Nurse Blog

October 23rd, 2012
Jenna Fischer

A PBS NewsHour report looks at how America stacks up against other countries in terms of healthcare.

They interviewed Mark Pearson, who is the head of Division on Health Policy at the Organization for Economic Co-operation and Development (OECD), an organization with 34 member countries. NewsHour asked him questions like how US spending ranks compared to other OECD countries, how some other countries are keeping down their costs, and why some procedures cost so much more here than they do in other countries.

First, and unsurprisingly, Pearson points out that the United States spends “by far” the most in the world on health care. While the U.S. spent $8,233 on health per person in 2010, the next-highest spenders (Norway, the Netherlands and Switzerland) all spent at least $3,000 less per person. And the average for all of the other 33 OECD countries was $3,268 per person.

Other countries keep their costs down in a number of ways, including a consistent fee schedule; government intervention in costs if they see something getting out of hand; keeping down administrative costs; and embracing technology (for example, in Sweden, all drugs are prescribed electronically, with a message sent directly from the doctor’s office to the pharmacy, which reduces medical errors as well as saving 1-2 hours of work by pharmacists per day).

NewsHour: Are there particular areas the U.S. is doing poorly compared to other OECD countries?

Overall, the life expectancy of a U.S. citizen, at 78.2 years, is shorter than the average among OECD countries of 79.5 years and there are a number of specific areas where U.S. health care is weak when compared with other countries.

The U.S. needs stronger policies in tackling lifestyles that lead to poor health. While many states are making efforts to reduce smoking, there are fewer policies to tackle the harmful use of alcohol in the U.S. than you would find in other OECD countries, such as higher taxes on alcohol or minimum prices.

The U.S. could certainly do a lot more on obesity. It’s a big risk factor for poor health in the U.S., more so than you find in other OECD countries. Adult overweight and obesity rates are the highest in the OECD, and have kept growing even in the last couple of years, while they have nearly stabilised in some other OECD countries, such as England, France and Italy. Child overweight and obesity rates are also very high, but they have been relatively stable over the past 10 years. The slides below show that the U.S. does poorly both in terms of diet and physical activity, even in comparison with other high-obesity countries, across all age groups.

The first lady’s “Let’s move” campaign is great, but it cannot achieve a lot if it isn’t supported by other measures. Support for physician counseling and programs to help encourage healthier lifestyles vary widely with different insurance arrangements. The U.S. has a national program to cover breast and cervical cancer screening for low-income women, why not have one to cover lifestyle counseling for low-income people? Advertising regulation is left to the food and beverage industry (e.g. the IFBA “Pledges”) and this is not likely to have a major impact.

In terms of health care services, the biggest areas of concern are the quality of primary care services and coordination of care for long-term conditions. Asthma, a condition readily managed by general practitioners in the community, should require hospital admission on very few occasions. In the U.S. however, hospital admission rates for asthma are more than double the OECD average (120.6 per 100,000 population compared to an OECD average of 51.8, 2009).

A similar picture emerges for chronic obstructive pulmonary disease (230 admissions per 100,000 population compared to an OECD average of 198, 2009). These outcomes can be improved through better health care. In a Commonwealth Fund survey of seven nations (Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States), 16 percent of American patients reported delays in being notified about an abnormal test result (the highest proportion reported) and only 75 percent of primary care physicians reported often or always receiving correspondence from specialists after referral, suggesting systemic problems with care coordination.

Jenna Fischer
September 25th, 2012

The Los Angleles Times reports that a group of nurses who claimed that they were mocked for their accents and ordered to speak only English won a settlement of nearly a million dollars yesterday. It is the largest language discrimination settlement in the U.S. healthcare industry.

The 69 nurses who filed the case nurses are immigrants from the Phillipines, and claimed that they suffered “constant harassment and humiliation when they opened their mouths” from their bosses and coworkers at the hospital in California where they worked. The nurses say that they were banned from speaking Tagalog and other dialects in break rooms, hallways, and the cafeteria. Not only were they not required to speak English, but they say that they were also followed by housekeepers and security guards who were told to watch the nurses and report them if they didn’t stick to English only.

Officials at the hospital insist that they didn’t do anything wrong and that they only settled the lawsuit because it made more sense, financially.

During a 2006 mandatory meeting for Filipino staffers, nurses were told they were forbidden from using their native language at “any time in the hospital,” said Wilma Lamug, a former 10-year employee.

She said the hospital’s former chief executive vowed that “he would install surveillance cameras in nursing stations. Whoever is caught, they were threatened with suspension or termination,” Lamug said. “Sometimes, we were speaking English, but due to our accent and diction, they thought we were speaking something else.”

Although the hospital, near Bakersfield, employed a mix of bilingual employees speaking Spanish, Hindi, Bengali and other languages, managers targeted only the Filipinos and encouraged supervisors and other staffers to “act as vigilantes.”

The language policy created such a hostile work environment that one worker even sprayed air freshener on a Filipino employee’s lunch to register her “hatred for Filipino food,” Park said.

Hurt, Lamug and others drafted a petition and collected more than 100 signatures, sending it to management to express their shock. Park said it did not change the atmosphere “of intimidation.” The lawsuit alleged that the hospital’s language policy violated the Civil Rights Act.

Hospital administrators denied wrongdoing, according to a statement released Monday, saying it “made no financial sense for the hospital to continue this lawsuit and further waste valuable assets which could be better spent on the community’s healthcare needs.”

The nurses’ lawsuit was “an attack” on Delano’s policy requiring the use of either English or the patient’s preferred language while providing patient care.

The hospital “has the same policy with the same goals — protection of patients,” said John Szewczyk, Delano’s attorney.

The settlement calls for administrators to conduct regular staff training on diversity and to enforce reporting and handling of discrimination complaints. An outside monitor will be hired to review Delano’s compliance for three years, said Laboni Hoq, litigation director at the Asian Pacific American Legal Center.

“We feel we restored our dignity — but there’s no closure,” said Hilda Ducusin, a staff nurse for 10 years. “The scar is always there.”