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zoom RSS 英国ではケネディ上院議員の脳腫瘍治療はできない?/米国医療事情 医療制度改革

<<   作成日時 : 2009/08/15 01:15   >>

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画像 英国ではケネディ上院議員が脳腫瘍治療は受けられないと聞いたと共和党グラスリー議員が言及したことで、英国の医療制度を違う戦いの渦中に入れてしまった。
 国際的な視点は強硬な方針を巧妙に立てる時に不可欠であるが、現在の医療制度議論においては池の向こう側を見ることは両国の医療政策をより悪化させることになる。
 英国人は米国の医療制度について直感的に懐疑的に思っている。英国のシステムは皆保険制と無料という2つの原則に基づいている。英国人は、4,600万人もの米国人が無保険であるということに理解できない。
 しかし、4,600万人という統計上の数字は誤解を招きやすい。短期間の無保険も含んでおり、多くは30才未満である。相当多くの人が年収50,000ドル以上であり、1/3は適格なのに連邦保障に登録しないことを選択している。
 この誤った統計データにより、英国は競争の採用を遅らせ、民間医療部門の導入に抵抗してきた。このことは歴史的に英国には利益をもたらさなかった。
 競争は品質と革新をもたらすエンジンであり、患者の治療を改善する可能性がある。ガンや脳卒中の集中治療で米国が英国よりずっと優れていることは一部はその結果である。最近になり、英国で競争原理を導入して患者満足度や成果が上がってきている。
 しかし米国も同様の過ちを犯している。無保険者の数字と同じことが、待機時間や治療制限の噂として誤解を生んでいる。英国の待機時間は最近10年間で低下し、最新のガン治療薬へのアクセスも改善した。実際、ケネディも英国でガン治療を受けられただろう。
 治療制限は英国だけの問題ではなく、米国でも違った形で行われている。英国では治療薬や治療法は客観的に効果判定を決めている公的機関の影響を受ける。公的機関が推奨するが従うかどうかは地域が決定する。米国では治療費自己負担を払えるかどうかで治療制限がかかる。
 グラスリー議員のコメントは米国での医療改革がなぜ重要かを理解できていない。ケネディはどこに住んでいようと最高の医療を受けられるだろうが、他の人は現実には違う。全額保険を持っていれば米国でガン治療を受けるだろうが、慢性疾患で2人の子どもを抱え保険が無ければ英国で治療を受けたい。
 オバマ大統領は皆保険へと進めており、われわれが英国から学ぶ必要のある教訓がある。第1に、英国はホームドクターに多額の出資をし、品質を高めてコストを省く非常に効率的な方法である。良いプライマリケアを持てば慢性疾患の改善と多くのER患者を救うことになる。第2に、利益がない治療に代金は払わないということを英国から学ばなければならない。必要な治療へのアクセスを保証し、無駄な治療から離れるように患者を誘導するような治療制限が効率的で健康的である。
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Would Ted Kennedy Get Medical Care in the U.K.?
U.K.'s National Health Service Faces off Against the U.S. Political Right
OPINION By ZACK COOPER
LONDON, Aug. 13, 2009
http://abcnews.go.com/Health/HealthCare/story?id=8318458

England's National Health Service has always been a political punching bag, but usually, the jabs are aimed at British politicians, and they are most often thrown by the English electorate.
healthcare england
(/ABC News)

Iowa Republican Sen. Chuck Grassley's recent off-the-cuff remarks in which he mentioned that he had heard that Sen. Ted Kennedy might not get care for his brain tumor in England, have put the English health system into a very different kind of fight. Now, the English are facing off against the U.S. political right.

Usually, international learning is vital to crafting strong policies. However, in the current health care debate, looking across the pond is actually making American and English health policy worse. Instead of looking at what we can learn from each other, both countries are so paralyzed by each other's faults that neither country can move forward.

For ABCNews.com's complete coverage of health care reform, click here.

The British are intuitively skeptical about the U.S. health care system. The English system was founded on two principles: that coverage was comprehensive and that care was free and not based on ability to pay. The English simply cannot understand the idea that an estimated 46 million Americans go without insurance coverage.

However, they do not realize that the 46 million uninsured Americans statistic is misleading. While un- and underinsurance are indeed huge problems in the United States, the 46 million tally includes individuals who are without insurance for very short periods of time. Further, many of the uninsured are under 30 years old, a surprising number are making more than $50,000 annually and almost a third are already eligible but choose not to enroll in federal coverage.

Separating Facts from Fiction in the Health Care Wars

This misread of the U.S. statistics in part reflects why England was slow to adopt competition and reluctant to embrace private sector health care providers.

This malaise historically didn't do England any favors. Competition can be the engine to drive quality and innovation and fundamentally it can improve the patient experience. Indeed, it's partly the result of competition that high intensity care for cancer and strokes in the United States is so much stronger than it is in England.

Of late, England has begun to more actively embrace competition, and as a result, patient satisfaction and patient outcomes are improving.

But the United States is equally guilty of letting anecdotes get in the way of policy. Americans cannot understand the concept of long waits for care, or the rumors of rationing care in England.

However, just as the 46 million uninsured statistic is misleading, so, too, are rumors about waiting times and rationing. Waiting times have plummeted in England over the last decade to the point where they are no longer a problem. Likewise, England has taken big strides to improve access to the latest cancer medications.

And yes, Kennedy would have received cancer care in England.

It also turns out that rationing is not an exclusively English phenomenon. It is also done in the United States, just differently. In England, decisions about which drugs and treatments to pay for are influenced by a quasi-government agency that decides whether medications and therapies are clinically effective. Cost does come into the picture, but it is not the arbiter of whether or not a course of treatment is paid for. The agency makes nonbinding recommendations that local areas decide whether or not to follow.

In the United States, there is rationing too. It takes the form of individuals choosing not to purchase care or not to make a co-payment because they can't afford it. And those decisions tend not to be evidence-based. Similarly, private insurers make similar decisions about paying for treatment to the ones that are made in the NHS; they're just more subtle.

Where to Get Better Health Care?

Grassley's comments show that he misses the point about why health care reform in the United States is important. Ted Kennedy would get amazing care, no matter where he lived. However, the real test of our health system isn't the quality of care we provide for Kennedy, it's the quality of care we provide for the rest of us.

To be sure, if I had full insurance and I got cancer, I'd want to be treated in the United States. However, if I had a long-term illness, had a small business and two kids and didn't have insurance, I would probably prefer to be in England. This is why President Obama is promoting universal coverage, and this is why there are lessons that we need to learn from England.

First, England invests heavily in family doctors, and that turns out to be a very efficient way to improve quality and save costs. Having better primary care in the United States would improve the way American doctors deal with patients with chronic disease, and it would keep more patients out of emergency rooms.

Second, the United States must learn from England about how to say no to paying for care that we know does not have clinical benefits. We need to assure that have access to care they need and to steer patients away from care that is fruitless. This type of "rationing" is more efficient and healthier than forcing individuals to choose between necessary care and other household expenses.

The U.S. and English health systems are fundamentally different, and we'll never see a situation where we're delivering care the same way in both countries. However, this doesn't mean that we need to misrepresent each other. Every country is facing rising health care costs and rising patient demands, and dealing with those challenges without looking at what other countries are doing is like getting into a fight with a hand tied behind our back.

Zack Cooper is a health economist for LSE Health at the London School of Economics and Political Science, and a native New Yorker.

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