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Topic: Healthcare, USA v Cuba. Access to International Healthcare Statistics (Read 1403 times) |
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Hermit
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Healthcare, USA v Cuba. Access to International Healthcare Statistics
« on: 2007-08-12 10:05:08 » |
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Given that the World Health Organization recently ranked France as the leader for healthcare and noted that USA life expectancies are dropping and that despite the United States spending more than anyone else (per capita) on health care, the US is ranked thirty-seventh for healthcare, worse than any other industrialized country and just above Slovenia, having access to to the facts that lead to this conclusion may be useful.
The WHO's statistical web system may be found at http://www.who.int/whosis/en/.
This makes a good background for the following interesting article:
US could learn from Cuba, say healthcare experts
Source:UPI
Authors: Not Credited (UPI)
Dated: 2007-07-24
Dateline: Washington, USA
The United States could learn a thing or two from Cuba's healthcare system, some experts say, particularly as US policymakers delve into healthcare reform.
Although Cuba probably isn't the first thing to pop into most Americans' minds when they picture efficient healthcare, the small country challenges stereotypes of healthcare in poor regions, said Paul Farmer, a professor of medical anthropologies at Harvard Medical School.
"The most important contribution that Cuba's given to global healthcare is (an) example -- the idea that you can introduce the notion of broad healthcare and wipe out the diseases of poverty," Farmer said in "Salud!," a recently released documentary about Cuba's healthcare system.
Despite its low per-capita income, Cuba excels in providing preventative, comprehensive care to its citizens, said William Keck, a professor at Northeastern Ohio Universities College of Medicine and the producer of "Salud!"
"Cuba has managed to do a great deal in terms of health status with comparatively few resources," Keck said at a panel discussion hosted by The Rockefeller Foundation and The Atlantic Philanthropies.
In fact, data from the World Health Organization shows little difference in health benchmarks between the United States and Cuba.
In 2004 the life expectancy for Cuban women exactly equaled that of American women, and the statistic for Cuban men came in just one year younger than the projected age for men in the United States. The healthy life expectancy, probability of dying under age 5 and average number of deaths for 15- to 60-year-old Cubans also came close, and sometimes yielded better numbers, than the same statistics for Americans.
In part, these similarities between data reflect the high degree of health disparity in the United States that creates a wide gap between the health outcomes for the rich and those for the poor, Keck said.
"We have areas that are more healthy than most areas in Cuba, but we also have areas that are much less (healthy), and when you average them out, it comes out to about the same" he told United Press International. "When you go to Cuba, there are differences geographically and regionally, but they're much less (than in the United States) ... it's a much more egalitarian approach."
Although average health outcomes in the two countries may be similar, when it comes to cost, the numbers don't even come close.
While the United States spent $6,094 per person per year in 2004, or 15.4 percent of its gross domestic product, Cuba spent only $229 per person, or 6.3 percent of GDP.
Cuba operates on a socialized medicine system, providing free healthcare to all citizens, and relies heavily on manpower to keep its system alive. Having enough doctors and nurses is essential, because they compensate for a lack of equipment and shortages of pharmaceuticals, said Fitzhugh Mullan, head professor of medicine and health policy at the George Washington University School of Public Health and Health Services.
"Cuba has a workforce of more than 60,000, which makes it one of the best resourced countries in the world," Mullan said.
This large workforce -- almost double the number of physicians per capita in the United States -- allows for personalized care administered by doctors who live in the communities they serve. Most family physicians spend the afternoons making home visits, teaching in the community and holding public health events.
Although the Cuban system has many benefits, social and political differences would make it difficult to uproot it and plant it in the United States, Mullan said. However, some of these practices could be encouraged through policy changes that support programs like the National Health Service Corps, a program that provides loan repayments and scholarships for doctors willing to work in poor communities, he said.
"These are areas where this model of community-based care is more realistic and is really a necessity," Mullan said.
For medical students graduating with debts of up to $200,000, the lower wages of a primary care physician in a poor area can be difficult to swallow, said Sandeep Krishnan, a student at the University of Missouri-Kansas City Medical School.
"It'd be cool to get back and help in a rural area," Krishnan told UPI. "On the other hand, debt is a big deal."
In addition to the lure of higher salaries elsewhere, some medical students are dissuaded from working in primary care by the stigma attached to it.
"If you say to your attending physician you want to be a family physician, they'll be like, 'You're too smart for that,'" Krishnan said.
In an attempt to introduce some of the benefits of the Cuban approach to medicine into the United States, one non-profit organization helps US students receive their medical training in Cuba. The students receive a full scholarship from the Cuban government on the condition that they work in a poor community in the United States upon graduation.
"Tomorrow is graduation day for the first batch of (eight) US students," said Gail Reed, international director of the Medical Education Cooperation with Cuba.
