>

> 

>

>

>

>

>

>

>

>

>

> Per our ongoing discussion of healthcare in the US.

>

>

>

> Lots of socialized medicine countries in there.

>

>

>

> Is Japan socialized?

>

>

>

> Wiki says...

>

>

>

> http://en.wikipedia.org/wiki/Health_care_in_Japan

>

>

>

> In the Japanese health

> care system, healthcare services,

> including free screening examinations for particular diseases, prenatal

> care, and infectious disease

> control, are provided by national and local governments. Payment for

> personal

> medical services is offered through a universal health

> care insurance system that provides relative equality of access, with fees

> set by a government committee. People without insurance through employers

> can

> participate in a national health insurance

> program administered by local governments. Since 1973, all elderly persons

> have

> been covered by government-sponsored insurance. Patients are free to select

> physicians or facilities of their choice.

>

>

>

> I'm not a big fan of having the gov't run anything in general, but one

> has to wonder if all these other countries are just healthier or if it is

> because they have socialized medicine and an emphasis on primary care and

> access

> to care...or not.

>

>

>

> Locke, MD

>

> =====================================================

>

>

>

> France is healthcare

> leader, US comes dead last: study

>

>

>

>

>

>

>

>

> Tue Jan 8, 2:13 PM ET

>

>

>

> WASHINGTON (AFP) - France is tops,

> and the United States dead last, in providing timely and

> effective healthcare to its citizens, according to a survey Tuesday of

> preventable deaths in 19 industrialized countries.

>

>

> The study by the Commonwealth Fund and published in the January/February

> issue

> of the journal Health Affairs measured developed countries' effectiveness at

> providing timely and effective healthcare.

>

>

> The study, entitled " Measuring the Health of Nations: Updating an Earlier

> Analysis, " was written by researchers from the London School of Hygiene and

> Tropical Medicine. It looked at death rates in subjects

> younger than 75 that could have been prevented by timely and effective

> medical

> care.

>

> The researchers found that while most countries surveyed saw preventable

> deaths decline by an average of 16 percent, the United States saw only a

> four

> percent dip.

>

> The non-profit Commonwealth Fund, which financed the study, expressed alarm

> at the findings.

>

> " It is startling to see the US falling even farther behind on this crucial

> indicator of health system performance, " said Commonwealth Fund Senior Vice

> President Schoen, who noted that " other countries are reducing these

> preventable deaths more rapidly, yet spending far less. "

>

> The 19 countries, in order of best to worst, were: France, Japan, Australia,

> Austria, Canada, Denmark,

> Finland, Germany,

> Greece, Ireland,

> Italy, Netherlands,

> New Zealand,

> Norway, Portugal,

> Spain, Sweden, the United Kingdom

> and the United States.

>

> Some countries showed dramatic improvement in the periods studied -- 1997

> and

> 1998 and again between 2002 and 2003 -- outpacing the United States, which

> showed only slight improvement.

>

> White the United States ranked 15th of 19 between 1997-98, by 2002-03 it had

> fallen to last place.

>

> " It is notable that all countries have improved substantially except the

> US, "

> said Ellen Nolte, lead author of the study.

>

> Had the United States performed as well as any of the top three

> industrialized countries, there would have been 101,000 fewer deaths per

> year,

> the researchers said.

>

>

> ________________________________

>

> From:

> [mailto: ] On Behalf Of

> Guinn

> Sent: Wednesday, January 09, 2008 8:15 AM

> To:

>

> Subject: Re:

> Value for health care $

>

>

>

> No dashboard, but good feedback on how the practice is doing through

> " Hows Your Health, " a patient generated survey that gives feedback in

> critical

> areas such as access and efficiency, also gives quality information on how

> well

> patients are educated about their chronic disease and are managing it.�

>

>

> The copy of the powerpoint slide below looks at just a few examples of the

> data available:

>

>

>

>

>

>

>

>

>

>

>

>

>

> ----------------------------------------

> Malia, MD

>

> Malia Family Medicine & Skin Sense Laser

> 6720 Pittsford-Palmyra Rd.

> Perinton Square Mall

> Fairport, NY 14450

>

> (phone / fax)

> www.relayhealth.com/doc/DrMalia

> www.SkinSenseLaser.com

>

> -- Confidentiality Notice --

> This email message, including all the attachments, is for the sole use of

> the intended recipient(s) and contains confidential information.

> Unauthorized use or disclosure is prohibited. If you are not the intended

> recipient, you may not use, disclose, copy or disseminate this information.

> If you are not the intended recipient, please contact the sender immediately

> by reply email and destroy all copies of the original message, including

> attachments.

