I believe health care reform should include universal coverage, regardless of pre-existing conditions. To make this possible, we need to address the disparity of health care costs between the U.S. and other developed countries.
My views have been shaped by my experiences as a primary care provider, provider group manager, corporate purchaser and health insurance executive. My recent experience as a patient in a British hospital provided me with a particularly unique perspective. It certainly wasn’t planned.
After a week in southwest England, we departed for Heathrow Airport early one Saturday morning. As I drove out of the parking lot, I suddenly blacked out and our van collided with a stone cottage. Fortunately, I regained consciousness, and the five family members with me were not seriously injured. They were obviously concerned for me, but I assured them that I must have experienced a “simple faint.”
A new car and driver were arranged. Unfortunately (or perhaps fortunately) I continued to experience abrupt brief blackouts over the next several hours, was brought to a small hospital near Heathrow and quickly transferred by ambulance to a large public teaching hospital. At no time did I detect irregularity of my pulse, nor did I experience chest pain or other symptoms.
After an evaluation in the ER where my EKG was completely normal, I was admitted to the coronary care unit. There I blacked out for the sixth time. As I slowly regained clarity of thought, a defibrillator was being rolled to my bedside. After much persuading by me, the nurse showed me my rhythm strip—it was a flat line. Here’s where the British system comes in.
I had multiple EKGs, a thorough H&P and chest X-rays. I did not have an angiogram, echocardiogram or other tests that would have likely been performed in the U.S. The technology all had to be wheeled into the ER. The CCU was a single large room with seven beds holding men and women. The nurse’s station was in one corner, allowing three nurses to maintain visual contact with all of us. There were no phones, TV or radio. Food was limited. Yet the hospital staff could not have been more knowledgeable, caring or attentive. The focus seemed to be patient care.
The cardiologist determined I needed a permanent pacemaker. When efforts to prevent more episodes with IV medication failed, a temporary pacemaker was placed on Saturday evening. The permanent pacer was implanted on Monday. I was discharged Tuesday, had a follow-up appointment Friday and was cleared to fly home on Saturday.
At no time was I asked to provide an insurance card, credit card or other assurance that I would pay for my care. When I inquired about that, the hospital CFO assured me that I would receive care without any form of initial payment.
Ten weeks later I received the bill – a one-page letter with a single line: “For medical services rendered…” The total cost in U.S. dollars: $8,200. I can assure you that is a small fraction of what those same services would have cost in the U.S. That included the ambulance, ER, three days in a CCU, multiple physicians, diagnostics and a follow-up visit. In the U.S., each of those items would have generated a separate bill.
Of course, this is just my experience and just one case. But it raises questions and suggests reasons why the U.S. system is so costly. To note just a few differences between the two systems:
1) The U.S. billing system is complicated, fragmented and extremely inefficient.
2) British public hospitals are short on frills and long on direct patient care. They are designed to provide urgent/emergent care in an appropriate and timely manner. Elective, non-urgent conditions may require longer waiting times. The “impatient patient” can receive those services through private facilities at their own cost or with private insurance coverage.
3) Fewer diagnostic studies suggest that British physicians feel less inclined to practice defensive medicine.
4) Medical equipment and medical devices appear to cost much less outside the U.S. I received a
Medtronic pacemaker identical to those used here. I can only speculate that the cost of just the device in the U.S. would have exceeded the total cost of my British care.
This is a short list; there are many more. Some issues can be corrected; a lot of waste can be eliminated. I think it would be naïve to believe that U.S. patients will give up their TVs or their private rooms. However, I do think we need to question why a Medtronic pacemaker appears to cost so much less in the U.K.
We need to focus on what truly adds value for patient care and then question why we continue to tolerate everything else.
Dale Andringa, M.D., began his medical career in internal medicine. He served as president of the medical staff of Iowa Methodist Medical Center and chairman of the board of clinical governors of the Iowa Health System. He was a founder of HMO Iowa and, later, medical director of American Republic Insurance Company. He then was medical director and director of strategic improvement at Vermeer Manufacturing Company in Pella, Iowa, managing its 7,000-member self-funded health plan. Prior to his retirement in 2009, he was chief medical officer of Wellmark Inc.
