I just returned from a once-in-a-lifetime trip to Europe with my wife and kids – a truly awesome (and thoroughly exhausting) experience we’ve been planning for the last year. In between seeing the old-world sites that make Paris and London ridiculously lucrative tourist destinations, I jotted a couple of healthcare-related observations I feel compelled to share here.
First, what’s the deal with triple antibiotic ointment? My wife was bitten by a spider on our first day in London – while the bite wasn’t bad, it’s the kind of thing your Mom would tell you to cover with triple antibiotic ointment and a Band-Aid for a few days “to keep from getting nasty.” In the UK we had the choice of:
- Using the hotel’s antiseptic wipes,
- Buying Peppa Pig “elastoplasts” impregnated with silver, or
3. Going to an NHS clinic to see a GP.
We literally give this stuff away to kindergartners in America but no British pharmacy would sell it to me. Same deal with Children’s Benadryl – can’t get it.
Again, I’m talking about Neosporin and Benadryl not Percocet and Xanax. In a nation where 18 year-olds can buy Vodka and codeine is over the counter, we would have had to either beg a friend in America to AirMail us antibiotic ointment or buy it off eBay and hope the tubes weren’t refilled with either toothpaste or crystal meth.
You’d think we’re at a place globally where we could come to some universal concept of what over-the-counter means… until then, I’ll be packing a mini-pharmacy with me wherever I go from now on.
Second, while the spider bite improved and we never had to interact with a UK hospital or clinic we did interact frequently another industry in both France and Britain – restaurants. It struck me that when it comes to restaurant service, America’s model is much closer to true value-based reimbursement than Europe’s.
What do I mean?
In America, our waiters’ compensation is (by and large) a function of the number of tables they serve, the size of each bill, and their level of personal service. This is why people like my wife made for tremendous waitresses in high school (think the guy from Office Space with 37 pieces of flair) and I stuck to selling shoes.
On the other hand, every European café and restaurant we visited automatically included a “service charge” of 12.5% in the bill, guaranteeing the server a minimum tip with no regard to their actual performance. And while patrons were “welcome to add additional gratuity” I got the sense that 12.5% was good enough for most of the folks we encountered and the focus was exclusively on speed, bill size, and volume.
To be clear, I’m not calling European waiters mean or lazy people – human beings just act differently depending on the rules of the game. It’s basic human nature to learn the rules and then do everything in your power (within legal and ethical bounds) to do as well as you can playing it.
In European restaurants that equates to churning volume and driving up the bill with as many add-ons as possible, accepting that with minimal additional service each table is at least worth 12.5%. In America that model would backfire as restaurant-goers have the final say in whether and how much tip to leave – without strong personal service a waitress could end her night totally empty-handed no matter how many people order the Dom Perignon. So while healthcare has learned LEAN from the engineering industry and checklist management from the airline and nuclear power industries, perhaps we have something to learn from food service as well as we complete our transition away from pure fee-for-service and into value-based and risk-bearing reimbursement.
In closing, I’d like the record to show that I did leave at least one French waiter a solid “additional gratuity” – he not only got our orders right, but he also brought my kids glowsticks and knew all the words to Hakuna Matata.
And while he didn’t have 37 pieces of flair I’m quite certain that old Stan would have approved.