> ----------------------------------------

>

--

Graham Chiu

http://www.synapsedirect.com

Synapse-EMR - innovative electronic medical records system

[Guest guest]



I suppose this is getting a little off topic for the list, but it is a fascinating area that possibly explains what options would work or not work for changes in health care in the US based on how our distribution of wealth is set up.Quick search shows the following in regards to income distribution.

I think it is interesting that the majority of those with better healthcare outcomes (based on the article) have low Gini values.

What does that mean for us? Have no clue.

If we redistribute the wealth, we'll have better healthcare outcomes?

If we move to a socialized medicine system, we'll have better outcomes?

Got me, but the info is interesting - to me at least.

Locke, MD

===============================

I'm sure if one was an expert, they can spin the #'s every which way but loose, but here are some basics on the web.

Gini coefficient

From Wikipedia, the free encyclopedia

Jump to: navigation, search

Graphical representation of the Gini coefficient(The area of the whole triangle is defined as 1.)

The Gini coefficient is a measure of statistical dispersion most prominently used as a measure of inequality of income distribution or inequality of wealth distribution. It is defined as a ratio with values between 0 and 1: the numerator is the area between the Lorenz curve of the distribution and the uniform distribution line; the denominator is the area under the uniform distribution line. Thus, a low Gini coefficient indicates more equal income or wealth distribution, while a high Gini coefficient indicates more unequal distribution. 0 corresponds to perfect equality (everyone having exactly the same income) and 1 corresponds to perfect inequality (where one person has all the income, while everyone else has zero income). The Gini coefficient requires that no one have a negative net income or wealth.

The Gini coefficient was developed by the Italian statistician Corrado Gini and published in his 1912 paper "Variabilità e mutabilità" ("Variability and Mutability").

The Gini coefficient is also commonly used for the measurement of the discriminatory power of rating systems in credit risk management.

The Gini index is the Gini coefficient expressed as a percentage, and is equal to the Gini coefficient multiplied by 100. (The Gini coefficient is equal to half of the relative mean difference.)

The original article that spurred the discussion on health care around the world said...

The 19 countries in the article, in order of best to worst, were: (http://www.sciencedaily.com/releases/2008/01/080108082944.htm)

FranceJapan, Australia,Austria, Canada, Denmark,Finland, Germany,Greece, Ireland,Italy, Netherlands,New Zealand,Norway, Portugal,Spain, Sweden,United KingdomLast - United States.

Here is a list of Gini Coeffecients based on the wiki....

I threw in Mexico because the table says the US Gini index is basically the same as Mexico.

Country

UN Richest 10% to poorest 10%

UN Richest 20% to poorest 20%

UN Gini index

UN Survey year

CIA Gini index

6 Denmark

8.1

4.3

24.7

(1997)

23.2 (2002)

17 Sweden

6.2

4

25

(2000)

25 (2000)

14 Norway

6.1

3.9

25.8

(2000)

25.8 (2000)

1 France

9.1

5.6

32.7

(1995)

26.7 (2002)

7 Finland

5.6

3.8

26.9

(2000)

26.9 (2000)

8 Germany

6.9

4.3

28.3

(2000)

28.3 (2000)

12 Netherlands

9.2

5.1

30.9

(1999)

30.9 (2005)

4 Austria

6.9

4.4

29.1

(2000)

31 (2002)

5 Canada

9.4

5.5

32.6

(2000)

32.6 (2001)

Belgium

8.2

4.9

33

(2000)

33 (2000)

Switzerland

9

5.5

33.7

(2000)

33.7 (2000)

10 Ireland

9.4

5.6

34.3

(2000)

34.3 (2000)

16 Spain

10.3

6

34.7

(2000)

34.7 (2000)

9 Greece

10.2

6.2

34.3

(2000)

35.1 (2003)

3 Australia

12.5

7

35.2

(1994)

35.2 (1994)

18 United Kingdom

13.8

7.2

36

(1999)

36 (1999)

11 Italy

11.6

6.5

36

(2000)

36 (2000)

13 New Zealand

12.5

6.8

36.2

(1997)

36.2 (1997)

2 Japan

4.5

3.4

24.9

(1993)

38.1 (2002)

15 Portugal

15

8

38.5

(1997)

38.5 (1997)

19 United States

15.9

8.4

40.8

(2000)

45 (2004)[3]

Mexico

24.6

12.8

47.3 (2006)[citation needed]

(2002)

46.1 (2004)

Description

World map showing the Gini coefficient, a measure of income inequality.

Representation of Gini coefficient in the world (colored by countries, see also the legend)

██ < 0.25

██ 0.25 - 0.29

██ 0.30 - 0.34

██ 0.35 - 0.39

██ 0.40 - 0.44

██ 0.45 - 0.49

██ 0.50 - 0.54

██ 0.55 - 0.59

██ > 0.60

██ N.A.

