Advanced Mediterranean Diet

From Bayou Renaissance Man:

I’m facing multiple surgeries this year, and frankly I’ve been horrified by the deterioration in professionalism and competence that I’ve observed in the past couple of months, compared to what it was even five years ago.  The bureaucracy and administrative orientation (rather than patient and health orientation) is mind-boggling – so much so that I’ve already refused to continue with one major medical practice, and asked to be referred to a different specialist for a forthcoming surgery.  If things are that bad inside “the system”, we need to make ourselves as independent as possible of that system by improving our fitness and personal health, ceasing unhealthy habits, and….

Regarding that last sentence, I can help.

Steve Parker, M.D.

A few days ago I posted here my brief overview of high-income countries’ healthcare systems. I did more research to see if those countries’ citizens like their systems. Americans bitch about their healthcare system mainly because it’s too expensive, about twice as much as other high-income countries. Why bother with this? I’ve been thinking about ways to improve the U.S. healthcare system.

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It would be interesting to check healthcare system satisfaction levels of residents in high-income countries: Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, and United States.

I’ll stipulate at the outset that it is very difficult to find accurate, up-to-date, numbers on healthcare system satisfaction, particularly comparing one country to another. I found one survey in which 25-30% of respondents were “neither satisfied nor dissatisfied.” Furthermore, accuracy of satisfaction surveys can be affected by bias of the surveyors, source of the funds paying for the survey, specific wording of questions,  number and economic class of survey participants, etc.

But first let’s consider satisfaction in the U.S. based on data from a 2023 Gallup poll. Surveyed residents rated the overall quality of healthcare as excellent (10%), good (36%), or only fair (34%). They rated coverage as excellent (5%), good (25%), or only fair (37%). Regarding the healthcare industry as a business, 49% of respondents had a somewhat negative (31%) or very negative (18%) view. Regarding cost of the system, 19% were satisfied, 81% were dissatisfied. When asked if the system was in crisis or had major problems, 14% said “in crisis,” 55% said “major problems,” and these numbers were fairly steady over the prior 20 years. When asked if they preferred a government-run system versus one based on private insurance, 54% said private insurance, 44% preferred government-run. So even if you prefer socialized medicine, a majority of U.S. residents is not on board, at least not yet.

Ipsos in 2023 published a multinational survey that touched on healthcare satisfaction. Unfortunately for us, the 28 countries did not include New Zealand, Norway, or Switzerland. Ipsos asked residents to “rate the quality of healthcare that you and your family have access to in your country.” Options included “very good/good” and “very poor/poor.” (You may well argue that the general public is in no position to judge the quality of their healthcare.) The global country average response of “very good/good” was 42%. Here are the “very good/good” responses by country:

• Australia: 64%
• United States: 61%
• Netherlands: 58%
• Sweden: 56%
• Great Britain: 48%
• Canada: 44%
• Germany: 41%
• France: 39%

Malaysia, by the way, was the top performer at 66%. Singapore was #4 at 63%. Most of the countries had a 25-30% “no opinion” gap between good and poor quality. You’ll note several mentions of Malaysia in these survey results; I suspect respondents were in urban areas, and the rural residents would not be so positive. The Legatum Prosperity Index’s health pillar ranked Malaysia #42 out of 167 countries.

Ipsos asked “How satisfied are you with the government’s healthcare policies?” These are the “very/fairly satisfied” responses (the global country average was 48% “very/fairly satisfied”):

• Australia: 67%
• Netherlands: 62%
• Canada: 52%
• Germany: 50%
• United States: 45%
• Great Britain: 45%
• Sweden: 45%
• France: 36%

Singapore was tops at 81%.

Ipsos asked respondents to agree or not that it was easy to get an appointment with a local doctor. Here’s the % that “strongly/tend to agree” (global country average was 39%);

• Netherlands: 55%
• United States: 48%
• Australia: 47%
• Sweden: 37%
• Canada: 35%
• Germany: 33%
• Great Britain: 29%
• France: 25%

India won at 62%.

