OT: France finally beats the US

[Johny]

France might not win the Tour but...

http://news.yahoo.com/s/afp/20080108/ts_alt_afp/ushealthfrancemortality

[sg8357]

Just think how much farther ahead those countries would be if they didn't have socialized medicine.
France has higher unemploment than the US probably due to the lack of
insurance people and lawyers that we are blessed with here.
Poor fools.

[handsomerob]

Measuring "improvement" can be spun like crazy.

i.e....

Company A made $100 net profit last year and this year it made $200 profit.... so "Profits are up 100% over last year"

Company B made $10000 net profit last year and this year it made $11000 profit...
so "Profits are up 10% over last year"

Without the actual numbers it would appear that Company A would rank higher. Which company would you rather own?

[Johny]

Without the actual numbers it would appear that Company A would rank higher. Which company would you rather own?

Good point. They have actual numbers and the US is still behind in both actual number and reduction rate. Take a look of the original paper: http://content.healthaffairs.org/cgi/content/full/27/1/58

Some citations:

"In 1997–98, amenable mortality among males in the United States was, at 128.5 per 100,000 population, exceeded by Ireland, Portugal, Finland, the United Kingdom, and Austria. The U.S. rate was about 8 percent higher than the average rate (119.5) and 50 percent higher than in France, which at 85.9 had the lowest rate of amenable mortality among males. For females in the United States, amenable mortality was lower than in the United Kingdom, Ireland, Denmark, Portugal, and New Zealand, but at 101.6 it exceeded the average rate of 86.9 by 17 percent and the lowest rate (Japan, 62.1) by 64 percent.

By 2002–03, mortality from amenable causes had fallen in all countries studied, although the scale and pace of change varied. Exhibits 3Go and 4Go display the relative changes in mortality from amenable causes between 1997–98 and 2002–03 for males and females separately, with the relative change in mortality from causes that are considered not amenable to health care ("other") as defined here included for comparison. Among males, amenable mortality fell by 17 percent on average and by more than 10 percent in all countries except the United States, where the decline was only 4 percent. This contrasts with Austria, Ireland, the United Kingdom, and Finland, which began with very high rates, as well as Norway and Australia, where amenable mortality fell by more than 20 percent during that period."

[Grant McLean]

Ride the bike, an apple a day, and pick good parents,
that's my health plan...

-g

[Johny]

Ride the bike, an apple a day, and pick good parents,
that's my health plan...

-g

McLean for President.

[93legendti]

Having lived in 2 countries with socialized medicine, I'll take the US system every time. When I lived in Windsor, Ontario anyone that needed elective surgery or life saving treatment (cancer, heart) in our neighborhood went to the US for treatment--and they are still alive 30 years later. :)

[Kevan]

Ride the bike, an apple a day, and pick good parents,
that's my health plan...

-g

that's all find and dandy when visiting the farmer's market for those apples and you also buy and enjoy a big hunk of soft-smelly cheese offered at the stand next to the apples. True story: My daughter did part time at the stand this summer and fall. The house was foolish with apples (ask mikemets about the apple pie my wife made for his family), but the wonderful..creamy..stinky cheese did in my colesterol numbers for my physical the next day. The doctor had me comeback to prove myself. When I figured out what happened we both laughed and agreed the cheese was awesome. His closing comment: moderation. Now let me ask you this...where's the fun in that?!

[Johny]

Having lived in 2 countries with socialized medicine, I'll take the US system every time. When I lived in Windsor, Ontario anyone that needed elective surgery or life saving treatment (cancer, heart) in our neighborhood went to the US for treatment--and they are still alive 30 years later. :)

Good that your neighbors could afford it. :)

[andy mac]

Having lived in 2 countries with socialized medicine, I'll take the US system every time. When I lived in Windsor, Ontario anyone that needed elective surgery or life saving treatment (cancer, heart) in our neighborhood went to the US for treatment--and they are still alive 30 years later. :)


sounds like a loooong time ago, 30+ years....

i have lived in multiple countries recently with both systems: europe, australia, usa.

can't say the treatment seems much and better or worse. big diff was the long US wait times and the massive $$$$$$.

[53-11]

Having lived in 2 countries with socialized medicine, I'll take the US system every time. When I lived in Windsor, Ontario anyone that needed elective surgery or life saving treatment (cancer, heart) in our neighborhood went to the US for treatment--and they are still alive 30 years later. :)


was that socialized medicine or socialized insurance???