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With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
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Hermit
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Re:Healthcare, USA v Cuba. Access to International Healthcare Statistics
« Reply #1 on: 2007-08-14 02:50:44 » |
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World’s Best Medical Care?
Source: New York Times
Authors: Not credited (New York Times Editorial)
Dated: 2007-08-12
Many Americans are under the delusion that we have “the best health care system in the world,” as President Bush sees it, or provide the “best medical care in the world,” as Rudolph Giuliani declared last week. That may be true at many top medical centers. But the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.
Michael Moore struck a nerve in his new documentary, “Sicko,” when he extolled the virtues of the government-run health care systems in France, England, Canada and even Cuba while deploring the failures of the largely private insurance system in this country. There is no question that Mr. Moore overstated his case by making foreign systems look almost flawless. But there is a growing body of evidence that, by an array of pertinent yardsticks, the United States is a laggard not a leader in providing good medical care.
Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations. France and Italy took the top two spots; the United States was a dismal 37th. More recently, the highly regarded Commonwealth Fund has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data. Its latest report, issued in May, ranked the United States last or next-to-last compared with five other nations — Australia, Canada, Germany, New Zealand and the United Kingdom — on most measures of performance, including quality of care and access to it. Other comparative studies also put the United States in a relatively bad light.
Insurance coverage. All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by the patients. The United States, to its shame, has some 45 million people without health insurance and many more millions who have poor coverage. Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.
Access. Citizens abroad often face long waits before they can get to see a specialist or undergo elective surgery. Americans typically get prompter attention, although Germany does better. The real barriers here are the costs facing low-income people without insurance or with skimpy coverage. But even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.
Fairness. The United States ranks dead last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens. Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions or to get needed tests and follow-up care.
Healthy lives. We have known for years that America has a high infant mortality rate, so it is no surprise that we rank last among 23 nations by that yardstick. But the problem is much broader. We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.
Quality. In a comparison with five other countries, the Commonwealth Fund ranked the United States first in providing the “right care” for a given condition as defined by standard clinical guidelines and gave it especially high marks for preventive care, like Pap smears and mammograms to detect early-stage cancers, and blood tests and cholesterol checks for hypertensive patients. But we scored poorly in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting their needs and preferences, which drove our overall quality rating down to last place. American doctors and hospitals kill patients through surgical and medical mistakes more often than their counterparts in other industrialized nations.
Life and death. In a comparison of five countries, the United States had the best survival rate for breast cancer, second best for cervical cancer and childhood leukemia, worst for kidney transplants, and almost-worst for liver transplants and colorectal cancer. In an eight-country comparison, the United States ranked last in years of potential life lost to circulatory diseases, respiratory diseases and diabetes and had the second highest death rate from bronchitis, asthma and emphysema. Although several factors can affect these results, it seems likely that the quality of care delivered was a significant contributor.
Patient satisfaction. Despite the declarations of their political leaders, many Americans hold surprisingly negative views of their health care system. Polls in Europe and North America seven to nine years ago found that only 40 percent of Americans were satisfied with the nation’s health care system, placing us 14th out of 17 countries. In recent Commonwealth Fund surveys of five countries, American attitudes stand out as the most negative, with a third of the adults surveyed calling for rebuilding the entire system, compared with only 13 percent who feel that way in Britain and 14 percent in Canada.
That may be because Americans face higher out-of-pocket costs than citizens elsewhere, are less apt to have a long-term doctor, less able to see a doctor on the same day when sick, and less apt to get their questions answered or receive clear instructions from a doctor. On the other hand, Gallup polls in recent years have shown that three-quarters of the respondents in the United States, in Canada and in Britain rate their personal care as excellent or good, so it could be hard to motivate these people for the wholesale change sought by the disaffected.
Use of information technology. Shockingly, despite our vaunted prowess in computers, software and the Internet, much of our health care system is still operating in the dark ages of paper records and handwritten scrawls. American primary care doctors lag years behind doctors in other advanced nations in adopting electronic medical records or prescribing medications electronically. This makes it harder to coordinate care, spot errors and adhere to standard clinical guidelines.
Top-of-the-line care. Despite our poor showing in many international comparisons, it is doubtful that many Americans, faced with a life-threatening illness, would rather be treated elsewhere. We tend to think that our very best medical centers are the best in the world. But whether this is a realistic assessment or merely a cultural preference for the home team is difficult to say. Only when better measures of clinical excellence are developed will discerning medical shoppers know for sure who is the best of the best.
With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has “the best health care system in the world” and turn instead to fixing its very real defects. The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally. But there is also plenty of room to improve our coordination of care, our use of computerized records, communications between doctors and patients, and dozens of other factors that impair the quality of care. The world’s most powerful economy should be able to provide a health care system that really is the best.
