Chinese healthworker Li Chunyan examines a patient at a small private clinic at Datang village, in China's rural Congjiang county, Guizhou Province in 2006. (Reinhard Krause/Reuters)

Planet Health Care

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As debate rages in Washington, the answers are out there. You just need to know where to look.

By Thomas Mucha
Published: October 9, 2009 05:29 ET

BOSTON — Health care reform was the main event in Washington, D.C., again this week.

With good reason: the fate of America's troubled system will no doubt affect the $14 trillion U.S. economy for good or ill, depending on how the drama plays out.

Moreover what happens in the U.S., which produces more than 20 percent of global economic output, matters greatly to the economies of the rest of the world.

So, yes, play close attention to the health care debate and all the politics behind it.

But while members of Congress are spitting on each other about creeping socialism, death panels to kill Grandma and the pros and cons of a public option, GlobalPost correspondents have been quietly searching for ground truth, health care-style.

Their mission: To find out what's really happening in the hospitals, clinics and waiting rooms around the world. What works? What doesn't? And which of these global lessons should America adopt, consider or avoid?

Over the past two months our correspondents have amassed a wide variety of insights and observations — from a sick China, to a healthy Confucian influence in Taiwan, to a booming India, a healthy Australia, a faltering South Africa, as well as the various schemes in Germany, France and the United Kingdom.

Here's a quick tour of Planet Health Care, or more simply: 10 things you need to know about what's happening around the world right now.

1) China is attempting to reform its giant health care system — with mixed results.

China's system was once a model of low-cost and efficient delivery that served millions of patients. But as its socialist economy broke down in the 1980s, so did its health care system. Since 1980, the percentage of personal income Chinese spend on health care has doubled. In 2006, a survey showed that nearly half of Chinese people refused to see a doctor when they fell ill. Meanwhile, some 200 million are uninsured.

So earlier this year Beijing set out to fix it. Health care reform is being rolled out in stages through 2011, beginning with a basic opt-in insurance program for hundreds of millions of rural residents.

To document these sweeping changes, correspondent Kathleen E. McLaughlin and photographer Sharron Lovell traveled from the remote mountains of Guizhou to the top hospitals in Beijing. Here's their three-part report, The China Syndrome.

2) Health care in rural China is bad, and in some areas, non-existent.

As Kathleen and Sharron report, many villagers in remote Guizhou province — one of China’s poorest — suffer a predicament that is all-too-common among China’s estimated 800 million rural residents. Faced with a health care system so fragmented and underfunded, the sick often go bankrupt trying to get better.

While things are still grim, there have been early successes. Basic insurance unveiled this year has encouraged more Chinese to visit doctors. “Before the patients would only come in when they were seriously ill,” one doctor said. “Now they come for treatment when they first get sick.”

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Posted by david wayne osedach on October 9, 2009 08:38 ET

My vote goes to Britains NHS - National Health Service. Why can't we base our national health care overall on that?

Posted by Keli Kristine Davies on October 9, 2009 11:52 ET

I am an American living in the UK and I can give you pages of reasons why the US should not have the UK health care system as a template. First, I am pregnant and so I have done a lot of research into the local hospitals and this is what I found: you have no choice in doctors or hospitals, the closet one to your house is what you get, and you only get 10 minutes; the hospitals still have wards, some of them are mixed and there's usually only one toilet for the ward- this means that you bring your own sanitizer; when delivering there is only a 30% chance that you will have met the person (not doctor) delivering your baby before that moment; if you need an operation that is not life threatening i.e. a new hip or arthroscopic on a joint, you will wait for 9 - 18 months for this to happen, during which time you are doing irreparable damage; women receive a pap smear once every 5 years, you can die from cancer you didn't know you had in that time; if for example, you want to get birth control, the doctor asks what kind you'd like and then writes you a prescription- they don't ask if you smoke, they don't take your family history and they don't even take your blood pressure; my step son is another example, he needs special shoes because his right foot suffers from metatarsus adductus, basically he is so pigeon toed he trips over his foot often, he had just turned 8 when we took him to the doctor (again because the first doctor said there was no problem) and he won't be seeing the specialist until he is nine, so that's an eighth of his life more that he will be tripping and falling down; my friend had a 'serious health issue' and went to the doctor to be referred to a specialist, the nhs doctor refused to refer him saying there was nothing wrong and giving tylenol as the answer, so he did it through his own private health insurance, as it turns out he is very ill and in need of much more medical care than tylenol or he would have faced life threatening scenarios. Also, the government is promising to make hospitals cleaner but at the same time cutting £12 billion in funding over the next 10 years. Their system is quota based and does not do preventative care. So when you ask the English if they like their health care system, ask how many of them have private insurance or how many would if they could afford it.

Posted by arethuza on October 11, 2009 18:44 ET

When my wife gave birth to our son we got a choice of hospitals - that policy is confirmed by the NHS website:

http://www.nhs.uk/LiveWell/pregnancy/Pages/Wheretogivebirth.aspx

We don't call it Tylenol in the UK - that is a North American brand.

As for private health insurance - I used to have it, can afford it, and gave it up because it was pointless. The NHS is far from perfect, but it has provided excellent care for all members of our family.

Posted by bbdanzig on October 11, 2009 21:32 ET

Only 3% of the health care provided in the UK is private so unless you believe a minute portion of the population can afford private insurance, your conclusion is bogus. Also, perhaps your son has received poor care in the UK, but in the US he would be unable to receive insurance under our current system. And you're an expecting mother? Great, the UK has lower rates of infant mortality than the US. It is also not uncommon for girls in the US to show up at the hospital in labor without ever having seen a doctor; this is not the case in the UK.

Also, I don't believe the statement that doctors do not perform preventative care. UK doctors receive incentives for practicing preventative care, and this makes up a substantial portion of their income.

On the birth control point, pharmacists/chemists in the UK have much more authority to offer advice and even some level of diagnosis. I have experience with this; a pharmacist diagnosed a skin rash I had as bug bites, and she was correct. This was done in an effort to take some of the load off of General Practitioners in the UK. The doctors, knowing this, might be of the mind that perhaps you already consulted a pharmacist and received advice or that you will when you buy the meds. By the way, you failed to mention the extremely low cost of medications covered by the NHS.

I will also say that I had an excellent experience with the NHS. I broke my nose and cheek bone when I was studying in London. I got an ambulance ride to the hospital, they fixed my nose as best they could for the time and stitched a gash on my head all without asking the very first question you hear in a US ER, "Do you have insurance?" In fact, the only administrative work I had to do of any kind was give them my address AFTER I received treatment. By the way, this was not at the closest medical provider to my place of residence and the specialist and surgeon I saw within 3 weeks was not either. I was also told I could switch my appointments to a closer health care provider so I kind of don't buy that you can only choose the GP that is closest to you.

I think many of your other points are valid, but they don’t necessarily mean you cannot use the good aspects of the NHS as a TEMPLATE. I do not know what your idea of a template is, but it is certainly possible to use things that work and tinker with things that do not work. These things can and are being improved (or at least attempts are being made) even within the NHS. Also, the NHS is a superior health care system to the one we have in the US in terms of cost, quality (outcomes at the macro level), and coverage. You’ve brought up some horror stories, but they mostly have to do with having to wait to receive treatment of things that will not kill you (with the exception of your friend that was “seriously ill”). The nature of the horror stories in the US are much worse: 20,000 people die each year of treatable diseases and several hundred thousand people file for bankruptcy as a result of the insufficiencies in our system. Although there are some systems that are better or more feasible in the context of the US than the NHS, it is a better system, and I would prefer it to what we have.

Source:
The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care

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