Posted At Irish Medical Times

BY : Emer Mullins

reports that the international health news in 2005 showed that doctors across the world share common concerns.
The news from abroad in 2005 was dominated by four or five themes including humanitarian disasters, the privatisation of medicine, the growth of medical tourism, the reform of medical systems in the West and the threat of a bird flu pandemic.

Europe

Medical reform continued to cause strife and protests throughout Europe, with GPs protesting in France, Holland, Germany and Belgium over planned governmental changes to the way in which they were paid or did business. GPs were told by various governments that there was no money available to them and they must tighten their belts.

Also in Europe, fears of a mass exodus of medical personnel from the new accession states to the EU never occurred.

It was thought that doctors from poorer countries such as Latvia, the Czech Republic and Poland would flock to the UK and Ireland to work.

"Medical professionals come and go, but the situation is far from dramatic," said one hospital manager in the Czech Republic.

A study on patient satisfaction in 12 countries in the EU showed that the Dutch were most satisfied, followed by the Swiss, the Germans, the Belgians, Estonians, French, British, Italians, Poles, Swedes, Spanish and Hungarians.

The results also showed that waiting lists made people most unhappy.

Britain

In Britain, it emerged that hospital managers could face criminal charges if patients caught the super bug, MRSA, on a dirty ward.

Health Secretary Patricia Hewitt pledged a much stronger legal framework in the NHS to help hospitals reduce the rate of antibiotic-resistant MRSA and other hospital-inquired infections. Managers would be legally obliged under new legislation to keep their hospitals clean.

What were described as ground-breaking changes in medical training in Britain were also introduced.

A new curriculum for junior doctors was launched as part of the Modernising Medical Careers programme. This meant that trainee doctors would have to demonstrate competence in a number of areas, including communication and consultation skills, patient safety and team working, as well as the more traditional elements of medical training.

A structured two-year programme was designed to give trainees exposure to a range of career placements across a wide range of specialties including A&E, obstetrics and gynaecology and anaesthetics.

It would also give trainees exposure to general practice and to smaller specialties and academic medicine.

An educational supervisor would oversee each trainee and each post would benefit from a dedicated clinical supervisor.

Skills learning would be continually assessed throughout the two years. "This marks a new era in British medicine," said chief medical officer for England Sir Liam Donaldson.

"This is very much a curriculum for patient safety, ensuring that, at the end of their two years' training doctors are both confident and competent," he said.

Holland

In Holland, doctors were paid 77 per patient per year, but the government wanted to introduce moves to allow more efficient and hard-working GPs to negotiate directly with insurers for higher rates.

Spain

In Spain, the government proposed increasing taxes to plug the ever-widening hole in the health care budget.

It planned a new investment fund for healthcare and cuts in the cost of prescription drugs as health care costs rose from 25 to 32 billion between 1999 and 2002, an increase of almost 25 per cent.

Belgium

In Belgium the government was looking at ways of reducing its 600 million health care deficit and froze doctors' fee-per-item rates.

Austria

In Austria, consultants were outraged when it emerged that one of that country's largest insurance companies proposed cutting its rates of pay by ten per cent.

The company said it spent 360 million annually on specialists' fees and faced a deficit of 50 million. Doctors must also take responsibility for problems in the health service, they were told.

Canada and the US

In Canada and the US, the debate raged over public versus private healthcare, cuts in payments to doctors treating the poorest patients on Medicare in the USA and the controversial introduction in August of private health insurance in the province of Quebec.

A Supreme Court ruling meant that people could buy private health insurance for the first time to try to avoid long waiting times for public treatment already provided for by Medicare, the government's public health system.

While the government downplayed the move, the Court ruled 4-3 that patients should not have to suffer the physical and psychological suffering caused by long waits for services in the overburdened public system.

The Canadian Medical Association said the ruling would change Medicare as Canada knew it. It seemed that prediction was true just this month when the first private primary health care centre in that country opened.

Reports claimed it was an elitist club and would bring American-style medicine north of the border. But advocates claimed that the centre, which offered membership for an enrolment fee of $1,200 and an annual fee of $2,300, would allow doctors to give patients more time and more extensive diagnostic services.

The issue of private versus public healthcare in Canada looks set to be a major one in the next federal elections.

