What’s wrong with health care systems?

It is generally quite easy to create a blog using one of those online services such as Blogspot. In fact many people create a blog and after a couple of posts they lose interest and neglect to update it. There is a blog I would like to draw your attention to, http://fakellaki.blogspot.com/. This blog was last updated on 3rd May 2007, one month ago. Quite sadly, it will not get updated again because the blogger has just passed away.
Amalia, the blogger, has been a victim of malpractice of the health service (both national and private) who failed her. For Amalia At the age of 8 she was complaining that there was pain at her leg. The doctors failed to diagnose a case of schwannoma (a type of benign tumour). Seventeen years latter and after many visits, the tumour became malign and she developed cancer. A further five years of fight against cancer and she passed away in May 2007.
At the time of writing, her final blog post has over 1500 comments.
In the US there is no national healthcare system which leaves tens of millions of people without basic healthcare. For the rest, who have private healthcare, it appears there is a varying degree of satisfaction. Michael Moore, in his latest documentary Sicko, talks about the trend in the US private healthcare system to actively look for technicalities so that they do not cover the medical expenses.
What is wrong with the health care system? Is health care inherently expensive so that quality naturally drops? Are the examples depicted above the norm or are they just mere exceptions? What’s the true cause of the problem?

7 comments

  • elkosmas

    Simos we were expecting Sicko… it’s a revelation for us europeans even Health Care workers… it’s expensive and the cause of problem (from were I see it) is not profit but UltraBigProfit

  • Simos

    I would expect the market to self-regulate itself in the area of private health insurance. If one looks for ultra profits, they would lose customers in the process.
    What’s the root of the issue? Are those affected the minority, perhaps people that chose a very cheap health insurance policy?

  • hawkeye

    The root of the issue is that one cannot apply free market rules to healthcare. In markets, consumers make decisions and stimulate competition. In healthcare, patients are not qualified to decide who is the best doctor or which hospital is the best – they can only see how extravagant the doctor’s office looks, but that doesn’t say anything about the quality of health service the patient gets, or for that matter, the cost of that quality. Plus, there are numerous conflicts of interest in free market healthcare, as doctors themselves are under pressure from their employers to minimize costs, often resulting in patient harm. Not to mention drug companies, which usually influence doctors more than patients. As I said, the patient cannot know in advance whether the drug the doctor prescribed is beneficial or harmful.

    For example take the Vioxx scandal. This drug was given to millions of patients, in Greece and abroad. The evidence that the drug increased cardiovascular mortality was there from the beginning, but both the FDA and most doctors disregarded it and fell for the drug company’s aggressive marketing. This resulted in hundreds of thousands of excess deaths from myocardial infarction. The problem is no single death from an MI can be “traced” and attributed to Vioxx. Thus the doctors who disregarded the evidence and prescribed Vioxx went un-noticed and did not lose their patients preference.

  • Simos

    hawkeye: While going through the http://sicko-movie.com/ website (testimonials), it looks that the US problems appear to stem from the way private health insurance works there, rather than the doctors/hospitals per se. In the US there is the notion of an HMO (Health Maintenance Organisation; http://en.wikipedia.org/wiki/HMO). These insurance companies try hard to find ways not to cover medical expenses, thus increase their profits. Hospitals and doctors have to follow the line of the HMOs, otherwise they lose the contract. The people apparently are not aware of the situation and choose badly.
    I am not quite sure what is the cause of the situation in Greece.

  • hawkeye

    The very nature of medical care is bayesian in origin. For every patient, there is no “linear relationship” between money spent and patient outcomes. The HMOs however, by their very nature, need to precisely define costs per service provided based on disease and outcome. They need to set rigid restrictions on what is neccessary and is not, while this distinction is not clear at all in medicine. This is a fundamental contradiction in the way healthcare is delievered in America.

    For example, I read somewhere that an HMO covered one single day of hospitalization for patients with diabetic ketoacidosis. True, some patients will only need a day to recover, but many of them need more. The doctors then are under pressure to deal with the disease more aggressively, in order to stay within the constraints the HMO sets, and this can result in harm to the patient (in this example, neurological complications due to quick correction of the ketoacidosis).

    True, in any given health system the doctor is also in effect a “healthcare manager”, with a responsibility to make the best use out of finite healthcare resources. However, the HMO model ensures that doctors are under constant pressure to cut costs; the ΗΜΟs will always see some costs as un-neccessary, because they do not fit within their rigid accounting models. And it is not a problem of choosing the best HMO – all of them, by nature, put their accounts before patient welfare.

  • Simos

    Could there be at least some sort a variation of the HMO model so that it manages to work? Or, shall we give up on private insurance altogether?

    The current state of afairs in the medical system in the US does not provide balanced competition among sides so that the system is self-sustained. Patients are not in a position to check what exactly is provided by their medical insurance, commonly only when it is too late.
    Should the HMO be restricted in some way from influencing the hospitals and doctors on the level of service they provide? Should the patients have more freedom on the hospital to go to? Should the patients accumulate “credits” from their insurance companies that can use for full treatments?

  • hawkeye

    Patients are not in a position to check what exactly is provided by their medical insurance, commonly only when it is too late.

    Patients do not have the required knowledge to judge the importance and relevance of their insurance’s medical cover. Thus they are not qualified to chose which health insurance is the best or the most cost-effective, or even determine whether their health plan is adequate for their needs. Thus patients can easily be misled. Restrictions on HMOs would not solve this fundamental problem.

    The solution is to have a social health system, in which scientists and healthcare professionals will determine how and what services should be offered to the population, in order to maximize everyone’s health and welfare. This sounds paternalistic, but it is the only way to ensure that everyone’s needs are covered. From that point on, the quantity, quality and availability of healthcare becomes a political matter, up for every citizen to judge.

    So yes, the HMO model and private health insurance altogether should indeed be scrapped. To remove any doubt, I should point out that, in my experience as a doctor, a good deal of the population is a “hypochondriac” of some sort. They are always afraid that they are sick (though we doctors have a big responsibility for that). In a public health system, these people are appropriately investigated and they are then offered reassurance that they are in good health. But in a private health system, these people are usually victimised: they are easily persuaded into unneccessary investigations and ineffective treatments, which nevertheless earn a good profit for their carers. This is exploitation and should be stopped.

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