Cost of Life
Text and photo by Glib Bitiukov, Patriot Defence instructor
Patriot Defence instructors Glib Bitiukov and Stanislav Gaievskiy successfully finished their Emergency Medical Technician course at the National EMS Institute in Boston, USA.
During the month of studies they went through a course that includes work with isolated trauma on patients at the prehospital stage, including neurological conditions, toxicology, pediatric diseases, exigent immunological rejection of the principles of pharmacology and assistance in terrorist attacks and disasters. While in the USA our instructors used the opportunity to get acquainted with the work of medical institutions, their peculiarities and approaches to treatment in American hospitals.
In this article Glib Bitiukov explains why a healthy population saves the state money and compares patients' attitude to life in American and Ukrainian hospitals.
Spending my last evening in the USA I decided to write about the cost of life. How do we evaluate it? How much does it cost? I ask myself this question all the time, especially when I see our wounded soldiers without first aid kits, when learning that medical care wasn’t delivered in time, when thinking about my ambulance work or when visiting a hospital. Is the price really so low that we let our medical system waste so many lives?
A majority of people would say that “life is priceless” (not to be confused with “costless.”) For every mother, the life of her child is priceless, for kids - the life of their parents. The lives of our relatives, families, friends are priceless.
But how much does a life of citizen cost the state? How much does a patient’s life cost the hospital?
Here life becomes an abstract statistical statement. We have to evaluate our own life, in order to derive some meaning.
Everything comes down to money. This price does exist, somewhere. We just have to recognize it and know it. Why we have to do this will become clear at the end.
“Cost of Illness”
The scrupulous Swedes already counted the “life price.” This counting system is called the “Cost of Illness”.
They collected year-long data on accident victims and calculated all the money spent on them including both funds for treatment, and the so-called direct and indirect investments. Namely medical insurance, resulting disabilities, holidays spent on treatment, etc., that resulted in the idea that healthy civilians are financially profitable for the state compared to the cost spent treating those that are not.
• Read also: Principles Of Emergency Medicine In Sweden
The United States found out long ago the same idea that money has a way of arranging things in an order. The one paying and the one being paid do not only transfer money between themselves, but also responsibilities.
It isn’t easy to become a doctor in the USA. That’s why approaches to choosing the medical profession are consciously made and the same as to the medical education system.
To get a nursing license you need to pass 3-4 years of studies. It is not hard to enter college, but your studies will cost nearly $35,000-45,000 per year. To enter college one needs to have basic knowledge of biology, physics, and also organic and inorganic chemistry and be fluent in English. There can be additional requirements of previous volunteer internship in a hospital, community service or work as Emergency Medical Responder (EMR) or Emergency Medical Technician (EMT). Majority of colleges accepts students require an entrance test on basic knowledge but few are turned away.
At the start of their first day of training in the United States, our instructors were given 1500 page textbooks, and by the end of the day they already had to write their first test.
But as the process advances, so do the requirements. Testing occurs constantly, and American students are not even aware of bribes and cheating. They simply don’t understand it. It's a non-issue. Not everyone completes their studies, but the graduates have knowledge and skills of a really high quality.
Students are fully responsible for their studies. No one reminds them about bad marks or a failed exam, nor do they invite parents to college.
Licensing and Employment
College gives nothing more than knowledge. Graduation doesn’t mean automatically give you a licence. You need to pass exams in other institutions. And after being licensed, make one mistake and you'll lose that licence.
But wait, there is more. For instance, getting a paramedic licence doesn’t guarantee immediate employment. Starting at the ambulance station you’ll have to pass some more training, work under supervision for long time, after additional tests you be able to take a position as paramedic.
Why is it so complicated? Because of responsibility - read as money. Employee mistakes are fined at a minimum, at a maximum fired and fined so hard that you will have to pay for many years. But the worst part falls on the shoulders of the employer and the company whose employee made the mistake. And because no one likes to lose their own money, the requirements are so high.
In Ukraine a call to an ambulance somewhere on the road is a tremendous challenge. Dispatchers will decide at length whose jurisdiction is it, from where to send the vehicle, and finally ambulance will arrive in 30-40 minutes. In the USA an ambulance arrives on scene not more than 10 minutes following the call, while in practice it's normally 2-5 minutes. As a rule, vehicles are not waiting for a call at substation, but are dispersed throughout the city. In case the call is broken or disrupted, the phone location is tracked and an ambulance will be sent there, together with police and fire brigade. If you are unable to speak, you can send an SMS to call ambulance.
Ambulance call-out in the USA will cost a patient nearly $520 for the lowest level of medical support, or 630$ for the highest. In the event that emergency procedures were conducted, for instance intubation or reanimation, the price rises to $700-800.
Expensive? For sure. This price is not cheap even for an average American with salary $3,500-4,000 per month who is renting an apartment, pays for medical insurance, for mobile phone services etc. Especially if the call will result in hospitalization, a cost that also has to be paid.
In case of hospitalization, an average duration of stay of a patient in a US hospital is 3 to 4 days, and in Ukraine it will last about 11 to 12 days.
Apparently this means that over two weeks in a Ukrainian hospital doctors can’t cope with things doctors do in four days in Europe or the USA having less than three times as many hospital beds. Perhaps this is because no one feels responsible because no one demands accountability?
The number of hospital beds in Ukraine is three time as many (9 per 1,000 people versus 3 per 1000 in the USA and 5 per 1000 in Europe). Does the higher number of beds mean that we are treated better?
It's pretty simple to find out. Ukraine ranks second in the world (among 225 countries analysed) in number of deaths. That is, the frequency of death in Ukraine, 14.46 per 1,000 people, and in Lesotho it is 14.89 per 1,000. Does anyone know where Lesotho is? In the USA, this figure is almost twice as small at 8 per 1,000.
• Read also: Who's Who in US emergency aid
So what does the number of hospital beds in Ukraine mean? In fact nothing. We have more chance of dying in the hospital or on the road without provision of medical aid, than being in the US Army during the war in Iraq.
Cost of Life
The average life expectancy in Ukraine is 71, while in Europe or the USA it's 80. Being here in the USA, I see elderly grandparents leading active lifestyles, driving cars, visiting restaurants, meeting friends, while in Ukraine they would have long been considered "too old."
Why is it like this? Because in Europe and the USA there is the price of each individual. We are consistently told that our medicine is one of the best that we should not radically change the health care system. But still we see our guys dying everyday, hospitals failing to do what they should, ambulances do not reach patients in time, the Ministry of Defence purchases old rubber tourniquets that should be thrown in the trash, and demanding that everyone else shut-up and agree with them. The solution is to transform everything into a monetary equivalent and then everything will fall into order.
Let's look at the situation through the eyes of a hospital or ambulance. A doctor does not receive only a patient but a certain amount of money. It's not some random man on the street that calls an ambulance, but a paying customer. If something goes wrong, he will go to the courts, and then the ambulance or hospital will pay for the improper fulfilment of services.
And the hospital should not receive grants or funding from the state. It should get money for servicing or treating each patient. If the treatment is substandard or fails - the next time no one comes to the hospital.
It should be financially unprofitable not to cure the patient. That ambulance that fails to save a patient or gives inadequate help - should be financially unprofitable.
It turns out that healthy nations are much more profitable. Citizens are employed, have enough income for spending on entertainment, travel and goods. That makes the country richer when taxes are paid and there is little need to protest or organise revolutions.
The more a man has, the more he has to lose. And his behaviour is more moderate. Moderatio in omnibus as the saying goes.
This is why we need to know the cost of life. If it is difficult to determine the level of moral responsibility for the loss of life then money and numbers arrange everything back in order.