I have just returned from the United States and have had the opportunity to discuss healthcare systems with a number of gynaecologists there. Having had these conversations and others over the years with other gynaecologists having a similar practice it strikes me that whilst the US is good in the main part for many people it offers a far from optimal overall health system. My strong belief is that Australia offers an incredibly good, high quality system that is extremely good value for money. As an Australian, it is almost inconceivable to consider that the major source of personal bankruptcy in the US relates to health care costs.
My comments and thoughts should be taken in a generalist nature and I freely admit my understanding of the US health system is superficial.
Two areas, however, of significant interest to me seem wildly different between the US and Australia.
In the US it appears many if not most insurance companies do not offer anywhere near an adequate reimbursement for excisional surgery for endometriosis particularly in complex cases which may involve multi-specialty surgeons. As a consequence many patients end up with simple diagnostic type laparoscopies or diathermy techniques only followed by usually futile medical therapy and often failed IVF. Whilst we have clear problems as I have alluded to in earlier blogs in relation to the surgical management of endometriosis, at least in Australia the system allows surgeons to receive some form of reasonable recompense for the treatment of these difficult cases. Additionally we have a private and public system which allows for access to all (albeit there can be a significant waiting time for some).
Whilst the best units in the US offer high quality services and impressive success rates it strikes me that in keeping with the US desire for self promotion, success rates there are often construed as a measure of an ongoing pregnancy rather than the healthy arrival of a singleton pregnancy safely to a well mother. The commercial imperatives of publishing success rates appear to have resulted in many clinics performing multiple embryo transfers resulting in multiple pregnancy statistics which we in Australia would consider of significant concern. Given the well known major problems associated with multiple gestation (prematurity in particular) and the world wide trend to decrease this phenomenon in relation to assisted conception it is somewhat extraordinary to consider that the plaintiff lawyers within the US have not identified this particular issue as a potential rich source of future earnings.
Australians should be deeply and justifiably proud of our health system which allows high quality services for assisted conception and endometriosis surgery in particular.