The NHS & the United States of America

[Loyal Rogue]

And from what I read, it is not 6 million, but over one million, by 2010.

The medical tourism site quoted the wrong figures.
If you follow the link "Researchers have confirmed that:" it will take you to the real article at TIME which states:

The medical tourism industry has experienced massive growth over the past decade. Experts in the field say as many as 150,000 U.S. citizens underwent medical treatment abroad in 2006 — the majority in Asia and Latin America. That number grew to an estimated 750,000 in 2007 and could reach as high as 6 million by 2010.

For some reason the links to TIME don't work from FK.
It seems that all links here go through some "go.internet.com" proxy redirect which screws up the TIME url.
Copy and paste the url below to go to the article.

time.com/time/health/article/0,8599,1861919,00.html

Following some of the links in that article leads to other related TIME articles.
An interesting sidenote, I always thought that medical tourism from the US was mainly for cosmetic/plastic surgery, but according to the CEO of the Bumrungrad Hospital in Bangkok, 83% of American patients flew in for noncosmetic surgeries.

time.com/time/magazine/article/0,9171,1196429,00.html

Whiplash was just the first agony that Kevin Miller, 45, suffered in a car accident last July. The second was sticker shock. The self-employed and uninsured chiropractor from Eunice, La., learned that it would cost $90,000 to get the herniated disk in his neck repaired. So, over the objections of his doctors, he turned to the Internet and made an appointment with Bumrungrad Hospital in Bangkok, the marble-floored mecca of the medical trade that--with its liveried bellhops, fountains and restaurants--resembles a grand hotel more than a clinic. There a U.S.-trained surgeon fixed Miller's injured disk for less than $10,000. "I wouldn't hesitate to come back for another procedure," says Miller, who was recovering last week at the Westin Grande in Bangkok.
With this surgical sojourn, his first trip outside the U.S., Miller joined the swelling ranks of medical tourists. As word has spread about the high-quality care and cut-rate surgery available in such countries as India, Thailand, Singapore and Malaysia, a growing stream of uninsured and underinsured Americans are boarding planes not for the typical face-lift or tummy tuck but for discount hip replacements and sophisticated heart surgeries. Bumrungrad alone, according to CEO Curtis Schroeder, saw its stream of American patients climb to 55,000 last year, a 30% rise. Three-quarters of them flew in from the U.S.; 83% came for noncosmetic treatments. Meanwhile, India's trade in international patients is increasing at the same rate.

[gerbick]

How is this really any different?

Analysts say "Romney care" is basically "Obama care" minus the public option.

So it's the public option that has everybody calling random people Nazis, whatnot?

[TallGuyLittleCar]

How is this really any different?



So it's the public option that has everybody calling random people Nazis, whatnot?

I think when anybody calls somebody else a nazi or compares them to hilter.. you can pretty much rule out logic and reason.... except saddam hussein.. cause he was bad.

[FlashLackey]

Dan Hannan is a ****ing nobody moron who was paid a **** load of money by your insurance companies to slag off a system that, yes, has its faults, but provides for every man, women and child in Britain.

At a lower quality than they could receive in the US.

He's not even a real MP, he's an MEP – Member of European Parliament. He has no power, say or vote on any NHS matters.

I judge peoples ideas by their merit, not by the persons title or function. Besides, the point is that LR was mistaken in claiming that conservatives are for socialized health care. By definition, it's the opposite of a conservative solution. Not that someone who calls themselves a conservative can't make an exception for something.

FlashLackey, consider this: I'm a single father with three kids. Their mother died of cancer. She was the income earner for the household and had insurance for us. Now I've got a part-time job, as well as looking after the kids, but it doesn't come with insurance, so I'm having to pay for it myself, which I can barely afford for the whole family. I can't afford broadband or to take the kids on holiday. I can only just put food on the table after the I pay the insurance. I have a liver disease, which my insurance company doesn't cover because it's "pre-existing".

In a year's time I will need an operation to remove my liver.

In this circumstance, what would happen to me in the US today? What would you propose?

I believe that you would qualify for Medicaid and you would receive assistance.

Can you not agree that, in that circumstance, a national health service is better for his family?

