I was in London for the just-concluded EULAR congress. Oh, the United Kingdom, that bastion of socialist medicine, where the National Health Service is the great equalizer. Heaven sent to some, death spiral of long wait times and old-fashioned medicine to others. While there, I chatted with people who have had experience with the NHS.
I spoke with a health care consultant, whose job is to make hospitals less wasteful. He says the U.K.’s health care expenditure as a percent of GDP [gross domestic product] is too high, compared with other Western nations. I suspect this was a line that he probably heard somewhere and blindly repeated, because when I pressed, he could not tell me what the numbers were, nor could he name the countries he was referring to.
I asked him for examples of how he thought the hospitals he’d served might save money. His biggest complaint was that many patients stay in hospital for months not out of medical necessity but because there is no system in place for lower-level care.
Another friend is the director of a home care service just outside Central London. She tells me that patients have access to an extraordinary amount of resources that allows them to stay at home: suction machines, dialysis machines, home aides. This is great for patients, but she is astounded by how many people got services that she thought were undeserved.
She also told me that, apropos of the impending Brexit, many of their home health aides come from other Eurozone countries. The British do not want to do these jobs, so should the Brexit happen, home health aides will be much harder to come by.
Of course, the most common complaint I heard was that wait times to see a physician are ridiculous. Those who can afford it, can get private insurance, which would allow them access to physicians sooner. In fact, private insurance is often an incentive for people to get promoted.
The British think their health care system is wasteful, as we do for ours. But according to the World Bank’s data from 2014, their health care spending as a percent of GDP is 9.1%, which is much better than ours at 17.1%. And although I was told by the health care consultant that their figure is higher than their neighbors, that just isn’t true. France’s figure is 11.5%, Belgium’s 10.6%, and Spain’s 9.0%. So what I took away from it was this: As different as our health care systems are, they are problematic in the same ways. People have health care that works. But hospital stays are often unnecessary, people take advantage of social safety nets, and there are jobs that mostly only immigrants are willing to perform. Wealthy people can afford to pay for private insurance. And the wait times! People will always complain about wait times, just like they do here, and elsewhere.
Dr. Chan practices rheumatology in Pawtucket, R.I.
