by Nick Jacobs

What can you do for just $186E per year? If you're located in the small Balkan country of Serbia, the answer is relatively simple, that's what you have per person to provide health coverage to all of your eight million citizens. On a recent trip to Belgrade for a medical conference, I had the privilege of meeting privately with the Crown Prince; the Prime Minister of Health; also with the Major General in charge of the country's primary military hospital, and hundreds of physicians. Their primary message to me was that everyone needs to move on as we begin to seek co-operative opportunities to explore medical research that will provide a brighter future for all mankind.

We visited a rehabilitation hospital that provided spa coverage for its patients in the form of massage, mud wraps, heat treatments, saunas, hot springs, and numerous other amenities. At this spa hospital, the average stay for a joint replacement and rehabilitative treatment is about 21 days. In the U.S. you are usually released to Home Health and Home Physical Therapy after three.

We had an opportunity to visit a primary teaching hospital that does approximately 1200 invasive heart procedures annually and is fortunate enough to have over 30 cardiologists on staff. Although the average physician in this country makes less than a first year school teacher in the United States, they are so abundant because government supported education is still provided to all citizens.

But what of this challenge to care for the masses with less than $200 per year per capita compared to a nearly $6000 per year per capita expenditure in the United States? Obviously, there are not three MRI's per hospital in a country where the MRI was made possible through the work of Nicholas Tesla, a phenomenal Serbian scientist and inventor.

It's also a fact that their society is not so litigious as ours. In fact, during a presentation by a British MD/PhD he alluded to the fact that their guidelines were not written like those of the United States by and for the attorneys. Because of that fact alone, medicine is practiced very differently. It was interesting to watch a physician examine a patient without millions of dollars of diagnostic equipment meant to protect that physician from potential legal exposure and litigation. It seems like twenty years ago when you could observe a physician in the U.S. make a diagnosis from examining a patient by looking at them and listening to their breathing, heart beat and blood flows.

When patients ask me why an emergency room visit takes hours, the usual answer is that no one wants to take the chance of diagnosing or, worst yet, miss diagnosing a patient because of the lack of back up from numerous pieces of diagnostic equipment.

Moral to this post? Under $200 per year per capita is not nearly enough to protect and help an entire country's population, but $6000 with still questionable outcomes is probably significantly more than needed in a normal world.