Although the United States is generally regarded as the leader in healthcare and clinical advances, cystic fibrosis patients who are publicly insured in America may have worse outcomes than their counterparts in the United Kingdom when undergoing a lung transplantation procedure. The surprising results were published in the American Journal of Transplantation by a team at Johns Hopkins Medicine led by Ashish Shah, MD.
“Our results indicate that the United Kingdom’s national public health insurance system outperforms its US equivalent, and given that a significant portion of Americans rely on publicly funded insurance for their medical coverage, we, as a country, ought to have an honest conversation about the reasons behind this disparity and find ways to close the gap,” said Dr. Shah in a news release from Johns Hopkins Medicine.
The team’s article, “National Healthcare Delivery Systems Influence Lung Transplant Outcomes for Cystic Fibrosis,” was composed using data from over 450 cystic fibrosis patients receiving a lung or heart-lung transplant living in the United Kingdom and over 2,300 living in the United States. A large portion (39%) of American patients had publicly funded Medicare or Medicaid insurance.
Comparing these patients who had public health insurance to those who had private insurance in the United States or those living in the United Kingdom, the publicly-insured patients had a significantly lower survival.
“The UK National Health Services’ lung transplant program equals the top-notch care achieved under American private insurance and outperforms care received by publicly insured Americans,” said Stephen Clark, DM, professor of cardiothoracic surgery at the University of Northumbria and Freeman Hospital in Newcastle and lead investigator of the United Kingdom part of the team. “The results of the study underscore the ability of publicly funded health care systems to achieve excellent results in complex transplant surgery, and this is something we are rather proud of.”
Due to the manner in which the study was conducted, the researchers were unable to identify why publicly insured Americans had poorer survival, and suggest that future studies should focus on the contributing factors for the gap in care in order to eliminate the disparity. “Lung transplantation is among the most complex procedures performed today, one that requires a wealth of resources and careful long-term management by multiple specialists, and as such remains an imperfect therapy,” said Dr. Shah. “So it is paramount that we pinpoint and eliminate any systemic factors that interfere with its success.”
While the reason is being worked out, the team concluded that a single-payer national health care system (NHS in the UK) is capable of providing far-reaching care that yields patients similar outcomes as those who have private insurance. “One of the popular criticisms of a single-payer health system has been the fear of scarcity of resources and rationing that may lead to suboptimal care,” said lead author Christian Merlo, MD, MPH. “The comparable outcomes between lung transplant patients with public health insurance in the UK and their privately insured US counterparts indicate this fear may be unfounded or largely exaggerated.”
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