However, notice that these colors do not represent the data as shown in the wikipedia Gini coefficient page. It is probably out of date.

Derived from Image:BlankMap-World.png by User:Vardion

A vector version of this image ("SVG") is available.It should be used in place of this raster image when superior.

Image:World Map Gini coefficient.png Image:World Map Gini coefficient.svg

For more information about vector graphics, read about Commons transition to SVG.There is also information about MediaWiki's support of SVG images.

Deutsch | English | Español | Français | עברית | Italiano | 日本語 | Polski | РуÑÑкий | УкраїнÑька | +/-

http://one-simple-idea.com/WealthDistributionAndNumbers1920-1998.GIF

List of countries by income equality

From Wikipedia, the free encyclopedia

Jump to: navigation, search

World map of the Gini coefficient

This is a sortable list of countries or dependencies by income inequality metrics including Gini coefficients, according to the United Nations and the CIA. A Gini index of 0 represents perfect economic equality, and 100 perfect inequality. UN data may represent income shares by percentiles of population, ranked by per capita income, or expenditure shares by percentiles of population, ranked by per capita expenditure; see original for identification by individual countries. (Note: different dates for estimates in table may bias comparisons.)

Country

UN Richest 10% to poorest 10%

UN Richest 20% to poorest 20%

UN Gini index

UN Survey year

CIA Gini index

Denmark

8.1

4.3

24.7

(1997)

23.2 (2002)

Sweden

6.2

4

25

(2000)

25 (2000)

Slovakia

6.7

4

25.8

(1996)

25.8 (1996)

Norway

6.1

3.9

25.8

(2000)

25.8 (2000)

Bosnia and Herzegovina

5.4

3.8

26.2

(2001)

26.2 (2001)

France

9.1

5.6

32.7

(1995)

26.7 (2002)

Albania

5.9

4.1

28.2

(2002)

26.7 (2005)

Finland

5.6

3.8

26.9

(2000)

26.9 (2000)

Hungary

5.5

3.8

26.9

(2002)

26.9 (2002)

Czech Republic

5.2

3.5

25.4

(1996)

27.3 (2003)

Germany

6.9

4.3

28.3

(2000)

28.3 (2000)

Slovenia

5.9

3.9

28.4

(1998–99)

28.4 (1998)

Croatia

7.3

4.8

29

(2001)

29 (2001)

Belarus

6.9

4.5

29.7

(2002)

29.7 (2002)

Ethiopia

6.6

4.3

30

(1999–00)

30 (2000)

Kyrgyzstan

6.4

4.4

30.3

(2003)

30.3 (2003)

Pakistan

6.5

4.3

30.6

(2004)

30.6 (2002)

Netherlands

9.2

5.1

30.9

(1999)

30.9 (2005)

Austria

6.9

4.4

29.1

(2000)

31 (2002)

Romania

7.5

4.9

31

(2003)

31 (2003)

Ukraine

5.9

4.1

28.1

(2003)

31 (2006)

European Union

n/a

n/a

n/a

n/a

31.6 (2003 est.)

Bulgaria

7

4.4

29.2

(2003)

31.6 (2005)

Tajikistan

7.8

5.2

32.6

(2003)

32.6 (1998)

Canada

9.4

5.5

32.6

(2000)

32.6 (2001)

Mongolia

17.8

9.1

30.3

(1998)

32.8 (2002)

Belgium

8.2

4.9

33

(2000)

33 (2000)

Moldova

8.2

5.3

33.2

(2003)

33.2 (2003)

Yemen

8.6

5.6

33.4

(1998)

33.4 (1998)

Bangladesh

6.8

4.6

31.8

(2000)

33.4 (2000)

Switzerland

9

5.5

33.7

(2000)

33.7 (2000)

Latvia

11.6

6.8

37.7

(2003)

33.7 (2003)

Kazakhstan

8.5

5.6

33.9

(2003)

33.9 (2003)

Ireland

9.4

5.6

34.3

(2000)

34.3 (2000)

Egypt

8

5.1

34.4

(1999–00)

34.4 (2001)

Poland

8.8

5.6

34.5

(2002)

34.5 (2002)

Tanzania

9.2

5.8

34.6

(2000–01)

34.6 (2000)

Laos

8.3

5.4

34.6

(2002)

34.6 (2003)

Spain

10.3

6

34.7

(2000)

34.7 (2000)

Indonesia

7.8

5.2

34.3

(2002)

34.8 (2004)

Greece

10.2

6.2

34.3

(2000)

35.1 (2003)

Australia

12.5

7

35.2

(1994)

35.2 (1994)

Algeria

9.6

6.1

35.3

(1995)

35.3 (1995)

South Korea

7.8

4.7

31.6

(1998)

