Monday, May 16, 2011

A day in the life of Danish Health Care

A young man is getting chemo for his cancer. He has about a 60% chance of cure and it's very important that he gets scanned on time between his chemo treatments.

His chance of cure may fall to 59% or 59.5% if he doesn't get scanned on time, or it may not fall at all, statistically. But for his kind of cancer, having spread the way it has, this particular scan and this very particular time will guide which chemo he gets next.

But Denmark needs money. So the health care budget grew less than it should, meaning each hospital got less money. At our hospital, the radiology department was hit unreasonably hard. CT slots were cut. Nurses, techs and radiologists were no longer allowed to work overtime, as this is usually very well-paid in Denmark.

The wait-lists grew, but since our patients tend to be very sick and very salvagable, they tend to get the scans they need, and I have only been vaguely aware of the problem.

Until Thursday, when I realized my patient hadn't gotten his scheduled scan. My first thought (my first fear, rather) was that I had forgotten to schedule it. But no; there it was, clearly ordered for a specific week. I called radiology and was told it couldn't be done on time. I had to tell this to the patient. He is a nice guy, with a warm smile, but he was visibly worried about the delayed scan. I had to walk a tight line between blaming "the system" (and keeping his faith in me) and pretending the scan could easily wait (keeping his faith in the system).

I got his scan scheduled today, after reaching an onco-radiologist, who sympathized with my plight. Still, the scan will be a week late.

For those interested, here are my thoughts on the future of the Danish health care system.

I think the standard of care is running away from Denmark. So far, we have been saved by our wealth and a health care system that offered high-level care in bare-bones surroundings. In Denmark, we have been able to treat people with $100,000 biologic agents, while they sleep in 3-bed hospital rooms with a shared bathroom (if they are lucky; sometimes, they sleep in the hallway). But the growth in the number of, and duration of, treatments have outpaced economic growth. Where, just 10 years ago, some diseases had very cheap, palliative treatments, there are now piles of novel, or biologic, agents to try. They are without serious side effects, so you can use them in everyone.

We're seeing some rationing, but it's politically impossible for anyone to devise a list of who can receice which drugs, and who can't. Drug costs will rise exponentially and the health care budget will stay steady.

I'm not optimistic. The Scandinavian credo has always been that everyone deserves the same care, rich or poor. In ten years, a wealthy American (or a wealthy Chinese, for that matter) will receive care that is unavailable in Denmark. Can we stand that?

Now, I'm not neccesarily a fan of the American health care system. Where I frequently work, it's not unusual to see people in their twenties with dentures, because their parents couldn't afford dental care (or the one medicaid dentist in the area moved). I have seen old couples ration out pills between them, because they couldn't afford meds for two.

I don't know what's right, but I don't like what I see.

In other news, I'm fat. Natali thought it was funny that my man boobs jumped up and down last night. I am so miserably out of shape.

In other, other news, the Girl and I have a plan. It's great; it's a dream, and my spirits are high. The plan? I can't reveal it, for fear of the Girl changing her mind.

1 comment:

SteveQ said...

"Denmark needs money" was the sequel to "Mars Needs Women," I think.