[93legendti]

http://en.wikipedia.org/wiki/Medicare_(Canada)

[93legendti]

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijrdm/vol1n2/princess.xml

...By the time Diana reached the emergency room, it was nearly an hour and 45 minutes after the crash. According to the deposition of the on-duty doctor, who admitted her into the hospital, she arrived alive and with a cardiac rhythm. Though she had no serious external injuries, X-rays indicated internal hemorrhaging that was compressing her right lung and heart. Within 10 minutes of her arrival, the patient again suffered a cardiac arrest, prompting the doctors to inject large doses of epinephrine directly into the heart, and to perform an emergency thoracotomy...Precisely, in the U.S., the standard approach to emergency treatment is “scope and run” meaning accident victims receiving minimal onsite treatment from paramedics and are rushed to the operating room. In France they favor extensive onsite treatment and stabilization, performed by specialized doctors arriving in fully equipped mobile hospital units. Both systems have their advantages and drawbacks. But the French method, which is excellent in many respects and saves many lives in the aggregate, may not have been the best adapted to a case like Diana’s.

As Dr. Ochsner points out, you couldn’t try to repair that injury on the scene, you’d have to be in the hospital. Concerning the go slow driving technique to avoid shocks and bumps, Ochsner bristles. Shocks and bumps? You know, if you trying to save a life, you have to get them to the operating room quickly. Asked point-blank if the princess of Wales would have been saved if she had gotten to the hospital faster, Ochsner replies: I can’t second-guess anybody. What I’m saying is that if there was a small rent, the patient would have plenty of time. But if it’s big enough and slowly bleeding, as her was, something between a minor tear and a complete bleed out, there had to be some resistance of flow with a clot or something. Otherwise she would have bled out. What I’m saying is this: given that she was still alive after nearly two hours, if they have gotten her there in an hour, they could have saved her....

[97CSI]

can't say the treatment seems much and better or worse. big diff was the long US wait times and the massive $$$$$$.When you are giving 45 cents of every healthcare dollar to bureaucrats (i.e. insurance companies) it is no wonder that we have, by far, the most expensive healthcare in the world. Medicare spends 8 cents of everything healthcare dollar on the bureaucracy. Very efficient. Would be even more efficient if congress would allow them to spend more on fraud enforcement. But that might hurt the big insurance/big pharma donors too much. So we will never see it.

[Avispa]

McLean for President.

No don't spoil the good guy!

I say, McLean for Secretary of Transportation or Secretary of Health!!!
:D :D :D

..A..

[malcolm]

If you are acutely ill the health care in the U.S. is the best available. Where I work we routinely do emergent MR's from the ED in a matter of minutes. Our time to the cath lab for an acute MI is under 30 minutes. I don't think you will find this many other places especially in France. I recently had a patient that was visiting Paris and passed out and hit his head. He was admitted to the hospital and had a CT and was dx with some sort of intracranial bleed, I suspect hemorraghic contusion. They sat on him for almost a week either trying to arrange an MR or decide if he needed one while he had various vague neurological symptoms and seemed to wax and wane. His family finally arranged to transfer him home and came straight the the ED where he had an MR that revealed he had bled into a primary cns lesion (tumor). Ultimately it probably made little difference, but this was a diagnosis that would have been made within a day at most hospitals it the US especially in a city the size of Paris. I won't begin to discuss costs, but I don't think outright fraud is a major contributor. If you are ill in the U.S. you are in the best place you can be. All numbers and statistics can be massaged to get the result you want and none lend them self to this more than healthcare numbers.

[andy mac]

If you are acutely ill the health care in the U.S. is the best available. Where I work we routinely do emergent MR's from the ED in a matter of minutes. Our time to the cath lab for an acute MI is under 30 minutes. I don't think you will find this many other places especially in France. I recently had a patient that was visiting Paris and passed out and hit his head. He was admitted to the hospital and had a CT and was dx with some sort of intracranial bleed, I suspect hemorraghic contusion. They sat on him for almost a week either trying to arrange an MR or decide if he needed one while he had various vague neurological symptoms and seemed to wax and wane. His family finally arranged to transfer him home and came straight the the ED where he had an MR that revealed he had bled into a primary cns lesion (tumor). Ultimately it probably made little difference, but this was a diagnosis that would have been made within a day at most hospitals it the US especially in a city the size of Paris. I won't begin to discuss costs, but I don't think outright fraud is a major contributor. If you are ill in the U.S. you are in the best place you can be. All numbers and statistics can be massaged to get the result you want and none lend them self to this more than healthcare numbers.