35.8 (2000)

Estonia

10.8

6.4

35.8

(2003)

35.8 (2003)

United Kingdom

13.8

7.2

36

(1999)

36 (1999)

Italy

11.6

6.5

36

(2000)

36 (2000)

Lithuania

10.4

6.3

36

(2003)

36 (2003)

New Zealand

12.5

6.8

36.2

(1997)

36.2 (1997)

Azerbaijan

3.3

2.6

36.5

(2002)

36.5 (2001)

Uzbekistan

6.1

4

26.8

(2000)

36.8 (2003)

India

7.3

4.9

32.5

(1999–00)

36.8 (2004)

Mauritius

n/a

n/a

n/a

n/a

37 (1987 est.)

Vietnam

9.4

6

37

(2002)

37 (2004)

Timor-Leste

n/a

n/a

n/a

n/a

38 (2002 est.)

Japan

4.5

3.4

24.9

(1993)

38.1 (2002)

Guinea

12.3

7.3

40.3

(1994)

38.1 (2006)

Portugal

15

8

38.5

(1997)

38.5 (1997)

Israel

13.4

7.9

39.2

(2001)

38.6 (2005)

Jordan

11.3

6.9

38.8

(2002–03)

38.8 (2003)

Mauritania

12

7.4

39

(2000)

39 (2000)

Malawi

22.7

11.6

50.3

(1997)

39 (2004)

Burkina Faso

11.6

6.9

39.5

(2003)

39.5 (2003)

Morocco

11.7

7.2

39.5

(1998–99)

40 (2005 est.)

Tunisia

13.4

7.9

39.8

(2000)

40 (2005 est.)

Mali

23.1

12.2

50.5

(1994)

40.1 (2001)

Guinea-Bissau

19

10.3

47

(1993)

40.3 (1994)[citation needed]

Georgia

15.4

8.3

40.4

(2003)

40.4 (2003)

Russia

12.7

7.6

39.9

(2002)

40.5 (2005)

Ghana

14.1

8.4

40.8

(1998–99)

40.8 (1998)

Turkmenistan

12.3

7.7

40.8

(1998)

40.8 (1998)

Armenia

8

5

33.8

(2003)

41 (2004)

Senegal

12.8

7.5

41.3

(1995)

41.3 (2001)

Cambodia

11.6

6.9

40.4

(1997)

41.7 (2004 est.)

Thailand

12.6

7.7

42

(2002)

42 (2002)

Ecuador

44.9

17.3

43.7

(1998)

42 (2003)[1]

Burundi

19.3

9.5

42.4

(1998)

42.4 (1998)

Singapore

17.7

9.7

42.5

(1998)

42.5 (1998)

Iran

17.2

9.7

43

(1998)

43 (1998)

Nicaragua

15.5

8.8

43.1

(2001)

43.1 (2001)

Turkey

16.8

9.3

38 (2005)[citation needed]

2003

43.6 (2003)

Nigeria

17.8

9.7

43.7

(2003)

43.7 (2003)

Kenya

13.6

8.2

42.5

(1997)

44.5 (1997)

Philippines

16.5

9.7

46.1

(2000)

44.5 (2003)

Cameroon

15.7

9.1

44.6

(2001)

44.6 (2001)

Cote d'Ivoire

16.6

9.7

44.6

(2002)

44.6 (2002)

United States

15.9

8.4

40.8

(2000)

45 (2004)[3]

Uruguay

17.9

10.2

44.9

(2003)[1]

45.2 (2006)

Jamaica

11.4

6.9

37.9

(2000)

45.5 (2004)

Uganda

14.9

8.4

43

(1999)

45.7 (2002)

Malaysia

22.1

12.4

49.2

(1997)

46.1 (2002)

Mexico

24.6

12.8

47.3 (2006)[citation needed]

(2002)

46.1 (2004)

Costa Rica

30

14.2

49.9

(2001)

46.6 (2003)

Rwanda

5.8 (1983-5)

4 (1983-5)

45.1

(2003)[2]

46.8 (2000)

People's Republic of China

18.4

10.7

44.7

(2001)

46.9 (2004)

Nepal

15.8

9.1

47.2

(2003–04)

47.2 (2004)

Mozambique

12.5

7.2

39.6

(1996–97)

47.3 (2002)

Madagascar

19.2

11

47.5

(2001)

47.5 (2001)

Venezuela

20.4

10.6

44.1

(2000)

48.2 (2003)

Argentina

34.5

17.6

52.8

(2003)[1]

48.3 (2006)

Sri Lanka

8.1

5.1

33.2

(1999–00)

50 (FY03/04)

Niger

46

20.7

50.5

(1995)

50.5 (1995)

Zambia

13.9

8

42.1

(2002–03)

