Three spine surgeons compare the U.S. healthcare system to other leading countries.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.
Next week's question: What are the biggest telemedicine trends in spinal care? Where do its obstacles and opportunities lie?
Please send responses to Alan Condon at acondon@beckershealthcare.com by Wednesday, March 25, 5 p.m. CST.
Note: The following responses were edited for length and clarity.
Question: How does the US healthcare system compare to other countries you have worked in or traveled to?
Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Our healthcare system is so uniquely broken compared to most any other system in the industrialized nations. The fact that it is still functioning is nothing short of miraculous. However, in countries like France and Canada, long waits are the standard. The quality of medicine practiced is still very much on par with our system. What is the most difficult part to grasp is how to fix what we have. We need healthcare parity — access to healthcare. Pressuring those that provide the healthcare and squeezing them to the point where burnout becomes an issue is not making it better. What we are seeing is the powers that be talking out of both sides of their mouth. On one end is the 'quality' and on the other is 'cost.' A national health service, seen most prominently in England, also suffers from the feeling of helplessness from their workers — it is not perfect and possibly not sustainable.
What we have all over the world are mature experiments of what the different variations of what could be. How it is that we as a nation cannot already see what becomes of nationalized healthcare is stultifying. What we should be doing is realizing we do have a great system and fix it by going after those that profit from the misery — insurance companies.
Alan Hilibrand, MD. Rothman Orthopaedic Institute (Philadelphia): In 2007, I traveled overseas with four other American orthopedic surgeons as part of the American Orthopedic Association's American-British-Canadian Travelling Fellowship. We traveled to England, Scotland, Australia and New Zealand. The most obvious thing we learned was that not all 'universal care' systems are the same. In Canada, for example, there are very real restrictions on the number of surgeries that could be done. Our co-travellers talked about many patients waiting over one year for elective orthopedic surgery, with nowhere else to go — no parallel private system — other than across the border in the U.S.
In England there is a parallel private system, but at that time surgeons had to provide 48 hours of care in the National Health Service before they could tend to their private patients. The result was long waits for orthopedic procedures, though perhaps less than in Canada. In Australia, on the other hand, there was a robust 'two-tiered' system at the time with about half of the population holding supplemental private insurance above and beyond a comprehensive universal coverage provided by the government. In Canada and England, the queues clearly suggested some degree of rationing care. In Australia, although patients had to wait longer to have surgeries, the wait was limited due to the capacity of the private system. One element in Australian orthopaedics that America should emulate is the near-universal participation in registries that allowed Australians to track products and outcomes.
In America, we enjoy excess capacity to handle variable volumes of elective surgery with little impact on wait times for treatment. This capacity comes at a price; namely a very expensive healthcare system, yet one that is likely able to absorb 'black swan events' like the COVID-19 pandemic more easily than the more constrained systems we saw on our tour.
Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): I grew up in Russia. Both of my parents were internal medicine doctors. I was very familiar with the healthcare system of the Soviet Union and then Russian Federation, which was socialized medicine. A detailed description of how this differs from the current U.S. healthcare system will take many hours. In summary, the U.S. healthcare system offers higher quality of care with greater access to this care, but at much higher cost, both to the patients directly and to the society in general through taxes.
A lot more money in the U.S. healthcare system is wasted on administrative tasks, defensive medicine, unfunded mandates and regulatory inefficiencies.The vast majority of those expenses do not translate into better quality or access to care and frequently do the opposite. With all its problems, however, I would still rather receive my medical care here in the U.S. than in any other country.