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In an older article, talking about the definition of success, I’d talked about the obsession we have with measuring. Your camera is this many megapixels, while your stereo system is this many megawatts. A tablet has this much memory, while the computer has this much storage capacity. All these are good and nice, until we confuse measurement with quality. Today I want to talk about public healthcare value.

Inspiration for this article came after I noticed something peculiar: Google allows ratings for public hospitals, as if they were books, cinemas or restaurants. That, in my opinion, is bizarre to say the least. Moreover, it is plagued with aspects of ideology – far exceeding the scope of this article, but you know, food for thought…

Public Healthcare Value: As Sense-Making as Rating Your Relationship

In a previous article I gave you some tips on how to review a book fairly. A book is something relatively easy to rate (though still far harder than, say, a restaurant or a hotel). But how, exactly, do you go about rating public healthcare value? In which sense should one measure the success of a hospital or healthcare center providing public good?

Let me put this another way: Is your relationship a 3/5 stars or a 4/5 stars one? And how do you measure it, exactly? Because trying to assess the services of public healthcare is about as sense-making as that. The mission of public healthcare is not to make profit. As I said, its mission is to provide public service.

When, therefore, you try to compare the services of a private hospital (the mission of which is to make profit) to that of a public hospital, you inevitably enter into a fallacious comparison.

Public Healthcare Value: If You Want Numbers, here Are Some

I mentioned that the inspiration for writing this article came when I noticed that Google allows users to rate public hospitals. Well, my local public hospital is rated as 3.7/5 stars. Most people would probably consider a rating of less than 4/5 “average” or slightly “above average”. To put it this way, if you saw a restaurant or hotel rated 3.7/5, you would perhaps keep looking for another option.

Context is Everything

So, a public hospital rated 3.7/5 would probably not sound all that great. Parenthetically, the first aid unit of the same hospital is rated separately, and only at 2.4/5 stars. Wow, I bet you’re thinking “I hope I won’t have to be treated in that godawful third-world place”, right?

Would you change your mind if I told you that the hospital I’m talking about is a university hospital in Finland – one of the most functional countries in the world? Does a rating of 2.4 scored in Finland differs from a rating of 2.4 scored in, say, Bangladesh? What are we measuring, anyway? Quality of service? Waiting time? Money? Let’s talk about this latter, for a while.

And Here Are Your Numbers

My partner broke her wrist some time ago. We went to the 2.4-star first aid unit in a Sunday afternoon. The day being Sunday, this unit had to deal with all emergencies of the city and its surrounding towns – a good half a million people in total. The first assessment occurred within minutes of our arrival, and after the nurse gave my partner ice, he guided us to a waiting hall area. It was comfortable, clean, well organized.

We waited for about two hours, which I consider reasonable under the circumstances (injury not being life-threatening or even too painful at that point). After three attempts of re-positioning the bones into their right place (with a fresh cast and X-Ray each time), we were good to go.

Two checks followed, a week and ten days later. X-Rays showed the bone wasn’t in its place, so the doctor suggested a surgical procedure, which successfully took place in the (3.7-star) hospital.

Total cost for one emergency room visit, 3+1 casts, half a dozen X-Rays, two doctor visits, an operation (including placing a titanium-alloy plate), and two days’ stay at the hospital: Less than 200 euros – or about $200.

Check for yourself what the cost would be in a US hospital, for instance using this link. It’s at least 100 times greater.

Public Healthcare Value: It’s the Taxes, Stupid

I often see people living in countries without truly functional public healthcare (such as the United States) find fault in the social welfare systems of other countries, such as the Scandinavian ones. The usual argument is “But…but…the taxes are so high!” Well, I don’t know if a tax rate of about 20% is high for an average middle-class income earner. But let me tell you, nothing feels better than paying taxes when you come to realize how much you get in return.

You see, people who don’t realize how taxes work, have a skewed understanding of the motive behind taxes. No, it’s not “your money paying for other people’s healthcare”. It’s insurance in case you find yourself in a situation where you need help and can’t afford it.