Wealth doesn't equal happiness, even when it comes to healthcare.
Consumer confidence in a nation's health system doesn't correspond to its healthcare spending, according to a consumer survey by the Commonwealth Fund, a New York City-based healthcare policy foundation, and the Harvard University School of Public Health.
Of five English-speaking countries examined-Australia, Canada, New Zealand, the United Kingdom and the United States-dissatisfaction was greatest in the U.S., the country that spent the most. The British were the most confident in their system and spent less than respondents from the four other countries.
In the U.S., the only country surveyed that lacks universal insurance, the most common complaint was that healthcare is unaffordable. In Canada, New Zealand and the U.K., respondents were most concerned with low governmental funding. In Australia and New Zealand, respondents complained most about long waits.
Nearly one-third of Americans, Australians and New Zealanders would like a an overhaul of their countries' healthcare systems, while only 23% of Canadians and 14% of British citizens wanted to rebuild their systems, according to the survey.
Privacy on the line. Telemedicine is expanding healthcare access in remote corners of the world. But it's also posing some sticky legal and ethical questions.
For example, should a physician be authorized by the government where the "remote" patient is located? And who will police the confidentiality of patient records?
The World Medical Association has been grappling with these issues to try to come up with a policy to guide the use of telemedicine internationally.
The national medical associations of Australia, Finland, France, Germany and the U.S. had a hand in developing a policy that will be considered by the association's General Assembly at its annual meeting in Tel Aviv in October. If passed, national medical associations worldwide would be urged to adopt its principles.
Organized medicine is particularly concerned that telemedicine will trample physician-patient relationships. For example, the policy recommends that national medical associations promote training, develop practice protocols and discourage "commercialization or mass exploitation."
A draft version contained other principles:
* Telemedicine should be used only when a physician cannot be physically present in a "safe and acceptable time period."
* Telemedicine should be used only when the physician has an existing professional relationship with the patient or adequate knowledge of the problem.
* Telemedicine should be open to all doctors, even across national borders.
* Physicians should be authorized to practice in the state or country where the patient is located, or an internationally approved service should be used.
Fraud fighters. Consumer protection agencies in Canada, Mexico and the U.S. have agreed to coordinate their efforts to combat fraudulent healthcare products and treatments. But don't expect the healthcare equivalent of Interpol, the international police investigative agency.
A task force, formalized last December by a pact called the Joint Strategies to Combat Health Fraud, has no unified budget or staff. Nor does it have its own enforcement teeth.
The agencies have agreed to share information and cooperate in investigations. They are also participating in consumer and business education programs.
Since the agreement was signed, task force members have searched for false or deceptive advertising claims on the Internet, monitored Spanish-language ads in the U.S. for suspicious claims and assisted a crackdown on border clinics in Mexico promising cures for cancer, AIDS and multiple sclerosis.
The agreement was signed by the Food and Drug Administration and the Federal Trade Commission in the U.S.; Mexico's consumer protection agency, called Procuraduria Federal del Consumidor de Mexico, and its federal department of health, called the Secretaria de Salud de Mexico; and Health Canada, Canada's department of health.
State and provincial law enforcement officials in each country, such as attorneys general from U.S. border states, also participate in the task force.
Hey, recycle that! Ready to mothball an X-ray unit? About to junk your office equipment? Suffering a glut of surgical gloves? At least two charitable organizations can take them off your hands.
Denver-based Project C.U.R.E (for Commission on Urgent Relief and Equipment) and Carelift International of Bala Cynwyd, Pa., both collect surplus medical supplies and equipment from U.S. providers and give them to overseas providers.
As U.S. providers consolidate and downsize, the two groups expect to reap more excess equipment and supplies to send to such destinations as Africa, Eastern Europe and South America.
Both were founded by successful entrepreneurs who saw healthcare practitioners in poor countries working with substandard equipment and supplies. Using their business savvy, they recognized an opportunity to help others by donating surplus medical goods to poor countries.
Project C.U.R.E. says it has donated medical supplies to 70 countries around the world and expects to donate $25 million worth in 1999. Carelift conveyed $21 million of goods in 1998 and helped poor countries build self-sufficient healthcare systems by providing clinical and administrative training and assisting entrepreneurs.