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Tue Jan 8 16:58:36 GMT 2008

Dear Marc,

Thank you for pointing out your differences in perception of the results. But the real question for Mike is where is the study published? So that its methods can be examined (how is needless death defined and how are these statistics gathered?) and thereafter perhaps a thoughtful response can made regarding any conclusions. If this is not currently available we should wait before passing comments on who is right and who is wrong etc.

Since the range of the "avoidable death rate  per 100,000" seems quite narrow 65-110, what we realy should ask is on what basis "they deemed ~deaths~ could have been prevented by access to timely and effective health care, and ranked nations on how they did."
Would you be satisfied if the US reported rate of 110 was the "best" and every one else had a higher rate, thus absolving you of any feeling of being bashed ( as if the London School of H +TM was purposely wanting to malign the US!)
Would you not still want to examine the results to help in finding ways to  strive for better rate, even though you would be proud to have been first? 
Tom Horan

> ----------
> From: 	trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org] on behalf of Marc Matthews - MedPro MMC X[SMTP:Marc_Matthews at medprodoctors.com]
> Reply To: 	Trauma &amp; Critical Care mailing list
> Sent: 	terça-feira, 8 de janeiro de 2008 11:21
> To: 	Trauma &amp; Critical Care mailing list
> Subject: 	RE: discussion on frances system
> 
> All,
> 
> I work in a "County" medical center in Arizona called Maricopa Integrated Health Systems. Everyone in Arizona, no matter where they come from, gets "free healthcare", if they do not have a cent and need medical assistance. Many, if not most of my patients, do not have insurance yet they have unfettered access to me and many physicians. This even includes anyone from south of the border that becomes sick in the United States and subsequently needs help. So the statement, "Nolte said the large number of Americans who lack any type of health insurance -- about 47 million people in a country of about 300 million, according to U.S. government estimates -- probably was a key factor in the poor showing of the United States compared to other industrialized nations in the study", is probably not as accurate as he would like to believe. Laws such as EMTALA, make sure that if you do not have insurance, you will still receive care and I would suspect that if you live in AZ, CA, KY or any state (places that have similar county or university hospitals), you get care on demand without the demonstrated ability to pay. Certainly this means life-saving care. 
> 
> So, exactly what were they looking at to come to these conclusions? Is he talking about follow up? Has he heard of a 9- global period? Patients are still eligible to get care in AZ and I am sure many states as we have ways to do help patients especially through Medicare and money via foundations, so again statements like this, ""I wouldn't say it (the last-place ranking) is a condemnation, because I think health care in the U.S. is pretty good if you have access. But if you don't, I think that's the main problem, isn't it?" Nolte said in a telephone interview", are not exactly accurate or else the study has a flaw(s) that have led them to an inaccurate conclusion. While we are not perfect and are constantly a work in progress, much like our democracy, I doubt that in the industrialized world we are last. 
> 
> I am also getting more than a little tired of the United States being maligned and bashed.
> 
> Sincerely,
>  
> 
> Marc R. Matthews, MD, FACS
> Medical Director of Trauma Services 
> Maricopa Integrated Health Services
> 
> 
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> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Mike Smertka
> Sent: Tuesday, January 08, 2008 5:51 AM
> To: Trauma &amp, Critical Care mailing list
> Subject: discussion on frances system
> 
> Happy new year everyone. 
>    
>   I thought this headline was interesting considering all the talk about the French Trauma prehospital system as of late. I know this doesn't break down trauma from respiritory infections in neonates, but I thought it was worth considering:
>    
>   http://news.yahoo.com/s/nm/20080108/hl_nm/deaths_rankings_dc
>    
>   Basically it says france rated first in preventable deaths and Us was much lower on this list.
>    
>   Mike
> 
>        
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