How Far Is It?

August 25th, 2009 | Healthcare Reform

Its about 650 miles from Paris, France to Berlin, Germany.  It’s about that far from Boston to Charlottesville, Virginia and from San Francisco to Portland, Oregon. And, its about 3000 miles from Portland to The Big Apple.  Along the way from West to East, you pass over mountains, through deserts and vast hectares of farmland where very few people live.  Point is, a lot of things change when you move far away from a given location. Lifestyle, food, environment, health and – guess what – healthcare.  There are a lot of rather silly comparisons between European-style healthcare systems for small countries you can easily cross in half a day and the United States, one of the largest countries by square miles in the world and with an ethnically diverse population.  These comparisons are similar in foolishness to the comparisons of public transit systems in countries the size of American states.  The population of England is about 51 million in an area less than the state of Oregon, whose population is less than 4 million.  England is 9 times more densely populated than the US: I’ll betcha that makes public transit work better – if you can find a seat.

California has the sixth or seventh largest economy in the world – at least it did before the recession.  The areas like San Francisco have very mature Managed Care market structures.  If you go to Jackson, Mississippi you are not going to find a Managed Care insurance system like San Francisco.  And, given the lack of population size and density, you could never make one work.  The Greater Boston Area has the highest concentration per capita of physicians in the country – and perhaps the world.  (find it here: http://www.cms.hhs.gov/MedicareMedicaidStatSupp/LT/list.asp#TopOfPage)  That is not true of Millinocket, Maine or the State of Montana.  Because of the disparity in geographical distances and provider concentration (among other factors) the Medicare Program has a special class of hospital called a Critical Access Hospital to service rural areas, which are paid based upon their costs rather than the standard Medicare Prospective Payment System – Millinocket has one of these.  Montana has less than 1 million people, but in size it is about the same square miles as Germany, which has 82 million residents.  You have to travel a long way for healthcare in much of Montana, without public transit.

I heard a rather curious report on NPR yesterday, which did not serve to freshen the air. http://www.npr.mobi/templates/story/story.php?storyId=112172939.  The interviewee was a Washington Post Reporter who had traveled around the world for three years to write a book on different healthcare systems.  He had a number of anecdotes about doctors he had interviewed in various countries, the collection of which made him an expert on what healthcare system was best, I guess.  To be fair, I haven’t read the book, but I have been doing this for more than 30 years and doubt you could learn every major health system in only three years.  My favorite story was how the Japanese love going to the doctor.  He failed to mention that per capita spending on pharmaceuticals in Japan is 16% higher than in the US, the highest in the developed countries. Don’t take my word for it, read it for yourself. http://www.vfa.de/download/SAVE/en/vfa-en/publikationen-en/e-statistics/e-statistics-2008.pdf  This has something to do with the fact that “Japan has fewer physicians per capita than most other OECD countries. In 2006, Japan had 2.1 practising physicians per 1 000 population, well below the OECD average of 3.1. The relatively low number of doctors per capita in Japan is due at least partly to government policies fixing limits on the number of new entrants in medical schools.” http://www.oecd.org/dataoecd/45/51/38979974.pdf  No time for treatment, take this pill.  He did say, without elaboration, that Japan’s average hospital stay is 36 nights versus our 6 nights.  I, for one, would love to hear what he learned about that.

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