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zoom RSS 英国医療に対する海外駐在員の意見/医療制度改革 オバマ政権

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英国医療に対する海外駐在員の意見
 距離をおいて客観的に見ると、米国の政治的な討論が騒々しい誤った情報をもった論客によりなされているように見えるときがある。有名な物理学者スティーブン・ホーキングがオバマ大統領と議会による医療制度改革提案についての討論に巻き込まれた例がその一つである。
 67才のホーキング氏はルー・ゲーリック病であり、四肢が麻痺し音声合成装置を通して話しをし、多くの医療的援助が必要であり、英国に住んでいる。61年間彼を含め多数の人々に無料の医療を提供してきたNHS国民健康保険の害悪の例として取り上げてしまった。
 Investor’s Business Dailyは8月3日、米国でNHSスタイルの医療制度を提案するとしてオバマ大統領を非難する論説で、NHSがホーキング氏の人生を「本質的に無価値であり」、「英国ではチャンスがないだろう」と宣言した。その後、訂正し、ホーキング氏自身はNHSの助けにより現実に生き続けているとの声明を発表した。
 医療についての議論はしばしば個人的である。どの制度が最もよいかを言うときに、自分自身や家族・友人の経験に基づいている。良い結果が得られればそこで病院や医師を信じ、結果が悪ければ非難する。
 現在英国に住んでいる米国人としてたまたま医療サービスについて書く機会があり、公的な医療と時々帰国して利用する私的医療の両方を利用してみて、全ての側から直接議論を見てきた。
 1980年代にジョージタウン大学病院の救急処置室で、トイレットペーパーを耳栓として使おうとして取り除いてもらうのに333ドルを支払った者として、私自身は無料のシステムを賞賛する。
 1948年、厳しい戦後に設立されたNHS国民健康保険は英国のアイデンティティに必須である。しかし英国人はまるで国技のようにNHSの不平を言う。治療を配給している、待機を強制する、年寄りに冷たい、歯科治療はほんの基本的なもののみ、病院に耐性菌がうようよしている。こうしたことはしばしば当を得ている。NHSは救急医療や小児医療ではすばらしい。わが子たちはワクチンや眼科検査などすべて完璧に世話になった。私の友人はガンになり米国同様の治療を受けて亡くなったが、家族に数万ドルの請求書が届くことはなかった。
 しかし、限界はある。無限の予算があるわけではないため、末期がん患者に数ヶ月延命するかもしれない薬剤がその値段に値するかどうか決めることによって治療を配給する必要がある。
 病院はいつもきれいというわけではなく、官僚的である。医師や看護士は酷使され、患者はしばしば消費者というより嘆願者であるかのように治療される。出産する女性は子どものオムツなどを持参するように言われる。患者は必ず検査や治療を待たされる。資源は有限であり地域ごとに治療割り当てがあり、待機時間は地域で様々である。治療についても同様である。
 提供できる治療の制限のため医師は、全ての可能なオプションや全ての起こりうる副作用を説明しない。逆に米国の医師は奇妙なことに将来おこるかもしれないことの警告にこだわり、より高価な治療をすることに熱心である。
 最初の子どもアリスは、NHS看護師が体重を量り診察し母乳保育の説教をするために家に来たが、当然ながら無料だった。湿疹があったが看護師は気にしていなかった。3ヶ月のアリスを連れてニューヨークのパークアベニューの小児科に行った時に、医師は非常に驚いて、湿疹があるのに、治療をしていないと非難した。
 英国人は彼らのシステムの制限には十分気づいている。しかし、社会化された医療の完全な失敗の証拠として挙げられたNHSを持つことを評価しているだろうか? 「オーウェル的」で、テロの温床、グラスリー上院議員が言うような「ばあさん」やケネディ上院議員まで誰でも治療を断るであろうと言われることを耳にしたいだろうか? そんなことはないだろう。
 英国人は乱暴な国家主義的な米国人の批判に反応した。新たなキャンペーン“We Love the NHS”は野党保守党キャメロンのみならずブラウン首相も応援した。大学在学中にブラウン氏の視野はラグビー事故後、NHS国民健康保険外科医によって救われた。2月に死んだキャメロン氏の6歳の息子、イワンは重度の障害があったが、NHSサービスから愛情深い治療を受けた。様々な病気で治療を受けた者からの感謝状でいっぱいである。
 私の場合、夫が1990年代に脳卒中となり、NHSはは神の賜物だった。彼は模範的な集中治療を受け、私は請求書をもらうことはなかった。
 後で知ったが私的な保険も使用できる。英国人の1/10が私的な補足的な保険を持っていて、専門医や早い治療を選択する時に使用する。夫が専門医から精密検査が必要だと言われ4ヶ月待ちだと言われたため、「私的な患者」と話し翌日の診察を予約することができた。
 リハビリを受ける時点で、NHSが提供した施設に行ってみたが、建物は古く人員も不足しており、食事も粗末だった。そこで、他のオプションである、私的なリハビリ病院を探し、保険で完全に支払われる個人病院を選んだ。そこに入院していたのは中東の豊かな国の出身者のようだった。
--------------------------------------------------
Health Care in Britain: Expat Goes for a Checkup
http://www.nytimes.com/2009/08/16/weekinreview/16lyall.html
By SARAH LYALL
Published: August 15, 2009

