Comes from a socialist system of course:


How the NHS could learn from Sweden
By Nick Triggle
BBC health reporter

Whenever health systems are ranked, Sweden always seems to come top or at the very least a close runner-up.

With its dazzling array of new hospitals and plentiful supply of doctors, nurses and state-of-the-art medical technology, the Scandinavian country can confidently boast it provides first-class care to its nine million inhabitants.
Cancer survival rates, infant mortality and life expectancy figures all outstrip many of its European neighbours.

So how does Sweden do it and what can the National Health Service learn?

The simple answer is that Sweden has a long history of spending lots of money on health.

Money

In the early 1980s, the country was splashing out 9.2% of its GDP on health care - the highest in Europe and over 3% more than the NHS got at the time.

Two decades on it may still be spending the same proportion, but many countries, including the UK, are still playing catch up.

The result is that Sweden has more doctors per head than most - 3.3 per 1,000 compared to two per 1,000 in the UK - allowing patients to have direct access to everyone from hospital consultant down.

But it is not just a matter of money. Sweden, traditionally reliant on treating people in hospital rather than in the community, recognised in the mid-1990s that as people began to live longer, health services had to change to meet increasing demand.


As hospital treatment tends to be expensive compared to GP or district nursing care, Sweden started to push for more patients to be treated in primary care in much the same way ministers want the NHS to do.

Over the last eight years the number of visits to GPs has gradually risen, compared to a drop in the number of consultant appointments.

The Swedes have also tried to push patients through the hospital system much more quickly.

In 1992, the average length of stay stood at 7.9 days, compared to just over four now. In the UK it is nearly six.

Having less people treated in hospitals, for less time, has allowed the Swedish county councils, which are responsible for hospitals and GP services and fund 70% of health services through their tax raising powers, to plough more investment into community services.

The number of people being given medical care at home for conditions such as heart disease and diabetes has risen from 35,000 people to 80,000 people.

And there has been an increase in local health centres, which provide an extended range of services from GP care to physiotherapy.

Roger Molin, deputy director of the Swedish Association of Local Authorities, said the country has several advantages over the UK in pushing through such reforms.

He said the devolved nature of the health system meant councils were more responsive to patients needs than a more centrally-controlled system such as the NHS.

Nurses

And he added: "Traditionally, nurses have had a much greater role in health care here. They have got involved in treating long-term conditions such as asthma.

"But there is more flexibility in our system. Patients can either register with a specific GP - as 40% do - or use any doctor they like".

But Mr Molin also said Swedish councils have not been afraid to use the private sector.

About a tenth of health care is provided privately, but unlike the UK much of this is at a community level rather than in hospitals.


Mr Molin said private providers have brought more efficiency to the system, but had been largely contained to the primary sectors as it was not so easy to introduce change to large institutions such as hospitals.

The use of the private sector is also cautiously welcomed by doctors.

Dr Thomas Flodin, a board member of the Swedish Medical Association, said he did not have any objection to increased use of the private sector.

"What is important is not who provides the care, but that it remains available to everyone."

And this seems to be one of the underlying characteristics of the Swedish system.

Unlike in the UK where a two-tier system has developed with wealthy patients paying to go private, there is virtually no market for such care in Sweden.

While patients have to pay for public health care, fees are nominal, limited to a ceiling of £60 a year.

Only a few thousand people have private health insurance and firms which provide services for the public health system are banned from providing private care.

Trust

Swedish doctors believe the system allows them to develop a better relationship with patients when they need major hospital treatment - analysts estimate a third of consultant time is spent with patients, one of the highest rates in Europe.

Dr Hans Berglund, a cardiologist at the Karolinska University Hospital in Stockholm, who has worked in countries across Europe and in the US, said: "There is a level of trust that does not seem to be there elsewhere."

But Chris Ham, professor of health policy at Birmingham University, said the success of the Swedish system had to be viewed in context.


