Monday, November 21, 2005

Access to medical care

A recent article in the SMH about health care in Australia surprised me. It was a review of reasonably sick people, and how likely they were to skip treatment because of the cost in different countries.

The study was based on interviews with 7000 adults, from six industrialised countries, who said their health was fair or poor, had been admitted to hospital, or had had a serious illness in the past two years. It was described as being by a "left leaning" think tank (by the SMH), but the only evidence of that in the study was in the questions that they decided to ask.

I wasn't surprised that adults in the US came out pretty much worst of all on all the criteria (the study's abstract says "The United States often stands out for inefficient care and errors and is an outlier on access/cost barriers") but I was surprised at how much better the UK was on access criteria. In answer to the question about access problems due to cost over the past 2 years, only 13% of patients in the UK reported any form of access problems, where as 22% of Australians didn't access health care for cost reasons (similar in Canada and Germany), and a whopping 51% of citizens of the US.

I had previously had the vague impression that the UK spends a significantly lower amount on health care as a % of GDP than we do, for roughly the same outcomes (with a lot less patient choice).

The general standard of care doesn't seem that much better or worse in the UK. But the NHS certainly seems to be doing something right for the ability of sick citizens to actually get health care when they need it.


At 10:44 pm, Anonymous elsewhere said...

My vague understanding of the NHS from talking to an English Dr here is that they still preserve some principle of access to primary health care as a fundamental given.

Also GPs are salaried public servants, so no suggestion that health is a commodity or that primary health care should operate on a fee for service basis. I'm sure there was some comparative article in the MJA a couple of years back by a Scottish Dr working in Australia.

At 12:05 pm, Blogger Susoz said...

Yes. Visiting a GP in the UK, you never have to pay - anything. Same with visiting a public hospital. You do, however, have to be registered with a GP and you can only go to that surgery - you can't choose any old GP to visit, as you can here in Oz. I found that slightly off putting when I lived there. Changing GPs is a small amount of bother. I go to a bulk-billing GP here but I know some people whose illness eg a severe flu, has cost them quite a lot of money in GP visits and home-visits. We have a bulk-billing after-hours service which I've only used three times in seven years - if I'd had to pay, I probably woldn't have used it and would have had to drag a sick child to the hospital - or risk not having him seen by a doctor.

At 8:57 pm, Blogger Jennifer said...

When I lived in the UK, as a healthy person, I found access harder than here (but I've always had enough money not to worry about an out of pocket amount) as I couldn't get ever get an appointment with my registered GP in the UK on the day I wanted one.

And I had always thought that here would be OK if you were sick, as doctors tend to bulk bill if you have a chronic illness (I know mine does).

But it seems from the study as if the UK actually does prioritise for sick people, rather than hypochondriacs like me (I was convinced I had Huntingdon's disease as I was waking up in a cold sweat worried about work, and only the nice GPs bulk bill for sick people, and then probably only for those they regard as "deserving".

At 11:05 pm, Anonymous elsewhere said...

In Alice, the idea of having a regular GP is laughable -- impossible to get the GP of your choice unless you book well over a week in advance. Not much choice in remote Australia.

At 8:10 pm, Blogger Jennifer said...

Of course, I've fallen into the trap of generalising based on my own (inner city) experience, which is what all these studies are designed to avoid! I remember being horrified by my friends' doctor experiences when they lived in Broken Hill - not the care itself, but the effort you had to go to to get it.

I assume the study tried to match locations as well as illness levels, but I haven't read it enough to know. It'd be interesting to find out, as I imagine that rural care in Australia is a bigger challenge than rural care in (say) the UK.


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