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Showing posts from March, 2018

Comparing the US with other high income countries: how do we pay so much for healthcare?

Healthcare costs in the US are significantly greater than in any other developed country and for this we have a shorter life expectancy than they. We also develop cutting edge technologies and miracle cures and are world leaders in medical research. Just how do we compare with other economically advantaged nations?

In a Special Communication article in the JAMA (Journal of the American Medical Association) this week, Harvard researchers Irene Papanicolas, Liana Woskie and Ashish K. Jha analyzed data from Japan, Australia, Switzerland, Germany, France, the Netherlands, the United Kingdom, Canada, Sweden and Denmark about healthcare and social spending as well as outcomes. It is a huge amount of data gleaned from diverse sources and the authors have presented it beautifully. I will only comment on it and can't possibly do it justice. Still, there are several really interesting facts to point out, so I will dig in.

In US dollars, our spending per person per year is higher than any o…

Drug costs and copays

Drug costs in the US are higher than in in any other industrialized country in the world. Our cost for an insulin glargine (long acting insulin) pen is $76.80 and in Canada, so very few miles away, it costs $19.60. The latter price is reasonable. The former price can make the difference between being able to afford a life saving drug and dying. It is illegal, however, for a US citizen to buy his or her insulin, or any other drug available in the US, from another country.

Costs of pharmaceuticals in other countries are usually regulated by the government. Not so in the US. This is due to the lobbying power of US pharmaceutical companies. Because US citizens pay more for our drugs, we do have earlier access to newly released products than other countries if we can afford them. Our deep pockets help make new drug development attractive to drug companies. For people whose lives depend on the development of a new drug, this is very important. For the vast majority of patients, however, hi…

South Sudan trip: take 4

I have just returned from Old Fangak, Jonglei State, South Sudan after my fourth trip. I seem to have earned a welcome there for teaching bedside ultrasound to anyone who will learn and doing ultrasound whenever anybody asks. Also I cook a mean soup and make delicious chocolate sauce in which a homesick American can dip a piece of local deep fried bread dough.

The hospital I visit is a community health center which has morphed into a full service hospital for tens of thousands of people displaced by chronic civil war. Jill Seaman, a doctor friend from my home town and a champion of treatment for complex and fatal tropical diseases (particularly Kala Azar and tuberculosis), has coordinated the multiple functions of this center for years. It serves as a distribution point for food aid, a triage center for war wounded when the war is close by, a referral center for treatment of tuberculosis and Kala Azar and now a major outpost for Doctors Without Borders (Medecins sans Frontieres--MSF)…