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With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
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Hermit
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Re:Healthcare, USA v Cuba. Access to International Healthcare Statistics
« Reply #2 on: 2007-08-15 15:01:20 » |
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De-Criminalizing Mental Illness
Source: Time
Authors: M.J. Stephey
Dated: 2007-08-08
"Psycho." "Freak." "Jason from the horror movie." These are the answers that psychologist Habsi Kaba gets from Miami police officers when asked to describe people with mental illness. Such stereotypes are surprisingly common, says Kaba, and not just within law enforcement. But these misconceptions are especially dangerous when they're held by police, who are often forced to make split-second, life-or-death decisions about mentally ill suspects. "The worst thing you can have is power and lack of knowledge," Kaba says.
Just ask Mike, 31, who knows firsthand. Mike suffers from schizophrenia, bipolar disorder and depression. Since the age of 17, the Los Angeles native has been repeatedly arrested during psychosis for nuisance crimes like disturbing the peace, only to serve his time, fall off his medication and get arrested again. On three separate occasions, his hallucinations were so severe he tried to commit suicide by provoking the police to shoot him. Though he is receiving treatment, rising health care costs and declining federal help mean Mike will likely end up in jail again.
L.A. Police Lieutenant Richard Wall told Mike's story to members of the House Judiciary Committee in March, in support of the 2007 Second Chance Act, which aims to reduce recidivism, in part with better mental health treatment for prisoners returning to society. Prisons, Wall testified, have become the nation's "de facto" mental health care provider. According to the Federal Bureau of Justice Statistics, there are currently 1.25 million inmates like Mike, with debilitating disorders ranging from schizophrenia to post-traumatic stress disorder, abandoned in the U.S. prison system instead of receiving treatment in hospitals.
"If you think health care in America is bad, you should look at mental health care," says Florida state judge and criminal mental health expert Steve Leifman. More Americans receive mental health treatment in prisons and jails than hospitals or treatment centers. In fact, the country's largest psychiatric facility isn't even a hospital, it's a prison — New York City's Rikers Island, which holds an estimated 3,000 mentally ill inmates at any given time. Fifty years ago, the U.S. had nearly 600,000 state hospital beds for people suffering from mental illness. Today, because of federal and state funding cuts, that number has dwindled to 40,000. When the government began closing state-run hospitals in the 1980s, people suffering from mental illness had nowhere to go. Without proper treatment and care, many ended up in the last place anyone wants to be.
"The one institution that can never say no to anybody is jail," Leifman says. "And what's worse, now we've given [the mentally ill] a criminal record."
Most police officers aren't trained to deal with people suffering from severe mental illness. But because they are the first to respond to calls involving psychiatric crises, police are in a unique position to fix the crippled system. That effort is now under way, thanks to Crisis Intervention Teams (CIT), which are being adopted by a growing number of police departments across the country. The concept was pioneered by the Memphis Police Department in 1988 after an officer was shot and killed by a person suffering from schizophrenic hallucinations. Working with the National Alliance for the Mentally Ill and two local universities, Memphis police trained and organized a unit of officers specifically to deal with people in psychosis — a mental state commonly suffered by patients with severe mental illness in which their thoughts don't match up with reality.
In these cases, normal police procedures often increase the chances of violence, confusion and even death. So, police officers are taught to approach psychotic suspects in a different way: by speaking softly, rather than shouting commands, repeating phrases, holding hands palms-up instead of holding a gun or badge, and wearing plainclothes instead of uniforms. These actions may seem minor, says Kaba, who is the CIT training coordinator for the Miami Police Department, but they go a long way in breaking down the barriers — psychological and otherwise — that often exist between the mentally ill and police.
The ultimate purpose of the CIT program is perhaps empathy. Using a device called Virtual Hallucinations, officers can begin to understand what it's like to be in the grip of a severe and untreated mental illness. Made by the pharmaceutical company Janssen, the rig and headphones simulate the disturbing and disorienting environment of a psychotic episode. After using the rig, Lt. Wall of the LAPD says he was struck by the idea of being exposed to such chaos all the time. "It's just a scary thing," Wall says, "I can do it and walk away from it." Those with serious mental illness, however, cannot.
Community members like John Kowal, 54, work with CITs to provide officers with a more intimate knowledge and understanding of psychosis. Kowal, who suffers from bipolar disorder and alcoholism, has been working with Miami's Police Department and inmates as a "peer specialist." His duties range from consultant to mediator to companion. "I can bond with [mentally ill inmates]. I can say, 'Hey, I was in jail. I take medicine. It's worth it,'" Kowal says. "I don't go by a book. I'm like a friend."
