Wandering the information superhighway, he came upon the last refuge of civilization, PoFo, the only forum on the internet ...
Well I always see this double-barreled factoid about the U.S. spending more per capita on healthcare and yet the health of Americans' was worse-than-average by most measurements..
There's no empirical evidence to back that claim.
British Rationing wrote:One of the most controversial rows over rationing concerns beta interferon, a treatment for multiple sclerosis.
The full effectiveness of the drug has yet to be established, and because it is very costly - approximately Â£10,000 per patient per year - some health authorities are reluctant to allow doctors to prescribe it.
Another example is a drug used in the treatment of ovarian cancer, Taxol, which has been licensed for use in the UK since mid-1998.
Viagra has been restricted to certain patients
It costs Â£1,500 per injection and the average course requires six of these.
There are two studies that show the drug extends a patient's life by a year, but this is not enough evidence to justify prescribing it for everyone with ovarian cancer.
During the years of fiscal famine of the 1990s, health professional enrolment was either reduced (e.g., 10% in the case of medicine) or flat-lined. While there have been increases since 2000, we are about to face the double impact of both an aging population as the first of the baby boomers reach 65 in 2011 and aging health professions. For example, more than 1 out of 3 physicians (35%) are aged 55 or older and the average age of the physician population is 51. As many as 4,000 physicians are expected to retire in the next 2 years.
Rationing : â€œEverything is Free but Nothing is Readily Availableâ€ (Frogue et al, 2001)
Like other nations experiencing limitless demand, an ageing population and the costly advance of medical technology, Canada has faced pressure to control health expenditure. It has done so through explicit rationing.
Set up in 1989, the Canadian Co-ordinating Office for Health Technology Assessment is the Canadian predecessor to our NICE, charged with exactly the same brief and, it seems, carrying out its function in the same way. For example, in the case of new cancer treatment, the latest pharmaceuticals (such as visudyne for macular degeneration), and high-tech diagnostic tests, Canadian governments simply reduce their expenses by limiting the service. Such a method of rationing is only possible in a single-payer monopoly. Medicare also shares other defining characteristics of monopolies: limited information, little transparency and poor accountability.
Canada has faced increased pressure to reform hospital structures to accommodate the changing pattern of care from an institutional to a community-based model. Reforms have attempted to limit growth and manage the system more effectively. Provinces have proven their ability to manage cost control by the use of their monopsonistic power associated with the single payer structure (WHO, 1996). Hospitals are paid through the imposition of annual global budgets by provincial governments. The downside of this cost controlling efficiency is
evident by the problem of waiting lists and dilapidated technology and equipment.
For example, the Canadian think tank, the Fraser Institute, found that, for patients requiring surgery, the total average waiting time from the initial visit to the family doctor through to surgery was 17.7 weeks, a significantly more than the 16 weeks found in 2001.1 Median waiting times remain higher in every category than are deemed â€˜clinically reasonableâ€™ median waiting times by physicians in 2005. (Fraser Institute, 2005, Chart 14.) Overall, 85 per cent of median waiting times are higher than clinically reasonable waiting times. (Fraser Institute, p. 27.)
In 2005 Canadians waited 12.3 weeks for an MRI scan, 5.5 weeks for a CT-scan and 3.4 weeks for an ultrasound. (Fraser Institute, Chart 16.) In 2002, Canada had fewer CT scanners per 1,000 population than the OECD average (10.8 compared with 19). Similarly, it had only 4.7 MRI scanners per 1,000 population compared with an OECD average of 7.9. Unsurprisingly, many choose to fly south to the US for diagnosis and treatment.
Canada ranked 24th out of 27 OECD countries in 2002 for the number of doctors per 1,000 population. It had 2.3 compared with an OECD average of 2.9.
A key factor behind these statistics is the inability of the Canadian system to provide even equipment deemed basic, let alone new technology. Dozens of diagnostic and therapeutic products developed decades ago, in widespread use in other countries, are relatively unavailable to Canadians. One example is the SynchroMed implantable drug infusion pump, a therapeutic device that, when combined with an antispasmodic drug, can be used in patients with severe spasticity resulting from injury (spinal cord trauma, brain injury) or disease (multiple sclerosis, cerebral palsy) to regain their mobility and independence, and to control their pain. Patients use SynchroMed, in Yugoslavia and Russia, saving their respective health care systems upwards of $100,000 per year in treatment costs. Canadian hospitals, however, refuse to provide patients with the $8,000 device (Gratzer, 2002, p. 83).
An assessment in 2000 by the Canadian Medical Association (CMA) argued that shortages have led to an â€œunconscionableâ€ delay in the diagnosis and treatment of diseases such as cancer, heart disease, and debilitating bone and joint ailments (Gratzer, 2002, p. 88). â€œWeâ€™re not talking about Ferraris and Lamborghinis here,â€ according to Dr Hugh Scully, the head of the CMA. â€œWeâ€™re talking about the Chevrolets and the Fords that are necessary to make it [diagnosis] accessible and reasonable for everybody.2 To use Dr Phil Malpassâ€™ phrase, medicare is â€œfunctionally obsoleteâ€.3
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