'best' is a word thrown around this site a lot recently in regards to the usa vs other countries.

there are lots of different ways to live and many truly great countries offering a high quality of life and services out there.

some humility and even reality would be a pleasant change...


:beer:

[stevep]

If you are acutely ill the health care in the U.S. is the best available. .

for everyone?
for anyone?
anyone with money?
anyone with health insurance?
unless the company wont pay?

there are a lot of questions that need to be added to your comments above i think to balance it a little.

not attacking, just asking.

[97CSI]

If you are acutely ill the health care in the U.S. is the best available.Believe the young lady in CA who died for lack of a liver procedure that was vetoed by her health insurance company last week couild be considered 'actuely ill'. In statistical terms, your hospital is a 'flyer' and not the norm. We definitely need to get the insurance companies out of healthcare. Single payer, government run with Medicare as the model. Only difference needed would be a considerably beefed up enforcement wing to catch the crooks.

[Louis]

for everyone?
for anyone?
anyone with money?
anyone with health insurance?
unless the company wont pay?

Amen to that.

[Avispa]

for everyone?
for anyone?
anyone with money?
anyone with health insurance?
unless the company wont pay?

You guys should have seen The Glen Beck Show a couple of nights ago... This is a guy with money, and what he had to say about the health care he received for a recent surgery, was pretty bad!

Go figure...

..A..

[Grant McLean]

McLean for President.

thanks, but no thanks!
why someone would want that job is beyond my level of understanding...

Everyone has their stories about how the health care system was
great or did them wrong. Thousands of people die from simply
getting the wrong medicine every year, and the system created to
treat childhood cancers means over 80% of kids with cancer will live.

It's a complex topic... which could be made most irrelevant by refocusing
on the goal of "health" not the disease. Diabetes doesn't have to
happen to the millions it's going to take down. A healthy population
wouldn't need to spend all it's money pushing drugs that people wouldn't
need. How do we get there from here?

-g

[malcolm]

Very few people in this country die because a procedure is refused from inability to pay. Go to any university hospital and most not for profits and see the rate of pay. I haven't seen the numbers for transplants,but I suspect a fair number go to the uninsured or in the process of being worked up for the procedure part of the process is to qualify them for medicare/caid. I've worked ED's in three states over the past 20 years and I can't begin to tell you how many people we admit for surgery etc that have no insurance. I can tell you this I've never seen anyone not operated or treated that I have direct knowledge of in all my years. I'll tell you what I have seen more times than I can count is someone's family member from another country come here incredibly sick and literally go from the airport to the ED and be admitted and treated. The problem I see mostly in my day to day practice is lack of access, the uninsured have to go through the ED and many times are initially seen endstage. People do die waiting for transplants there aren't enough organs to go around and the groups that use the most donate the least. If you are insured our care is the best if you aren't but are critically ill I still think it is the best. The inbetween is where the problem lies and that is probably where socialized medicine does better. I can honestly say no hospital I've been affiliated with has ever refused care to someone ill because they couldn't pay and I mean for simple gall bladder surgery to cancer care. Maybe I've just been lucky and been at decent places, but I think most of the my child died because no one would treat him stories are hollywood. We actually admit a lot of indigent/no insurance patients for problems we would send insured patients out with because we know follow up is a problem without money ie: non acute gall bladder disease with insurance I would send you home with surgical follow up, no insurance but in need of surgery although not urgent I would likely admit. Don't get me wrong I think the system is very broken, but I still say if you have to be acutely ill even without money this is the place.
Steve I'm not sure if the above answered your questions or not. The one thing I left out is I'm sure the aftermath of an illness survived or otherwise for the uninsured is devestating. The costs for a short stay for something simple is huge and I can't imagine what it would be for something major. I don't know the answers, the system is broken but the product when applied is good. As far as the Glen Beck thing goes I didn't see it but my little boy just spent a week in a state of the art childrens hospital and it was an absolute clusterfruck totally unorganized, sign of an overburdened system with too few trying to do too much. End of ramble.

