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In spite of denials by charities who have a vested interest in making the tragedy of women dying during childbirth seem worse than it is, there has been substantial progress in reducing maternal deaths. Bangladesh has introduced low-cost innovations which have helped reduce death in childbirth from 322 per 100,000 births to 194 over the last decade. Much of the improvement involved better training for midwives who help with home births.
Midwives need help deciding when things are going wrong and it's time to call a hospital. Some blood loss during birth is normal, so how does a midwife deciding when the mother is hemorrhaging?
A doctor introduced a sterile birthing mat which absorbs just under a half-liter of blood. If the mat becomes saturated, the mother has lost too much blood and needs emergency treatment: the mat comes with a dose of misoprostol to make the uterus contract to slow the bleeding. The midwife injects the drug and calls for help.
The first batch of 77,000 mats resulted in 37 fewer maternal deaths than would have been expected without them. The midwives said they'd be willing to pay 50 cents for a mat during future deliveries because they know the value of cleanliness and they appreciate the clear instructions and useful medical help.
Can anyone imagine any item of diagnostic equipment costing 50 cents in America? The mat kit not only warns the midwife when a mother has bled too much and provides first aid for the condition, it also reduces infections during normal births.
How much would it cost to get such an item approved in the US? What would the 50-cent item cost once each unit had to absorb its share of the cost of getting it approved?
Back before its archives went on-line, the Wall Street Journal reported that an oncologist started selling a low-cost rubber mat to help women examine their breasts for cancer. For some reason, feeling the breast through the mat made it easier to find lumps.
The FDA banned the device even though it had been approved in Canada. The inventor couldn't afford the cost of a clinical trial, so it remains banned to this day. So much for low-cost, affordable health care.
The Economist reports that Sweden understands that just because the government pays for a service, there's no need for government employees to supply it. Although the government pays, private businesses provide 20% of public hospital care and 30% of public primary care. The government realizes that a high-cost country like Sweden can't afford health care unless it's delivered efficiently.
The average hospital stay in Sweden is 4.5 days compared with 5.2 days in France and 7.5 in Germany, yet Swedes live slightly longer.
This model will be hard to transfer to other countries because they're so suspicious of private businesses. In England, protesters wave signs showing greedy businesses carving up the national health service.
Obamacare combines the worst of both models. The government pays for a large fraction of medical care and regulates private hospitals and insurance companies as if they were government-owned. This makes it even more difficult to cut medical costs.
We've seen another step in the direction of increasing medical costs with the publication of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This $199 book, popularly known as DSM-5, will become a best-seller because almost any doctor who treats children or does primary-care practice will need one.
DSM-5 attempts to codify everything known about mental disorders so that medical practitioners can claim reimbursement from insurance companies. Many critics believe that it's become a "vehicle for misdiagnosis, overdiagnosis, the medicalisation of normal behaviour and the prescription of a large number of unnecessary drugs."
Children may now, for example, be diagnosed with "disruptive mood dysregulation disorder" - what used to be known as temper tantrums. Past versions of the DSM stipulated that those mourning a death should not be classified as depressed. DSM-5 scraps this "bereavement exclusion." It also includes a new binge-eating disorder, defined as eating to excess at least once a week over the previous three months. Such a diagnosis covers millions of Americans, roping in people who would not remotely consider that they were mentally ill.
Such diagnoses expand the scope for practitioners to bill for more and more services, of course. More than 1 American in child in 10 has been diagnosed as mentally abnormal based on the new definitions. Of those, about 2/3 are prescribed drugs, to the greater glory of Big Pharma.
So we have three approaches to medicine.
Is it any surprise that the "Affordable Health Care" act has worked out to be anything but?