Next, Ipsos asked if respondents agreed or not with, “I trust the healthcare system in my country to provide me with the best treatment.” Global country average of “strongly/tend to agree” was 42%. Our residents at hand that “strongly/tend to agree:

• Australia: 58%
• Netherlands: 54%
• France: 48%
• Great Britain: 46%
• Sweden: 45%
• Canada: 44%
• Germany: 44%
• Unites States: 43%

Singapore and Malaysia were top of the chart at 63 and 61%, respectively.

More Ipsos poll questions:

Agree or disagree?: “Waiting times to get an appointment with doctors are too long in my country.” Global average for “strongly/tend to agree” was 60%. Here are “agrees” in our countries:

• Great Britain: 76%
• France: 68%
• Canada: 67%
• Germany: 65%
• Sweden: 61%
• Netherlands: 56%
• Australia: 55%
• United States: 42%

Agree or disagree?: “The healthcare system in my country is overstretched.” Global average for “strongly/tend to agree” was 56%. Our countries:

• Great Britain: 83%
• Sweden: 79%
• France: 75%
• Netherlands: 71%
• Australia: 70%
• Canada: 69%
• Germany: 62%
• United States: 52%

Japan won this contest with only 14% thinking their system was overstretched.

Not surveyed by Ipsos were residents of New Zealand, Norway, and Switzerland.

In 2023 a satisfaction survey of Swiss adults found that 63% rated quality of care as very good or excellent. That percentage was 74 in 2020. Regarding medical care by their “regular doctor,” 89% responded that it was very good or excellent. However, 60% noted it was somewhat or very difficult to get care on weekends, evenings, or holidays without going to an emergency department. (Isn’t that an issue everywhere?) One out of every four adults had visited an ED in the prior two years. A quarter of the adults admitted foregoing a medical service (most often a doctor visit) due to the cost. Similar to France and Netherlands, Switzerland’s chronic disease burden is somewhat lower than that in the U.S. and Australia.

Regarding system satisfaction in New Zealand, a Gallup World Poll in 2018 asked citizens “if they were satisfied with the availability of quality healthcare in the city or area where they lived.” OECD reported that 82% of New Zealand citizens reported they were satisfied. The average citizen satisfaction response for all OECD countries was 70% in 2018. For comparison, the satisfaction number for Netherlands was 90%, Norway 89%, Switzerland 88%, Australia 86%, Germany 81%, Sweden 79%, U.S. 76%, Canada 75%, and France 69%. I was not able to find a more recent Gallup World Poll for all these countries other than 2018’s.

A less extensive 2021 poll by OECD Trust Survey asked citizens, “On a scale of 0 to 10, how satisfied or dissatisfied are you with the healthcare in [country] as a whole?” The “satisfied” responses for a few of our countries were South Korea 79%, Norway 77%, New Zealand 72%, France 64%, Sweden 57%, and Japan 51%. The average for OECD overall was 62%.

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After wading into the weeds of these mind-numbing satisfaction numbers, we find only a few clues about how we might devise a better system for the U.S. We can’t necessarily conclude that single-payer, social insurance, or private insurance systems is better than all others. Many high-income countries have a mixture of public and private insurance, plus significant out-of-pocket costs, like the U.S. Whether single-payer, social insurance, or private insurance predominates, most countries have supplemental private- or employer-based insurance to help cover co-pays, dental, drugs, out-of-pocket costs, and other non-covered services. I had heard good things about the Singapore system before; Malaysia was a complete surprise. Australia and Netherlands are looking pretty good, too. U.K., Germany, and France may not be the best countries for the U.S. to emulate. We may also see some of the downsides to socialized medicine, such as difficulty getting a timely appointment with a physician. Nevertheless, the U.S. stands out as paying too much for healthcare.

If disagree with the above, or have newer/better data, please leave a comment below.

Steve Parker, M.D.