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Differences Between American And German Healthcare Systems: One Physician’s Perspective

I have been in Hamburg, Germany for the past five days. I enjoyed an amazing opportunity to visit one of the world’s most respected heart rhythm labs. Among other things, the main purpose was to learn a new way to ablate atrial fibrillation.

It was an incredible learning experience, one for which I owe an enormous debt of gratitude to the kind and generous people of Dr Karl-Heinz Kuck’s EP lab. Though these people are famous, they treated me as a respected colleague.

Details of all that I learned regarding this newly-approved ablation technique is a matter for future posts. Suffice it to say, I already feel like a better AF doctor.

For now, may I highlight a few of the more striking differences between Europe and the States, as noted by a Kentuckian on his first trip across the Atlantic? Read more »

*This blog post was originally published at Dr John M*

The Timeline Of Healthcare Reform

As the dust settles on the Great Healthcare Reform Bill of 2010 passage in Congress, it’s time to ask what we got for the effort. No matter what people thought of the bill before, like it or not, it’s here.

Still, few people really understand what the bill contains and when the benefits and costs for the measure will be incurred on a year-by-year basis. Given the bill’s complexity and tortuous path though Social Security and IRS tax codes, this really isn’t a surprise, I suppose.

So here’s my simplified broad-brush overview, broken down by year, culled from several sources as referenced. Read more »

*This blog post was originally published at Dr. Wes*

Canadians Are Turning To Market-Based Healthcare Solutions

Many Americans look to Canada, as an example of a government-run health care system that works.

But is that really what it is?

Health care in Canada is funded mostly publicly, but is provided mostly privately.  That is, most care is delivered by privately run hospitals and medical clinics, with fees paid for by the various provincial governments.

Americans often call this system “single payer,” but it’s really not true.  There are many other payers.

For example, if you’re injured on the job, your care is paid by a workers compensation insurance plan funded by employer premiums.  Millions of  Canadians also have supplementary health insurance policies, typically called “extended health care” coverage, which cover things not paid for by the government, like prescription drugs and other medical services.  There is also a growing market for full medical insurance plans, and critical illness plans to provide cash to offset the out of pocket burdens of medical cost.  As much as 30% of Canadian health care expenses are funded through these non-government payers.

However paid for, supply (and funding) for health care has not been able to keep up with increasing demand.  The result has been well-documented: long waits for health care services.  Waiting is a normal part of the Canadian health care experience, with provincial governments publishing  information on wait times and working to fix them.  The Canadian Supreme Court admonished the provincial governments in 2005, saying “access to a wait list is not access to health care.”

And so an interesting dynamic has emerged.

Canadians are justifiably proud of their extraordinary health care system, and care deeply about preserving its core principles.  But they also care deeply about looking after each other, and are as creative and innovative as any people on the planet.  As wait times have grown, so has a burgeoning private market.

Hospitals running diagnostic imaging equipment like MRIs are only paid by the government to run during certain hours of the day.  So creative hospitals decided to run the same machines during the overnight hours, charging patients (rather than the government) a fee for the service, which could be provided on an expedited basis.  While politically controversial, it made it possible to serve more patients without the need for additional government funding.

These types of ideas have grown, extending now to stand-alone diagnostic centers.  A couple of days ago, I visited one, Mayfair Diagnostics, in Calgary.  This center was created by a group of physicians, who, like others I have met, knew they couldn’t change the system, but could improve the part in which they work.  So they bought leading imaging equipment and opened up centers that cater to self-pay patients, as well as those funded through other sources.  They actively promote themselves as a way to get needed medical insight only a couple of days – as opposed to the 6-8 week average wait patients would otherwise face.  Doctors working in this center also work in hospitals serving government-sponsored patients, making the Mayfair center and others like it a supplement to the government system.  And at a price of $650 for an MRI, it’s inexpensive by U.S. standards.

Other kinds of private centers have opened up as well.  Some operate almost as membership-only medical practices, offering much of what might be considered primary care.  Others provide even more comprehensive services, making most aspects of ambulatory care available on a privately-paid basis.  For certain specialties like orthopedics, some even offer complete hospital surgical services.

The Canadian system remains very different from the American one.  Canadians do not want their system transformed into anything that reflects American “rugged individualism.”  And yet the natural human desire to look after oneself and ones family poses dilemmas.  When a loved one is sick, all the abstract ideas melt away, and you think – how can I do everything I can to get help, now.

We’re all entitled to that kind of help — Americans, Canadians, whatever.

The ways Canadians are trying to make sure everyone gets that help are slowly changing the face of Canadian health care.

*This blog post was originally published at See First Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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