Meanwhile, the USA was gearing up to cut payments to doctors in 2006, a move strongly opposed by medical representative bodies, that claimed doctors would face a 26 per cent cut in fees for Medicare patients while the estimated cost of caring for those patients would rise by 15 per cent during the same period. Congress was urged to tackle the issue within the next two years.

It also emerged that some 45 million Americans had no health insurance, leading politicians to roll out health care agendas vying for attention and votes by promising to expand cover for the uninsured and bring down health insurance costs. Only one million Americans had special savings for their health care, it was claimed.

People who put money into a Health Savings Account could claim tax relief and small businesses that offered them to employees could also claim tax breaks, Republicans said.

A separate report showed that women were neglecting their health care because they simply could not afford to visit a doctor.

Japan

In a related development, Japan's largest medical chain announced its plans to build two new hospitals in Bangladesh to cash in on a share of the estimated $330 million now spent annually by wealthy Bangladeshis on overseas health care.

The deal would see two 500-bed multi-specialty hospitals built in Bangladesh and an initial investment of $75 million.

Humanitarian disasters

Globally doctors were called into action in the aftermath of a number of humanitarian disasters, beginning in December, and and in January 2005, in response to the tsunami in southeast Asia.

However, it soon became clear that the field hospitals and medical equipment being sent from countries all over the world to the affected regions were of little use, as there were few survivors with injuries seeking treatment. Before the end of January the World Health Organisation (WHO) was urging medical personnel to stay away.

The international medical humanitarian group, Doctors Without Borders, appealed to people to stop sending it money just weeks after the disaster, perhaps most telling of all. Almost one year, on, what is clearly still needed is psychological help for the traumatised survivors, WHO said.

In October, medical teams were again called to service in the aftermath of the large earthquake in Pakistan, as WHO warned that many villages in the Himalayas were not being reached.

Those who could make it down from the mountains were being treated in makeshift mobile medical centres in the various refugee camps around Mussafarabad.

The WHO said thousands of injured people were evacuated by helicopter to other nearby cities for treatment and an estimated 62,000 people had been injured.

The Ministry of Health in Pakistan opened a field hospital beside Islamabad airport to cope with demand, it was reported.

In September, the USA was also struck by disaster in the form of Hurricane Katrina, which left New Orleans submerged under water and the threat of water-borne diseases in Louisiana.

One of the medical stories to emerge from the New Orleans hurricane was that Congress had to pass Good Samaritan legislation to protect volunteer doctors and medical personnel who helped survivors from being sued for their intervention.

The American Medical Association said the Katrina Volunteer Protection Act of 2005 would ensure that doctors and other volunteers could focus on providing aid instead of the threat of lawsuits.

Meanwhile, in Asia, the growth in so-called medical tourism continued. In the Philippines, the government was urged to promote its country as a medical hub to solve its financial crisis.

It was told to become more aggressive in the way it marketed its medical services to the international community. Professor Maria Cherry Lyn S. Rodolfo of the University of Asia and the Pacific said Thailand, India, Singapore and Malaysia were the top destinations for medical tourism in Asia, and they offered significant cost benefits for international patients. It appears that Thailand was visited by 800,000 foreign patients in 2003.

G8 Summit

The world's richest countries met at Gleneagles outside Edinburgh in July for the G8 summit, and the US pledged to spend $1.2 billion to fight malaria, the cause of death of thousands of children every month in sub-Saharan Africa. The pledge was designed to cut by half the death toll of more than one million Africans each year from the disease. President Bush said his plan would include indoor spraying, provide long-lasting insecticide-treated nets and new combination drugs for treatment and would initially begin in Tanzania, Uganda and Angola.

Avian Flu

The fear of a pandemic of the so-called bird flu caused a number of countries and the World Health Organisation to update their plans to tackle a medical crisis should a human variant of the disease spread.

Asian countries killed thousands of infected birds to try to stop the spread and US President George Bush signed an executive order authorising the government to impose a quarantine to deal with any outbreak of the potentially lethal variation of flu.

In March, 28 nations gathered in Ho Chi Min city in Vietnam, where 69 people died of avian flu, to discuss ways of battling the virus.

"The threat is very real and the potential is very high," said a spokesperson for the Rome-based Food and Agriculture Organisation.

UN officials complained that wealthy western nations showed an alarming lack of commitment in the fight against the H5N1 virus.