Rich - of course there are barriers. Socio-economic factors are not as much in play in the UK as the US, but we are trying hard to catch up with your gross disparities, unlike some of our European neighbours.

But - and let’s take a big example - any woman in the UK can see a primary care physician within 48 hours for a breast lump and be referred to see a specialist - typically now in a multidisciplinary breast centre - within two weeks. This is just not available to all in the US, and access to the very top places - eg Sloan-Kettering and MD Anderson - can involve a lot of hoops.

Medicaid and the underinsured are the problem:
http://cmhmd.blogspot.com/2007/09/public-citizen-publications-report.html

Chris

So you’re not saying that the entire populace has ready access to top specialists, rather, you’re saying that the entire populace has ready access to top specialists.

But seriously, I understand your point. I just cannot reconcile it with economic reality.

Many people in the US do not have access, or we would not have this discussion. I simply cannot accept that there are no barriers in say, the UK. The barriers must exist, but perhaps they are not as evident, i.e. not related to insurance status or wealth.

You have asserted that the distribution geographically, of top specialists is better, and that there are no significant wait times. If I can drive a few miles to see the top specialist within a reasonable period of time, why see anyone else? What is the incentive to forego the opportunity to have “the best” and settle for less than the best?

We’ll have to agree to disagree on this one. I cannot reconcile it. FYI, in my area, Medicare patients have excellent access. The uninsured less so, unless they are willing to pay, but the nearby academic centers, and several community hospitals, have free clinics which are supervised by, you guessed it, “Top Specialists.”

I did not say that. What I’m trying to explain is that there are no barriers to access to the top in say the UK, and many top specialists run clinics where if you don’t see the top guy you’ll be pretty close and have your case discussed with him/her by the other docs. How many of your top specialists are easily accessible by Medicare patients - or the uninsured?

You mean data on surgery outcomes for each surgeon is not collected and published? Are there plans for this?

The notion that the entire populace has ready access to Top Specialists is BS, nationalization or otherwise.

Rich

But, seriously, our ability to know who does a good job or not is extremely poor. There is just not enough good data to allow anyone to make a reasonable decision. Coronary bypass surgery (and a couple other tiny spots here and there) is the exception. In PA, in particular, we have a darn good database for bypass outcomes. As it happens, my mother in law may need an open heart procedure for a ascending aortic aneurysm. I’d be guessing to say that the surgeons who do well with CABG do well with this surgery ( or valves, or whatever).

People often ask me, as an intensivist, who is a good surgeon in my hospital. Since all I see are the cases where things aren’t going swimmingly, and I have no idea of the denominator (that is, how many of this type of case a particular surgeon does at my hosptial let alone the other places they work), I really can’t say. I can tell them who I like, who seems bright, et., but they are not always the same people.

Cheers,

Is there a difference between US hospitals? Well yes of course and a much wider one than you probably think. Eg:

‘Women treated for cardiovascular disease at the nation’s bestperforming hospitals have a 39 percent lower risk-adjusted mortality rate when compared with
women at the nation’s poorest-performing hospitals, according to the fourth annual HealthGrades Women’s Health Outcomes in U.S. Hospitals study, released today.’

Plenty more on this theme, and there are plenty of 1* hospitals on a 5* scale.

The issue raised was not waiting times, but access to “Top Specialists” in “Academic Centrtes of Excellence,” which is somehow increased (access, that is) by nationalization of healthcare.