> > From: "Anthony D'Costa" <[email protected]> > Hari: > I meant that I didn't fall seriously ill and hence never tested the > health care/delivery system. I have no doubt as to their > technical/medical abilities but the issues have to do with waiting time and > sometimes organizational snafus. At least this is what I heard from many of > my Danish colleagues. One evidence of this "shortcoming" is the presence of > private hospitals to circumvent the waiting times. But it's clear only the > very rich in Denmark can afford to have this additional health insurance. > Anthony > > Response;
Hello Anthony: Thx you for that clarification. I understand now what you were driving at. My own take on that for what it is worth - on 'rationing'. So waiting times is a common matter that proponents of a private health scheme system point to (I sincerely do not mean that you are - please do not take umbrage!). In reality - all health care systems are subject to forms of 'rationing'. This would even apply to systems that I would have no compunction about calling 'socialist' - whether the system pointed to by Henry Sigerist in the USSR at one stage; or that of Albania that I visited myself several times. (This is sincerely not meant as a provocation - I do not wish to waste my time in fruitless conversations - Please accept this as a potential illustration). This might be understood as the process in critical care scenarios of 'triage' - perhpas made famous by TV soaps, or better by MASH -reserving urgent care for those who are sickest. This is - by any other name-smell as sweet - is a form of 'rationing'. Capitalist societies - apply a rationing to health care by one of two mechanisms by and large - as far as I have seen: i) Reserving care for those who can and will pay. ii) Triaging less urgent (& Potentially less Evidence Based Care) for some vs more more immediate care for life-threatening illness. The classic example is for eg, of hip replacement: You do not die if your aged hip does not get done in 6-12 months rather than 1 month. But your Health Related Quality of LIfe... is another matter. Both systems are 'rationing'. But in the case of (ii) - what is important to me, is that the system is more 'fair' (by my standards anyway) and yet is flexible to people's wishes. I will try to show what i mean here: One 'classic' example for me is that of Coronary Artery Bypass Grafts in Ontario. At one stage there was rationing of this. The evidence was not exactly crystal clear - by the gold standard of Randomised Controlled Trials. There was a waiting list. What ensued was a rush of patient to the USA. Some costs for this was borne by the Ontario Government. By an increasing democratic pressure from below (patient complaints) - the Ontario Government did a rush evidence based review - and within 6 months had allocated adequate resources to get up new Operating rooms and newly appointed cardiology-cardiac surgical staff, nurses for ORs etc. The waiting list was dramatically cut as was the rush to the USA. Now this was in the pre-'Neanderthal'-Harpar era. One where both scientists and clinicians and patients - did actually have a voice - albeit in a capitalist state. Denmark - maybe different - I somehow doubt it, and suspect that the waiting list is for s small fraction of the population and may be largely for non-'urgent' stuff, albeit affecting Health Related QOL. Notwithstanding Louis recent tirades against Scandinavian social-democracy - which largely I agree with - the basic conditions of the working class are superior to that of their peers in the USA. The smae for Canada. Thanks again for clarifying. Hari Kumar
_______________________________________________ pen-l mailing list [email protected] https://lists.csuchico.edu/mailman/listinfo/pen-l
