Went to St. John’s Mercy hospital last week, accompanying my wife for the baby ultrasound thing. I am familar with St. John’s because I went there couple times before (once was I hurt myself during roller blade skating, and I had to get two stitches there).
As I said in my previous healthcare reform post, 10 years ago I was amazed by the good conditions of University of Missouri hospital (Columbia) because it’s clean and it’s just not like hospital (my impression of hospital back in China, read Went to Children’s Hospital – Refugee Camp from Wang Jianshuo and you will know. More recently he wrote Hospital is Badly Needed). This time I had similar feeling about St. John’s. Now they got Wifi so theoretically we can work from hospital cafeteria. I even told my wife does they have openings.
So with the gloomy and doom of all those healthcare debates, we should keep in mind US hospitals, I mean those hospitals I visited in the past, St. John’s, Depaul, St. Anthony’s, U of Missouri Hospital, are all in very good condition.
Hardware and facilities aside, US hospitals and healthcare providers have other advantages over China’s system. Some obvious ones:
1) The separation of doctors/hospitals and pharmacies. In China doctors are not paid by their services, rather by the prescription drugs and other diagnostic tests they order. Sounds alarming? Why is that? Well, the Chinese healthcare system or hospital operating model very much learned from old Soviets model, which basically means free care for everyone. There is only a nominal registration fee when patients go to hospital to see a doctor. Nowadays there is so called “expert clinic” in which those famous doctors can charge 50 Yuan ($7) or 100 Yuan for his service (seeing the patient). There are fees associated with surgery and in-hospital stay, but again doctors’ service (labor + hard work) are not compensated fairly. So what do they do? Doctors got it through other means: kickbacks from expensive drugs they prescribe for their patients and expensive tests they order for their patients. I am NOT saying all doctors do that. But this is the culture back in China, and so is the Hong Bao (red envelop with money inside, read more about red envolop from Wang Jianshuo) given by patients family to surgeons before operation. We all want our love ones being taken care of, right?
That is not to say in the US doctors are immune from that problem. Not the red envelop but the dining and entertainment provided by the pharmaceutical companies. But the extent are different, and because the doctors are paid by their services, they don’t need to take the dangerous routes of “red envelops”. Incentive-wise, some healthcare reform critics claim the doctors tend to do more expensive tests and order more expensive drugs too. I agree it to some extent, e.g., “take out tonsil” is much more common here in the US, which cost $5,000 early this decade.
2) The availability of emergency room to everyone, whether people carry insurance or not. Many Chinese hospitals also do this, but there are in some instances sick/injured patients were not helped because of lack of financial proof. Similar things also happened in the US, but not as widely as in China. As I heard from a doctor when asked about the cost of treatment of emergency room, he said: don’t worry, our first mission is to help patients. We are a private (charity) hospital, if people really cannot afford, that’s OK because we have the financial resoures to do that.
This is very important to patients and his/her family, because as we know a lot of fear comes from the uncertainty of financial consequence, besides the illness.
People already on the bus
One of the main problems of healthcare reform is, just like me, many people who have healthcare through employer benefits program, feel mostly fine with the current healthcare (although we all know some of the problems like rising cost). Now the government is asking those who are already on the bus squezzed inside, a little bit more, so that more people can board the bus. According to Wiki:
According to the United States Census Bureau, approximately 85% of Americans have health insurance; nearly 60% obtain it through an employer, while about 9% purchase it directly.[2] Various government agencies provide coverage to about 28% of Americans (there is some overlap in these figures).
To be continued…