Monday, June 7, 2010

U.S. vs. Global Health Care: Who Has Most Influence?


An intermediate or transitional phase


Definition of “ In Limbo”


The last 556 visitors to medinnovation.com include,

• United States, 479, 86%

• Canada, 9, 1.6%

• India, 7,1.3%

• Korea, 5, 0.9%

• U.K, 5, 0.9%

• Germany, 5, 0.9%

• Australia, 4, 0.7%

• France, 4, 0.7%

• Others, 39, 7.0%

These figures reflect my preoccupation with U.S. reform and innovation and simple fact that most of my readers are Americans. Nevertheless, the numbers led to three questions.

1. Which country has the most influence over the world’s health trends?

The U.S., for many reasons. We remain the most affluent, and we spend the most on health care- 16% of GDP. We are the most innovative – with 80% of Nobel Prize winners. Twenty five percent of practicing U.S. physicians are internationally trained. We train many of the world’s specialists. I recently spoke to an academic cardiologist, and he told me 90% of candidates applying for cardiology were foreign-born. Because the Web is English-language based, we dominate it, especially when it comes to health-information technologies. We ae home to the world’s biggest IT firms – Google, Yahoo, Microsoft, Apple. But our dominance and influence may be about to change, as indicated by the world’s top Internet users.

Top Internet users, population, Internet penetration


1. China, 1.3 billion, 27%

2. U.S., 307 million, 74%

3. Japan, 127 million, 76%

4. India, 1.2 billion, 7%

5. Brazil, 199 million, 34%

6. Germany, 82 million, 66%

7. U.K. 61 million, 76%

8. Russia, 140 million, 32%

9. France, 62 million, 69%

10. South Korea, 49 million, 77%

2. Should the U.S. health system perform more like the rest of the developed world with its national health systems which spend about half as much as the U.S. on health with similar results?

I do not know, but I know the present president and his administration want us to be more like Europe, with its cradle to grave social welfare benefits. The troubles of this scenario are three-fold; one, most U.S. health participates will continue to act locally, rather than globally, for the U.S. is where the money is; two, voter resistance in America – two-thirds of Americans oppose Obamacare; and three, due to aging populations ,overly-generous pension benefits, and skyrocketing debts, the social welfare systems of those countries, and probably of the U.S., verge on collapse.

In the U.S., the U.S. will have to increase the age on entry into Medicare and perhaps means test Medicare recipients, by charging the more affluent more and raising Medicare participation fees and co-pays.


3. How is the world of health care likely to change for the U.S. and rest of the world’s health care systems?

Changes are underway. Over the last few years, medical tourism has gained popularity. American patients seeking health care abroad numbered between 500,000 to 750,000 in 2007. Medical experts estimate 200,000 to half a million Americans traveled out of the country for medical procedures. The medical tourism market may reach $100 billion by 2012.The medical tourism industry is booming, with Americans going abroad for less expensive procedures - hip and knee replacements, angioplasties and bypasses, cosmetic and dental procedures. Foreign-run hospitals are moving offshore near the U.S. to perform these procedures. American drug and device manufacturers are moving aggressively into the emerging markets like India and China. Drug companies are conducting clinical trials abroad to lessen their expenses. Internet users in other countries are reading U.S. websites about medical breakthroughs and demanding their governments offer more access to these advances.

The U.S. system is in limbo. We are bending backward to get under the bar. Other countries are bending forward to get under the bar. Both hope to emerge on the other side of the bar upright.