PJ Letters: Europe

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The Pharmaceutical Journal Vol 267 No 7169 p506-509
13 October 2001

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Europe

Statistics can be made to mean anything

From Mr R. Richardson, MRPharmS

I write in response to the article (PDF* 70K)“How do primary health care systems compare across Western Europe?” by Guy Jepson (PJ, 25 August, p269). It is a long time since I have read an opinion so verbally dressed with a selection of convenient statistics. Statistics can be made to mean anything. The article has a long list of references but most of them are over five years old. Although Dr Jepson’s charts show that Belgium has equivalent costings to the UK, he chooses to ignore this when he comes to “Health system gatekeeper” conclusions. The costs are similar and the results similar but, in Belgium, because the general practitioner is not a gatekeeper, he can spend an extra 5.2 minutes with each patient and see seven more per week. Comparison of the two shows a terrible waste of the UK GP’s abilities: significant amounts of every UK GP’s time per week is not spent with a patient but on paperwork.

The UK figures that Dr Jepson gives for the cost of health care per capita are wrong and only reflect National Health Service spending. They do not include the substantial insurance costs, or the figures for medicines purchased from supermarkets and grocers. The French and German figures include these and are regularly published. Millions of pounds are spent in the UK, but these are treated as “other” purchases.

On the subject of prescription items, many patients in the UK are issued with regular prescriptions for two or three months’ worth of loose drugs. Is this a safe practice? In Italy there are a large number of items which are not reimbursable; only prescription medicines or drugs under scrutiny are reimbursed. In France, the patient on regular medication will leave the doctor with several prescriptions, all for sensible amounts. Respect for medication is much higher than in the UK. It is a criminal offence for a pharmacist to dispense more than one of these within strict time spans.

The charts also show no figures for “Unnecessary waiting times” per 1,000. When analysing gatekeeping to the health system, is this not important? Free access to a specialist of your choice reduces one GP consultation. If a patient has a cardiac problem what sense is there in visiting a GP who was a psychiatric registrar? The patient still has to visit the clinic at the hospital. With free access, a patient can visit the surgery of a GP who works under the cardiac specialist. The UK has many such GPs who work one or two days in a hospital clinic with a specialist.

Dr Jepson refers to the numbers of “non-restricted” patients in Belgium, France and Germany who routinely visit the “many” GPs — that old chestnut. This was dealt with years ago. Patients pay for the GP consultation and are reimbursed. They will only have the first consultation reimbursed unless by agreement. Thus the state has a tap it can turn off. The population is aware they will pay heavily for foolishness.

Roland Richardson
Monte Carlo,
France

GUY JEPSON replies

My article comparing primary health care systems across Western Europe was based on the literature review which formed part of a PhD thesis carried out in The Department of Primary Health Care, University of Newcastle upon Tyne. The thesis was examined May 2000. Regarding the age of some of the references, these appeared to represent some of the most reputably published literature available at the time of writing and were reappraised for the article. The document was written in the autumn of 1999, submitted to the PJ a year later and refereed with no changes deemed necessary. The article took a further 11 months before publication which I recognise is unfortunate.

I acknowledge (and did so in the article) that health care systems are undergoing continuous change and within the remit of the length of this general review it is difficult to address all the idiosyncrasies of health care systems. A number of issues are raised in the letter above but I am not aware that some of them, eg, “unnecessary waiting times per 1000”, were either published at the time of writing or are even available now.

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