LONDON ― There are times when, viewed from afar, American political discourse looks like nothing more than a huge brawl conducted by noisy, ill-informed polemicists. This is one of them, as Britain found last week when the renowned physicist Stephen Hawking was, bizarrely, drawn into the raucous debate over the health care proposals of President Obama and Congress.

画像Mr. Hawking, 67, has Lou Gehrig’s disease, is paralyzed, speaks through a voice synthesizer and needs a great deal of medical attention. He also lives in Britain. This makes him a spectacularly unfortunate choice to pick as an example of the evils of the National Health Service, which has provided free health care ― to him, and to millions of other people here ― for 61 years.

But that is what Investor’s Business Daily did on Aug. 3, in an editorial opposing Mr. Obama’s proposals by accusing him of wanting to institute an N.H.S.-style system in America. Mr. Hawking “wouldn’t have a chance in the U.K.,” the newspaper declared, because the health service would declare his life “essentially worthless.”

The paper printed a correction, and Mr. Hawking issued a statement saying that, actually, the health service had helped keep him alive.

Debates about health care are often personal. Policy is full of statistics ― mortality rates, spending per capita, cost of drugs, length of hospital stays ― and full of hysterical predictions of what disasters change will bring. But in discussing which system is best, patients turn to their own experiences and those of their families, friends and acquaintances. People believe in the hospital and doctors where they had good outcomes; they deplore those that have let them down.

As an American who now lives in Britain, occasionally writes about the health service, and uses public and private medicine here (as well as back home, occasionally), I have seen firsthand the arguments from all sides. Certainly, as someone who in the 1980s paid $333 to have an emergency room doctor at Georgetown University Hospital remove a piece of toilet paper from my ear after I had unsuccessfully tried to use it as an earplug, I applaud a system that is free.

Founded in 1948 during the grim postwar era, the National Health Service is essential to Britain’s identity. But Britons grouse about it, almost as a national sport. Among their complaints: it rations treatment; it forces people to wait for care; it favors the young over the old; its dental service is rudimentary at best; its hospitals are crawling with drug-resistant superbugs.

All these things are true, sometimes, up to a point.

The N.H.S. is great at emergency care, and great at pediatric care. My children have enjoyed thorough treatment for routine matters ― vaccines, eye tests and the like. A friend who had cancer received the same drugs and the same treatment, I was assured, as she would have in the United States. When, heartbreakingly, she died, her family was not left with tens of thousands of dollars of outstanding bills, or with the prospect of long, bitter fights with hardened insurance companies.

