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July 15th, 2010
08:37 AM ET

Britain offers best care for the dying, review says

Great Britain leads the world in the quality of care it provides the dying, leaving many developed nations trailing behind, according to a study released Wednesday.

A well-established network of hospices as well as strong government support for end-of-life care placed Britain at the top of the list of 40 countries, despite not having the best health care system, said the report from the Economist Intelligence Unit, a research arm of The Economist.

Researchers looked at factors including public awareness, access to painkillers and doctor-patient transparency, financial burden to patients and government-led national palliative care strategy to compile the "quality of death" index.

Australia came in second followed by New Zealand. Ireland, Belgium and Germany were also within the top 10 positions.

The report placed the U.S. in the No. 9 spot, highlighting flaws within the American health care system.

While the U.S. ranked well in its infrastructure, its overall score was dragged down because of the financial burden of end-of-life health care on patients, the report said, citing the low availability of public funding and Social Security spending as the key issues.

The report also noted that while the U.S. has government-funded reimbursements for hospice care through Medicare and Medicaid, patients in the U.S. need to give up curative treatment in order to obtain reimbursements.

“That’s completely different than from the U.K., where people can continue to have cancer treatment alongside palliative care. So in the U.S., hospice care typically is about end-of-life care,” professor Sheila Payne, director of the International Observatory on End-of-Life Care, says in the report.

Spencer Levine from the Hospice Foundation of America said that despite the either-or option, opting for hospice care in the U.S. doesn’t mean patients have reached a dead end.

“If there’s a curative therapy that comes along, experimental or otherwise, and you say ‘I want to give this a try,’ you can opt out of the hospice benefit, and at a later date, if or when conditions for you change, you opt back in again without penalty,” he told CNN.com.

“People kind of think of it like Hotel California – you can check in but never leave – but it’s not like that. You do have choices you can exercise,” he added.

Most hospices in the U.S., especially not-for-profits ones, also provide financial assistance for those who do not have personal medical insurance.

Many rich nations were unexpectedly in the bottom half of the list, including Denmark (22) and Japan (23). India bottomed the list at number 40, with Russia, Portugal and South Korea also in the bottom 10.

In the worst cases, the study found the quality and access to care was often poor; policy coordination was lacking.

The report suggested that richer countries might have scored poorly because they have “strong hospital medical-care programmes that see little value in hospices,” and instead, “value the service of oncologist and the power of medicine.”

The report cited data from the Worldwide Palliative Care Alliance, showing that more than 100 million patients and their family caregivers need palliative support annually, but fewer than eight percent of them get access to it.

"Governments and providers are in a race against time," the study said, warning that the rate of aging demographics was rapidly outpacing efforts to provide the care needed.


Filed under: Death and Dying

soundoff (45 Responses)
  1. jaylee lee

    Why is that a surprise? Socialist medicine is intended to deliver quantity not quality, and it has no one to compete with or report to. So killing your customers is always a good way to do business. Can't wait for Obamacare to do the same to us!

    July 15, 2010 at 09:11 | Report abuse | Reply
    • Jon

      How is 'socialist' medicine intended to deliver quantity not quality? That doesn't even make any sense, not to mention 'Obamacare' isn't even socialist.

      If anything I think you meant to say privatized health care was meant to deliver quantity and not quality. But I think you're a little confused to say the least.

      July 15, 2010 at 09:21 | Report abuse |
    • Sean

      I really think this is the most stupid comment I've ever seen posted.

      July 15, 2010 at 11:45 | Report abuse |
    • Ryan

      We have a versioon of 'Obama Care' in Canada and as an average, midle class citizen, I'm pretty stoked on it. Any medical problem I have is taken care of practically free of charge. Do you know how much of a relief it is to know that as I get older and break down I'll never have to worry about healthcare for myself, my children, etc. I think Obama's on the right track, but what do I know?

      July 15, 2010 at 12:38 | Report abuse |
    • Gor

      jaylee lee – what you've just said is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul.

      July 15, 2010 at 15:31 | Report abuse |
  2. Nicola Brady

    My mother was English and developed terminal cancer of the spine. I was amazed at the wonderful treatment that she received while dying. She had the morphine and the whole staff from the doctors, nurses, etc., treated her with love and kindness. I could not have been more grateful.