The best service for his family would be one that charges every tax payer and gives all the revenue directly to him so that he could then be a multi-billionaire. At issue is not what is best for a single circumstance or person. Rather, what serves the society at large, best? A system that is convenient for one situation isn't much good if over-all, more people in that society die due to lower quality of care. The sum result is the society lost more citizens that it didn't have to.

If one thinks that "Competition fixes all" in regards to health insurance they are sadly mistaken. When Obama during the election spoke of the turmoils his mother went thru with her health care provider trying to get them to own up to their responsibilities it struck a nerve with me.

We don't currently have normal competition in the health insurance industry. You can't even buy insurance from across state lines, allowing many companies to establish local monopolies. Wouldn't it make sense to pit them against each other more so that they are forced to hold the lowest margins they can afford and the best terms in order not to lose market share to their competitors?

The changes proposed by Obama, et al, would not have been affected my father's outcome - I'm not that stupid either. However, it pains me that people have the audacity to think that people actually want to be uncovered - when a lot have no choice to do so. It's either pay for a light bill, or pay the health bill... or pay for groceries... or pay for health coverage. I've seen that.

Some do have no choice, true. But, it's simply a matter of fact that a lot of the uninsured choose not to be covered. It's not at the expense of light bills or groceries but ipods and sneakers.

Anyway, argue on. I'm amazed at the argument against a change than the reasons why a change might be needed.

What's wrong with a change that addresses the things you are concerned about that isn't Obama's solution?

What I can't get my head around is why are so many people so passionate about lining the pockets of the insurance companies?

Who is so passionate about that?

http://www.time.com/time/health/arti...861919,00.html
<THIS LINK DOES NOT WORK - but is the heading of the first paragraph in the second link...

http://www.health-tourism.com/medica.../usa-research/

...Not statistics per se, but reporting based on statistics.

That's not reporting based on statistics. That's hearsay. We don't know who these experts are, what their methodology was or if they even had one at all.

It's interesting to note this excerpt under "Reasons Why American Patients are Traveling Abroad for Medical Treatments":

Patients from the US are provided with brand new facilities and equipment due to fierce competition among hospitals and global medical tourism centers. Though price is an important factor, there are other benefits of medical tourism.

This sounds like it supports my position that increased competition increases quality facilities and equipment for lower prices.

And this article describes the opposite trend while specifying a source:

But while the trend continues, and raises important questions about why so many Americans can't afford health care at home, a new report points out that the largest segment of medical travelers are headed stateside. And, experts say, they're also growing in numbers.

http://www.forbes.com/2008/05/25/hea...tsourcing.html

FL tried to make it seem that the article he quoted earlier was saying that people are flocking TO the US when it actually said the opposite.

Interesting. I don't recall posting a link regarding that point in the past. But, I have now. I suppose you will also think that McKinsey & Co. are part of the vast right-wing conspiracy as well.

How is this really any different?

It's quite a bit different than Obama's solution. Though, I will say that I am not a fan of it either, compared to other more straight-forward plans.

[Loyal Rogue]

At a lower quality than they could receive in the US.

Oops, you forgot to put the qualifier on your statement again...

At a lower quality than they could receive in the US if every one of them were millionares.

There, fixed it.

See that's one of the problems in the arguments you try to use.
Overall quality of care for everyone cannot be judged by the quality care that only the wealthiest can afford, just as the overall quality of health of the population cannot be judged strictly on the basis of one or two narrow types of cancer while completely ignoring every other factor and health problem.

We don't currently have normal competition in the health insurance industry. You can't even buy insurance from across state lines, allowing many companies to establish local monopolies.

The major reason we don't have true competition in the industry is because that's the way the insurance companies have used their influence to write the laws.
They don't want competition.
They are the ones that create monopolies by spending billions buying legislation that allows them to takeover or force out any competition just like they are doing now to the public insurance option.

Some do have no choice, true. But, it's simply a matter of fact that a lot of the uninsured choose not to be covered. It's not at the expense of light bills or groceries but ipods and sneakers.

Nonsense. That is nothing more than a ridiculous republican talking point.
This is the same hogwash tactic that was used by the Reagan administration for the idea of "welfare queens".

