Because the NHS doesn't optimise for cost, it optimises for cost per QALY (quality adjusted life years). Given the high impact to quality of life for blindness your claim is dubious.
NICE make the decisions over cost effectiveness of treatments, and publish their findings. If you can tell me the name of the drug we can find the actual report.
Some Trusts were attempting to make this the first line treatment as an off-license prescription as it was cheaper and the pharmaceutical companies were trying to sue the Trusts for "not providing NICE approved medications and therefore disadvantaging patients" while simultaneously not seeking to license Avastin for wet AMD.
This was a few years ago so I may have misremembered some details.
I'm getting really repetitive but transparency transparency transparency.
Let's make public the cases where the suppliers collude to withhold drugs for actual effective usages "because we have this other more expensive option that's the only one we sent in for approval" whine bitch stfu and do what's best for the patients you money grubbing bastards.
Lots of hits in google.
https://www.independent.co.uk/news/health/glaucoma-nhs-delay...
https://www.thetimes.co.uk/article/elderly-go-blind-as-nhs-i...
https://www.telegraph.co.uk/news/2018/06/06/hundreds-going-b...
https://www.dailymail.co.uk/health/article-122995/You-blind-...
https://www.lbc.co.uk/news/long-nhs-delays-mean-patients-are...
https://www.thesun.co.uk/news/10702618/nhs-delays-left-patie...
https://www.dailymail.co.uk/health/article-7864729/22-glauco...
The cost decision involved was of course not to have the follow up appointments sooner..
In 2012 they issued a report about the usage of Visudyne/photodynamic terapy which the Royal National Institute of Blind People objected to.
Avastin / Lucentis does not support the point being made. Lucentis, a very expensive medication, was both licenced for AMD and was approved by NICE for that use.
Avastin is identical, but was not licenced for AMD and so NICE was not able to recommend its use for AMD.
Doctors were using Avastin off label, and they wanted the government to force Avastin to be licenced for AMD which would have allowed it to be recommended by NICE.
The makers of Avastin and Lucentis fought this in the courts for years, and took action against NHS Trusts using Avastin off-label. The NHS won that legal case.
https://www.bbc.co.uk/news/health-30138097
https://www.hsj.co.uk/finance-and-efficiency/breaking-nhs-wi...
There is a problem of people going blind while waiting for treatment, but this is related to cataracts and glaucoma, not AMD, and it has nothing to do with NICE (who are the organisation that decides about cost effectiveness) and everything to do with a government that has chosen to de-fund the NHS.
This is what I was referring to.
The cost decision involved was of course not to have the follow up appointments sooner.
I don't really believe that doctors are keeping people sick on purpose to keep demand for their profession high, but if that were going on, I don't think socialized healthcare would necessarily erase that incentive. There are plenty of government and private sector workers who try to preserve their own jobs to the detriment of the whole.
Of course, it’s far from perfect just like any regulatory agency ever.
I know Canada used to be fee-for-service. The more the doctor does, the more they get paid.
They certainly had an incentive to “do more”.
On short: much better to be a healthcare provider in US; much better to be a patient in EU.
The ability of national health systems to say “no” is one of the big levers to controlling cost, in the US, that control is quite fragmented.
Except that in such countries healthcare costs completely explode over time as well.
0: https://www.businessinsider.com/cost-of-healthcare-countries...
Yes, the US has the highest cost. But the ratio between the US and others has stayed roughly the same over the last 50 years (maybe longer--that's as far back as my data source goes). The US pays twice as much as France now because we paid twice as much as France in 1990, and both systems have had costs explode by about the same factor since then.
Here's a table of costs per capita in US dollars for the UK, France, and the US:
Year UK FR US
1980 385 659 1036
1990 782 1458 2700
2000 1561 2686 4557
2010 2871 4048 7939
2018 4070 4965 10586
Year UK FR US
1990 2.0 2.2 2.6
2000 4.1 4.1 4.4
2010 7.5 6.1 7.7
2018 10.6 7.5 10.2
Source:
1. Go to https://data.oecd.org/healthres/health-spending.htm
2. Uncheck "latest data available". This enables the year range selector control.
3. Use the year range selector to expand the range to 1970-2018.
4. The chart will then show the total costs in US dollars/capita by year of health care in 50 countries. You can use the "Highlighted Countries" drop down to narrow that to select a "background" of OECD, EU, Euro Area, G7, or G20 if you want. You can then add individual countries using the list on the left of that dialog.