But there are limits. Without an endless budget, the N.H.S. does have to ration care, by deciding, for instance, whether drugs that might add a few months to the life of a terminal cancer patient are worth the money. Its hospitals are not always clean. It is bureaucratic. Its doctors and nurses are overworked. Patients sometimes are treated as if they were supplicants rather than consumers. Women in labor are advised to bring their own infant’s diapers and their own cleaning products to the hospital. Sick people routinely have to wait for tests or for treatment.

Because resources are finite and each region allocates care differently, waiting times can vary widely from place to place. So can treatment, as in the United States, regardless of how it is paid for.

Limited in what treatments they can offer, doctors sometimes fail to advise patients of every option available ― or every possible complication. American doctors, conversely, often seem strangely alarmist about your future and overeager to prescribe more expensive treatment.

After I had my first baby, Alice, a National Health nurse came to my house regularly to weigh and examine her and to lecture me about breast-feeding. It was all free, a matter of course. The baby seemed to have mild eczema, but the nurse was relaxed about it. When I took Alice, at 3 months, to New York and we went to a Park Avenue pediatrician for a minor, unrelated complaint, the doctor seemed unaccountably exercised.

“This baby has ECZEMA!” he said accusingly, pointing to a few reddish spots. “What are you doing about it?”

Britons are well aware of the limitations of their system. But do they appreciate having the N.H.S. held up by Americans on the right as Exhibit A in discussions of the complete failure of socialized medicine? Do they want to hear that it is “Orwellian,” that it is a breeding ground for terrorism, or that, in the words of Senator Charles Grassley, Republican of Iowa, it would refuse to treat everyone from “Granny” to Senator Edward M. Kennedy?

No, they do not.

Like squabbling family members who band together against outside criticism, Britons have reacted to the barrage of American attacks on the N.H.S. with collective nationalist outrage.

A new Twitter campaign, “We Love the NHS,” has become one of the most popular topics on the site, helped by Prime Minister Gordon Brown himself, as well as the leader of the opposition Conservative Party, David Cameron.

Mr. Brown’s eyesight was saved by a National Health surgeon after a rugby accident when he was in college; Mr. Cameron’s 6-year-old son, Ivan, who died in February, was severely disabled and received loving care from the service.

The Twitter campaign is full of testimonials from recipients of successful treatment for brain abscesses, complicated pregnancies, mangled toes, liver disease, hernias, car accidents, nervous breakdowns, cancer ― you name it.

For me, the health service was a godsend when my husband suffered a severe stroke in the 1990s. He got exemplary critical care; I did not get a bill. It was only in the aftermath ― when I learned that, unusually in Britain, my husband’s job came with private health insurance ― that I came to realize what it could and could not do. A little over one in 10 Britons have some sort of private supplemental insurance; others pick and choose when to use the N.H.S. and when to pay out of pocket for the top specialists or speedier care.

Told my husband needed a sophisticated blood test from a particular doctor, I telephoned her office, only to be told there was a four-month wait.

“But I’m a private patient,” I said.

“Then we can see you tomorrow,” the secretary said.

And so it went. When it came time for my husband to undergo physical rehabilitation, I went to look at the facility offered by the N.H.S. The treatment was first rate, I was told, but the building was dismal: grim, dusty, hot, understaffed, housing 8 to 10 elderly men per ward. The food was inedible. The place reeked of desperation and despair.

Then I toured the other option, a private rehabilitation hospital with air-conditioned rooms, private bathrooms and cable televisions, a state-of-the-art gym, passably tasty food and cheery nurses who made a cup of cocoa for my husband every night before bed.

We chose the private hospital, where the bills would be paid in their entirety by insurance. My husband lived there for nearly two months. We saw the other patients only when they were in the gym for treatment when my husband was. Most of them seemed to be from rich countries in the Middle East. Perhaps they were the only ones who could afford to pay.

Sarah Lyall, a London correspondent for The Times, is author of “The Anglo Files: A Field Guide to the British.”

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英国医療に対する海外駐在員の意見/医療制度改革 オバマ政権 医師の一分/BIGLOBEウェブリブログ
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