Got a boo boo? Go to the ER!

If you haven't figured out already from my posts, the Danish and the American health care systems are quite different. On Wednesday, I was able to experience the Danish in action as I shadowed one of my professors for the morning. We spent most of our time in the ER as she was the on-call doctor for surgical consults. Granted, I haven't spent that much time in American ER's to truly comment, but overall, the Danish version seemed to operate in much the same manner. The one major difference was the utilization of the ER by the Danes. Remember, Danes' health care is covered by the taxes they pay, so a visit to the ER doesn't cost them anything extra. This, in turn, leads to some people coming in for things that they really shouldn't. This included a twisted ankle that wasn't even swollen, and a single in-grown hair on a person's back. The first got nothing, the second got a band-aid. The other interesting aspect was how serious they take possible infectious disease. One woman came in with diarrhea and vomiting. She was immediately isolated, and both the nurses and doctors wore a second layer of clothing that was immediately removed upon leaving the room. While this may seem over the top, it does work. Denmark is one of the few countries in the world that does not have a true resistance to penicillin. Spending 5 hours in the hospital was great, and made me realize I had really never done anything like that before -- just being on the floor of the hospital and seeing patients as opposed to observing surgeries. Mathilde, my professor, was a little upset by the fact that I couldn't have any of my own patients just because nothing presented itself. Hopefully, I'll get a chance to go back before I head home and maybe then I'll get my first patient!

Dealing with pain/suffering? That'll be 150 DKK

Once again the Danes have a great concept regarding health care. This time its in regards to patient compensation for malpractice and in this case there is no doubt in my mind that this should be implemented in the states. The Danish system is not even comparable to the American system. They are night and day. Just in case you are not aware, the American system is based on litigation and the court system. Personal injury lawyers have ads everywhere, telling patients that if things didn't go perfectly that court is the answer, because that's where patients can receive compensation. This, in turn, requires doctors to spend money on malpractice insurance to cover themselves in case a patient proceeds with a lawsuit against them. It doesn't even matter if the doctor did nothing wrong; there is nothing stopping frivolous lawsuits. So there's the recap on the American system.

Now for the Danish system. The Danes base their system on no fault compensation. For full information on the system check out this website: http://uk.patientforsikringen.dk/public/dokumenter/
pdf/pjecer/engelsk/patientsentitlement.pdf

I'll do my best to try to summarize the information. First, the patient compensation is looked at as a patient's right, therefore all patients are covered by this "insurance" in pretty much all cases, except for dental care. The compensation scheme applies to injuries caused by both examination and treatment. But there are limits, as you cannot obtain compensation for an injury caused by the illness or accident for which you were treated, nor can you obtain compensation for treatment not leading to the recovery you expected. Compensation can be paid if the injury was in all probability caused in one of the following ways: if the injury could have been avoided by better treatment; if the injury is due to the malfunction or failure of technical apparatus and instruments, etc.; if the injury could have been avoided using another treatment technique or method of equal efficacy; if the injury is very unusual and serious in relation to the disease you were treated for and therefore goes beyond what you should reasonably have to endure. Compensation itself is fixed in accordance with the provisions of the Danish Liability for Damages Act. Compensation can be paid for loss of earnings, loss of ability to work, permanent damage, and pain and suffering. Compensation can also be paid for recovery costs resulting from the treatment. In the case of pain and suffering there is a cap set at 150 DKK per day, or about $30 per day A board consisting of doctors and governmental workers determine if claims are appropriate and deserve compensation.

This system creates equality amongst all patients, and also acknowledges that doctors are human and can make mistakes and should not have to be punished to provide compensation for the patient. If the doctor has made a grievous error than there is a board that can provide appropriate punishment. What this allows, though, is for doctors to practice medicine in a non-defensive posture, as they do not have to constantly protect themselves. All in all, a much better system than what the states makes use of. Again, the hangup with implementing a system like this in America would be the issue of where the government would get the funds to provide compensation as it would probably require more taxes, which are never popular with the American public. Nonetheless, in my opinion, this is a great system that would make medicine better for all involved.

Do You Have a Billion Dollars Lying Around?

We had an interesting reading associated with Tuesday's lecture in my Health Care in Scandinavia course. The reading can be found at http://rand.org/pubs/research_briefs/RB9169/. Pretty much what this fact sheet says is that over a billion dollars a year could be saved if insurance companies lowered co-payments on prescription pharmaceuticals. This assumption is based on the data, which showed that for every $10 rise in co-payment, compliance decreased by 5%, and if there is a higher compliance in taking pharmaceuticals by reducing co-payments for those sick or at a high-risk of becoming sick and higher co-payments for low-risk patients, then there is a greater proportion of healthier patients, which could result in 80,000 to 90,000 fewer hospitalizations and 30,000 to 35,000 fewer ER visits. All of this equates to a savings of $1,000,000,000. That's a lot of money.

No Tolerance

I found out today that I have no tolerance for certain things: people who believe that everything American is inherently better, and people that are unable to grasp concepts that are mentioned in class due to the aforementioned superiority complex. This all happened in my Healthcare in Scandinavia course where today we were discussing 7 theoretical healthcare financing setups. These ranged from a system very similar to how the US does it now to a completely socialized setup like in Denmark. Keep in mind that this was a theoretical discussion only, there was no comparison, we were simply looking at the characteristics and pros/cons of each system, independent of the others. The first thing that really frustrated me was when the professor asked for cons for a system that involved compulsory tax payments to a single insurance company/the government. An unnamed student responded that in the states this concept is highly criticized because of the possibility that it will give motivation for people that are not working to continue to not work, because they will have their health care paid for, and therefore this was a bad system. Whoa! When were we ever asked to for that kind of response? It was not what the professor was looking for, and the haughty attitude that it was said with, did not help. He simply ignored the comment and moved on. The next issue was in a similar situation except in this theoretical setup the single insurance company/the government had contracts with multiple providers, and the text stated that this situation led to consumer choice. No one in the class could understand how this was possible. They were all focusing on the economic standpoint, and they are correct there, there is no competition between the providers for the patients that will result in lower prices, but that's fine because the government pays for it. What people failed to see was the competition between providers to provide the best quality of care in order to have more patients use them, especially if they are being paid in a fee for service or capitation program. It was just an incredibly frustrating situation.

On a similar note, now that classes are picking up, I am going to try to comment on anything interesting that happens in them, such as the above or something entirely different.

One surprising thing I learned today in my Human Health & Disease course was that in Denmark MRI is rarely used due to its expense (for some reason its very expensive here, as CT scans are cheaper). This even includes orthopedic diagnoses. Instead, orthopods use almost only ultrasound to diagnose soft tissue damage, including torn ligaments and tendons. A different way to do things, with both pros and cons. The test can be done faster, and cheaper, but the image results aren't nearly as clear. In my opinion, especially if surgery is needed I would want better image results, but that's just me.