[andy mac]

Very few people in this country die because a procedure is refused from inability to pay. Go to any university hospital and most not for profits and see the rate of pay. I haven't seen the numbers for transplants,but I suspect a fair number go to the uninsured or in the process of being worked up for the procedure part of the process is to qualify them for medicare/caid. I've worked ED's in three states over the past 20 years and I can't begin to tell you how many people we admit for surgery etc that have no insurance. I can tell you this I've never seen anyone not operated or treated that I have direct knowledge of in all my years. I'll tell you what I have seen more times than I can count is someone's family member from another country come here incredibly sick and literally go from the airport to the ED and be admitted and treated. The problem I see mostly in my day to day practice is lack of access, the uninsured have to go through the ED and many times are initially seen endstage. People do die waiting for transplants there aren't enough organs to go around and the groups that use the most donate the least. If you are insured our care is the best if you aren't but are critically ill I still think it is the best. The inbetween is where the problem lies and that is probably where socialized medicine does better. I can honestly say no hospital I've been affiliated with has ever refused care to someone ill because they couldn't pay and I mean for simple gall bladder surgery to cancer care. Maybe I've just been lucky and been at decent places, but I think most of the my child died because no one would treat him stories are hollywood. We actually admit a lot of indigent/no insurance patients for problems we would send insured patients out with because we know follow up is a problem without money ie: non acute gall bladder disease with insurance I would send you home with surgical follow up, no insurance but in need of surgery although not urgent I would likely admit. Don't get me wrong I think the system is very broken, but I still say if you have to be acutely ill even without money this is the place.
Steve I'm not sure if the above answered your questions or not. The one thing I left out is I'm sure the aftermath of an illness survived or otherwise for the uninsured is devestating. The costs for a short stay for something simple is huge and I can't imagine what it would be for something major. I don't know the answers, the system is broken but the product when applied is good. As far as the Glen Beck thing goes I didn't see it but my little boy just spent a week in a state of the art childrens hospital and it was an absolute clusterfruck totally unorganized, sign of an overburdened system with too few trying to do too much. End of ramble.


best used x 2


easy there cowboy...

if you want i can help you find some other words or phrases.

maybe even a something like "i haven't seen any better..." or "to my knowledge, having only ever lived in one country..."


:beer:

[malcolm]

Andy I'm not trying to offend or insult and I'm certainly not a cowboy. I'm 48 years old and I've traveled extensively. I have my opinions and apparently you don't share them. I'll certainly not allow your meager argument to sway me and I doubt I need your help with phrases or probably anything, but thanks anyway.

[thwart]

When you are giving 45 cents of every healthcare dollar to bureaucrats (i.e. insurance companies) it is no wonder that we have, by far, the most expensive healthcare in the world. Medicare spends 8 cents of everything healthcare dollar on the bureaucracy. Very efficient. Would be even more efficient if congress would allow them to spend more on fraud enforcement. But that might hurt the big insurance/big pharma donors too much. So we will never see it. As someone in the business (and it is very much a business nowadays) I would agree.

If you're born with the wrong parents, so to speak, and your company downsizes here in the good ol' US (leaving you sans insurance), you are screwed.

Not too many on this Forum have felt the pain, I suspect. Easy to talk about this topic in the abstract when you are sitting with a nice health insurance plan, and are a nice, healthy bike rider.

[soulspinner]

As someone in the business (and it is very much a business nowadays) I would agree.

If you're born with the wrong parents, so to speak, and your company downsizes here in the good ol' US (leaving you sans insurance), you are screwed.

Not too many on this Forum have felt the pain, I suspect. Easy to talk about this topic in the abstract when you are sitting with a nice health insurance plan, and are a nice, healthy bike rider.


+1

[stevep]

Steve I'm not sure if the above answered your questions or not. .


thanks for the response.
i am sure that excellent care is available here.

i think its the access and the cost more than the actual care although there are places where the care is not that great also.
i have good friends with decent health insurance who have gone to belgium to pay out of pocket for tried and true procedures that are not allowed here.
( 2 good cycling friends- both very big hip trouble, both super happy with results and both back on the bike and fixed ).
as noted this system is designed by insurance cos and a huge amount of the cost drains out into those pockets.

also part and parcel is the devastating cost of health insurance and the burden on small companies to figure out a way to pay for it. costs have escalated in my small company some years by 25% or more... one point we had a 25% increase one year followed by a 23% increase the following year*. even the most noble employer gets slammed by these costs.
general motors ( and probable every other major us corporation ) pays a devastating amount per vehicle for health insurance for employees...as does many other major us corporations. think this doesnt matter in the world we live in?

also, as well noted, infant mortality here as well as general mortality falls behind every western democracy and behind some countries that would not be considered medical havens.... so somewhere in here there is room for a new vision on this.

* small state - few carriers, no alternatives.