5. You can change what is shown from total to government/compulsory, voluntary, or out-of-pocket and you can change the measure from per capita to % of GDP.
About 50% of all R&D worldwide happens in the US. The US's global share has shrunk a bit, but only because China and India have grown rapidly, not because Europe has ramped up (it hasn't).
Some new drugs are developed in European countries, or by European pharmaceutical companies - that's true. But European pharmaceutical companies all make a disproportionate amount of their revenue off of sales in the US market. So Europeans quite literally benefit the most from the fact that Americans pay more for the same drugs.
Yes, I agree that it's a foolish choice for the US to subsidize foreign countries' healthcare in this manner. Regardless of this decision that we both agree is foolish, it means that it's misleading to compare cost-effectiveness between the US and other countries directly.
Can you elaborate? Genuinely interested in the details.
It's hard to see how this can be true, since government operations are infamous for excessive cost.
The US system is very far from a free market.
If a lot of people in the US can’t afford treatment, then why does the US lead the world in several cancer outcomes? If people were just dying for lack of treatment, that would make outcomes far worse.
0: https://www.theguardian.com/us-news/2020/jan/07/americans-he...
The US even had a popular TV show about someone who got cancer and started making and selling meth to be able to afford treatment. Fantasy, sure, but nobody outside the US would even consider that a remotely plausible premise.
Sounds like you've never had a friend or family member die because the NHS found a reason to refuse treatment for their non-terminal cancer. At that point, if you don't want to die, your options are actually more expensive than in the US.
Yes, this happens - a lot more than people on HN like to admit. It's one of the reasons that the UK has one of the worst success rates for cancer treatment out of all of Europe.
Sounds like this is more a problem with NHS-specific bureaucracy or NHS funding rather than universal healthcare in general, though.
For a system designed to heal people, the priority should be to heal people, and to make the cost of doing so as low as possible. In this system, when somehow someone is unable to access healthcare they need, it's a failure of this particular implementation of the system, and something that needs to be fixed. The goal of the system is to take care of everybody.
The US system isn’t designed at all. Many if not most hospitals and insurers are non-profits, while others are operated by varying levels of government. The resulting patchwork is regulated on multiple levels of government with a variety of differing policy outcomes, but “profit” is not generally one of them.
There are, indeed, for-profit producers of drugs and medical equipment, but this is also true in the UK (GlaxoSmithKline is a British drug company).
> For a system designed to heal people, the priority should be to heal people, and to make the cost of doing so as low as possible. In this system, when somehow someone is unable to access healthcare they need, it's a failure of this particular implementation of the system, and something that needs to be fixed.
Minimizing cost and maximizing access are, in fact, competing goals. If a certain medical treatment is inherently costly to provide, you have to make a specific choice between cost and access. If you are unwilling to budget for competitive pay for health care professionals, you directly affect the availability of care by risking shortages of these professionals. Likewise if you don’t build enough hospitals. This fundamental constraint applies to all health care systems.
I would argue that having the government individually operate each hospital and directly employ each doctor and nurse imposes a heavy administrative burden that is fundamentally impossible to optimize for cost-efficacy. “Failures of implementation” are inevitable and systemic in this model; you may have paved a road with good intentions but that doesn’t mean it leads where you want to go. This is why the NHS is relatively unique even among universal systems and was not broadly replicated even in other European or Commonwealth countries, most of which seem to have better health outcomes.
I’m not saying the US system is perfect, or even better for that matter, but countries like Switzerland and a Singapore have systems that are arguably more privatized than the US while providing better outcomes as well. Even most countries with universal health insurance have some private sector involvement. The problems with the US health care system are far more complicated than the oversimplified conspiracy theories people keep spouting (theories that aren’t far off from those of anti-vaxxers or known frauds like Kevin Trudeau).
That isn't what happens in the English NHS. https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-eng...
Current inefficiencies in the NHS are caused by lack of investment in buildings and in staff. The NHS has less management than similarly-sized commercial companies, and none of that management is The Government.
> CCGs buy services from organisations of different shapes and sizes – from NHS trusts that run hospitals and community services, to GPs and others that provide NHS care, including organisations run by charities and the private sector.
