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Which is better - private funding or public? Which gives a better outcome for the individual (* clinical outcome, * user experience, * cost-effective, * sustainable) and is there a clear picture?

One way to examine this question is to look at different countries in the world and see what works for them.  I tackle this in the latest blog on Technorati.

Which is better - private funding or public? Which gives a better outcome for the individual (* clinical outcome, * user experience, * cost-effective, * sustainable) and is there a clear picture?

The figures are clear:

At around $1800 Healthy Life Expectancy is pretty good, and by $3000 per head (£2000, €2200) it doesn't get any better (see colourful chart to the right - based on WHOSIS figures for 2001-2006).

You can spend more but you don't improve life expectancy.  Now many would argue that you get better healthcare - more comfortable, more convenient, better quality of life - I can't say (and nor can WHO) - Healthy Life Expectancy is a pretty good measure of health.  I wonder what happens to the extra money?

Lets look at this a different way - by % of GDP.

A lot of people think that we are now rich enough to kill ourselves.  We have enough spare money to eat too much, drink too much, smoke too much, never have to exercise, often not even to work, and of course to go hypochondriac on the internet, not only diagnosing all sorts of weird and wonderful diseases, but also to medicate them with medicine of dubious provenance.

So if we're richer, healthcare should naturally cost more?  It should cost more because it is more expensive to deliver (wages are higher, we use more expensive equipment, etc).  It would be fairer to look at healthcare compared to GDP (Gross Domestic Product).

Lower spend as a % gives lower life expectancy (I've had to exclude a lot of countries to make the graph simpler).  That's what is to be expected.  But look at some of the exceptions above the 7.5% mark.  Japan (relatively low % of GDP in this sample) has the best life expectancy at birth.  Diet? Stress? 

UK - although spend is relatively low, life expectancy is terrible compared with the group.  Alcohol? Smoking? Could it be a failure of healthcare? I doubt it, with all of the health tourism INTO the country.

The real anomaly is USA.  In 2006, a frightening 15% of GDP ($1 in every $6.5) was spent on healthcare.  Nowadays it is more like 17% ($1 in every $6).  Not to put it too crudely, healthcare is very important and the healthcare workers work very hard, but it doesn't create new wealth.  No, I tell a lie, in USA some people are getting very rich out of healthcare.

According to some estimates, 40% of all healthcare "spend" in USA goes to administration in the insurance companies that purchase healthcare on behalf of the public - they don't run hospitals (many hospitals are charities) they simply take the cream off the top.

No wonder so many people oppose Obama's proposed healthcare reforms - they don't want to give up their really rich sources of income!

For my next blog, I'm going a bit closer to home - look at the impact of numbers of primary care doctors (GPs) on A&E admissions in UK.  It could be interesting (I haven't done it yet!)