German Health Care Attracts Foreign Patients
By NICHOLAS KULISH and CHRIS COTTRELL
BERLIN — When Jalal Talabani, the president of Iraq, needed advanced medical care for a stroke suffered this week, he flew not to the United States or Britain but to Germany, for treatment here in the capital.
For many Americans, Germany is known as a way station where soldiers wounded in Iraq and Afghanistan received immediate medical care on United States military bases. But it is also a popular destination for wealthy and prominent patients from the Middle East, Russia and beyond, experts say.
Before the Arab Spring uprisings, the Egyptian president Hosni Mubarak traveled to Munich in 2004 for back treatment and to Heidelberg in 2010 to have his gallbladder removed. Last year, President Nursultan Nazarbayev of Kazakhstan reportedly had a surgical procedure on his prostate at the University Medical Center Hamburg-Eppendorf.
According to German government statistics, the number of hospital patients from the United Arab Emirates rose to 1,754 from 339 between 2000 and 2010, the most recent year available. From Saudi Arabia, the figure climbed to 712 from 143. The numbers from Iraq were smaller but still rose to 176 from 95. Over the same period, the number of Russians jumped to 4,873 from 842.
“We have one of the worldwide best health care systems and people from abroad know that,” said Isabella Beyer, research associate in medical tourism at the Bonn-Rhein-Sieg University of Applied Sciences. Mr. Talabani, 79, is among them; he was treated in Germany before for back trouble.
Mr. Talabani is now being cared for at Berlin’s Charité hospital, which is more than 300 years old and is one of Europe’s largest university hospitals. The storied institution was home to several Nobel Prize winners, including Robert Koch and Paul Ehrlich. A spokeswoman for Charité, Manuela Zingl, confirmed that Mr. Talabani was being treated there but said that she could not disclose any information on his condition because of rules on medical privacy.
When The Doctor Works For The Insurance Company
Some insurance companies are taking a page out of their own history books: running their own doctors' offices and clinics. Though the strategy previously had mixed results, insurers think that by providing primary care for patients, they might reduce costly diseases and hospital stays in the long run.
Dr. Michael Byrne spent eight years working for a Brooklyn hospital and he saw firsthand why the United States spends more on healthcare than any other country in the world.
"I would regularly see patients who were admitted to the hospital, I took care of, who got better and we'd discharge with plan of care," he said. "And they'd come back either to the E.R. sick or to the floor. It's a common occurrence."
Roughly 25 percent of patients hospitalized in Brooklyn were back in the hospital within a month, according to Byrne. They wouldn't fill their prescriptions or take their medications; they'd miss appointments for follow-up tests or consultations with specialists.
Surgical study cites objects left in patients, other errors that should ‘never’ occur
Posted Dec. 21, 2012, at 8:57 a.m.
They sound like some of the worst mistakes a surgeon could make: Leaving an instrument inside a patient. Operating on the wrong body part — or the wrong person. They’re aptly named “never” events, the errors that should never, ever occur.
Turns out, however, these “never” events happen quite frequently, about 500 times a year. Between September 1990 and September 2010, new research in the journal Surgery found evidence of 9,744 paid malpractice claims for never events.
About half of those cases were ones in which surgeons left an object inside the patient (separate research suggests that the most frequently forgotten items are sponges). The other half were cases where the surgeon operated on the wrong part of the body or performed the wrong procedure. A small number, 17, involved surgeons operating on the wrong person altogether.
These events are dangerous: When the researchers analyzed a smaller cohort of data, from 2004 through 2010, they found that 6.6 percent of patients experiencing a never event subsequently died. A third had a permanent injury and 59 percent had a temporary injury.
Patients who received the wrong procedure were at highest odds of death or permanent injury. The research also found that younger patients had significantly better odds of surviving a never event than did patients over 60.
Keep in mind, these data only draw from malpractice claims that were paid. The data would not capture a never event where a patient did not experience harm.