Right, so “the government” funds a few public agencies which themselves pass on money to the CCG’s, which also seem to be quasi-autonomous public agencies. The actual care providers are sometimes in the private sector. I’m not sure what distinguishes NHS England or the CCG’s from “the government” other than semantics, but sure.
This is still more administrative overhead than other “universal” systems and does not seem to address the tradeoffs between cost and availability of care. Per Wikipedia:
> A survey of CCGs by the Health Service Journal in April 2015 found that more than a third were planning to save money by restricting access to services, particularly on "procedures of limited effectiveness", podiatry, IVF, and limiting access to procedures based on aspects of a patient's health, for example whether they smoke or are obese, which can affect outcomes.[30] A similar survey by the GP magazine Pulse, in July 2015, found that many CCGs were planning to restrict access to routine care in various ways.[31]
They're not run by a government minister; they're not staffed by civil servants; they're not a government department.
> This is still more administrative overhead than other “universal” systems
It really isn't though. Of course some management exists, it's a budget of over £100bn. But compared to other healthcare systems the NHS is relatively efficient. "The NHS is over-managed" is a persistent myth. See for example chapter 2 of this study: https://www.nuffieldtrust.org.uk/files/2018-06/the-nhs-at-70... (This study does contain a lot of stuff that the NHS is poor at).
>> They found that the NHS spends relatively little on overseeing and planning care, relative to other comparable systems. In 2014, the UK, Portugal and Ireland all devoted 1.5% or less of their government or compulsory health care expenditure to administration. This compares with an average of 3.1%, with 4.1% in France, and 7.9% in the United States.
> "procedures of limited effectiveness"
They're not going to fund things that don't work. Why is that a bad thing?
But, again, I've said that there are problems caused by the choice to de-fund the NHS and that if we had comparable funding as other nations we'd start seeing better outcomes.
It is extremly expensive to run the "insurance industry", much more than inefficiency in goverment run healthcare.
Do you think your insurance agent work without getting paid?
Well, sort of. Some treatments are free. Some other treatments are not covered at all by the NHS, which counterintuitively makes those conditions more expensive to treat in the UK than they would be in the US.
> longer life expectancy
Life expectancy is a horrible way to compare healthcare systems, because there are far too many confounding variables to draw any meaningful conclusions. In reality, factors such as genetics, economic history, and demographics will overpower any effects that healthcare delivery could possibly provide.
> and better health outcomes
Not quite. The UK scores better on some healthcare outcomes, but it scores dramatically worse on others. For cancer treatment, in fact, it's one of the worst in Europe, and far behind the US. (This has been demonstrated by a series of studies that have been replicated multiple times over the past 20 years, the most recent being published only one year ago).
It's only hard to see when you believe what business lobbyists tell you. It's actually easy to see when you look at the numbers.
The real lesson here is: don't believe everything people tell you. Look at the evidence first.
Now there are plenty of government projects that are woefully inefficient, but health insurance seems to be one that governments are actually good at. Maybe not great, but better than an unregulated market.
The US health system is very highly regulated. For what an unregulated market looks like, see the software business. Consumer costs for software have been largely driven to zero.
The software market is a very different market from the health care market. An unregulated software market may not quite be a free market due to monopolies and vendor lock-in, but for consumers, it's quite possible to say no to any software purchase. That's not the case with health care, where often your options are to pay or die. That means that in a profit-driven health care market, prices can be raised indiscriminately, especially in the case of the US where health care prices are often kept hidden, because the people who can afford to, will pay anyway. There's better margins in providing health care to the rich than in providing it to the poor. It's profitable to let the poor go without healthcare.
This makes the healthcare market a very poor market to let be government primarily by a profit motive. Of course health care companies in other systems still make a profit, but they are very limited in how far they can rip off their customers compared to the US.
Sure, private businesses want to charge as much as possible. But they only succeed when they've managed to get the government to limit or eliminate their competition (as goes on in health care).
At the same time most average employees will struggle to buy a house.
And the social security will reimburse well only medical costs (visit to family doctors or medical acts done in hospitals). For other costs, hospital care, glasses, dental or hearing costs, it reimburses very little.
So for me France's SS is actually a kind of mandatory way to channel money towards doctors.
Thus, that money doesn't just go to health care. It also goes to other social security programs and government projects.
Not in countries with a national health system, where the government is incentivized to keep people healthy in order to reduce cost.