    July 15, 2010 at 09:24 | Report abuse | Reply
    • Randy

      I'll bet you'd be even more grateful if she were still alive.

      July 15, 2010 at 10:38 | Report abuse |
    • Simon

      Randy – get over yourself – the US Healthcare system is fixated on prolonging life at any cost (financial and suffering of the patient), whether we want it or not. How is that a good thing?

      July 15, 2010 at 10:55 | Report abuse |
    • MCO2

      My sincere condolences on your loss... and for your having to put up with people like 'Randy' who are so anxious to make their point, whatever it may be, that they fail to realize how obnoxious they sound doing it.

      July 15, 2010 at 11:54 | Report abuse |
    • Allen

      And Randy are you saying she would be without NHS? You don't even know the OPs situtation: what if they weren't millionaires? The grandmother would have died even sooner.

      July 15, 2010 at 14:56 | Report abuse |
  3. Scottish

    I believe the Brittish have a form of scocialized medicine. The medical care President Obama has passed is not taking away your insurance, but giving insurance to people who do not have it. Or at least making them get it and pay for it and pay a fine.

    July 15, 2010 at 09:34 | Report abuse | Reply
  4. Walt

    Well of course they are best for dying. They are also best for refusing treatment to the elderly based on quality of life scales. If the government doesn't think you will live long enough after treatment to provide any use to the state or society they just won't treat you. So if you are too old, according to the government, and your medical care will cost too much they just let you die. Therefore they are best for dying because that's what they do best.

    July 15, 2010 at 09:46 | Report abuse | Reply
    • Randy

      Well said. Britain ranks as the best place for dying, and yet the WHO ranks it's health care system 18th. That disparity speaks volumes.

      Every economy, of any theoretical variety, rations. Every economic good, in every type of economy, is rationed. In the US, health care is rationed by price – by ability of the patient to pay. In Britain, health care is rationed by utility – by willingness of the single payor to pay. The decision US private health insurors make at the payment level when they choose to cover or not to cover their customers, the British government makes universally for every British citizen at the provider level when they choose whether or not to give care at all.

      Rationing is unavoidable. Just as the US has people who must pay out of pocket for care insurance companies will not cover, Britain has people who must pay out of pocket for care government will not provide through the NHS. In both countries, those without the money to keep themselves alive, die.

      The difference between the two systems is in terms of what is available to those who CAN pay. And in this the US wins hands down.

      July 15, 2010 at 10:37 | Report abuse |
    • Simon

      Wow, you are certainly a jingoistic idiot.

      Exactly what experience (direct or through people you have come into contact with) have you had with other nation's healthcare systems? I would have to guess exactly NONE. As a British ex-pat, I can relate from personal experience that the US system is overall inferior to the UK system, not necessarily in the quality of care, but in how it works (or in the case of the US system fails to work).
      Get off you high horse, the US system is a joke, and an expensive one at that. The British system of Healthcare has many failings, just as almost all of them do, but it stands head and shoulders above the American system.

      July 15, 2010 at 10:52 | Report abuse |
    • Christina

      Stop listening to propaganda!
      My friends 79 year old father has had nothing but outstanding treatment by the NHS since suffering a heart attack two years ago. As his only contact with the government is to draw his retirement benefits it's difficult to imagine what use the state will have for him when he's recovered.

      July 15, 2010 at 11:43 | Report abuse |
    • Ryan

      So Randy, you get cancer, pay your Doctor an exorbant amount to cure you and after years of treatment, you can return home to your cardboard box on the street because you have no money left. Good luck with that.

      July 15, 2010 at 12:48 | Report abuse |
    • Allen

      Walt and Randy: you both are complete idiots, you know that? My grandmother was never denied care while in Great Britian. There isn't any system by which they determine you are no longer useful to the state and then let you die. You get care right up to death. And the article says its the best place to die because they offer the best end of life care, not because they kill you.

      And Randy: the WHO ranks America's overrall healthcare quality even lower than Great Britians. We're in the mid 30s last I checked. What that "disparity" means is that other countries provide better overrall healthcare, but the US is not among them.

