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Wed Jan 9 05:37:33 GMT 2008

Does anyone have access to the journal 'Health Affairs' who can post a
pdf of the original paper to this list??
Thanks, Ian

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751
Director of Clinical Research, Sydney West AHS
Clinical Lecturer, University of Sydney

>>> thoran at sarah.br 9/01/2008 3:58am >>>
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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