He said while the country had a "well developed" health system, society was relatively homogenous without the immigration and levels of poverty other European countries had.

And for all the platitudes, the Swedish system is far from perfect.

Patients routinely complain about waiting lists - the government has recently introduced a six-month waiting guarantee - and it is common to find hospital doctors scrambling around trying to find beds for patients.

And Swedish councils are also looking to learn from the way the NHS measures hospital performance through targets and performance indicators to iron out regional variations.

But with these being phased out in the NHS, it remains to be seen whether they will catch on and, for the most part, Britain seems to have more to learn from Sweden.

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/h...th/4460098.stm

I believe free health care is foolish but we should make health care more affordable for the people who cannot afford an overpriced operation.

It is so foolish that it is ranked amongst the best in the world

Working in the health care field, I feel allows me to speak with some clarity on this issue. Case in point, the other day a gentleman came in to have some lab work performed. He wanted me to tell him how much the testing would cost. After looking up the cost to perform the tests the doctor had listed, I was able to give him an approximation. The gentleman then wanted me to make a declarative statement of how much the testing would cost, I told him that I was unable to do that. This upset the gentleman and he would not listen when I tried to explain why.

The problem within my field is that although we have set costs for certain tests, these costs do not reflect the cost of additional testing. Why would additional testing might be needed, if the results of the original testing did not confirm the doctor diagnosis, or if they were in some cases elevated or decreased, additional testing would be needed to determine what was causing this condition.

Overall, in the health care field, no hospital, public or private, will turn away a patient needing care. To do so would violate federal law, and result in the hospital losing its credentials to practice.

The major problem in the cost of health care today is the third party pay system. No longer do people pay for health care out of their pockets, they rely upon insurance companies, medicare and medicaid. The problem is that the government fixes rates for certain procedures, meaning that the government insurance - medicare and medicaid - will only pay a certain amount for certain tests and/or procedures.

The problem arises with the misuse of the system. The emergency room cost of medicine is higher than any other cost besides those involving surgery. The emergency room is also highly regulated. If a patient comes in complaining of certain pains or illness, the emergency room must perform certain tests and procedures. For instance if some who has been lifting heavy weights, i.e. like boxes or moving furniture, comes in complaining of chest pain, the muscles in my chest hurt, the emergency room must do a cardiac workup, which includes cardiac enzymes, ekg, and x-ray. Even though the doctor may suspect only a pulled muscle, the doctor must work-up the chest pain as a cardiac patient. Instead of only a simple blood test and x-ray, the patient will get the whole exam.

The other problem is that far too often, people will come to the emergency room in lieu of a doctor visit. A doctor visit may cost $150 to the patient for meidcare and medicaid, but the emergency room visit is billed at $500. Why??? The patient didn't want to wait a day for the appointment or didn't want to wait at the free clinic in town, so instead they came to the emergency room. This is especially true of medicaid and medicare recipients. The misuse alone cause the increase in the billing of government insurances, which in turn drives the cost up.

Perhaps one of the best ways to fix this misuse and lower the cost of health care would be to implement a co-pay system for the medicaid and medicare recipients. If the patient has to face out of cost expenses, this would cut down on the amount of misuse. The savings from this alone would reduce the cost of private insurance making it much more affordable for everyone, and it would also help to reduce the cost of procedures.

dmk

The countries like Sweden with national health care pay higher taxes.... There is no free lunch. And all US hospitals must treat everybody including indigents in an emergency......though some hospitals try to unload the uninsured on public hospitals...... I have had internet conversations with people from England and Canada, and they told me that they often have long waits for care and sometimes never quite get called.... They think American medical care is tops..... You go figure..... ------------I do believe in basic national health care, but what do I know? Relatively few people with good jobs and health insurance support national health care UNTIL they lose medical coverage and need care......

If something can be abused, somebody will do it...... How about King Georgie Bush the First?? He is a great example of abuse...... I have to add that there is a copay system in place for medicaid recipients, at least in Florida......