The days are thankfully long gone when there were major differences in the way a patient with a particular disease was managed from one place to the next.* This homogenization of practice is due to a combination of facile movement of physicians across time zones and borders, global communication, the mandate that every therapeutic measure has an evidence-based justification and, for countries with too many lawyers, the ever-present stick that punishes missteps known as malpractice, further shrinking the intersite differences in management. Strep throat, type 1 diabetes, hypertension and deep vein thrombosis, and a host of etceteras are for the most part, treated the same way with the same generic agents in Johannesburg as Jakarta.
*I’d like to think I was the last pathologist to ever perform a bone marrow biopsy on a patient who clearly had iron-deficiency anemia (at the clinician’s request, mind you). In the 1990s, fully 10 years after the AIDS epidemic began in earnest, there were still clinicians who transfused packed red cells as a “tonic”.
British map with apologies to Ireland
In contrast, the infrastructure on which practice in disparate regions is based can be as different as night and day. The oft-quoted line about the UK and the US, variously attributed to George Bernard Shaw, Oscar Wilde and others, …two countries separated by a common language is also applicable to the two health care systems. The American system reflects the free market economy on which it is based and requires each citizen to have health insurance. A patient can have the best care in the world…as long as he can pay for it, which explains why tens of millions of Americans can’t afford health care and despite the fact that 20% of the population is un-insured or underinsured, health care consumes 18% of the US GDP. Americans don’t view health care as a fundamental right.
In contrast, the UK adopted its system of socialised medicine with the founding of the National Health Service in 1948* under the guidance of Aneurin Bevin, the then Minister of Health. The remit of the NHS was that it meet the needs of everyone; that it be free at the point of delivery; and that it be based on clinical need, not ability to pay.
The pros of the UK system of universal coverage include a lower cost (10% of the British GDP); more efficient patterns of specialist referral; better (longer) training and expertise of specialists; homogeneity of pay for doctors; lack of aggressive marketing for patients from doctors and hospitals.
The cons of the UK healthcare system include waiting lists for a fair number of procedures–e.g., hip replacements, a paucity of hospital beds resulting in queueing problems, bloated bureaucracies within acute hospital trusts, lack of accountability of non-governmental organisations meant to act as oversight bodies, excessive salaries for hospital CEOs and COOs*, poor quality of construction of hospitals built through PFIs (private finance initiatives); unconscionable interest rates for PFI loans.