
UK has best health system in developed world, US analysis concludes - DanBC
http://www.bmj.com/content/358/bmj.j3442
======
comstock
This analysis of a report seems pretty bad, even with only the title and
abstract available.

Firstly, the report doesn't even cover the entire developed world, just 11
countries. Notably, Japan doesn't appear to be included. To be honest, I found
that slightly offensive.

Secondly the U.K. isn't the overall clear "best" of those 11. It's not bad,
and does better on some things, worse on others.

In my subjective experience (as a Brit) British people often think the NHS is
the best health service in the world. It's not bad, and it's free. Waiting
times are often long, particularly for non-urgent conditions. Compared to the
U.S. system I prefer the NHS, but there are other options, and the NHS could
provide a better service than it does.

~~~
jseliger
_In my subjective experience (as a Brit) British people often think the NHS is
the best health service in the world_

Having experienced it, I'm surprised that Brits feel that way. When I was
studying abroad a while ago (which was not a great experience for other
reasons... [https://jakeseliger.com/2012/11/18/about-the-university-
of-e...](https://jakeseliger.com/2012/11/18/about-the-university-of-east-
anglia-uea-why-you-shouldnt-go/)), I needed an x-ray and then a CT scan for
what appeared to be a minor issue. So I went to the clinic and signed up for
one, only to discover a week later that an x-ray typically takes 6 - 8 weeks
to be done! I asked around and was told to go to Bupa facility
([https://en.wikipedia.org/wiki/Bupa](https://en.wikipedia.org/wiki/Bupa)). To
the Brits this seemed like an obvious solution, and paying in cash is in fact
a good way to get things done quickly. It turns out that when people have
something really wrong with them, the solution is often to just pay out of
pocket!

This disabused me of any notion that publicly-provided healthcare is
automatically superior.

~~~
mikeash
Is it really a big deal to wait 6-8 weeks to get an x-ray for a minor issue?
Obviously this is not ideal, but it seems pretty minor compared to the
ridiculous stuff we deal with in the US system, especially if you compare to
the pre-ACA US system.

~~~
2skep
Actually, I never understood this. Is demand and supply matched and this is
just the lag in the system (ie 6-8 weeks remains 6-8 weeks forever) or demand
is greater than supply and this number will grow. If it is the former then
there doesn't seem to be a cost advantage for the wait. A temporary increase
in supply could bring this waiting time to zero with just the cost of 6-8
weeks worth of x-rays outsourced. And then you have a steady state system with
zero waiting.

~~~
makomk
In terms of efficiency, you're right. However because people get fed up of
waiting and having to put up with their health issues and pay to go private
instead, this reduces demand and the cost to the NHS. Think of it as a softer
way of rationing access to some kinds of NHS healthcare to only those who
don't have the money to pay for private care instead.

~~~
comstock
Or less charitably... they die...

------
ggambetta
As a resident of the UK and a former resident of Switzerland, I can't
understand how they came to this conclusion. Don't get me wrong, the NHS is
great and the system works much better than in the US, but health care in
Switzerland is just on another level.

Before you say "but in the UK it's free" \- considering what I paid for
(private, mandatory) insurance in Switzerland, and the National Insurance
contribution that gets deducted from my paycheck in the UK, I'm not so sure...

~~~
JamesMcMinn
I don't think anyone, in the UK at least, thinks the NHS is free. Most people
in the UK who describe it as "free" really mean "free at the point of use"
(i.e. no invoice after treatment), but that's a bit of a mouth full.

~~~
mjevans
It removes an entire department and source of variable from a 'company' that
doesn't need it.

Ultimately you aren't going to deny someone coverage based on cost*, they're
going to end up in an ER and 'written off' which will then be billed in to
everyone else's costs. Worse, the outcome for the individual is often less
good and frequently means they will be, overall, more of a burden on society
than if they had received proper treatment in an early stage.

Instead, the 'cost' of billing that is 'outsourced' to the government's tax
collectors, which are going to be the /very/ last thing removed if ever.