      And few people but the most rich CAN afford to pay, as you put it.

      July 15, 2010 at 14:54 | Report abuse |
    • MrsFizzy

      Some people have really been soaking up the scare-mongerers' propaganda. It is just not true that it is rationed and that they deny care for the elderly. It is a much more humane system and actually not more costly to the taxpayer. It's true that the quality of individual patient care can sometimes vary between hospitals but that is the case here when you can go broke trying to pay for it!

      July 15, 2010 at 15:19 | Report abuse |
    • Walt the 'tard

      I hear that in perpetually frozen socialist Canada that once the government decides that a person no longer has any value to the state (can't skate, or shoot) that they place them on ice floes and let nature (polar bears) take it's course.

      July 15, 2010 at 16:00 | Report abuse |
  5. Charlene

    The terms "Obamacare" and "socialist," name- calling shows how much we are swayed by the political and media spin. Come on, people ! Question question question and RESEARCH what you hear. In addition to the people I know in Belguim, Scotland, Italy, France, etc., I also have a friend who works for the National Health Care System in the U.K. She couldn't believe the misinformation and scare tactics that we use to put down national health care , aka "Obamacare". She explained Briitains' system to me in detail . I hear the same thing from people in other countries . The health care isn't that different from ours, and some of it is better ! The big difference? Health care is availabe to all . If you lose your job or can't afford health insurance in the U.S., God help you !

    July 15, 2010 at 09:56 | Report abuse | Reply
    • yanni

      the term "socialized medicine" was coined to fight efforts in the U.S. to establish a national healthcare system. Tying the effort to communism helped defeat it and left us with the non-system we have now. Look at where we stand worldwide in infant martality and other indices that measure the performance of a country's healthcare system. We spend the most but get third-world results.

      July 15, 2010 at 10:52 | Report abuse |
    • Chuck in Jasper Ga.

      You hit the nail on the head. Most of the postings that I see negative in nature reference this article are for the most part, being posted by complete morons that quite frankly, have no clue as to the workings of or quality of care one receives from a country with a "socialized medical system. Most of them simply repeat what some other misinformed loon has said to them or they have read somewhere. I would be surprised if even one of the posters that are disputing the conclusion that Great Britian is a better place to die if you have to die because of the medical care a person receives, has even read about the treatment given in England and how the National Health System works. It's what Americans do, oppose anything not American without at least looking at it. It comes from a false sense of granduer. By the way. I was born and raised in the U. S. of A, also served 22 years in our military. Not all Americans are so caught up in the belief "they are superior" simply because they are American. I have an open mind, not an inflated ego a based on being an "American".

      July 15, 2010 at 12:31 | Report abuse |
    • Ivette

      excellent, Bob. grab a cold one as my way of saying carongts . here's to many more years of B&R, enlightening discussion, boneheads and other things of the day, and a general increase in fan base. what has it felt like to still be creating an amazing legacy?

      September 11, 2012 at 03:02 | Report abuse |
  6. Brian

    Walt you need to travel a bit or at least talk to someone from outside the US, I think you might be surprised how healthcare actually works in other countries.

    July 15, 2010 at 09:56 | Report abuse | Reply
  7. Carl

    We have to get over this notion of "socialized medicine." The British system is twofold, a national health care system, which is in theory available to all, and a private one, available to those who choose it. With any organized system, there is a capacity limit, just as there is here in the U.S., whether we admit it or not. The difference is that we rely on insurance as the funding agent vs. the government.

    The U.S. also generally suffers from the misimpression that we must, at all costs, prolong life, however futile the effort. We simply have not matured to the point where we recognize that death is inevitable, and must be seen as part of the life process. Only in recent years have we more widely recognized the need for hospice care as part of that process.

    As noted, "Obamacare" is a palliative effort to insure more people against medical costs. It does not address the existing system of health care and why it has become one of the most expensive on the face of the Earth wihtout necessarily becoming any more effective than others. We've heard claims and anecdotes to the contrary, but there is precious little evidence, if any, to discredit the health care systems of other developed countries like the UK, Germany, France, Canada, etc. I suspect a great deal of the moise is from people who simply refuse to admit that anyone else could do a better job of it than the U.S.

