Remedies to achieve improved healthcare

States of Health, a week-long series of in-depth analysis of international healthcare, which ended in yesterday's Irish Times…

States of Health, a week-long series of in-depth analysis of international healthcare, which ended in yesterday's Irish Times, highlighted the best aspects of health systems across the world - and some ways of providing healthcare most definitely to be avoided.

So, what has stood out? And if we were to conjure up a super Irish health service made up of a patchwork of the "best of the rest", what would we include?

Firstly, there is no such thing as the perfect health system. There are some very good ones and there are others we might criticise on a theoretical basis but that seem to deliver good results in the context of a state's particular health needs.

Take France for example. "People want to choose their own doctor and the doctor prescribes whatever he wants to," we were told. They consult multiple physicians and consume more medication than any other nationality, not surprisingly running-up a huge annual cost to the French exchequer in the process. But they get a high-quality service, with virtually no waiting times and equal access for all.

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The proof of the system's effectiveness can be seen in the longevity of French women. They live longer than in any other OECD country bar Japan.

And while such fiscal abandon may offend those with an Anglo-Saxon disposition, the cost of healthcare in France has an untouchable status in the national psyche. What would be the price for Charlie McCreevy to adopt the attitude of his French counterpart, who nonchalantly labelled healthcare as a UFO - an unidentified financial object?

In Germany, Padraig O'Morain reported on a system - funded by compulsory health insurance - that is firmly based on the belief everyone should have equal access to healthcare. And they do, to the point where "doctor-hopping" is common, aided by patient-held cards that contain all their essential medical details.

If one had to pick a particular aspect of the German health system for immediate introduction in the Republic it would be such a patient "smart" card. Not to encourage multiple consulting - but to smooth the interface between GPs, hospital doctors, pharmacists and other health professionals.

The message from the US was unequivocal. For 80 per cent of the population, it is one of the best health systems in the world. For the remaining 20 per cent, who cannot afford health insurance or who do not qualify for limited State-funded care, it is one of the worst. What feature might we choose to integrate into our forthcoming National Health Strategy?

Apart from saying yes to their spending on health - at 13 per cent of GDP - it would be the US methods of ensuring that the latest cancer research is integrated into everyday medical practice. As a result, more treatments are made available more quickly. Patients can access detailed information on cancer trials and a list of physicians registered for each trial. There are moves by oncologists to introduce something similar in the Republic - their efforts must be given full backing and funding by the Department of Health.

New Zealand emerged as remarkably similar to the Republic - a definite urban/rural divide in a system where public and private medicine exist side-by-side.

Its experience of drastic reforms in the early 1990s - when they moved to an internal health market model - is certainly one to avoid. Ten years on, health still dominates national politics and New Zealand is firmly on course for population-based funding of its health system.

For this to work, they have introduced a system of universal patient registration, whereby everyone is encouraged to register with a GP. This was one of the main proposals in a recent policy document from the Irish Medical Organisation and the Irish College of General Practitioners, and it is one that is widely expected to be introduced in the final version of the health strategy.

Dick Ahlstrom went to Scandinavia, from where he reported on an excellent Danish healthcare system. What Irish citizen would say no to a guarantee in law that you will see a specialist within a fortnight of referral and receive surgical treatment within four weeks of a diagnosis of a life-threatening illness? And can we please have a Department of Health-run website where patients can search for the hospital with the shortest waiting times?

Our nearest neighbour's health service has been through the proverbial mill. The NHS is in recovery, however, and we can learn much from the efforts of clinical governance support teams to rebuild the process of healthcare.

For this writer, however, Canada is the system that has the most to offer us. Apart from it egalitarian approach to health and the use of "telehealth" initiatives, we should immediately reorganise our surgical services along Canadian lines.

By simply setting up pre-surgical clinics, where patients are fully "worked-up" for planned surgery prior to admission, we could have a much more effective throughput of patients. And the evidence from Canada is that standalone elective surgical facilities, such as the Orthopaedic Institute in Toronto, achieve targets set for procedures such as hip and knee replacements.

Finally, a suggestion we are most unlikely to see implemented here. We read of the Danish town that sends its oldest citizens on an annual holiday to improve their physical and psychological well-being. I have no doubt that it does; there have been many times when I wish I could have prescribed just such a break for my patients in place of "yet another" tablet to add to the myriad older people frequently take.