Thursday, November 10, 2005

Chinese Taken-In

Tyler Cowan's response
to Kevin Drum's naivete on single payer pre-paid health care reminds us we've forgotten to respond to Paul Krugman's ill informed November 7th advice to look far east, old men:

The funny thing is that the solution -- national health insurance, available to everyone -- is obvious. But to see the obvious we'll have to overcome pride -- the unwarranted belief that America has nothing to learn from other countries....

Taiwan, which moved 10 years ago from a U.S.-style system to a Canadian-style single-payer system, offers an object lesson in the economic advantages of universal coverage. In 1995 less than 60 percent of Taiwan's residents had health insurance; by 2001 the number was 97 percent. Yet according to a careful study published in Health Affairs two years ago, this huge expansion in coverage came virtually free: it led to little if any increase in overall health care spending beyond normal growth due to rising population and incomes.

Before you dismiss Taiwan as a faraway place of which we know nothing....

Perish the thought!. We distrust and verify:

The differences between care in the West and in Taiwan may, at times, seem quite pronounced. The doctor-patient relationship differs significantly and cultural differences abound in even the most modern health care settings. The infrastructure for health care in Taiwan is dependent on National Health Insurance, which covers most of the island's 22 million people. As a result, doctors and hospital-based outpatient clinics are under enormous pressure to see large volumes of patients in relatively short periods of time. It isn't unusual to find doctors seeing as many as 30 patients an hour in the largest and busiest specialties. (Many of these patients are simply renewing prescriptions.) Expect to wait in crowded, uncomfortable waiting areas to see your clinic doctor.

....Without question the most convenient place for privately insured Americans who don't speak Mandarin is in one of several western style clinics. Hospital based outpatient clinics, while frequently boasting very good doctors, will differ dramatically from Western notions of privacy and the doctor-patient relationship. Health care is generally much less expensive than in the United States. However, priority care centers for Westerners are more expensive - though generally cheaper than similar care in the U.S. Wherever you seek care, it is always pay as you go. If you are privately insured you must submit your own receipts for reimbursement.

....Although you can expect state-of-the art medical facilities in Taiwan's Medical Centers, the paramedic system is not in the same ballpark as that in the United States. There is an emergency dispatch system and ambulances can be summoned by calling 1-1-9. They are triaged by the dispatcher on the basis of the perceived nature of the emergency. Dispatchers may not speak English. There are potentially two levels of care associated with emergency medical services. Crews with more advanced training are directed to more serious cases. However, ambulances are not like those in the United States. In some instances, the ambulances resemble nothing more than a small van with emergency lights and a gurney in the back. Do not expect trained medical technicians to arrive with special medical equipment. Although the standard of care is changing, most do not even possess a simple defibrillator. Ambulance crews have not received advanced paramedic training. In many instances the driver has no training at all. Thus you cannot expect the kinds of advanced recussitative training associated with paramedics in the U.S. In cases that are less than extremely urgent, you may be better served by arranging private transportation.

....Visitors to hospitals in Taiwan find a veneer of similarity to hospitals back home. Beneath the surface, however, are big differences. In many hospitals it is expected that the patient's family will help provide routine hygiene chores frequently taken care of by licensed practical nursing staff in an American hospital. Indeed, many hospitals accommodate and expect at least one family member will sleep in the patient's room (even semi-private rooms). Some hospitals expect patients to bring their own bath towels, toilet tissue, soap and other toiletries. Often the floors, walls and medical equipment will appear much less clean than a typical American hospital.

....The vast majority of doctors have hospital-based practices and see patients in outpatient clinics which are either in the hospital or in ancillary buildings immediately adjacent to the hospital. Many are extraordinarily busy, seeing thousand of patients each day in the course of morning clinic, afternoon clinic, and evening clinic.

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