"Two Girls Two Countries One Cancer"

David Whelan has an interesting article at Forbes.com following two girls through the same serious cancer diagnosis here and in Britain.

As David put it, "When stories get specific, as in the cases of Zoe and Ellen, two kids from similar backgrounds with the same disease, the generalities [about the differences in our health care systems] start to break down."

This is What a Real Cost/Quality Decision Looks Like

The UK's National Institute for Health and Clinical Excellence (NICE) has decided in a preliminary ruling that four drugs used for the treatment of advanced kidney cancer are not effective enough and they won't be paid for by the National Health Service.

Now before someone just claims this is what single-payer health care plans do all the time, let me be clear that NICE is an organization that has largely gained the respect of the world health community. Andrew Dillon, NICE's director, participated in a conference on technology evaluation I chaired a few years ago and the domestic audience from business and policy was more than impressed with their work.

These guys are trying to do the right thing and using extraordinary means to do it. They don't make arbitrary and bureaucratic decisions--they follow the science.

But here's the crux of their decision.

NICE concluded that the drugs extended some patients lives but not enough to justify their high price.

Using clinical trial results that were imputed into complex financial models, NICE concluded the drugs cost between about $150,000 and $350,000 for each year of life they gave patients. Britain's standard says that the Health Service shouldn't pay more than about $60,000 for a year of healthy life gained. They call that their "quality adjusted life year" (QALY).

The chief doc at Cancer Research UK, a non-profit, responded that, "These drugs have shown a small but definitive improvement in an illness where there are few alternative treatments."

Two things:

1. If this was someone in my family, I would expect my U.S. health insurance to pay (today) or I would find the money to get them the drugs.
   
2. This is what real cost/quality decisionmaking looks like.

The next time any of us suggest that making better cost/quality decisions is an obvious next step to take we should remember this example of a real cost/quality decision.

The "Frontline" Report on International Health Care, "Sick Around the World," is Worth an Hour of Your Time

Last night the PBS program, "Frontline" gave us an hour long tour of the health care systems in Great Britain, Japan, Germany, Taiwan, and Switzerland and asked what can we Americans learn from them.

When I heard about the program, I was dubious that an hour long report covering five different systems could possibly be helpful. But this hour long tour de force accomplished a great deal and I came away impressed.

Did the report skirt a number of really important issues and fail to mention things that critics or supporters will be upset about? Yes.

But from my experiences in international health care I have to say it is a generally fair and balanced job. "Sick Around the World" is a constructive contribution to our national health care debate.

As the report pointed out, most of these systems rely heavily on the health care market--private insurers, private doctors, and private hospitals.

The program also offered a number of conclusions from their investigation of these national health care systems which, from my own experience, I cannot deny:

• These nations have health care systems--often as much market oriented as government oriented. Market or government, the U.S doesn't have a health care system as much as a hodgepodge of things we have drifted into over the decades and that creates much of our problem.
• That the quality of health care in each of these nations is generally as good as ours--it is a myth that the U.S. gets a lot more quality health care for the money we spend.
• That these nations take advantage of market forces but at the same time all impose limits that so far we have been unwilling to impose.
  
• That nations who successfully rely upon private insurance use only not-for-profit insurers and the insurers must accept everyone.
• That everyone is mandated to have insurance and the poor and near poor receive adequate premium support.
• That doctors and hospitals are required to accept one standard price structure--and their prices are far less than ours.

The program ended asking, "Can Americans accept ideas like that?"

I strongly recommend you spend an hour online watching, "Sick Around the World."

All of my posts on international health care