Comparison List

[KARL]

A list was recently published in the Lancet comparing 195 countries' health care performance on the basis of "mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality)". In plain language this would be described as "death being the outcome for no other reason than the healthcare being found wanting".
The list was published within an article (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30818-8/fulltext) and its top end can be seen here:
http://www.thelancet.com/cms/attachment/2094714513/2077254606/gr2a_lrg.jpg

The UK's position on this list is above the USA, but that is not much to be proud of when in 30th and 35th place respectively. I may simply not have noticed, but I am unaware of this list having been prominently mentioned in main/major UK media coverage (which, if it hasn't been, is unsurprising to me) but I find interesting which countries are in the top positions (the usual suspects are among them). What I personally find particularly damning for the UK are its scores in the neonatal disorders and the adverse effects of treatment categories, although those for several other conditions are similar or even worse and, frankly, rather shameful.

Meanwhile politicians and the public proceed on the assumption that the UK is, in this field as so many others, a world leader - that may be the hope, even the aim, but reality puts it quite differently, unless the definition of a leader is quite generous (wishful/biased ?).

[Old_Geezer]

I think one would need some deep investigation on the reasons why countries are where they are before we can conclude that we are useless and others are doing everything right. For sure it implies there are issues to tackle.

[KARL]

OG, you mean that a reality check is called for ? In which case I wholeheartedly agree - on this subject and a(nother) long list of others. By the way, I would not go so far as to use the word "useless", although if the UK was in 130th place it would probably qualify ;)

[Buenchico]

The Scandinavian countries (and their neighbours) always come above the UK in tables of healthcare provision, childcare provision, support for the elderly, etc, etc.

The reason is obvious. In the UK (after a tax free allowance) we tax people's income at 32%. (i.e. 20% Income Tax and 12% National Insurance). In the Scandinavian region (after tax free allowances) people are taxed at rates close to 50%.

The UK could perform just as well, or better, than those countries but Income Tax would need to rise by at least 50% (i.e. up to a minimum of 30%, with National Insurance still to be paid on top of that) for it to happen. Are you going to vote for it?

[KARL]

Chris, you are correct that the level of taxation on individual incomes varies but not to the extent you suggest nor do I think top tax rates are that significant in all of this. While many charge a higher top rate, Andorra's (No.1 on the list) tax is a fraction of the UK's, Iceland (No.2) levies a slightly higher tax than the UK but has no military at all. The difference, I think, lies in emphasis in that the UK's spending spectrum is differently balanced but perhaps also just as important is that all the best performers are small countries with no "leadership" ambitions, they also set priorities differently and are realistic. Smaller size permits much better oversight, less risk of waste and better focus - size really matters when you are trying to run an organisation, an authority/institution, a system, a country.

Having a culture of constantly questioning how things can be done better (which by definition means differently) helps a lot, whereas the burden of outdated thinking and chaotic management structures ("we have always done it like this, and after all, we are and always have been the world's best") really does not help, especially if/when you are inclined to fight change tooth and nail.

Were I asked to, I would vote for lots of change, more or less right through every institution/authority and system in the UK, including a higher top rate for individual incomes to match those in countries that do better than the UK so that people in the UK enjoy a better life than they do now. But I accept that, on the basis of evidence from past history to the present day, there is no real likelihood that, for the average individual (which is what these lists are about and reveal), the UK will become similarly promising (as Denmark, Norway, Sweden, Finland, Iceland, Switzerland, etc......or Andorra) to live in during my lifetime. More is the pity, we are talking of very many people.

[Zacs-Master]

Even though Iceland does not have a standing army, it still maintains a military expeditionary peacekeeping force, an air defence system, an extensive militarised coast guard, a police service, and a tactical police force.

[KARL]

Zacs Master, you are quite wrong, except that, being a founder member of NATO, Iceland makes a contribution (but not as much as Donald wants). The coast guard vessels are primarily designed and operated for policing the fishing grounds (licensing, quotas, seasonal closures, etc.), search and rescue (including stints watching for boat people in the Mediterranean on behalf of Frontex), etc. - they are small and very lightly armed (a single small cannon at the bow, I think). The police is unarmed but there is a "special unit" which can be called out to deal with serious incidents - it was in the news a couple of years ago (if memory serves me correctly) when they shot and fatally wounded a person for the first time ever (I believe there was quite a debate in Iceland questioning justification).

[jno]

the list is slightly baffling. The UK leads the world for treating chronic kidney disease, yet scores only 58 for Hodgkins lymphoma. Even allowing for the fact that the latter generally attracts lower scores, that's not too good - but as to why this is the case, I don't know. Better training for doctors in one speciality than the other? Government-imposed priorities (or funding cuts)? Lack of publicity to potential patients?

I don't know; but the UK is as wealthy as most of the countries ahead of it on the list, and really shouldn't be so far down. Ahead of Slovakia but behind Slovenia - what sense does that make?

[pixie374]

Priorities and sheer numbers of patients.

[KARL]

Zacs, I forgot to mention that there is absolutely no armed military element kept by Iceland at all. To the best of my knowledge, the staff that are sent by Iceland on NATO missions to such places as Afghanistan serve as community service agents on healthcare and such - they do not carry arms, military service is something tantamount to treason.

jno and pixie 374, if there is a single expression that explains the UK's poor performance then it is poor organisation/management from top to bottom - I doubt that the UK population produces a larger percentage of would-be patients than the countries seen to be performing much better. The areas of poor performance identified on this particular list are unflattering and some are downright shameful. There are other lists on other matters which similarly put the UK as unimpressive-to-poor when running its affairs.

[pixie374]

Without a doubt, organisation is a big part- that's what I meant by priorities.