~~~
HarryHirsch
_Ultimately you aren 't going to deny someone coverage based on cost_

For acute conditions, yes, but in the American ER they do not treat chronic
conditions, like cancer, depression and substance addiction. That's a public
health issue.

~~~
deepsun
And even for sub-acute thing, for example if you've broken ankle, it needs a
surgery to bring your bones together and put a metallic screws and a plate.
But the only thing they'll do in ER is put a cast on your leg (for ~$7,000
bill to your insurance). For the surgery you'll need to look for a surgeon
yourself (and, there's HUGE shortage of surgeons everywhere in US, seems like
the system wants it that way).

Then your surgeon's hospital will pre-agree on the surgery cost with your
insurance. If you don't have insurance or money -- welcome to limpers.

------
dbcooper
The report: [http://www.commonwealthfund.org/publications/fund-
reports/20...](http://www.commonwealthfund.org/publications/fund-
reports/2017/jul/mirror-mirror-international-comparisons-2017)

It ranks the UK 10th out of 11 on "Health Care Outcomes".

~~~
staofbur
Good spot. BMJ won't be crowing that one though.

~~~
inopinatus
They could, because it also points out the UK had the "fastest reduction in
deaths amenable to health care in the past decade" i.e. the most improvement
in that category.

If you take a look at the raw data, you can see the basis of comparison (four
major diseases: heart attack, stroke, breast cancer, colon cancer, + overall
mortality data). The biggest outlier for the UK is clearly the cancer survival
rate, where it is more than two standard deviations worse than average and
this has been known for some time. The underlying reasons are complex, partly
social, mostly ones of late diagnosis, partly due to failure to implement good
screening programmes; reports on the topic vary in their tendency to blame
patients for presenting late or for comorbidity factors, but here's one of the
more measured, from 2011: [https://www.kingsfund.org.uk/sites/files/kf/How-to-
improve-c...](https://www.kingsfund.org.uk/sites/files/kf/How-to-improve-
cancer-survival-Explaining-England-poor-rates-Kings-Fund-June-2011.pdf)

Most tellingly, with breast cancer, a 2008 report suggested that if you remove
all the women who die within a year of diagnosis (whose cancers were likely to
have been diagnosed at a very advanced stage), then UK survival rates fall
into line with the European average. In other words, the UK has a problem with
late diagnosis.

Note that the UK also has a better cancer registry. Germany only captures 1%
of the population, the UK captures 80%. Unsure whether the OP report has
attempted to detect any resulting skew in the statistics.

Bottom line: if the UK improves the five-year cancer survival rate to OECD
standards - and note that the data in this report is from 2015 - then it will
flip its position in those rankings and totally cement the #1 position
overall.

------
coldcode
One can argue about who is best, but amongst first world countries, it's sadly
not hard to figure out the worst.

~~~
tonyedgecombe
That depends on whether you are rich or poor.

------
jlarsson89
As a swede living in London, I was shocked to find the NHS still uses paper
prescriptions that are consumed upon use, at least in my limited experience.
In Sweden, every prescription I have is digital and tied to my ID, accessible
from any pharmacy or hospital in the country and is not necessarily consumed
upon use, I can easily reuse it and renew it.

------
tehabe
Is the abstract really shorted and the author is mentioned but as affiliation
it only says "London". They really don't want to know much about the paper
before you pay for this paid research.

~~~
zkms
Use sci-hub to avoid paying anything to get full-text PDF.

~~~
adambj
Hey zkms, this reply isn't about the main thread, but bear with me. I happened
upon your comment here
([https://news.ycombinator.com/item?id=13454185](https://news.ycombinator.com/item?id=13454185))
asking about the status of Parabix. Granted, that was almost half a year ago,
so you may not even remember making the comment. But just in case you're still
curious about Parabix, yes it is still very much in development! I've been
working on it since about the time you made that comment. The most fully
featured application we've built so far is icgrep -- an attempt to rewrite
grep from the ground up using Parabix. It's still a bit rough around the
edges, but it's usable and exceptionally fast. On large collections of files
(10s or hundreds of GBs) it's often orders of magnitude faster than grep, and
has more robust Unicode support to boot. We're working on some other pretty
neat stuff too, but they aren't quite ready for widespread release yet.

I'll see what I can do about getting our website updated! Thanks for your
interest.

------
IsaacL
This really is a matter of what variables you choose to measure.

