Tuesday, March 16, 2010

Part I - Background: A Chance to Size Up Two Health Care Systems

Being here at the American College of Cardiology Scientific Sessions in Atlanta, Georgia, USA, I have had a unique opportunity to meet with an interventional cardiologist from "across the pond" in England: Sarah Clarke, MD. Sarah is a Consultant Interventional Cardiologist at Papworth Hospital, Cambridge UK. Her undergraduate years were spent at the University of Cambridge, UK and postgraduate training was undertaken in the region. She attained an MD from the Univeristy of Cambridge. She was awarded a Fellowship in Interventional Cardiology at the Massachusetts General Hospital in Boston, and returned to take up her Consultant post in the UK in 2002. In 2006 Dr Clarke was appointed the Clinical Director of Cardiac Services at Papworth. Papworth Hospital is a 240ish-bed hospital that performs about 2,000 interventional cardiology procedures per year.

We thought it would be interesting to compare and contrast two heart patients - one with insurance and one without insurance - from our two health care systems, to illustrate how these patients obtain health coverage, might be managed, and how things look from the patient's perspective. It should be noted that Dr. Clarke has had an experience with the American health care system first-hand when her father (from England) suffered a myocardial infarction while visiting her in Boston. Her interest in contrasting our health care system prompted her to attend the session between Chris Jennings and Congressman Paul Ryan and she gave her take earlier. I, on the other hand, have no experience with health care from the UK, other than working to occlude my left anterior descending artery while sipping tea with a few biscuits and clotted cream in Oxford. (Smashing!)


Any way, I will be performing the US perspective on this blog, and Sarah will be writing about the UK perspective on her blog. We simply cannot cover every patient scenario or income range due to length (and time) considerations. Still, these posts might serve as a background for discussion as we consider the health care reform efforts underway in the United States.

For the purposes of the exercise, we'll take two patients, Mr. Thurgood Powell, a highly successful 57 year-old businessman making $250,000 (£166,128) per year with his company PoshPosh Entertainment, and Mortimer T. Schnerd, a pleasant 43 year old man who is unemployed but working part-time in the local K-mart, earning $17,400 (£11,562) per year. Both men will experience heart attacks, both men will present to Emergency Rooms in both countries, and both men with require 4-day ICD stays and require the implantation of an automatic defibrillator and follow-up for the first year after the heart attack. Beyond that, heck, who knows. But that will at least give us a starting point to discuss the good, the bad, and the ugly of both health care systems and to compare and contrast the two systems. We will purposely refrain from political commentary in our posts (that's for you to do in the comments section!). We only ask that the commentary discussion be respectful and civil. I would be thrilled to hear what the British think of their health care system/costs/etc. over on Sarah's blog and the U.S. perspectives on this blog. (Whether this works out or not, I have no idea, but at least we're trying...)

So check back later today after we have a chance to confer a wee bit before we post our case scenarios. And by all means, have fun at today's meeting!



Keith said...


I am REALLY looking forward to this one! Jolly good show!

DrJohnM said...

After the MI patient, I wonder how my uninsured AfF patient with the INR of 10 would fare across the pond. Could not afford his INR check, or got sick of the cardiology group asking him about his outstanding balance when he came back for his INR. A brief synopsis was yesterday's topic... http://drjohnm.blogspot.com/2010/03/how-does-one-treat-atrial-fibrillation.html

My guess is, he would still be non-compliant, but would fare better in the British system.

Enjoying the ACC coverage, though it looks like significant work.


Anonymous said...

I look forward to the discussion but I hope you won't neglect a topic that frequently comes up in your blog...the economics of the patients' care. I know that is very broad, but I'm especially interested in how NIH docs are paid and if their numbers are decreasing as Rep. Ryan suggests ours will due to $300K debt upon completion of training. (I wonder what the debt level is for others with post-graduate degrees. I don't expect you to know, but found his figures lacking a wee bit of analysis.)