Malibuflyer wrote:
I still have to wait to hear of an individual that I have met personally …
… dying from substance abuse
… being killed in a traffic accident
… being victim of government oppression
… being raped
… being inprisonated by a authoritarian regime
… being punished for airspace infringements
… being denied a pilot license due to German “Zuverlässigkeitsüberprüfung”, TSA-Check, DHS-lists
… being killed in a accident of of a powered airplane
… getting sick from wearing a mask
You’re actually probably quite fortunate if you don’t know anyone personally who has suffered those things. I’ve had what I consider a pretty normal “middle class life” yet I know personally two people who’ve died from substance abuse, several who have died in road accidents (including two very close friends), a victim of government oppression (my next door neighbour, who is Albanian), one rape victim, and a couple of people who have died in light aircraft crashes. I’m not particularly old, either.
Malibuflyer wrote:
If I remember it right, there is also a significant statistical artifact involved: Level 2 Beds are reported as ICU in Germany whilst Switzerland only considers Level 3 Beds as ICU.
The definition “level 2” and “level 3” is not used in German medical circles. The key distinction is between beds with a ventilator and those that don’t have one, which the DIVI (German Society for Intensive Care and Emergency Medicine) defines as “high care” and “low care”, and they seperately list number of ECMO beds in their daily report (www.intensivregister.de). Currently, about 15500 beds exist in the “low care” category and 13000 in the “high care” category, as well as 750 ECMO beds. There is an “emergency” reserve of 12000 beds which can be activated within 7 days, if the personell can be made available (e.g. by re-assigning personell that is otherwise working in the operating room). One peculiarity of the German health system is that while we have plenty of “kit” (beds, monitors, ventilators), we were already short on personell to staff these with before Covid-19 even existed! Especially nursing staff has been systematically reduced to the breaking point, with about 50.000 to 150.000 nurses missing in the system, depending on whom you ask.
Malibuflyer wrote:
The question is what you optimize for: Average quality for everyone or Peak quality for the ones who are willing to pay.
(Former) CEO of AZ once brought it to the point at a dinner discussion: “Just look outside the window at the parking lot: Do you really believe you would see 10 year old VW-Golf out their if people would pay a fixed monthly fee and in exchange could drive any car they wanted”?
Yeah, right now the German system is extremely patient friendly: You basically pay a flat-rate and can get “any car” you want. You might have to wait for it, but you’ll eventually get it. Very few health systems in the world afford patients such a broad access to medical care without additional payments.
And now for something completely different:
Evidence shows human transmission in deadly outbreak of mysterious disease in Bolivia
Apparently, a new virus related to haemorrhagic fevers, such as Ebola, Hantavirus or Lassa Fever, was discovered in Bolivia and can be transmitted from human to human (at least in health care settings).
Way to remind us that nach der Pandemie ist vor der Pandemie (after this pandemic is only before the next pandemic)
MedEwok wrote:
You might have to wait for it, but you’ll eventually get it.
Agree! And even that is very mild in the German system: While other systems with comparable structure (e.g. Korea or Japan) use waiting times as a conscious measure to steer demand, in Germany it is (still) more perceived as an “accident”.
The NHS tends not to use intensive care beds as much as much as other countries. As an example, for an elective joint patient to get one would be the exception rather than the rule. I think there is also a feeling that a public system is more likely to elect to turn a ventilator off, or to decline to admit a moribund patient to ICU, than privately funded systems.
In the first case, the question is whether the patients are losing out by not being as closely monitored following their surgery. By and large they don’t seem to suffer avoidable harm, though much of medicine consists of avoiding rare tragedies so this is one of those situations where I would be wary of trusting personal impressions.
In the second case, it’s ultimately down to ethics. I have colleagues who have worked in the Middle East who talk about the ‘rich patients on ventilators’ indefinitely, despite the futility of their treatment. That’s one endpoint, and not one that is attractive to me. But there is a large gray area as to how aggressively you treat people before giving up. There is a feeling – on which I can’t comment due to lack of experience – that some other countries are more likely to persevere until death, due to differences in religious background (Life at all costs!) or finance – the NHS looks to save money; private systems often look to make money. One thing is clear: intensive care can be a form of torture, despite the best efforts of the staff who work there to be humane, so whilst more ICU beds would be welcome within the NHS, I would not want to see every dying patient end up on one.
Either way, in Britain we have very few ICU beds of whatever level, in comparison with many other developed countries. I was fascinated to look at the ICU bed occupancy figures for Houston when they had their wave of cases there. They rose to several times what we could achieve in the UK, even with surge strategies such as using theatres and cross-trained staff.
Graham wrote:
Graham
18-Nov-20 09:37
279Fuji_Abound wrote:
The NHS is always in the firing line as being a disaster, but when you consider the per capita spend it does surprisingly well compared with the other more privately lead health services in other democracies. It is far from perfect and its success rates are not as good as they might be, but if the per capita spend even approached countries that a do a lot better it would be highly competitive on the data.I’m afraid I rather take the opposite view – I don’t think it’s a lack of funding holding the NHS back.
