Great Britain In Denial About How Lousy Their Healthcare Actually Is
In April, the British Medical Journal published “How the NHS Measures Up to Other Health Systems,” a report about two studies conducted by the New York–based Commonwealth Fund that compared the health-care systems of 14 advanced countries. On the 20 measures of comparison, Britain’s famous or infamous centralized system, the National Health Service, performed well in 13, indifferently in two, and badly in five. Was this a cause for national rejoicing?
If popular satisfaction is the aim of a health-care system, the answer must be yes. According to the report, the British were the most satisfied with their health care of all the populations surveyed; they were the most confident that in the event of illness, they would receive the best and most up-to-date treatment; and they were the least anxious that their personal finances would prevent them from receiving proper treatment. One could doubtless raise objections to these measures of comparison, but let us for the sake of argument take the results at face value. Subjective satisfaction and relief of anxiety are not minor achievements. Indeed, though the free market’s ability to satisfy more needs and desires than any other system is usually cited as one of its principal advantages, here was an apparent instance of the contrary: a nonmarket health-care system that yielded the most satisfaction.
Still, the studies contained a paradox that the authors of the BMJ article failed to notice or, at any rate, to remark upon. On several measures of actual achievement, rather than subjective assessment, the NHS came out the worst of all the systems examined. For example, it ranked worst for five-year survival rates in cervical, breast, and colon cancer. It was also worst for 30-day mortality rates after admission to a hospital for either hemorrhagic or ischemic stroke. On only one clinical measure was it best: the avoidance of amputation of the foot in diabetic gangrene. More than one reason for this outcome is possible, but the most likely is that foot care for diabetics—a matter of no small importance—is well arranged in Britain; the amputation rate is four times higher in the United States.
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