Healthcare Questions

Within the last two weeks, I've had the following healthcare related experiences :

1. Got a non-emergency appointment to see my HMO Primary Care Physician at 8:30AM for 2:10PM on the same day

2. Had the remnants of a split root canal tooth extracted the afternoon of the day I called the dentist.

3. Had a low priority open MRI head scan scheduled and done eight days after asking for an appointment. This was supposedly a longer than normal delay and the private MRI facility no longer needed 24 hour scheduling to meet demand.

Question #1 :

Based only on the above, am I more likely to live in Toronto or Boston?

Question #2 :

Upon leaving the MRI facility, I was given a CD that included both head images and a viewer for use on a PC. As a lay person, what interesting use can I make of this besides proving that vacuum has a texture? Although my PCP will receive an independent report, has anyone published 'MRI Scan Analysis for Dummies'?

Addendum below :

Reference

If there is any doubt community hospitals have lost their dominance over the imaging business to entrepreneurs and doctors' groups, a trip along crowded roadways near Northshore Mall in Peabody would be instructive.

MRI centers have sprung up like fast-food restaurants. Ringing the mall are a new MRI center operated by Sports Medicine North, a group of orthopedic doctors in partnership with MRI Centers of New England, a major Shields rival; the Shields MRI at Lahey Clinic Northshore, which is operated by Shields Health Care Group; and North Shore Magnetic Imaging Center, a joint venture of Beverly Hospital, Salem Hospital, and two other North Shore hospitals.

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He tried to implement a

He tried to implement a ‘dummy invoice’ policy so the patient would see what it cost ’somebody’ but the gov’t disallowed it.

I'm sorry--did I read that correctly? The Canadian government has actually prohibited doctors from telling patients how much they cost the taxpayers?

A lot of people responded to

A lot of people responded to my stats about infant mortality and life expectancy. But all of them are logically suspect.

You didn't deal with the one saying that EU countries didn't report premature death statistics.

But yea, there were a lot of statistics thrown about with no links.

We have that in Canada, it’s called the government. In the United States the government is prohibited from using its size to negotiate a better deal.

There's a whole subset of economics explaining why that is a bad idea. It's called Public Choice.

CS - I'll point it out again

CS -

I'll point it out again since you missed it, but Europe and the US have a fundamental difference in what they consider an "infant mortality". Europeans do not count pre-term babies that die as infants in their stats. Europeans also don't attempt to save premature infants as often and as vigorously as Americans do. American hospitals count premature infants that die in mortality statistics. That alone
will cause a spike in infant mortality in reported statistics.

And again, EU stats are usually counting not the newly accessed countries, but the rich western fringe. I went through the statistics and lumped in the poorer countries of the EU and found that whatever difference there was disappeared, and got worse if you dropped in other European countries not in the EU. Eastern Europe is in far worse shape, health care stats-wise, than the poor parts of America.

My objection on size grounds is simply that France (for example) is a small, densely populated rich country that is highly developed and has an extensive infrastructure all over the country to deliver all manner of goods and services. This is not the case in, say, the deep South or Montana or other parts of the wide and rural plains/mountain west. But especially given the historical background of the Deep South (with its high concentration of impoverished blacks & whites with little infrastructure development until recent decades), there is going to be an obvious difference in health care outcomes- rich folk with easy & ready access to capital-intensive health care (human & physical) are going to have better outcomes than poor people who do not.

The US, like Europe, has large regions that are not rich & do not have capital-intensive health care. To compare apples to apples, you must compare ALL of Europe (the crappy parts included) with all of the US, or if you want to examine developed health care systems, compare Western Europe to the richest equivalent proportion of the US; do one or the other. However, you want to compare only the most developed & richest parts of Europe to *all* of the US and say that Euro systems are better than the US systems. That is, frankly, bullshit.

As far as the socioeconomic factors that the US has that Western Europe does not have, well, a huge minority of the US population was once enslaved just over one and a half centuries ago, and since then was subject to second class citizenship & discrimination for another 100 or so years- not to mention the same geographic area that held the bulk of this population was razed to the ground in a civil war and left essentially fallow for almost a century (until air conditioning led the revival). Isn't it reasonable to think this ethnic subgroup in particular and folk in the geographic area in general are going to have a very high likelihood of adverse health outcomes compared to regions & ethnicities that did NOT suffer the same adverse effects?

Eastern Europe was laid waste by the Soviets & totalitarian/imperial communism for 50 years (and held as an extractive economic colony for Russia), so its partially analagous to the American South. But aside from the very recent introduction of large North African arab/muslim ethnic minorities in parts of Western Europe, the only equivalently persecuted group for Europe would be the Jews, and, well, Europeans didn't leave many of them alive in the 20th century to constitute a similar large minority. Though Jews in general usually exceed the mean rather than fall below it, so that doesn't really compare either.

All of these problems are problems of society but do not tell us whether or not the system is delivering. In a comparison examining a variable (health care system) you need to keep as much equal as possible. There is very little equivalence between Western Europe's aggregate population and the US's aggregate.

Though if you look at ethnic group to ethnic group, you'll find similar to Milton Friedman's quip that while there is little poverty in Scandinavia there is likewise little poverty amongst scandinavian descendents/communities in the US, either (suggesting, horror of horrors, that there may be cultural, ethnic, & social-institutional reasons for social outcomes vs. a strict government political determinism). I imagine that there are non trivial differences in health outcomes by ethnicity, try as academics might to ignore them or say that its all "socially constructed", etc etc.

Thus to compare systems you need similar populations & socioeconomic conditions to avoid confounding variables. Hence you must compare Britain to, say, Massachusetts (or NY, probably not Texas or Cali), or a collection of western euro nations to similar US states. Then you have a statistically relevant & valid set to make a comparison. Not until then.

It is non-sensical to equate

It is non-sensical to equate independent collective bargaining groups, whose members entered into the group via their own free will, and compete for members in the marketplace, with the collective, monopolistic power of the state.

As for the reason drugs are cheaper almost everywhere other than the US, that is due to price controls. Since the US has no price controls, the costs of R&D are passed onto US consumers. If the US did have price controls, then drug research would grind to a halt and we would all be worse off. Thanks for nothing, you freeloading Canadian. :furious:

For anyone who didn't see our friend C.S. here get mauled by Dave Hitt, see here.