Likewise, the program challenges stereotypes of law enforcement officers as trigger-happy bullies. "Just like police don't understand people with mental illness, we don't understand them," Kaba says. "They're social workers, they're brothers and sisters, they're priests. They play every role out there."
Some officers initially dismissed the CIT program as run-of-the-mill sensitivity training or extreme political correctness, but Cindy Schwartz, director of Florida's Eleventh Judicial Circuit Criminal Mental Health Project, says those same officers now marvel at the program's success. The CIT model has received numerous awards from nationally recognized mental health organizations, law enforcement agencies, and humanitarian groups for treating mental illness as a disease, not a crime. Such change cannot come too soon.
Last December, the Advocacy Center for Persons with Disabilities filed a federal lawsuit against the state of Florida, alleging that it was violating the civil rights of hundreds of mentally ill convicts and inmates awaiting trial by leaving them jailed and without treatment. "We reached a crisis point," says Leifman, the Florida judge, of the state's inability to address mental illness. "We have hundreds of defendants languishing in jail." It got so bad that two mentally ill inmates in a Pensacola, Fla., jail died after being brutally subdued by guards. And in Clearwater, Fla., a schizophrenic inmate gouged out his eye after waiting weeks for a hospital bed.
In June, New York legislators passed a bill outlawing solitary confinement for mentally ill inmates after a study found that such isolation — to which mentally ill prisoners are often subjected — worsened psychiatric symptoms and often led to self-mutilation or suicide attempts.
When it comes to mental health care in the U.S., Leifman says, history is repeating itself. During the 1800s, long before state-run agencies existed to treat mental illness, families would simply drop their loved ones off at jails or prisons, where their conditions remained untreated. Then came state-run hospitals that Leifman refers to as "horror houses" given that patients were usually either neglected or abused — experiments involving drugs and electroshock therapy inspired movies like One Flew Over the Cuckoo's Nest and finally drew the public's attention to the civil rights abuses of people with mental illness. There appeared a glimmer of hope in 1963, when President Kennedy, in what would be his last public bill-signing, authorized $3 billion to create the first national network of mental health facilities. But after Kennedy's assassination, the country turned its focus to Vietnam and not one penny went into the project.
"It's the one area in civil rights that we've gone backwards on," says Leifman, noting that nearly half of the nine floors in Miami-Dade's County Jail are mental health wards, even though the building is "more like a warehouse than a facility." He decries the conditions that these inmates face, including vermin-infested, decrepit buildings that lack adequate ventilation, lighting and water supplies. Leifman also laments the amount of taxpayer dollars used to fund such an inadequate system. Florida taxpayers spend $100,000 each day to house the mentally ill in prison; moreover, studies show that people with mental illness stay in jail eight times longer than other inmates, at seven times the cost.
"We can't really build our way out of the problem. It's not just about state hospital beds or jails," Leifman says. "We need to really take a hard look at how we're dealing with the problem overall."
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With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
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Blunderov
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"We think in generalities, we live in details"
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Re:Healthcare, USA v Cuba. Access to International Healthcare Statistics
« Reply #3 on: 2007-08-15 16:23:59 » |
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Quote from: Hermit on 2007-08-15 15:01:20 <snip>
Prisons, Wall testified, have become the nation's "de facto" mental health care provider. According to the Federal Bureau of Justice Statistics, there are currently 1.25 million inmates like Mike, with debilitating disorders ranging from schizophrenia to post-traumatic stress disorder, abandoned in the U.S. prison system instead of receiving treatment in hospitals.
</snip>
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[Blunderov] Apparently this care is sometimes a little less than tender.
http://www.tdcj.state.tx.us/stat/executedoffenders.htm
Date of Execution:
May 18, 2004
Offender:
Patterson, Kelsey
Last Statement:
Statement to what. State What. I am not guilty of the charge of capital murder. Steal me and my family's money. My truth will always be my truth. There is no kin and no friend; no fear what you do to me. No kin to you undertaker. Murderer. [Portion of statement omitted due to profanity] Get my money. Give me my rights. Give me my rights. Give me my rights. Give me my life back.
"Convicted in the killing of Louis Oates, the 63 yr old owner of Oates Oil Co. in Palestine and business secretary Dorothy Harris 41. Oates was standing on the loading dock of his business at 507 W Reagan when Patterson walked up behind him and shot him with a 38 caliber pistol. Patterson walked away after the shooting but returned to shoot Harris when she came outside and began screaming. Patterson then walked a short distance to a friends house, put down the gun, and took off his clothes. He was standing naked in the street when arrested. A motive in the murders was unclear but a friend of Oates told the police that Patterson and the victim had once argued over who was the better football player, Patterson or Oates' son."
[Bl.] This was a sane person? I seriously doubt that.
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