AiA Library: Global Healthcare

Waiting Your Turn: Hospital Waiting Lists in Canada (11th ed.)
"This grim portrait is the legacy of a medical system offering low expectations cloaked in lofty rhetoric. Indeed, under the current regime–first-dollar coverage with use limited by waiting, and crucial medical resources priced and allocated by governments–prospects for improvement are dim. Only substantial reform of that regime is likely to alleviate the medical system's most curable disease—longer and longer waiting times for medical treatment."
Fraser Institute, Sep 2001

Waiting Your Turn: Hospital Waiting Lists in Canada (10th ed.)
"Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, rose from 13.3 weeks in 1998 to 14 weeks in 1999. This nationwide deterioration reflects waiting-time increases in eight provinces, while concealing decreases in waiting time in Manitoba and Ontario."
Fraser Institute, Oct 2000

Turning Patients Away: Can new cash from Ottawa end the hospital crisis?
"For Canadians in need of urgent medical care, the nation's hospitals all too often appear to be in a state of crisis. Horror stories abound -- of patients turned away from hospitals, of cancelled surgeries, and cancer patients flown across the country or to the United States for treatment that cannot be delivered closer to home. In Toronto, a 45-year-old cystic fibrosis victim missed out on an urgently needed double lung transplant on Feb. 3; the operation had to be cancelled -- and the donated lungs discarded -- because no bed or nursing crew could be found."
Maclean's, Mar 3, 1999, p. 16

Medical Savings Accounts: Universal, Accessible, Portable and Comprehensive Health Care for Canadians
"Evidence from American firms that have adopted MSA plans show that MSAs are conducive to more prudent health spending without compromising individuals' health. Where they have been adopted, MSAs have resulted in lower employer and employee costs, accumulated savings, and high degrees of employer and employee satisfaction. The empirical literature in the United States indicates that MSAs or similar arrangements have the potential to reduce health expenditures up to 20 percent. One would predict an even larger decrease in health expenditures had these simulations been performed using Canadian data because Americans already face financial incentives with respect to their use of health care while Canadians do not for the most part."
Fraser Institute, May 1998

Government in the medicine cabinet
1. Uniform Global Prices Mean Higher Prices for Drugs
2. Newspapers Feature a Few Victims, Ignore Many Beneficiaries in Cisapride Story
3. Overkill: The Regulation of Natural Health Products in Canada
4. Reference-Based Pricing in British Columbia's Pharmacare: How Post-it Notes Changed the Market for Nitrates
5. Can the Drug Approval Process be Reformed to Save Lives?
Fraser Institute, Feb 2002

How Private Hospital Competition Can Improve Canadian Health Care
"The literature on the effects of hospital competition in the US reveals that, over the last 10 years, competition has been unambiguously beneficial, lowering cost and increasing quality. Prior to that time, competition had been found to increase quality but also to increase cost."
Fraser Institute, Jan 2000

The False Promise of Single-Payer Health Care
"In a system that claims to deliver comprehensive, accessible, and universal care, many Canadians find they must wait months and sometimes years for critical care. Canadians confront few barriers—and no bills—when they need to see a primary care doctor. But should that doctor diagnose a serious disease, Canadians, both young and old, are fast exposed to their system’s limits. Remember Paul Tsongas, Democratic primary candidate for the presidency and cancer survivor who several years ago during the campaign said, “had I been living in Canada when my cancer was diagnosed and treatment needed, I would not be alive today.”
Sally C. Pipes, Oct 9, 2002

United Kingdom
The Socio-economic Burden of Hospital Acquired Infection
"Patients who had one or more [Hospital Acquired Infections] identified whilst in hospital, incurred hospital costs that were, on average, 2.8 times greater than uninfected patients, equivalent to an additional £2,917 per case, and remained in hospital, on average, 2.5 times longer than uninfected patients, equivalent to an additional 11 days...HAIs were estimated to cost the hospital sector £930.6 million annually (in-patient costs only)."

'Four-year wait' for outpatient appointment
"Some patients in England are having to wait up to four years for an outpatient appointment in hospital, according to new research ... Health Minister John Denham defends the government's recordA study has shown that waiting times after referral by a GP are up to four years - or 208 weeks - for one orthopaedic surgeon ... The research by the charity, the College of Health, also shows patients are waiting 147 weeks and 145 weeks to see foot specialists in two separate hospitals ... The worst waiting time for an out-patient appointment in neurology was 126 weeks, with one example of a 95-week wait to see an eye specialist, the study showed."
BBC, Nov 11, 1999.

Cancer surgery postponed four times
"A cancer patient has had important surgery cancelled four times because of the flu crisis ... Mavis Skeet, 74, has been waiting for five weeks to find out if her cancer of the oesophagus has spread ... She was due to have an eight-hour operation in December to remove her gullet and to assess the progress of the disease ... But the surgery at Leeds General Infirmary was cancelled because a member of the operating team had flu ... Since then it has been put off three more times - the latest cancellation was on Monday - because there have been no available intensive care beds due to the flu bug ... Mrs Skeet's daughter, Jane, of Horbury, Wakefield, West Yorkshire, said that on one occasion her mother was being taken to operating theatre when the surgery was cancelled because her intensive care bed was needed by another patient ... She said: "This is all because of the flu crisis. My mum has been strong up to the last time, but then she broke down and was in tears ... "We are very angry. The doctors say they can't tell whether the cancer's spread until they operate, which means it could be spreading all the time while there's a lack of beds ... "This is due to lack of resources and bad planning. The government is trying to cover it up by saying the hospitals are coping, but they're obviously not."
BBC, Jan 22, 2000.