That's not reporting based on statistics. That's hearsay. We don't know who these experts are, what their methodology was or if they even had one at all.
....
And this article describes the opposite trend while specifying a source:
....
Interesting. I don't recall posting a link regarding that point in the past. But, I have now. I suppose you will also think that McKinsey & Co. are part of the vast right-wing conspiracy as well.

A dodgy "study" (that statstically ignores 98% of medical travelers) by a giant corporate consulting firm in a business magazine run by a conservative, supply-side, rightwing republican politician?... yes, I can see where some might be a little skeptical about the motive, methods, and math behind it.

All conspiring, collusion, and marketing damage-control aside, just looking at the numbers that McKinsey throws out there should send up a huge red flag to anyone who's read more than that single article.
Considering that by all other estimates, worldwide medical travelers already number in the millions, the fact that Forbes would state about the study that "It narrowly defined medical travelers as only those whose primary and explicit purpose in traveling was to obtain in-patient medical treatment in a foreign country, putting the total number of travelers at 60,000 to 85,000 per year." just shows that they are twisting the numbers from the get go.

Let's take a moment to look at a single but HUGE statistical error in your "study".
McKinsey only counted in-patient procedures while ignoring the fact that the vast majority of medical travel is not for in-patient procedures.
Dental is one of the main forms of health insurance that Americans can't afford and accounts for up to 40% of all medical travel from the US to foreign countries.
None of that is in-patient so was not counted in McKinsey's "study".
Neither were any procedures such as eye surgery, cataract removal, corneal transplant, lasik, hip replacement, knee replacement, tumor removal, cancer treatments, esophageal surgery, colon/rectal surgery, diverticulosis, ear surgey, cochlear implants, or most other forms of surgery on ear/nose/throat or extremities all of which are considered out-patient procedures.
According to the National Center for Health Statistics at the Centers for Disease Control and Prevention, in 2006 two-thirds (15 million) of all surgeries in the US were out-patient procedures.
So looking at across-the-board surgeries according to the CDC, McKinsey's so-called "study" ignores at least two-thirds of all surgeries.
And that's before McKinsey even starts to massage the rest of the numbers by only using data from a very small percentage of wordwide hospitals that only belong to a particular accrediting body (50) while ignoring all other in-patient procedures done at the thousands upon thousands of other hospitals, surgery centers, and clinics around the world.

So from the beginning, out of the estimated 5 million worldwide medical travelers, the McKinsey "study" pretends that more than 98% (4.9 million) don't even exist.
So out of the 2% left, they further state that 40% of those travelers are the wealthy ones that don't care about cost or distance and just want the very best that money can buy (because they can afford it).
The article further states that of that 40%, "Most of those patients in search of the best care" are going to the US.

So to recap Forbes and McKinsey, "most" of less than half of 2% of medical travelers are headed for the United States.

That may be one of the best examples of the old adage that "Figures don't lie, but liars figure" that I have ever seen.

Now that I think about it, it becomes very apparent why you would be attracted to that particular article.
It uses language and reasoning very similar to your own arguments.

a new report points out that the largest segment of medical travelers are headed stateside.

Ooops, seems they forgot to add the qualifier to that statement also...

a new report points out that the largest segment of less than 1% of medical travelers are headed stateside.

There, fixed.

[FlashLackey]

See that's one of the problems in the arguments you try to use.
Overall quality of care for everyone cannot be judged by the quality care that only the wealthiest can afford, just as the overall quality of health of the population cannot be judged strictly on the basis of one or two narrow types of cancer while completely ignoring every other factor and health problem.

Yes. Overall quality provided by a system can't be judged by what only the wealthy have. But, it can be judged by the over-all performance. And I have provided evidence demonstrating that it is comparatively high, over-all in the US. You have not shown anything to the contrary.

It was three cancers studied, chosen because they are some of the most common cancers that people get. The performance of our system when dealing with those cancers is a good indication of general quality because it's not plausible that any system would have any reason to focus on and do well with three very common diseases at the expense of others.

If you think that there are other illnesses that Americans get that our system performs relatively badly at treating, go ahead and show the evidence.

