I may have been a little cruel with my last post. Sorry. I don’t know what gets into me sometimes. Pat yourselves on the back for putting up with it and then listen to Cascade, written and performed by Sam Rivers (tenor saxophone) and Dave Holland (bass). Cascade is the second side of their out of print 1976 album Dave Holland – Sam Rivers. It’s about 21 minutes long, so try to make yourselves comfortable. Regular political blogging should resume shortly.
Since it is so quiet here, I am hijacking this space for my subjective use. Here’s some healthcare meat to chew on if there are any dogs out there this weekend.
There is a good study out in The Journal of Public Health which tells us progressives more of what we already know (see abstract and linkage below). I know from other encounters how the market-side conservatives respond to this study. They say that critcally ill people in Canada do not get care soon enough because they queue up there by first in line and somewhat by severity. Well now in the US, we queue by income and privilege, so many do not get needed care here. The lack of social fairness in the US with the growing disparities in access due to income and ethnicity are leading slowly but surely to a social turmoil that could be prevented by a fairer system. Canada has the system in place, even if it needs some modifications, to prevent social war over this issue, but we in the US are still going the exact wrong way and the cliff is coming up fast!
link to story
RESEARCH AND PRACTICE
Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey
Karen E. Lasser, MD, MPH, David U. Himmelstein, MD and Steffie Woolhandler, MD, MPH
Karen E. Lasser, David U. Himmelstein, and Steffie Woolhandler are with the Department of Medicine, The Cambridge Health Alliance and Harvard Medical School, Cambridge, Mass.
Correspondence: Requests for reprints should be sent to Karen E. Lasser, MD, MPH, Department of Medicine, The Cambridge Hospital, 1493 Cambridge St,
Cambridge, MA 02139 (e-mail: klasser@challiance.org).
Objectives. We compared health status, access to care, and utilization of medical services in the United States and Canada and compared disparities
according to race, income, and immigrant status.
Methods. We analyzed population-based data on 3505 Canadian and 5183 US adults from the Joint Canada/US Survey of Health. Controlling for gender,
age, income, race, and immigrant status, we used logistic regression to analyze country as a predictor of access to care, quality of care, and satisfaction with care and as a predictor of disparities in these measures.
Results. In multivariate analyses, US respondents (compared with Canadians) were less likely to have a regular doctor, more likely to have unmet health
needs, and more likely to forgo needed medicines. Disparities on the basis of race, income, and immigrant status were present in both countries but
were more extreme in the United States.
Conclusions. United States residents are less able to access care than are Canadians. Universal coverage appears to reduce most disparities in access
to care.
This is related to my previous post about disparities and health systems. You folks should know that we will never likely have a functional health system that can reach all people for an affordable cost unless and until we allow expanded use of mid-level providers and ease up on the scope of practice acts that give a monopoly for services to physicians and dentists. This is already happening to a degree in Medicine with nurse practitioners and Physician assistants. In dentistry however, rural areas, especially Alaskan native areas, have a very hard time getting dental care both becasue of costs and a lack of dentists willing to practice in such places To solve this problem there needs to be a mid-level dental provider that does not need to go to 8+ years of school to treat simple cavities and teach and practice prevention.
The Alaska native tribes are trying out the New
Zealand model of home grown dental therapists, a model that has work down under for 50 years, but guess who comes out of the woodwork to sue the
tribes. None other than organized dentistry, the ADA, whose sole mission seems to be to keep dentists rich and screw the poor without access to the
care that only these dentists can provide by social law. Screw that!! Change the law and increase the types and supply and scope of practice of various providers!
There is more! Organized dentistry (ADA) seems to only care about its current and future profits and not about actually meeting its obligation as the only providers CURRENTLY allowed by society to help out folks with dental disease, something the profession is not doing in Alaska too well. The Alaskan tribes are trying to use self-determination to help their people out here, and all they get from the ADA is a lawsuit. Here is an audio file from Alaskan public radio which talks more about this issue, which is an important one for overcoming health disparities and special interests that hurt people.
That’s such a disturbing story. Have you thought about writing up a full post on it?
I thought I just did. Remember, I hijacked your front page post!
thank you.
How can someone with such good taste in music bring himself to even touch that Hasselhoff thing? Although it did get us talking on a slow night.
How can someone with such good taste in music bring himself to even touch that Hasselhoff thing?
A little something I like to refer to as alcohol.
Chris, let me tuck this away in a little noticed thread (the one where you apologize).
Given that I’m the kind of person who doesn’t have the skills to make people laugh in person, much less online, I’d like to tell you how much I appreciate your humor. I know that I need it desperately.
Thanks. That’s very nice of you.