50.8 (2004)

Papua New Guinea

23.8

12.6

50.9

(1996)

50.9 (1996)

Dominican Republic

30

14.4

51.7

(2003)

51.6 (2004)

Peru

40.5

18.6

54.6

(2002)

52 (2003)

Hong Kong

17.8

9.7

43.4

(1996)

52.3 (2001)

El Salvador

57.5

20.9

52.4

(2002)

52.4 (2002)

Honduras

34.2

17.2

53.8

(2003)

53.8 (2003)

Colombia

63.8

25.3

58.6

(2003)

53.8 (2005)

Chile

40.6

18.7

53.8 (2003)[citation needed]

(2000)

54.9 (2003)

Panama

54.7

23.9

56.4

(2002)

56.1 (2003)

Brazil

57.8

23.7

58

(2003)

56.7 (2005)

Zimbabwe

22

12

61 (2003)[citation needed]

(1995)

56.8 (2003)

South Africa

33.1

17.9

57.8

(2000)

57.8 (2000)

Paraguay

73.4

27.8

57.8

(2002)

58.4 (2003)

Guatemala

48.2

20.3

55.1

(2002)

59.9 (2005)

Bolivia

168.1

42.3

60.1

(2002)

60.1 (2002)

Central African Republic

69.2

32.7

61.3

(1993)

61.3 (1993)

Sierra Leone

87.2

57.6

62.9

(1989)

62.9 (1989)

Botswana

77.6

31.5

63

(1993)

63 (1993)

Lesotho

105

44.2

63.2

(1995)

63.2 (1995)

Namibia

128.8

56.1

74.3

(1993)

70.7 (2004)

Benin

9.4

6

36.5

(2003)

n/a

Gambia

20.2

11.2

50.2

(1998)

n/a

Haiti

71.7

26.6

59.2

(2001)

n/a

Swaziland

49.7

23.8

60.9

(1994)

n/a

Trinidad and Tobago

14.4

8.3

40.3

(1992)

n/a

-----Original Message-----From: Malia, MD Sent: Wednesday, January 09, 2008 11:05 AMTo: lockek@...; practiceimprovement1 Subject: Re: France is healthcare leader, US comes dead last: study --> was RE: Value for health care $I'm no expert on this, but actually, I believe I've heard that the single factor that relates most closely to improved general health is a more even distribution of wealth. That means that the countries with stronger "welfare states" have fewer very poor people, and fewer very rich, so the wealth is more evenly distributed. Part of that tends to be a government-sponsored/coordinated health system in most countries of course. So, for example, the USA has an uneven distribution of wealth so our health data is nearer to Latin American countries while Western Europe (and Japan perhaps) has a more even distribution of wealth and their health stats are ahead of us. It's supposedly a much closer relationship than money spent in health care system for example.To me that speaks to how little chance there is for a true improvement in our health care system. Americans believe that our "free-market" makes our lives wonderful and that we have the potential to move up the ladder in wealth status, even though studies show that Europe's countries have greater economic mobility for economic status, and the system is so utterly not "free" but rather weighted to helping corporate profits (ie- fascist in many ways). That said, no one in the USA government will have the gall to suggest a "welfare state" that actually could systematically improve (not perfect, just improve) health in our society.And the only thing being discussed in presidential campaigns is how to move around the money of health care SYSTEM. There's no real talk of ways to improve HEALTH.So, again, I think I'll just take the hours I have in each day and try to make them benefit my patients and my family and my friends as much as possible. And I'll play the game as best as possible to get paid and make a living. (... re--reading this .. I'm actually in great spirits right now, though this paragraph seems depressing ... in some ways it's quite empowering to be an IMP because I can be sure my time is spent for family/friends/patients and not to follow up on "company issues" or hassles other folks have made ... simplifying life is great!)Tim

[Guest guest]