The major reason we don't have true competition in the industry is because that's the way the insurance companies have used their influence to write the laws.
They don't want competition.
They are the ones that create monopolies by spending billions buying legislation that allows them to takeover or force out any competition

I agree with this. So, how is it not logical that we join together to simply repeal the government legislation prohibiting buying insurance across state lines?

This point suggests that there are simpler solutions to the problem than creating a new government bureaucracy.

Nonsense. That is nothing more than a ridiculous republican talking point.
This is the same hogwash tactic that was used by the Reagan administration for the idea of "welfare queens".

I've already posted evidence showing this. Do you have any evidence showing the contrary?

Considering that by all other estimates, worldwide medical travelers already number in the millions, the fact that Forbes would state about the study that "It narrowly defined medical travelers as only those whose primary and explicit purpose in traveling was to obtain in-patient medical treatment in a foreign country, putting the total number of travelers at 60,000 to 85,000 per year." just shows that they are twisting the numbers from the get go.

How is that twisting numbers? They clearly explain the criteria they used for their study.

Let's take a moment to look at a single but HUGE statistical error in your "study".
McKinsey only counted in-patient procedures while ignoring the fact that the vast majority of medical travel is not for in-patient procedures.

This doesn't describe a "statistical error" of any kind. Are you saying that more people are going to the US for procedures that require that they stay the night in the hospital but more people are going elsewhere for procedures that don't require that? Do you have any evidence demonstrating that to be the case?

Do inpatient procedures not indicate where people are going when quality matters more than cost? Someone trying to save money with an inexpensive boob-job in another country is not an indication that the quality of our health care is lower.

And that's before McKinsey even starts to massage the rest of the numbers by only using data from a very small percentage of wordwide hospitals that only belong to a particular accrediting body (50) while ignoring all other in-patient procedures done at the thousands upon thousands of other hospitals, surgery centers, and clinics around the world.

You are mistaken. There are more than 50 JCI hospitals in the world and the report used data from non-JCI as well as JCI hospitals.

So from the beginning, out of the estimated 5 million worldwide medical travelers, the McKinsey "study" pretends that more than 98% (4.9 million) don't even exist.

No they don't. They simply define their criteria.

So out of the 2% left, they further state that 40% of those travelers are the wealthy ones that don't care about cost or distance and just want the very best that money can buy (because they can afford it).

The article further states that of that 40%, "Most of those patients in search of the best care" are going to the US.

Exactly. Indicating that the US provides the highest quality medical care in the world. Those that can afford it will go to great lengths to receive it.

So to recap Forbes and McKinsey, "most" of less than half of 2% of medical travelers are headed for the United States.

To re-cap: the majority of people going somewhere for a procedure complicated enough that it requires they stay at a hospital over night are going to the US. This is an indication that the quality of health care in the US is very high.

[david petley]

bollocks




<edit> sorry, just typed the first thing that came into my head after reading the above...maybe it's not bollocks

<second edit> I am just always astonished at the statistical gymnastics that someone will go through to prove a point...it's like watching a contortionist bend themselves into a birdcage.

[Loyal Rogue]

Yes. Overall quality provided by a system can't be judged by what only the wealthy have. But, it can be judged by the over-all performance. And I have provided evidence demonstrating that it is comparatively high, over-all in the US. You have not shown anything to the contrary.

You have demonstrated only that you are willing to ignore the main indicators that are used to judge healthcare globally, infant mortality rates and life expectancy, in favor of extremely narrow "cherry-picked" stats based on unreliable test results to try and prove a false point because apparently you're unable to disagree with your ideology based on contradictory facts.

Much like the "evidence" for going to war in Iraq or the "evidence" against manmade climate change, this appears to be another issue where the rightwing faith-based community is not allowed to agree with the reality-based community and is willing to twist the facts until they can claim that they fit their faith.

It was three cancers studied, chosen because they are some of the most common cancers that people get. The performance of our system when dealing with those cancers is a good indication of general quality because it's not plausible that any system would have any reason to focus on and do well with three very common diseases at the expense of others.

Actually it's extremely plausible to only focus on the couple of tests that show good results out of the thousands of others that don't when you are trying to catapult the propaganda that you're #1 in an area where independent global statistics place you at about 37th.