I tend to view it as a financial black hole – it doesn’t matter how much money they pour into it, it never gets much better. Each new injection of cash just stems the tide for a short while and before you know it we have another ‘£1bn required to avert immediate crisis’ headline in the newspapers. I believe the fundamental problems are ones of poor organisational structures, poor management, massive waste and all the worst things that come with being a large taxpayer-funded employer. Fraud (of all kinds) is said to cost it about £1.2bn per year. The promulgated view is that this fraud is carried out by a small minority (one has to say that, to avoid implying a culture of entitlement and casual fraud within the organisation), but I’m not sure I believe it because if it were true then it would mean that small minority were defrauding it out of some truly enormous sums.
It’s fine for emergency medicine and does that quite well. But if you have a non-trivial interaction with it that isn’t an emergency then you really need to be switched on, reasonably well-educated and able to actively manage things. You’ll need to act as your own project manager because no-one within the system is going to, and without active management a patient tends to just bounce around with each element of the system discharging their immediate responsibilities but no more.
I fully understand your point of view.
There is no doubt from those I speak with, the inefficiency and waste is astonishing. The argument is that it is always this way in any nationalised “industry”.
On the other hand, as I mentioned the per capita spend is relatively low. I believe for example Sweden spends 20 times as much as the UK. More spend probably encourages more waste, but at these mutiples it can only result in better data as well, and they are multiples that are astonishing.
The buying power of the NHS is also enormouus, and so there maybe some arguments some of the losses in efficiency are gained in buying power – again I undestand one of the arguments for nationalised industries.
Personally I am a great supporter of the system they have in Oz. A blend of private health and state sponsored health seems to me to provide the best blend of both systems, but inevitably their popula†ion is a little more than a third of the UK, and I suspect all of these matters are easier when you are dealing with smaller numbers and less challenging demographics. 
Fuji_Abound wrote:
The buying power of the NHS is also enormouus, and so there maybe some arguments some of the losses in efficiency are gained in buying power
Theoretically I agree. Practically the picture is quite complex, but generally speaking the NHS is at least not realizing any advantages from this buying power.
For medical services that buying power is a theoretic concept anyways as providers have a local monopoly.
For drugs the picture is very mixed and varies molecule by molecule. In the grand scheme of things, many generic molecules are slightly lower priced in the UK while most of the patented drugs are (sometimes significantly) higher priced – obviously also a consequence of the structure of the UK Pharma industry…
On a separate note, with multiple vaccines likely to become available next year and testing introduced at larger airports, it seems likely that before travelling abroad we would either need to have been vaccinated or have a test (recently or at the airport). This has already led to fraud, where forged CV-19 test result paperwork can be bought for £50-150. So there needs to be a more foolproof system – perhaps a bit like our driving licence records, where hire car firms can be given a code to check whether you are banned or not.
CommonPass appears to be addressing that problem, with US/UK flight demonstrated last month. There are other companies offering similar solutions. Ideally we’d have just one or two systems globally, as we do for credit card clearing.
I also read that Ticketmaster plans to introduce some sort of Immunity Passport along similar lines, which would enable restarting of public concerts and other events
https://www.billboard.com/articles/business/touring/9481166/ticketmaster-vaccine-check-concerts-plan/
From a GA perspective, I wonder whether prior to foreign flights we would be required to submit proof of recent CV-19 test or vaccination, otherwise being limited to fly to/from airports equipped to conduct the tests onsite. The biggest issue would be that test results are only valid for a few days at most, and that’s a lot of hassle for a weekend trip which would be weather dependent. Those vaccinated may be more free to travel, but likely still some restrictions. Those having had the infection and recovered don’t seem to be mentioned as getting any benefit and would still need proof of vaccination or test.
Where do you see waste within the NHS? I’m sure there is plenty… Just curious as to where you see it? I’ll give some examples later when I have time.
There is waste within private systems also… The NHS spend per capita is comparable to what the US system spends on administration. I see fairly often see patients coming from private systems who have had investigations and surgery that were in my view unnecessary.
kwlf wrote:
Where do you see waste within the NHS? I’m sure there is plenty… Just curious as to where you see it?
(Disclaimer: Last time I really looked at it was about 4 years ago – some things have changed since then)
Just some drivers of that:
- Medical procedures take longer so that the same staff does less of them in the same time. Interestingly this is more due to ancillary processes rather than the core procedure (e.g. for surgery, incision to suture time is largely the same but prep of patient and OC as well as cleanup takes significantly longer).
- Capacity utilization is significantly worse than in many other countries. OC occupation times, MRTs per scanner, stents per cath lab, etc. are lower
- In general (even compared to German standards) admin overhead is eating up too much capacity
