We Americans enjoy the most expensive medical system on the planet, long considered the standard against which all others are judged. Why, then, are some US companies sending employees overseas to address their health problems?
Companies such as Florida-based United Group Programs, for example, have found that individuals covered by their plans can go to foreign countries, undergo major procedures—like a coronary artery bypass—and save tens of thousands of dollars, even when the costs of travel and lodging are added to the bill. Some unnamed Fortune 500 companies are considering the feasibility of participating in similar programs. At first blush, it might seem that large corporations and insurance carriers are once again simply cutting costs by directing employees and patients toward the cheapest care available. These firms’ investigations, however, have revealed that the care in some foreign hospitals rivals or exceeds that of American institutions:
Foreign physicians are often US-trained, and many practice in America prior to returning to their native country.
Foreign hospitals exhibit a much higher ratio of registered nurses to patients.
Many overseas hospitals are far more patient friendly, boasting “five star” accommodations.
Technology at foreign institutions is equivalent to that in US hospitals.
Hospitals involved in these referral systems typically possess Joint Commission International accreditation, which mirrors accreditation required of American hospitals through the Joint Commission on Accreditation of Healthcare Organizations.
Apparently, the quality of health care in some foreign countries is as good as what Americans receive at home—at least in the minds of certain employers and health insurance companies. But does this only apply to a small number of surgical procedures being performed in a few select countries? Perhaps this is merely an aberration, an example of a few profiteers who have found a golden pond on distant shores.
Unfortunately, while we in the United States spend more per capita on health care than any other nation, we fare quite poorly when the quality of our care is compared to that in other developed nations. In 2000, the World Health Organization published the results of its first ever analysis of health systems worldwide. Using five performance indicators designed to measure the quality of health care in 191 member nations, WHO found the US ranked 37th out of all countries included in the study. In contrast, the United Kingdom, which at that time spent only 6% of its gross domestic product on health care, ranked 18th.
One of the most important indicators used by WHO to determine the health of a nation’s citizens is called the “Disability Adjusted Life Expectancy (DALE).” DALE measures the number of years a person can expect to live in good health, before illness or disability causes a measurable decline in the quality of life. When calculating healthy life expectancy for babies born in 1999, WHO found that the United States ranked 24th among member nations.
In June 2000, Christopher Murray, MD, PhD, Director of WHO’s Global Programme on Evidence for Health Policy, stated, “The position of the United States is one of the major surprises of the new rating system. Basically, you die earlier and spend more time disabled if you’re an American than a member of most other advanced countries.”
By most reports, in the ensuing six years since WHO’s original report was published, health care in the United States of America has not improved significantly. Naturally, various causes have been cited for the relatively poor performance of the US system in WHO’s rankings. Rationales range from disparate numbers of unhealthy African Americans or Native Americans within our system, to a disproportionate number of HIV cases, to tobacco-related cancers and lung disease, to a higher incidence of coronary heart disease, to more frequent acts of violence and homicide.
As a board-certified Family Physician with over two decades of medical training, rural practice, and disillusionment under my belt, I would like to add one more compelling possibility to the list of reasons for our country’s abysmal performance: Perhaps, in our headlong race to transform health care into a cash cow, we have done ourselves a profound disservice. We have forgotten the wisdom of the Eclectics, who healed before the Age of Pharmaceuticals. We have ridiculed the empirical knowledge of civilizations whose roots are much deeper than our own. And we have dismantled the foundation upon which our own medical system was built.
Without question, we must continue to perform responsible, unbiased, forward-thinking research that affords us happier, healthier lives. We must then offer the benefits of our learning to everyone, regardless of station. But we must remain reasonably skeptical of a paradigm of “evidence-based medicine,” where said evidence is susceptible to manipulation; we must maintain a high degree of suspicion for well-marketed misinformation. Above all, we must discard the erroneous notion that the path to good health lies in just one more drug, just one more biomedical contraption.
There is hope. I sense a weather change in the way health care is administered in this country. Because a few vested interests are so well entrenched, it may take time to find balance, but I believe we are on the verge of finding something new—or perhaps rediscovering something very old.