If you think that there are other illnesses that Americans get that our system performs relatively badly at treating, go ahead and show the evidence.

LOL
Try ALL of them if you can't afford the treatments, have no insurance, are under insured, can't afford the deductibles or copays, or get denied by your insurance company.

I agree with this. So, how is it not logical that we join together to simply repeal the government legislation prohibiting buying insurance across state lines?

That is a red herring.
The whole "across state lines" issue is about allowing an insurance company to sell insurance in a particular state while ignoring the state laws that govern insurance companies within that state.
This would allow an insurance company to cherry-pick which one state's laws they will follow while ignoring every other.
Nothing is currently stopping an insurance company from selling in any state so long as they want to setup shop there and abide by that state's laws.

The problem with the industry is not too much regulation but not enough.
Competition won't come from removing the existing regulations. That will only allow bigger companies to force out more competition than they already do allowing more monopolies and less choice.
What kind of regulation do you propose to prevent that from happening?

I've already posted evidence showing this. Do you have any evidence showing the contrary?

Your "evidence" has been debunked by a new study on the Dept. of Health and Human Services website here:
http://www.ahrq.gov/news/press/pr2009/faminspr.htm

How is that twisting numbers? They clearly explain the criteria they used for their study.

Yes, I know they did.
If you are willing to ignore 98% of the data and only cherry-pick the 2% that agrees with your assumption then you can "prove" just about anything.

Using McKinsey's methods I could prove to you that most people shopping at Wal-Mart only purchase yellow Hello Kitty underwear if I define the criteria enough to exclude the other 98% of shoppers and products in the store.

To further expand on DP's gymnastics reference, you would clearly win a gold medal.

This doesn't describe a "statistical error" of any kind.

No? Then perhaps your definition for "statistical error" is different from the rest of the world?

Are you saying that more people are going to the US for procedures that require that they stay the night in the hospital but more people are going elsewhere for procedures that don't require that?

No, I'm simply stating that your so-called "evidence" is a gross distortion of the facts.
Considering that your own "study" only stated that "most" of less than 40% are going to the US, even they contradict your assumptions by leaving unspoken that more than 60% are not going to the US.
That's not even factoring in that they completely ignore 98% of all medical travelers in order to arrive at those bogus numbers.

Do inpatient procedures not indicate where people are going when quality matters more than cost?

No, that is a false assumption.
Quality of surgery has nothing to do with whether it is an in-patient or out-patient procedure.
Are you saying that people who have corneal transplants or any other surgery done to their eyes (all out-patient) aren't concerned about quality???

You are mistaken. There are more than 50 JCI hospitals in the world and the report used data from non-JCI as well as JCI hospitals.

No I'm not. I never said there were only 50 JCI hospitals worldwide.
There are over 200.
I said that McKinsey only collected data from 50 of those JCI hospitals and that comprised almost the total data for their study.

No they don't. They simply define their criteria.

Yes they certainly do.

Another 10.0 performance. Bravo!

To re-cap: the majority of people going somewhere for a procedure complicated enough that it requires they stay at a hospital over night are going to the US.

To recap: only if you ignore the 98% of data that doesn't agree with you.

After careful reconsideration, I'm afraid I shortchanged you earlier... I don't believe anyone could even come close to your performance so I'm awarding you not only the gold, but the silver and bronze as well.

This is an indication that the quality of health care in the US is very high.

Ooops, forgot that qualifier again... "for millionaires."

[gerbick]

Parts of this thread make more sense after watching Fox News for part of the day.

[david petley]

How is that twisting numbers? They clearly explain the criteria they used for their study.

Yes, and the criteria was exclusive.

You are mistaken. There are more than 50 JCI hospitals in the world and the report used data from non-JCI as well as JCI hospitals.

How many non-JCI hospitals out of the total?

No they don't. They simply define their criteria.

Yes, and the criteria was exclusive.

This link is obviously going to be biased towards promoting medical travel considering the source, but it is an interesting read on why one 'respected industry analyst' says Mckinsey got it wrong.