Cancer inoperable after flu delay
"A cancer patient whose operation was cancelled four times because of the flu crisis has been told her tumour is now inoperable ... Mavis Skeet, 74, had been waiting for five weeks to find out if her cancer of the oesophagus had spread ... However, a shortage of beds at Leeds General Infirmary led to the repeated cancellation of her operation. "
BBC, Jan 13, 2000.

Girl died after surgery was postponed
"A three-year-old girl whose heart operation was postponed seven times died after the surgery was finally carried out, it has been disclosed."
BBC, Jan 14, 2000.

Doctors: Intensive care failing patients
"Critically ill patients have been denied proper treatment because of shortages in intensive care, doctors have said."
BBC, Jan 15, 2000.

Vital surgery cancelled seven times
"A man suffering from a potentially fatal condition has had vital surgery cancelled seven times because of a shortage of intensive care beds ... Jack Barnett, from Scarborough, had surgery on a blood vessel cancelled an hour before it was due to begin ... On another occasion he was given an anaesthetic before the operation on an abdominal aortic aneurysm, a weakening of an artery, was abandoned."
BBC Jan 17, 2000.

Cancelled operations soar
"The number of operations cancelled the day they are due to happen has risen to an all-time high, an official watchdog has said ... Between 1998 and 1999 cancellations increased by 12% to a total of 56,000 at hospitals in England ... The problem was highlighted by the case of Mavis Skeet, whose throat cancer was found to be inoperable after exploratory surgery was postponed seven times. Earlier surgery may have saved her life."
BBC, Feb 24, 2000.

'Surgery a year too late'
"A man was offered an appointment for heart by-pass surgery a year after he had died ... When Brian Booy died of a heart attack in January 1999 he had been waiting for triple heart by-pass surgery for 18 months ... Days before the first anniversary of his death, his widow Pat received a letter from Bristol Royal Infirmary's cardiac unit saying that her husband could have the operation this Friday ... The revelation comes days after the cardiac unit's clinical director Dr Peter Wilde said 10 patients may have died because they had to wait too long for operations."
BBC, March 1, 2000

Plan to stop dangerous doctors
The government is to set up an "early warning system" to detect serious medical problems...The system will require hospitals to report all medical errors or near misses...It follows reports that about 230 people tested for cancer and other illnesses may have been misdiagnosed by 78-year-old pathologist James Elwood...The Department of Health is to launch an inquiry into the case after officials at Princess Margaret Hospital in Swindon warned that Dr Elwood, a freelance pathologist, made a number of serious mistakes while testing for cancer and other diseases.
BBC, 13 June, 2000

Pathologist warnings 'went unheeded'
"A doctor who made hundreds of mistakes was allowed to continue working in the health service despite concerns about his work dating back years...It emerged on Tuesday that pathologist Dr James Elwood was the subject of two hospital reviews into his work in the mid-1990s...But Dr Elwood has protested that inaccurate allegations have been made against him, and it appears that his error rate may fall within the limits expected in the NHS."
BBC, 13 June, 2000

Cutting out the medical blunders
"Ministers are wondering how medical errors can be reduced - but a successful way of tackling them exists already."
BBC, 17 June 2000

Parents 'not told of drug errors'
"Almost half the parents whose children received the wrong medication after hospital mistakes were never informed of the error, research has found ... The survey, covering five years of work at a paediatric teaching hospital in Scotland, revealed fewer mistakes than expected ... But the level of secrecy surrounding the blunders did surprise the researchers."
BBC, 20 Nov 2000

Learning from Bristol: the report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984 -1995
"To inquire into the management of the care of children receiving complex cardiac surgical services at the Bristol Royal Infirmary between 1984 and 1995 and relevant related issues; to make findings as to the adequacy of the services provided; to establish what action was taken both within and outside the hospital to deal with concerns raised about the surgery and to identify any failure to take appropriate action promptly; to reach conclusions from these events and to make recommendations which could help to secure high quality care across the NHS." July 2001

Inquiry into cancer drug tragedy
"The parents of a young cancer patient facing a slow death following a medical blunder have welcomed a hospital inquiry into the tragedy...The 18-year-old, who has not been named, is expected to die after the powerful chemotherapy drug vincristine - part of his treatment for leukaemia - was injected into his spine instead of a vein...It was revealed on Wednesday that exactly the same mistake has been made in UK hospitals on 13 occasions over the last 15 years."
BBC, 24 Jan, 2001

