Thursday, September 27, 2012

Comparing African and American health care

Last year, while you were living in Zimbabwe, Phil fell out of a tree and shattered his ankle. I shook my head as I read your account of scurrying around, trying to collect the cash required for each Xray and consultation.

Now, as you are in the States, poor Phil has fallen off of his bike and broken his collarbone. Can you compare the quality, access, and procedures of the health care industry in the two countries?


Very good question, but it took me a while to get my thoughts together. Being in the middle of the American labyrinth made it hard to see the big picture.

But now, a couple months on, I can make an attempt at objectivity. Surprisingly, I found them very similar.

The preliminary paperwork, getting "accepted" and all our ducks in a row was complicated in both places. Different ducks in different rows, but bureaucracy grinds on both sides of the Atlantic. We were no more/no less patients to the paper pushers. The Zimbabwean protocol requires money up front. The Americans just require you to sign your life away, and be in some network (which they may or may not be able to verify) before treatment commences.

Once you are in medical hands, the differences fade. People who deal with hurting folks are kind and friendly on both counts. We found nurses, doctors, techs all interested in us as people--eager to talk and sympathetic. Both sides also shook their heads and bemoaned the system they worked for, seeing it as ungainly and impersonal. (They were right on both counts.)

Obviously, there is a massive gap in the technology of Africa and the US. In Africa it was a little more footwork for us, as we had to run our blood to the lab or get ourselves to the x-ray room. But overall, unless one suffers from an exotic disease with difficult diagnostics or treatment, the tech level is insignificant. Highly technical societies depend on their technology, charge more for it, and only occasionally get the benefit. Phil calls this the law of diminishing returns. For example, in the US an MRI was ordered for his ankle. We were not in system, so it took quite of bit of extra effort to find a place which would take cash (the cost being half, $400, of the $800 had it been an insurance charge.) In the end, the money was ill-spent. The results were "inconclusive" and the orthopedic surgeon we found for Phil's shoulder assured us that an MRI could not have determined anything on the ankle. Technology in the wrong hands--

One raging difference between the US and Zimbabwe was the prices. Of course, you know that African prices are going to be less, much less. Less than a tenth of here. That is not the significant difference. In Zimbabwe, if you need an x-ray, they tell you now much it is, depending on the size. It is that price. All the time. Every day. But in the US, prices are negotiable. X-rays vary in price and size depending on YOU. Not the hospital or clinic, but whether you have insurance or are in their network. Why prices are such arbitrary items, I don't know. The organization should know how much it costs them, have a mark-up, and there is the price. But insurance and a host of other variables skew things. We pay much more for much less. And we will rarely get an answer to: "How much will this cost?" because no one knows. It depends on all the variables in your paperwork. 

The quality of care and sincerity of the health workers was comparable between the US and Zimbabwe. The bureaucrats also rated equally, with a parallel indifference to your situation and your patient's suffering. Their job was to get the money. Nothing else seemed to matter. In Zimbabwe, they demanded it up front, in cash. In the US, your signed everything and they would get it out of you or your insurance company one way or the other. It was all about the money, either way. Both countries get high marks for competent and personable health workers. Now if we could only turn medicine into a community service instead of a business.

No comments:

Post a Comment