McKinsey’s research on why people go into foreign hospitals conflicts with all other reports and the experience of people in this business. The clue here is that “Nearly every provider [McKinsey] visited has received this form of [JCI] accreditation”. This is a basic sampling error. Simply researching JCI hospitals does not represent a fair or accurate sample in any country. The vast majority of medical travellers use clinics, surgeries and hospitals that are not and have no need nor inclination to be part of the JCI system.

To re-cap: the majority of people going somewhere for a procedure complicated enough that it requires they stay at a hospital over night are going to the US. This is an indication that the quality of health care in the US is very high.

So, I forget, too much to re-read ...How did we get to where the number of overnight stays in US hospitals from medical tourists somehow measure the quality of the health care system in the US overall?

david

[FlashLackey]

You have demonstrated only that you are willing to ignore the main indicators that are used to judge healthcare globally, infant mortality rates and life expectancy, in favor of extremely narrow "cherry-picked" stats based on unreliable test results to try and prove a false point because apparently you're unable to disagree with your ideology based on contradictory facts.

Infant mortality has all kinds of problems as an indicator of health care quality:

Like census data, survey data on infant mortality may omit births and deaths, include stillbirths along with live births, and suffer from survivor selection bias and age truncation. Direct estimates of infant mortality based on survey data may also suffer from mothers misreporting their children’s birth dates, current age or age at death—perhaps more so if the child has died. The heaping of deaths at age 12 months is especially common. Age heaping may transfer deaths across the one-year boundary and lead to underestimates of infant mortality rates.

http://mdgs.un.org/unsd/mdg/Metadata...0&SeriesId=562

First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country.

Infant mortality in developed countries is not about healthy babies dying of treatable conditions as in the past. Most of the infants we lose today are born critically ill, and 40 percent die within the first day of life. The major causes are low birth weight and prematurity, and congenital malformations. As Nicholas Eberstadt, a scholar at the American Enterprise Institute, points out, Norway, which has one of the lowest infant mortality rates, shows no better infant survival than the United States when you factor in weight at birth.

http://health.usnews.com/usnews/heal...924/2healy.htm

Sounds like "unreliable test results to try and prove a false point" to me.

If you remove fatal injuries from life expectancies, as one logically would if they were interested in the quality of care rather than mixing peoples life decisions into the results, the US ranks very high: http://politicalcalculations.blogspo...in-united.html

Much like the "evidence" for going to war in Iraq or the

You don't believe that Saddam Hussein was in violation of multiple international laws consistently for several years?

"evidence" against manmade climate change, this appears to be another issue where the rightwing faith-based community is not allowed to agree with the reality-based community and is willing to twist the facts until they can claim that they fit their faith.

You have this backward. The burden of proof for a claim is on the person that makes it. It is for those making the claim to prove that climate change is man-made. The opponents you speak of are against basing new policy on the premise of man-made climate change because it has not been convincingly demonstrated.

The only people with faith on that issue are the vast majority of climate change believers. Don't believe me? Ask any one of them that you know to explain how they know that climate change is man-made. Then tell me with a straight face that there was no faith involved in their answer. That or a bunch of "uhhh... well... i'm no expert... [joke] hahaha..."

Actually it's extremely plausible to only focus on the couple of tests that show good results out of the thousands of others that don't when you are trying to catapult the propaganda that you're #1 in an area where independent global statistics place you at about 37th.

The WHO is about as independent to health care as members of a crowd selected to ask Obama specific questions.

Try ALL of them if you can't afford the treatments, have no insurance, are under insured, can't afford the deductibles or copays, or get denied by your insurance company.

Why dodge the question? Do you think we have good quality care or not? Is it access or quality that is the problem in your view?

That is a red herring.
The whole "across state lines" issue is about allowing an insurance company to sell insurance in a particular state while ignoring the state laws that govern insurance companies within that state.
This would allow an insurance company to cherry-pick which one state's laws they will follow while ignoring every other.
Nothing is currently stopping an insurance company from selling in any state so long as they want to setup shop there and abide by that state's laws.

Big whoop. Then create a federal body of laws that governs all health insurance the same. It would cost about three trillion dollars less in 10 years than the current proposal.

The problem with the industry is not too much regulation but not enough.
Competition won't come from removing the existing regulations. That will only allow bigger companies to force out more competition than they already do allowing more monopolies and less choice.
What kind of regulation do you propose to prevent that from happening?