    July 15, 2010 at 09:57 | Report abuse | Reply
    • johny

      Well said Carl! A uniform lack of research into the positions they take characterises the commentators in this debate. I am familiar with the British and Irish systems and the US system. The British and Irish systems overall I would characterise my personal experience as being Very Poor. The US system I would describe as Very Expensive. If each of these observations were untrue, it's still obvious that a health-care system that might work in a European country, with an essentially socialist society, will not necessarily work in a much larger free-market society. We should still try to improve what we have, where-ever we live. I'm not convinved that Obamacare is the answer, though.

      July 15, 2010 at 12:49 | Report abuse |
  8. Lulzmacher

    I don't care as much about my dying time than I do about my living time.
    Unfortunately, with the paranoid ban-happy society freedom isn't exactly rampant there.

    July 15, 2010 at 10:19 | Report abuse | Reply
    • Albert Fish

      This might come as a shock to you, but there is no shortage of people in many countries around the globe who consider themselves as free, if not more so, than Americans.

      July 15, 2010 at 16:06 | Report abuse |
  9. Cynthia

    My father was insured under a PRIVATE and quite expensive health plan in Texas that utilized the capitated health care theory. He was determined to be too old, at age 71, to receive a heart valve replacement despite the fact that he worked with a national firm in business development three days a week, took care of a 3-bedroom, 2-bath home by himself and drove a red Beretta. Increasing meds was much more cost-effective for the insurance carrier, so that's what they did until the day he died, horribly and in great pain after a week in hospital. Out lawyer came out quite well from the wrongful death suit, and we got the satisfaction of seeing the carrier go out of business. Not sure how a public healthy plan could be any worse than that.

    July 15, 2010 at 10:38 | Report abuse | Reply
    • Chuck in Jasper Ga.

      Sorry for the needless, early passing of your father first of all. Secondly, your story or similar stories can probably be told by thousands of people. It happens everyday in this country. That is why I supported and will continue to support Health Care (Insurance) reform. Too many people are dyeing in this country because they have no insurance, have inadequate insurance, or insurance coverage is denied or has cost "caps" placed on policies. Nobody in a country as advanced as the U.S. thinks it is, should die because of money. Nobody.

      July 15, 2010 at 12:40 | Report abuse |
    • jonah W.

      unfortunately nothing is in place to stop the public system from doing the same, since it will stay in business if such a such a scenario arises. Which is, of course, much worse.

      July 15, 2010 at 18:17 | Report abuse |
  10. Laura

    When I go to other countries or my former native country I buy all possible medicine for all possible health problem I might face in near future...The health care which is not affordable when you need it the most or generate to someone else the profit when you sick..., cant not be the best by definition...Actually, it means something fundamentally wrong with it,

    July 15, 2010 at 11:49 | Report abuse | Reply
  11. Jorge

    I've recieved healthcare overseas in places where the economy is similar to the U.S. Only a bonehead who has never stepped out of the U.S. to be sick somewhere half decent can say that the U.S. healthcare system is the best and least expensive in the world.

    July 15, 2010 at 11:57 | Report abuse | Reply
  12. ba

    Randy – you know life expectancy is longer in Britain than in the US right?

    July 15, 2010 at 12:22 | Report abuse | Reply
  13. Martin

    I wish people would quit whining about the British socialised medicine.

    They have had this since the late 1940's. Was bought in during a time of high national debt and uncertainty following World War II.

    They pay much higher taxes (both income tax and a 20% sales tax) in order to get this sort of care.

    I live in Canada, and when travelling in Britain I get free health care as I am a British Citizen.

    July 15, 2010 at 13:03 | Report abuse | Reply
    • Lucky Star

      Martin, you forget to mention people in the US pays sales tax (`10%) and have to pay medical premiums/co-pay if you can get insurance. "Sorry denied for pre-existing". If you look at World tax rates, the rates are not that much different. The difference is in the UK, they don't have 40 million people walking around without health insurance like the US. The UK also has a private system for those who want extra. The other main difference is if you lose your job in the UK you don't lose your health insurance because you can't work. I have lived in both countries for 20 years, I prefer the UK system. That's my 2 cents worth. Morally it makes no sense to leave people without care. People keep touting freeedom of choice with the US system, what choice, you pick from a list that your insurance book tells you, otherwise your out of luck (won't accept your card) or out of network (you pay bulk of charge).

