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Tue Jan 8 18:53:58 GMT 2008

I may not have been perfectly clear on my intent, but I don't think the study was specifically referring to trauma or emergency care. Nor was I tryng to bash the US. But from the discussion on EMS systems after the Princess DI article recently I wanted to illustrate there are different ways to measure a sytems effectiveness. I think in most places in the US people have access to emregency care, but from my perspective working for EMS and county/charity hospitals in the US, the US does leave a lot to be desired in preventative medicine and primary care. But I also think that everyone always believes their system to be the best. I would think that perhaps on the subconcious level these "observations" usually take into account the strengths of a particular system, which of course make others look worse. But the US doesn't always have to reinvent the wheel. Maybe we could cut and paste some of the things others do too. They take what they can from our system and implement it
 when they can. From my own perspective buying the furosimide for a 75 year old on a fixed income would probably save a fortune compared to the bill generated when the government pays for her emergency care when she goes into crisis. It might even be a preventable death too. But we just seem hell bent on not changing our system at all.

  Mike

Marc Matthews - MedPro MMC X <Marc_Matthews at medprodoctors.com> wrote:
  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 &, 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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discussion on frances system