None would be needed regarding that issue. It's possible that some small companies wouldn't be able to compete. However, large pools of insurance holders is what allows insurance companies to offer lower rates. And there are many nation-wide industries that have healthy competition, providing consumers with many affordable options.

The burden of proof is on you to substantiate why you believe that nationwide competition between insurance companies would create anti-trust issues.

Your "evidence" has been debunked by a new study on the Dept. of Health and Human Services website here:
http://www.ahrq.gov/news/press/pr2009/faminspr.htm

What? This doesn't "debunk" what I've posted at all. I can see how having such an ambiguous, low standard of evidence to support your assertions has led you into a wilderness of strange conclusions.

Yes, I know they did.
If you are willing to ignore 98% of the data and only cherry-pick the 2% that agrees with your assumption then you can "prove" just about anything.

The only twisting of numbers going on here is you saying that they are ignoring 98% of the data. The study is not cherry picking because it is data that applies to all subjects based on the same criteria.

Using McKinsey's methods I could prove to you that most people shopping at Wal-Mart only purchase yellow Hello Kitty underwear if I define the criteria enough to exclude the other 98% of shoppers and products in the store.

Every study defines criteria. I find it strange that you think that is a method unique to McKinsey.

The question is whether or not the criteria allows for meaningful data. I think that knowing where people travel for inpatient treatment is a meaningful indicator of the quality of care between countries. Can you explain why you think it is not?

No? Then perhaps your definition for "statistical error" is different from the rest of the world?

I like how you see yourself as representative of the rest of the world. Good one.

No, I'm simply stating that your so-called "evidence" is a gross distortion of the facts.
Considering that your own "study" only stated that "most" of less than 40% are going to the US, even they contradict your assumptions by leaving unspoken that more than 60% are not going to the US.

With people going between all kinds of countries for medical care, 40% of all of them going to the US is a strikingly high number. What do you think the next highest percentage is for a single country?

No, that is a false assumption.
Quality of surgery has nothing to do with whether it is an in-patient or out-patient procedure.
Are you saying that people who have corneal transplants or any other surgery done to their eyes (all out-patient) aren't concerned about quality???

I'm sure that people are always concerned about quality but to various degrees. I'm saying that inpatient procedures are more likely to involve problems that are life-threatening. Nobody wants poor quality for a corneal transplant. But, do you seriously deny that more scrutiny goes into where a person will go for a heart transplant or brain surgery?

Yes, and the criteria was exclusive.

That is what having criteria means.

How many non-JCI hospitals out of the total?

I don't know. I don't see how it is particularly relevant anyway. It's speculation that these hospitals wouldn't receive a representative number of inpatient travelers.

So, I forget, too much to re-read ...How did we get to where the number of overnight stays in US hospitals from medical tourists somehow measure the quality of the health care system in the US overall?

It's not a clear measure. Especially since it has a lot to do with cost. Many people may go to some other countries because it's cheaper, even though the quality is lower than in more expensive countries.

I just wrote that it was an indication of quality since, as the study noted, a large proportion of people are willing to spend a lot to have treatment here. We all know that health care is expensive here. It speaks to the quality of our care that people spend more than they would elsewhere to have treatment here.

[david petley]

I don't know. I don't see how it is particularly relevant anyway. It's speculation that these hospitals wouldn't receive a representative number of inpatient travelers.

...you don't see how it is relevant?? If it is ignoring a large slice of overseas institutions, then it's findings will be insufficient to draw any conclusions that any policy, or point of debate, could be based on.

Dude, unless we know the figures for certain, it is also pure speculation on your part that they did, or would, receive a representitive number by just gathering data from a potentially small range of overseas institutions.

david

[FlashLackey]

...you don't see how it is relevant?? If it is ignoring a large slice of overseas institutions, then it's findings will be insufficient to draw any conclusions that any policy, or point of debate, could be based on.

Dude, unless we know the figures for certain, it is also pure speculation on your part that they did, or would, receive a representitive number by just gathering data from a potentially small range of overseas institutions.

It is common for studies to make estimates based on smaller sample sizes. Just about every health statistics study does this, including the WHO statistics that you referred to.