[malcolm]

Steve we agree costs are absurd. Don't even get me started on the cost of drugs. I feel you when it comes to small business. I'm partner in two small urgent care clinics and we provide good benefits for our employees, but the health insurance is staggering. Infant mortality is a very slippery slope and the numbers are not what they appear. If you reasearch it you will see many things that falsely elevate U.S. numbers, just one example is the number of high risk pregnancies that come to term here because of better prenatal care and many other subtle factors. It isn't just counting up the number of dead infants. Hopefully something will change. I grew up in a single parent family without health insurance and have seen first hand how devestating illness can be without and how unfair insurance companies can be. I was fortunate enough to get a decent education and have made a good living in health care, but I'm just about done. I'm fed up with hospital management issues and lack of direction and just in general burned out. With luck the folks behind me will do a better job.

[97CSI]

...but I'm just about done. I'm fed up with hospital management issues and lack of direction and just in general burned out. With luck the folks behind me will do a better job.Wife has parathyroid problems. Spent some time with one of the rare experts for same in one of Phila.'s major medical hospital facilites a couple of weeks ago. He had a resident working with him, as well as a couple of med students. Being a teaching hospital, he is heavily involved in that aspect of the healthcare system, as well. He bemoaned the quality of the students coming in. He said that they are as bright as ever. But, they simply will not work. As in 'lazy'. He was not sanguine about the quality of dedication of the upcoming generation(s) of new doctors. I see the same thing in my HS classes. Students will not do the work and then the parents complain about grades and 'poor' teaching. We can lead the horse to water, but.............

[malcolm]

gp, my wife tells me the same thing. She is at an academic institution and heavily involved in resident and medical student education. She says the younger ones just don't have the same work ethic and have an intense sense of entitlement and don't want the job to infringe on their life. Maybe the flip side will be that they question the entire way we have been doing things.

[93legendti]

Lest we be persuaded by a raw statistic/ranking without understanding the numbers and the collection thereof:

"...While the United States reports every case of infant mortality, many other countries do not.

For example, a 2006 artilce in U.S. News & World Report states, "First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth.

Thus, the United States is sure to report higher infant mortality rates.

For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country." [2]

For example, historically, until the 1990s Russia and other countries of the former Soviet Union did not count as a live birth or as an infant death extremely premature infants (less than 1,000 g, less than 28 weeks gestational age, or less than 35 cm in length) that were born alive (breathed, had a heartbeat, or exhibited voluntary muscle movement) but failed to survive for at least 7 days.[2] Although such extremely premature infants typically accounted for only about 0.005 of all live-born children, their exclusion from both the numerator and the denominator in the reported IMR led to an estimated 22%-25% lower reported IMR.[3] In some cases, too, perhaps because hospitals or regional health departments were held accountable for lowering the IMR in their catchment area, infant deaths that occurred in the 12th month were "transferred" statistically to the 13th month (i.e., the second year of life), and thus no longer classified as an infant death.[4]

Another challenge to comparability is the practice of counting frail or premature infants who die before the normal due date as miscarriages (spontaneous abortions) or those who die during or immediately after childbirth as stillborn.

Therefore, the quality of a country's documentation of perinatal mortality can matter greatly to the accuracy of its infant mortality statistics. This point is reinforced by the demographer Ansley Coale, who finds dubiously high ratios of reported stillbirths to infant deaths in Hong Kong and Japan in the first 24 hours after birth, a pattern that is consistent with the high recorded sex ratios at birth in those countries and suggests not only that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths but also that those countries do not follow WHO recommendations for the reporting of live births and infant deaths.[5]

Another seemingly paradoxical finding is that when countries with poor medical services introduce new medical centers and services, instead of declining the reported IMRs often increase for a time. The main cause of this is that improvement in access to medical care is often accompanied by improvement in the registration of births and deaths. Deaths that might have occurred in a remote or rural area and not been reported to the government might now be reported by the new medical personnel or facilities. Thus, even if the new health services reduce the actual IMR, the reported IMR may increase..."

http://en.wikipedia.org/wiki/Infant_mortality

[malcolm]

Thank you '93. Many infants in the U.S. are resuscitated only to die later in the PICU although some survive. In other places they are allowed to die in the perinatal period and thus are not counted as infant mortality.

[93legendti]

My pleasure. The statement that US's IMR was lower than any other western democracy did not seem like it could be true, so I did a little research.

Countries do not use the same criteria for determining IMR so the ranking comparing countries is meaningless.