When my daughter lived in Japan she was required by her university to buy into the Japanese healthcare insurance (around 300/year).When she got into a bike accident, she was seen daily in a solo practice by both a doctor and nurse for wound care. Copay was 5. first day, 2. after that.Per our ongoing discussion of healthcare in the US. Lots of socialized medicine countries in there. Is Japan socialized? Wiki says... http://en.wikipedia.org/wiki/Health_care_in_Japan In the Japanese health care system, healthcare services, including free screening examinations for particular diseases, prenatal care, and infectious disease control, are provided by national and local governments. Payment for personal medical services is offered through a universal health care insurance system that provides relative equality of access, with fees set by a government committee. People without insurance through employers can participate in a national health insurance program administered by local governments. Since 1973, all elderly persons have been covered by government-sponsored insurance. Patients are free to select physicians or facilities of their choice. I'm not a big fan of having the gov't run anything in general, but one has to wonder if all these other countries are just healthier or if it is because they have socialized medicine and an emphasis on primary care and access to care...or not.  Locke, MD===================================================== France is healthcare leader, US comes dead last: studyTue Jan 8, 2:13 PM ETWASHINGTON (AFP) - France is tops, and the United States dead last, in providing timely and effective healthcare to its citizens, according to a survey Tuesday of preventable deaths in 19 industrialized countries.The study by the Commonwealth Fund and published in the January/February issue of the journal Health Affairs measured developed countries' effectiveness at providing timely and effective healthcare.The study, entitled "Measuring the Health of Nations: Updating an Earlier Analysis," was written by researchers from the London School of Hygiene and Tropical Medicine. It looked at death rates in subjects younger than 75 that could have been prevented by timely and effective medical care.The researchers found that while most countries surveyed saw preventable deaths decline by an average of 16 percent, the United States saw only a four percent dip.The non-profit Commonwealth Fund, which financed the study, expressed alarm at the findings."It is startling to see the US falling even farther behind on this crucial indicator of health system performance," said Commonwealth Fund Senior Vice President Schoen, who noted that "other countries are reducing these preventable deaths more rapidly, yet spending far less."The 19 countries, in order of best to worst, were: France, Japan, Australia, Austria,Canada, Denmark, Finland, Germany, Greece, Ireland, Italy, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, the United Kingdom and the United States.Some countries showed dramatic improvement in the periods studied -- 1997 and 1998 and again between 2002 and 2003 -- outpacing the United States, which showed only slight improvement.White the United States ranked 15th of 19 between 1997-98, by 2002-03 it had fallen to last place."It is notable that all countries have improved substantially except the US," said Ellen Nolte, lead author of the study.Had the United States performed as well as any of the top three industrialized countries, there would have been 101,000 fewer deaths per year, the researchers said.From:  [mailto: ] On Behalf Of  GuinnSent: Wednesday, January 09, 2008 8:15 AMTo:  Subject: Re: Value for health care $No dashboard, but good feedback on how the practice is doing through "Hows Your Health," a patient generated survey that gives feedback in critical areas such as access and efficiency, also gives quality information on how well patients are educated about their chronic disease and are managing it.�The copy of the powerpoint slide below looks at just a few examples of the data available:

[Guest guest]



Must be subsidized system.

$300 per year and $7-20 bucks to see the doctor.

Wouldn't cover the overhead.

Sweet for the patient.

But the money has to come from somewhere.

Locke, MD

From: [mailto: ] On Behalf Of GuinnSent: Wednesday, January 09, 2008 1:34 PMTo: Subject: Re: France is healthcare leader, US comes dead last: study --> was RE: Value for health care $

When my daughter lived in Japan she was required by her university to buy into the Japanese healthcare insurance (around 300/year).

When she got into a bike accident, she was seen daily in a solo practice by both a doctor and nurse for wound care. Copay was 5. first day, 2. after that.

Per our ongoing discussion of healthcare in the US.

Lots of socialized medicine countries in there.

Is Japan socialized?

Wiki says...

http://en.wikipedia.org/wiki/Health_care_in_Japan

In the Japanese health care system, healthcare services, including free screening examinations for particular diseases, prenatal care, and infectious disease control, are provided by national and local governments. Payment for personal medical services is offered through a universal health care insurance system that provides relative equality of access, with fees set by a government committee. People without insurance through employers can participate in a national health insurance program administered by local governments. Since 1973, all elderly persons have been covered by government-sponsored insurance. Patients are free to select physicians or facilities of their choice.

I'm not a big fan of having the gov't run anything in general, but one has to wonder if all these other countries are just healthier or if it is because they have socialized medicine and an emphasis on primary care and access to care...or not.

Locke, MD

=====================================================

France is healthcare leader, US comes dead last: study

Tue Jan 8, 2:13 PM ET

WASHINGTON (AFP) - France is tops, and the United States dead last, in providing timely and effective healthcare to its citizens, according to a survey Tuesday of preventable deaths in 19 industrialized countries.

The study by the Commonwealth Fund and published in the January/February issue of the journal Health Affairs measured developed countries' effectiveness at providing timely and effective healthcare.

The study, entitled "Measuring the Health of Nations: Updating an Earlier Analysis," was written by researchers from the London School of Hygiene and Tropical Medicine. It looked at death rates in subjects younger than 75 that could have been prevented by timely and effective medical care.

The researchers found that while most countries surveyed saw preventable deaths decline by an average of 16 percent, the United States saw only a four percent dip.

The non-profit Commonwealth Fund, which financed the study, expressed alarm at the findings.

