My Dinner Conversation

The Place and Time: Lyon, May 2010
Setting: Dinner Meeting at Brassier Nord, a Michelin star chef's local digs
Players: Neurosurgeons from France, England, German, and me (USA)
Theme: Medical systems: What works and doesn't
(Preliminary Info: All sitting at the table are pretty tops in field)

On a recent lecture tour in France, I sat back and listened to a remarkable discussion revealing the mixed assessments of physicians of mixed how successful their own medical delivery system worked-for both themselves (physicians) and themselves (patients).  Highlights:

Germany: Two tiered system.  Everyone must have insurance, responsibility is on individual (not employee), if you can't pay you get it anyhow, and if you earn enough you can opt out and get "private insurance."  Biggest catch for patient:  Once you opt for private, there is no going back!  Biggest catch physician: Little motivation for innovation, working hard, etc when on straight salary.

France:  Subtle two tiered system, everyone insured by state, private insurance allowed for upgraded service.  Increasing numbers opt private leaving the public system in tailspin.  Biggest perceived challenge: "fraternity" not fair that some have better than others! For doctors-the allure of the dollar is strong so they would rather spend their time in the private sector.

UK: Once the quintessential socialized system, now two-tiered and highly regulated.  Also crunched by work hour restrictions on house staff resulting in both workforce and competency issues.  Patient challenge:  wait times.  Physician challenge: highly regulated and little opportunity for creativity.  Leading edge of outcomes/quality assessment that I've encountered.

The US is entering a period of transition for our medical system.  There is so much propaganda flying around about the failings of other systems.  This dinner conversation proved many important things to me.  First, certainly no medical delivery system is perfect and effecting positive change in any system is excruciatingly slow.  Delivery of medicine is ever more complex, time consuming and less remunerative for physicians.  However, no one will argue that maintaining the status quo is just not a viable option.