[93legendti]

'best' is a word thrown around this site a lot recently in regards to the usa vs other countries.

there are lots of different ways to live and many truly great countries offering a high quality of life and services out there.

some humility and even reality would be a pleasant change...


:beer:
Reality:

Here's an email that came today from a friend of my Mom's. They live in Windsor, Ontario:

" A** had a heart attack some time Wednesday or Thursday and is in the wonderful Windsor hospital waiting......waiting for an angiogram. That is a whole story, and he is on the Board at Hotel Dieu and got bumped. Just let me know....tell her no concerns because he is stable, but we will know soon....Pray for an available doctor and room in our wonderful system tomorrow...and we donate and donate to our hospitals until we are blue in the face......and I could not get my MRI when I needed it and we had donated $10,000 to that (hospital).........M*****"


The local population is ~220,000 and the hospital is one of 2 in the city. This hopsital didn't have an MRI machine until my parents' foundation donated most of the the funds so the hospital could purchase one.

http://en.wikipedia.org/wiki/Windsor,_Canada#Health_systems

[97CSI]

If they were in the U.S. their insurance company would tell them they don't need the work and would refuse to pay for any of it. Thus, the hospital would kick them out.

[Polyglot]

My wife gave birth to our two daughters in Italy. C-Section both times, 10 day recovery the first time, 7 days the second one. She went home relaxed and fully recovered. My sister in Australia, had a C-section, 5 days recovery, relaxed return to her home. My sister-in-law in Britain, same situation, 4 days recovery. My neighbor here in the US, C-section for triplets, sent home with two of the children after 2 days (apparently the norm with most insurance companies)! Totally stressed out and despondent about not being able to bring third child home. Third child came home after 5 days. Mother developed infection and needed to return to hospital after 2 weeks, developed severe post-partum depression, supposedly caused by separation from babies for half of their first two months.

Now add to this, my wife was paid 5 months state-mandated paid maternity leave at 100% of her salary (2 months prior to expected birth and 3 months after real birth). In Australia and Britain, similar but somewhat shorter paid maternity leaves. In the US, my neighbor worked until the day before the C-Section and received no paid maternity leave whatsoever...

I have lived in 7 different countries and feel it only fair to say that, in my opinion and experience, you have the absolute worst preventative care, but at the same time the very best available remedial care in the US. Again from my experience, your average person is better cared for in most developed countries than they are in the US, but if I was suffering from some baffling disease, I would always want access to the diagnostic tools available to your average American doctor. Having said that, I still find myself calling my 76 year-old great aunt in the Netherlands, with her over 50 years of surgical experience, for her opinion regarding any diagnosis received. She is still of the old school who speaks bluntly without worries of malpractice and liability suits.

[93legendti]

If they were in the U.S. their insurance company would tell them they don't need the work and would refuse to pay for any of it. Thus, the hospital would kick them out.

This was in the thank you email after I was able to get some action:

"...I went through the same thing when I needed an MRI for my scoliosis and had to go to Toronto to get it through a friend because my GP would not send me....We personally donated $15,000 to this MRI..."

[93legendti]

The hospital finally did the angio today and found a number of blockages. My friend is off to London, Ontario for open heart surgery. London is 1 1/2 hours away by car/ambulance. G-d knows what happens if you are in acute cardiac distress and need surgery sooner than a 1 1/2 hour drive can provide.

[Ahneida Ride]

Wife has parathyroid problems. Spent some time with one of the rare experts for same in one of Phila.'s major medical hospital facilites a couple of weeks ago. He had a resident working with him, as well as a couple of med students. Being a teaching hospital, he is heavily involved in that aspect of the healthcare system, as well. He bemoaned the quality of the students coming in. He said that they are as bright as ever. But, they simply will not work. As in 'lazy'. He was not sanguine about the quality of dedication of the upcoming generation(s) of new doctors. I see the same thing in my HS classes. Students will not do the work and then the parents complain about grades and 'poor' teaching. We can lead the horse to water, but.............

PhD programs at leading universities are constantly being diluted also.
Qualifying exams have gone from Graduate level math to Freshman Calculus.

I sure hope the Medical Schools hold to a standard.

[malcolm]

Ray, my wife thinks her incoming students/residents are smarter than ever, she just questions their work ethic and commitment. They seem to think they deserve a life and medical training.

A for what it is worth, the hospital where I work has a aprox 20-30 time to the cath lab (angio) for acute mi dx. from the ED. I doubt the cardiologist/ed doc has any idea of their pay status before the procedure is completed.