      July 15, 2010 at 14:51 | Report abuse |
    • MrsFizzy

      Those taxes do not pay for the NHS. NHS is funded by the "national insurance" part of your income tax. When I moved back to the US I found that my Social Security contributions were higher than my NI payments, and they do not get me healthcare! Not such a good deal, I'd say!

      July 15, 2010 at 15:23 | Report abuse |
  14. buffyrat

    Ryan,
    I think you know a lot.

    July 15, 2010 at 13:28 | Report abuse | Reply
  15. Yes1Fan

    "Bring Out Your Dead!!"

    July 15, 2010 at 13:28 | Report abuse | Reply
  16. Liz Diamond

    The NHS came into being a couple of yerars after I was born,. My family had little money although all were gainfully employed. The NHS was wonderful for us and for the whole of my parent's lives. Other, better off people had the option of private health care and thus had real options i.e. either NHS or private care. If you have no choices but NHS it can harldy be described as an option as the word implies choice. I am profoundly glad we had it although I did not utilize it once I lived in the U.S. – it served my famil well.. I would like to see this kind of system here – it is a huge financial drain on hospitals to treat indigent or low-income people in Hospital emergency centers. Makes no sense mediclaly, economically or morally.

    July 15, 2010 at 13:44 | Report abuse | Reply
  17. Brianw

    Ever wonder why any threat of cutting funds to socialized medicine in Western Europe is polical suicide for a politician?
    It's because the VAST majority of people there treasure the freedom and security it brings. Uninformed people here in the US talk about lack of choice etc. People in Europe don't lose there home or have to declare bankrupcy due to ill health. People in Europe don't stay in jobs they dislike just because of medical coverage. Poor people in Europe don't just get minimum care at an emergency room just to be sent away and die a few days later. Uninformed people here in the US say "I dont want some faceless bureaucrat making decisions about my healthcare". I would rather have a nine to five bureacrat making those decisions than some corporate goon whose year end bonus depends on collecting the highest premiums and denying coverage based on cost rather than need.

    July 15, 2010 at 15:30 | Report abuse | Reply
  18. Kevin

    Great article highlighting the importance of hospice care. We have a Palliative Care Program that covers home care as well as a residential stand alone hospice home. Individuals enrolled in the program have access to home care, medical equipment (patient lifts, wheelchairs, etc), spirituality counseling/support and specialized end of life medical care. Although we are proud of our program, there will always be things we can do better to serve clients and families dealing with end of life issues.

    http://www.caring-for-aging-parents.com

    July 16, 2010 at 01:28 | Report abuse | Reply
  19. Dyck Dewid

    It seems here in the US we all must suffer a great deal more in order to do what it takes to fix our broken medical care machine. Like the factory farm, factory medicine is depleting, expeditious, uncaring, short sighted, greedy, disrespectful of life, all about fast money.

    July 27, 2010 at 13:29 | Report abuse | Reply
  20. Karsten

    Posted on This is always hanpeping to my mother, who knits like a mad fiend. She's always saying she's cursed by the knitting gods . She's gonna be so happy when I show this to her, and prove to her that she's not the only one who has this problem, so thanks for sharing!It's still pretty, even all stretched out. I hope the rework goes well.

    September 12, 2012 at 01:01 | Report abuse | Reply
  21. Razlan

    I can not begin to explain how awoesme of a show these dancers put on last night in Cedar Park Tx!! The energy from the very beginning to the end was unstoppable!! The way they incorporated the props into the dances was absolutely flawless!! I got to meet all of the dancers after the show and they were all extremely grateful and nothing but nice!!!! Fantastic job producers, choreographers and most of all dancers!!!!! I love you Melanie, you are beyond amazing!!!!!

    September 13, 2012 at 22:10 | Report abuse | Reply

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