NHS aims to improve patient safety
"All medical mistakes will have to be officially reported, whether or not the patient has been harmed, in a bid to improve safety in the NHS...An independent body is to be set up to log failures, mistakes and errors which occur in hospitals and GP surgeries...The National Patient Safety Agency (NPSA) will run a mandatory reporting system for incidents and "near-misses"...If something has prevented the patient being harmed but a problem has been revealed, it will still have to be reported under the new system.
BBC, 17 Apr, 2001

Post-Bristol safeguards on the way
"Bristol was already a hot topic in the NHS when Labour came to power in 1997, and ministers have had some time to consider their next moves...Well before the publication of the Bristol inquiry report, the government was making moves to beef up measures to protect patients."
BBC, 17 January, 2002

'NHS must learn from its mistakes'
"A recent study by the Audit Commission claimed there are around 1200 deaths every year from adverse drug events - a five-fold increase over the past ten years ... Some of the deaths are due to patients simply being given the wrong drugs while in other cases they are given the right medicines but at the wrong dose or in the wrong manner."
BBC, 12 Feb 2002

Poor birth care 'kills 200 babies'
"A minority of doctors are still failing to follow the latest procedures in maternity wards - leading to hundreds of unnecessary deaths, says a report ... The comprehensive survey of obstetric units in the UK, carried out by experts from the Department of Paediatrics at Leeds University, found that many were still using discredited techniques ... It suggests that as many as 200 babies a year may be dying as a result, as well as thousands of women being injured."
BBC, 25 Feb 2002

Medical error victims call for action
"Victims of medical errors have called for the government to provide better protection for patients."
BBC, 15 April 2002

Nurse fears over secret medication
How much autonomy and power do consumers have in a government-run system? As this shows, none. The state can determine, as the British have, that patients can be treated against their knowledge and agreement. Who pays the piper calls the tune, and in socialized, single-payer systems, consumers are powerless. This is simply medical totalitarianism.
"Nurses have challenged guidance over when they can hide patients' medication in food or drink ... The regulatory body, the United Kingdom Central Council for nursing, midwifery and health visiting, last year said drugs could be given covertly if it was in the patient's best interests - though the practice should not be routine ... How often nurses hide medicine is unclear, but the author of the UKCC's position statement, Joe Nichols said a small survey of nursing homes had found 75% of staff had given medicines covertly. "
BBC, April 23, 2002

Q&A: Hospital errors and accidents
"A pilot study suggests that patients are affected by thousands of "adverse incidents" each year. How worried should we be by this? ...BBC News Online provides a briefing on the issue - and the measures being taken to confront it by the government."
BBC, 17 June, 2002

Hospital 'near-miss' cover-up denied
"The first-ever detailed study of "adverse incidents" in NHS hospitals has found thousands in just a handful of trusts over a six month period...But a storm has erupted over claims that Health Secretary Alan Milburn tried to prevent the release of the figures to avoid creating alarm among patients...This has been denied by sources at the Department of Health, who said it would be "irresponsible" to publish preliminary, and possibly unreliable data in an official document."
BBC, 18 June, 2002

Doctors warned over 'lethal' treatment
"A warning is to be issued about a substance regularly used by doctors in UK hospitals which can be lethal if administered incorrectly...It has emerged that potassium chloride - widely used to treat the critically ill - killed three people after being administered wrongly in a handful of hospital trusts over a six-month period."
BBC, 18 June, 2002

UK 'has worst cancer record'
"The UK has the worst survival rates for cancer of any developed country, a major survey reveals ... Research by market analysts Datamonitor shows Britons who develop cancer are more likely to die from the disease than people living in other Western countries."
BBC, July 2, 2002.

Costly wait with dementia symptoms
"Many patients with dementia waited for three years before their carer reported early symptoms to their doctor."
BBC, 8 July 2002

Parents to sue over epilepsy row
"More than 200 families are planning legal action against Leicester Royal Infirmary after children were wrongly diagnosed with epilepsy ... An investigation has already shown 150 children were either given the wrong diagnosis, or the wrong treatments." ... Some children were put on cocktails of drugs in excess of normal limits."
BBC, 8 July 2002

Transplant waiting lists growing
"Figures show the active waiting list for liver transplants has increased by 47% between June 2001 and June 2002 and the total waiting list for the same period is up 2%."
BBC, 3 Aug 2002

National Patient Safety Agency (NHS)
"The UK has long had a socialized medical system which is know for its long patient waits and poor care quality. Where there is no competition there is little incentive to improve care."

Australian Patient Safety Foundation
Iatrogenic Injury in Australia: A Report by the Australian Patient Safety Foundation
"Healthcare is a risky business. Simply being a patient in an acute care hospital in Australia carries, on average, a 40-fold greater risk of dying from the care process than from being in traffic, and a 400-fold greater risk than working in the chemical industry...Iatrogenic injury is costly; at least 10% of admissions to acute-care hospitals in Australia are associated with a potentially preventable adverse event. It has been estimated that the direct medical costs of these events exceeds $2 billion per year and that the total life-time cost of such preventable injury may be twice that amount; there is also a heavy toll in human costs on both those who are harmed and those who care for them."
Runciman WB, Moller J, October 2001. Executive Summary (pdf), Full Report (pdf, 18.5 MB)

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