It’s hard to know whether this study even captures the full breadth of never events. As the study’s lead author Winta Mehtsun, a surgeon at Johns Hopkins University School of Medicine, points out, their data only cover malpractice claims. They don’t touch cases never filed.
“Although the data we utilized captured surgical never events resulting in malpractice claims, many do not reach legal process and are then only voluntarily disclosed, with little coordination among reporting bodies,” he writes in the Surgery article.
What the data do suggest is that we do know a bit about which doctors are most likely to experience never events. They are, perhaps unsurprisingly, doctors who had already experienced malpractice claims. Younger doctors also had higher odds of settling malpractice claims for never events.
Walking the Tightrope on Mental Health Coverage
By RON LIEBER
Insurance covers more mental health care than many people may realize, and more people will soon have the kind of health insurance that does so. But coverage goes only so far when there aren’t enough practitioners who accept it — or there aren’t any nearby, or they aren’t taking any new patients.
In the days after the Newtown, Conn., school shooting, parents and politicians took to the airwaves to make broad-based proclamations about the sorry state of mental health care in America. But a closer look reveals a more nuanced view, with a great deal of recent legislative progress as well as plenty of infuriating coverage gaps.
The stakes in any census of mental health insurance coverage are high given how many people are suffering. Twenty-six percent of adults experience a diagnosable mental disorder in any given year, and 6 percent of all adults experience a seriously debilitating mental illness, according to the National Institute of Mental Health. Twenty-one percent of teenagers experience a severe emotional disturbance between the ages of 13 and 18.
According to this year’s Society for Human Resource Management survey of 550 employers of all sizes, including nonprofits and government entities, 85 percent offer at least some mental health insurance coverage. A 2009 Mercer survey found that 84 percent of employers with more than 500 employees covered both in-network and out-of-network mental health and substance abuse treatments.
For now, some people who have no health insurance or who buy it on their own may avoid purchasing mental health coverage too, or may avoid seeking treatment for things like addiction or depression. This happens for many of the same reasons that there has historically been less mental health coverage than there has been for other illnesses. The earliest objections among insurance providers and employers had to do with whether mental disorders existed at all, according to Howard Goldman, a professor of psychiatry at the University of Maryland school of medicine. Then there were questions about whether treatment actually worked. Next, concerns arose over cost and how often people would avail themselves of costly mental health treatments.
N.Y.U. and Other Medical Schools Offer Shorter Course in Training, for Less Tuition
By ANEMONA HARTOCOLLIS
Training to become a doctor takes so long that just the time invested has become, to many, emblematic of the gravity and prestige of the profession.
But now one of the nation’s premier medical schools, New York University, and a few others around the United States are challenging that equation by offering a small percentage of students the chance to finish early, in three years instead of the traditional four.
Administrators at N.Y.U. say they can make the change without compromising quality, by eliminating redundancies in their science curriculum, getting students into clinical training more quickly and adding some extra class time in the summer.
Not only, they say, will those doctors be able to hang out their shingles to practice earlier, but they will save a quarter of the cost of medical school — $49,560 a year in tuition and fees at N.Y.U., and even more when room, board, books, supplies and other expenses are added in.
“We’re confident that our three-year students are going to get the same depth and core knowledge, that we’re not going to turn it into a trade school,” said Dr. Steven Abramson, vice dean for education, faculty and academic affairs at N.Y.U. School of Medicine.
At this point, the effort involves a small number of students at three medical schools: about 16 incoming students at N.Y.U., or about 10 percent of next year’s entering class; 9 at Texas Tech Health Science Center School of Medicine; and even fewer, for now, at Mercer University School of Medicine’s campus in Savannah, Ga. A similar trial at Louisiana State University has been delayed because of budget constraints.
But Dr. Steven Berk, the dean at Texas Tech, said that 10 or 15 other schools across the country had expressed interest in what his university was doing, and the deans of all three schools say that if the approach works, they will extend the option to larger numbers of students.
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