"It is startling to see the US falling even farther behind on this crucial indicator of health system performance," said Commonwealth Fund Senior Vice President Schoen, who noted that "other countries are reducing these preventable deaths more rapidly, yet spending far less."

The 19 countries, in order of best to worst, were: France, Japan, Australia, Austria,Canada, Denmark, Finland, Germany, Greece, Ireland, Italy, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, the United Kingdom and the United States.

Some countries showed dramatic improvement in the periods studied -- 1997 and 1998 and again between 2002 and 2003 -- outpacing the United States, which showed only slight improvement.

White the United States ranked 15th of 19 between 1997-98, by 2002-03 it had fallen to last place.

"It is notable that all countries have improved substantially except the US," said Ellen Nolte, lead author of the study.

Had the United States performed as well as any of the top three industrialized countries, there would have been 101,000 fewer deaths per year, the researchers said.

From: [mailto: ] On Behalf Of GuinnSent: Wednesday, January 09, 2008 8:15 AMTo: Subject: Re: Value for health care $

No dashboard, but good feedback on how the practice is doing through "Hows Your Health," a patient generated survey that gives feedback in critical areas such as access and efficiency, also gives quality information on how well patients are educated about their chronic disease and are managing it.�

The copy of the powerpoint slide below looks at just a few examples of the data available:

[Guest guest]

Instead of the insurance company taxing you, the government does it instead.

>

>

>

>

>

>

>

> Must be subsidized system.

> $300 per year and $7-20 bucks to see the doctor.

> Wouldn't cover the overhead.

>

> Sweet for the patient.

>

> But the money has to come from somewhere.

--

Graham Chiu

http://www.synapsedirect.com

Synapse-EMR - innovative electronic medical records system

[Guest guest]

We all subsidize care. We don't spend less for health care in this country individually or as a group. We spend more and get less. Must be subsidized system.$300 per year and $7-20 bucks to see the doctor.Wouldn't cover the overhead. Sweet for the patient. But the money has to come from somewhere.  Locke, MDFrom:  [mailto: ] On Behalf Of  GuinnSent: Wednesday, January 09, 2008 1:34 PMTo:  Subject: Re: France is healthcare leader, US comes dead last: study --> was RE: Value for health care $When my daughter lived in Japan she was required by her university to buy into the Japanese healthcare insurance (around 300/year).When she got into a bike accident, she was seen daily in a solo practice by both a doctor and nurse for wound care. Copay was 5. first day, 2. after that.Per our ongoing discussion of healthcare in the US. Lots of socialized medicine countries in there. Is Japan socialized? Wiki says... http://en.wikipedia.org/wiki/Health_care_in_Japan In the Japanese health care system, healthcare services, including free screening examinations for particular diseases, prenatal care, and infectious disease control, are provided by national and local governments. Payment for personal medical services is offered through a universal health care insurance system that provides relative equality of access, with fees set by a government committee. People without insurance through employers can participate in a national health insurance program administered by local governments. Since 1973, all elderly persons have been covered by government-sponsored insurance. Patients are free to select physicians or facilities of their choice. I'm not a big fan of having the gov't run anything in general, but one has to wonder if all these other countries are just healthier or if it is because they have socialized medicine and an emphasis on primary care and access to care...or not.  Locke, MD===================================================== France is healthcare leader, US comes dead last: studyTue Jan 8, 2:13 PM ETWASHINGTON (AFP) - France is tops, and the United States dead last, in providing timely and effective healthcare to its citizens, according to a survey Tuesday of preventable deaths in 19 industrialized countries.The study by the Commonwealth Fund and published in the January/February issue of the journal Health Affairs measured developed countries' effectiveness at providing timely and effective healthcare.The study, entitled "Measuring the Health of Nations: Updating an Earlier Analysis," was written by researchers from the London School of Hygiene and Tropical Medicine. It looked at death rates in subjects younger than 75 that could have been prevented by timely and effective medical care.The researchers found that while most countries surveyed saw preventable deaths decline by an average of 16 percent, the United States saw only a four percent dip.The non-profit Commonwealth Fund, which financed the study, expressed alarm at the findings."It is startling to see the US falling even farther behind on this crucial indicator of health system performance," said Commonwealth Fund Senior Vice President Schoen, who noted that "other countries are reducing these preventable deaths more rapidly, yet spending far less."The 19 countries, in order of best to worst, were: France, Japan, Australia, Austria,Canada, Denmark, Finland, Germany, Greece, Ireland, Italy, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, the United Kingdom and the United States.Some countries showed dramatic improvement in the periods studied -- 1997 and 1998 and again between 2002 and 2003 -- outpacing the United States, which showed only slight improvement.White the United States ranked 15th of 19 between 1997-98, by 2002-03 it had fallen to last place."It is notable that all countries have improved substantially except the US," said Ellen Nolte, lead author of the study.Had the United States performed as well as any of the top three industrialized countries, there would have been 101,000 fewer deaths per year, the researchers said.From:  [mailto: ] On Behalf Of  GuinnSent: Wednesday, January 09, 2008 8:15 AMTo:  Subject: Re: Value for health care $No dashboard, but good feedback on how the practice is doing through "Hows Your Health," a patient generated survey that gives feedback in critical areas such as access and efficiency, also gives quality information on how well patients are educated about their chronic disease and are managing it.�The copy of the powerpoint slide below looks at just a few examples of the data available:

[Guest guest]

Graham,

I haven’t read Collapse yet; but I’m not sure

your analogy flies. In the US, most would consider top down to mean that

the federal government runs the show, e.g. the armed forces. Here, this

is pejoratively called “socialized medicine.” Rather, the

current government believes its responsibility “to promote the general

welfare” is best realized by allowing Adam ’s “invisible

hand” to dispense healthcare with a band-aid here and there. Of

course, the free market is regulated to some degree. Right now, the

federal government is favoring the insurance, drug companies, and technology

companies, e.g. Medicare Part D, which while providing some marginal benefit to

medicare recipients, benefited the pharmaceutical and insurance industries

primarily. To top it off, the congressman primarily responsible for

writing the law did not run for reelection but instead became the millionaire

president of the pharmacy industry’s primary lobbying group. (No

Quid Pro Quo there.) But, I digress. The top of the health

care pops, France and Japan, appear to have universal health care, which I

would consider very top down health care planning. The contradiction to

this being the UK, the example of socialized medicine traditionally held up in

front of the American public (see Rudy Guiliani), which was next to worst just

ahead of the US. In NZ, you appear to have government provided

“surgery” which is equivalent, I believe, to what we call

“major medical” - car accidents, hospitalizations, etc.

at no cost at the public hospital. (How about oncology, transplant, CABG,

etc, is this done at the public hospitals?); and primary care is partially

subsidized. All these more top down systems outperform the US in

preventing preventable deaths (though I wonder if the US might not outperform

these others in preventing unpreventable death, at least temporarily, due

to the amount of money we spend on patients in their last month of life.)

The primary care docs are not being cut down, but a larger

percentage of the general population of doctors is adapting to the medical

environment by choosing to the economic and life style advantages of

specialties and subspecialties. Most of these specialists have hardware

whose cost are easily calculated and therefore are more amenable to

reimbursement than the more difficulty to quantify (though Gordon and others

are trying) value of knowledge, empathy and judgement. Not to say that

specialists don’t have these, it’s just that hardware is easier to

quantify and procedures have traditionally been over reimbursed. As the

environment is not hospitable to primary care, it’s languishing like the

orchid in my living room. I am not an IMP yet, but I see them as

physicians who love general practice trying to adapt their practices by

innovation and mutation using increasing inexpensive technologies such as EMR

and the web, low/no staffing, to decrease their nutritional needs while

exploiting those resources still available to them to try to thrive in a

nutritionally poor environment.

I agree that the current power players won’t change this, but

it appears that enough voters have finally had enough of the current crew to

throw the bums out. The question remains as to whether those who talk a

good game or those who claim to have played a good game have the determination to

really shake up the system.

By the way, and Tim, I’ve really enjoyed your last few

posts. I wonder if you have anything on the GINI coefficient for docs in

France and Japan versus docs in the UK and US?

Straz

Re:

> Value for health care $

>

>

>

> No dashboard, but good feedback on how the practice is doing through

> " Hows Your Health, " a patient generated survey that gives

feedback in

> critical

> areas such as access and efficiency, also gives quality information on how

> well

> patients are educated about their chronic disease and are managing it.�

>

>

> The copy of the powerpoint slide below looks at just a few examples of the

> data available:

>

>

>

>

>

>

>

>

>

>

>

>

>

> ----------------------------------------

> Malia, MD

>

> Malia Family Medicine & Skin Sense Laser

> 6720 Pittsford-Palmyra Rd.

> Perinton Square Mall

> Fairport, NY 14450

>

> (phone / fax)

> www.relayhealth.com/doc/DrMalia

> www.SkinSenseLaser.com

>

> -- Confidentiality Notice --

> This email message, including all the attachments, is for the sole use of

> the intended recipient(s) and contains confidential information.

> Unauthorized use or disclosure is prohibited. If you are not the intended

> recipient, you may not use, disclose, copy or disseminate this

information.

> If you are not the intended recipient, please contact the sender

immediately

> by reply email and destroy all copies of the original message, including

> attachments.

> ----------------------------------------

>

--

Graham Chiu

http://www.synapsedirect.com

Synapse-EMR - innovative electronic medical records system