For example, the US is by far the world leader in medical research spending -
44% of global medical research is spent in the US. (Until recently it was even
higher). [1]

On the same note, many nations regulate the price of prescription drugs -
drugs where the initial R&D was done in the states. (Yes, drugs are sold at a
huge markup, but that's to recoup the huge initial costs of research). In
other words, Americans are taking it in the chin to invest in pharmaceutical
innovations, which other countries then treat as a public good.

An additional point that's often obscured: there's no purely capitalistic
healthcare system in the world. Even pre-Obamacare, the US system was about
46% funded by the government. (As with the US education system, the
availability of government funds has massively pushed up prices). [2]

On a personal note - I'm a brit, but I've lived abroad, and the NHS is one of
the reasons I'm considering settling abroad long-term. I simply don't trust
the organisation as a whole to take care of my health. If you get assigned a
good doctor for your condition, you're OK, but I have my own stories (and I've
heard many others) of conditions being ignored or misdiagnosed, even after
multiple visits.

In contrast, I went to a hospital in Bangkok that was of far higher quality
than the average NHS hospital. (Granted, this was a private hospital, but it
puts things into perspective). One Israeli friend said that walking into a UK
clinic was like walking into a clinic in a third-world country. It's shabby,
the wait is long, the bureaucracy is confusing, etc.

Strange as it may sound, I trust a for-profit entity more with my health,
because their livelihood directly depends on taking good care of me. The
common argument that healthcare can't be a market because of information
asymmetry and doctors being in a position of power doesn't wash: the same
holds true for other complex services, like auto repair, and the solution is
simple: third party reviews. (On the moral argument, about affordability, I
think with a truly private healthcare system entrepreneurs would be able to
drive the costs down for people on middle-incomes, and only the bottom 15-20%
would be reliant on government or charity spending).

[1]
[https://www.urmc.rochester.edu/news/story/4233/u.s.-slipping...](https://www.urmc.rochester.edu/news/story/4233/u.s.-slipping-
as-global-leader-in-medical-research.aspx)

[2]
[https://en.wikipedia.org/wiki/List_of_countries_by_health_ex...](https://en.wikipedia.org/wiki/List_of_countries_by_health_expenditure_covered_by_government)

~~~
elmalto
Interesting thought regarding the r&d spending in the US versus the rest of
the world and hence subsidizing global health care. I did look at some numbers
in a more recent publication [1](page 21) where the latest r&d numbers for
both healthcare and biotech are listed. Germany‘s spending seems to be on
average a little less than 1/3 of the US which would make them equal on a per
capita level. The UK seems to be a little below those levels. Do you have any
data to support your claim?

[1]
[https://www.iriweb.org/sites/default/files/2016GlobalR%26DFu...](https://www.iriweb.org/sites/default/files/2016GlobalR%26DFundingForecast_2.pdf)

~~~
robocat
The UK could easily be more efficient/effective on how they spend their R&D
dollars (like for healthcare).

And R&D is very hard to compare due to different incentives to categorize R&D
depending upon taxation laws and charity institutions.

------
galadran
[https://pastebin.com/ibZM0C8Q](https://pastebin.com/ibZM0C8Q)

Some of the data from the Appendix on Equality pulled out. The difference
between countries is quite astounding!

------
warsharks
having had a fair amount of experience of the british healthcare system i find
this very hard to believe, ive been treated like shit by them many times, been
talked into an operation i didnt really want (i think they were extra keen
because its a rare condition) which they then managed to screw up and cripple
me.

another little gem is my current insurance claim, i was knocked off my
motorbike over a year ago, yet i still havent received a payout from my
insurance, id assumed their lawyers were dragging the process out but by this
point she has been convicted, my insurance company have been paid by hers but
i still havent had anything back, when i asked my lawyer what was holding it
up he said it was just one thing they need, they are still awaiting the
medical records from my GP which were requested and paid for back in September
but despite monthly attempts to get them to send it they still havent done so
and every time i try and contact them to ask why im told that the medical
secretary isnt in at the moment and only she can deal with it, but they will
tell her to call me as soon as she gets back in, i have yet to receive a
single call from them.

i could go on to site a ton of other various reports of shit service that i
have personally experienced let alone that of others i know. if i was
insurable id have taken private medical insurance long ago and still strongly
advise any healthy person in the UK to get private medical insurance ASAP,
sure its an extra cost no one wants to pay but if you ever do get sick youll
be damn glad you have it

