In Single-Payer Health Care, Quality Is NOT Job 1

A few weeks ago, I came across this blog post at KevinMD about one physician’s experience working in Sweden’s single-payer system:
There was, in my view, a culture of giving less than you were able to, a lack of urgency, and a patient-unfriendly set of barriers. One example: Most clinics took phone calls only for an hour or two in the morning. After that, there was no patient access; no additions were made to providers’ schedules, even if some patients didn’t keep their appointments, not that there was a way to call and make a same-day cancellation.
DeadPhoneThat jogged my memory and after some searching I found this diary by Patricia Balsom who was dying of cancer while under the “care” of Britain’s National Health Service.  Here are a few excerpts:
Left leg started to swell around 7.45pm. Called the out-of-hours doctor service. Two hours later we called again. The girl on the phone said she thought we just wanted advice, as this was a line for seriously ill patients. We told her I was terminally ill. She asked if we needed a doctor, and we asked her if she was medically qualified. She said she was not.
That was not her only “phone” difficulty:
We called at 9am about my blood tests. A district nurse came and took blood at 10.45am. She insisted that Mick took the blood sample to Hillingdon Hospital because she “didn’t have time” to take it herself. (What if I was alone and we didn’t have a car?) She told me the hospital would contact me in the afternoon with the results. Didn’t explain what I was supposed to do with them. Waited all afternoon and evening, and no call came.
How well an entity fields phone calls is a pretty basic standard of quality.  Businesses that answer calls promptly or return them in a timely fashion usually get good marks from customers.  It appears that single-payer systems fail even that basic test.
And here are some of Mrs. Balsom’s final thoughts on the NHS:
I feel Hillingdon Hospital are making whatever time I have left so much more stressful than it need be. They are cheating me out of quality time with people I care about….I don’t feel as if anyone in the NHS is really in charge of my case.
Read it all.

The National Center for Public Policy Research, founded in 1982, is a non-partisan, free-market, independent conservative think-tank. Ninety-four percent of its support comes from individuals, less than four percent from foundations and less than two percent from corporations. It receives over 350,000 individual contributions a year from over 60,000 active recent contributors.