US and Candian health systems

The New England Journal of Medicine has several interesting articles today about the US and Canadian health systems. The NY Times is running this brief Reuters article: Health Costs Compared

A comparison of health care costs has found that 31 cents of every dollar spent on health care in the United States pays administrative costs, nearly double the rate in Canada.

Researchers who prepared the comparison said today that the United States wasted more money on health bureaucracy than it would cost to provide health care to the tens of millions of the uninsured. Americans spend $752 more per person per year than Canadians in administrative costs, investigators from Harvard and the Canadian Institute for Health Information found.

That is the entire NY Times piece. The editor did not do his/her homework and omitted important parts of the article. Bureaucracy dogs health care: study

But in an editorial in the journal, Henry Aaron of the Brookings Institution in Washington, said the administrative costs in the United States may be 24 percent lower than the Woolhandler estimate.

He said the excess spending on health care administration in 1999 was probably closer to $159 billion, not $209 billion cited in the study.

Aaron said it also doesn?t prove the United States would save a lot of money if it converted to the Canadian system.

While Aaron characterized the U.S. health care system as ?an administrative monstrosity,? he said the latest comparisons ?clearly exaggerate? the differences between the North American neighbors.

Better yet they and you should read the entire editorial which finishes:

More fundamentally, the administrative structure of any nation’s health care system, and certainly those of Canada and the United States, evolves out of its political history and institutions. The U.S. health care administration, weird though it may be, exists for fundamental reasons, including a pervasive popular distrust of centralized authority, a federalist governmental structure, insistence on individual choice (even when, as it appears to me, choice sometimes yields no demonstrable benefit), the continuing and unabated power of large economic interests, and the virtual impossibility (during normal times in a democracy whose Constitution potentiates the power of dissenting minorities) of radically restructuring the nation’s largest industry ? an industry as big as the entire economy of France. For these reasons, careful scrutiny of how the United States administers its health care system, with an eye to how it can be improved within the limits imposed by history, politics, and economics, is useful. But analytically flawed comparisons with other nations, whose systems differ greatly from our own and that we are most unlikely to emulate, may titillate policymakers and others but provide them with little useful guidance.

For those who get the NEJM, read the editorial here: The Costs of Health Care Administration in the United States and Canada ? Questionable Answers to a Questionable Question

Medicare will pay for lung reduction surgery in selected patients

Medicare to Pay for Major Lung Operation

Medicare said yesterday that it would cover the operation for two groups of patients: those who have severe emphysema in the upper lobes of their lungs, and those who have both severe disease elsewhere in the lungs and a poor ability to exercise. In addition, such patients would need certain other test results to make sure they were not at high risk of dying from the surgery itself.

Medicare will also require that patients be given an extensive exercise and education program to improve lung function both before and after the surgery.

The operation will be covered only at certain hospitals accredited by the Centers for Medicare and Medicaid Services; the hospitals have not yet been named.

Two million Americans have emphysema, but only a small fraction ? perhaps as few as 10,000, researchers say ? would qualify for the surgery. The disease, which destroys the air sacs in the lungs, makes it increasingly harder to breathe. It is nearly always caused by smoking. Emphysema is incurable and often fatal, and it causes or contributes to 100,000 deaths a year in the United States. Caring for people with the disease costs more than $2.5 billion a year.

The decision to begin covering the lung reduction surgery is based on the findings of a government-sponsored study published in May in The New England Journal of Medicine. That study, called NETT, for National Emphysema Treatment Trial, found that in about 25 percent of participants, the operation improved both quality of life and length of survival. In others, it did not prolong life but did improve exercise capacity or overall quality of life. In an additional 30 percent, the operation was either too risky or simply did not help.

Simple advice – avoid getting emphysema. Do not smoke!!!!