That's why margin of error calculations are made, etc.

If you think that the McKinsey report doesn't use representative data, by all means, demonstrate it.

[asheep_uk]

A study reported in The American Journal of Medicine this month found that 62 percent of American bankruptcies are linked to medical bills. These medical bankruptcies had increased nearly 50 percent in just six years. Astonishingly, 78 percent of these people actually had health insurance, but the gaps and inadequacies left them unprotected when they were hit by devastating bills.

New York Times

While the NHS may provide a technically "lower" quality than you can pay hundreds of thousands of dollars for in the US, at least in Britain you have the choice whether you want to pay it. I can still get the level of cover received in the US, but without bankrupting myself.

My insurance company knows that if it made me pay £10,000, I'd stop them anything at all very soon. No nasty surprises.

[FlashLackey]

If they had to compete per individual and across state lines, they couldn't get away with gaps in coverage.

[FlashLackey]

PS:

David Himmelstein and colleagues recently contended that medical problems
contribute to 54.5 percent of personal bankruptcies and threaten the solvency of solidly
middle-class Americans. They propose comprehensive national health insurance as a solution.
A reexamination of their data suggests that medical bills are a contributing factor in
just 17 percent of personal bankruptcies and that those affected tend to have incomes
closer to poverty level than to middle class. Moreover, for national health insurance to have
an impact, it would have to define “medical” expenses in a much broader way than is now
typical of either private or government-funded plans.

http://content.healthaffairs.org/cgi...t/25/2/w74.pdf

As for the notion that greater government involvement in health insurance will reduce bankruptcy, it is helpful to compare personal bankruptcy rates in the United States and Canada. Unlike the United States, Canada has a universal, government-run health insurance system. Following the logic of Himmelstein and colleagues, we should therefore expect to observe a lower rate of personal bankruptcy in Canada compared to the United States.

Research on both sides of the border shows that the majority of debt among bankrupt consumers in both Canada and the United States is composed of non-medical expenditures and therefore has little to do with health insurance coverage.

Yet the evidence shows that in the only comparable years, personal bankruptcy rates were actually higher in Canada. Personal bankruptcy filings as a percentage of the population were 0.20 percent in the United States during 2006 and 0.27 percent in 2007. In Canada, the numbers are 0.30 percent in both 2006 and 2007. The data are from government sources and defined in similar ways for both countries and cover the time period after the legal reforms to U.S. bankruptcy laws in 2005 and before the onset of the 2008 economic recession.

Indeed, if we define medical bankruptcies the way Himmelstein and colleagues did for their study in the United States, we find such bankruptcies also occur in Canada. Survey research commissioned by the Canadian government found that despite having a government-run health system, medical reasons (including uninsured expenses), were cited as the primary cause of bankruptcy by approximately 15 percent of bankrupt Canadian seniors (55 years of age and older).

http://www.american.com/archive/2009...ankruptcy-myth

[david petley]

It is common for studies to make estimates based on smaller sample sizes. Just about every health statistics study does this, including the WHO statistics that you referred to.

That's why margin of error calculations are made, etc.

If you think that the McKinsey report doesn't use representative data, by all means, demonstrate it.

LOL, if you think it does, you demonstrate how...considering it used criteria that meant the authors may as well have been sitting in a dark cupboard asking each other their opinions and personal experiences.

david

[FlashLackey]

To create a rigorous and credible fact base about the nascent medical-travel market, McKinsey studied more than 20 medical-travel destinations; analyzed primary data on the number, type, and origin of medical travelers; and conducted interviews with providers, patients, and intermediaries in 20 countries.

http://www.mckinseyquarterly.com/Map...or_travel_2134

Must have been a very large cupboard.

[david petley]

http://www.mckinseyquarterly.com/Map...or_travel_2134

Must have been a very large cupboard.

....until i see a list of the institutions they did and DIDN'T canvas, I will continue to think that they did not look at the whole picture and suspect their results just like I suspect the flat-earth society's last report on why the Earth is flat for sure.

david

[FlashLackey]

You have posted a number of links in this thread to various analysis of data. Have you seen a list of institutions that they did and did not canvas in order to reach their conclusions?