What's most important to me is that in our health care system everyone is covered. What treatment you get is independent of your economy and social status. That's what counts IMO.
In general differences in diagnosis and treatment between countries, several factors are important:
- lack of consensus about what's necessary. One reason behind this is that many procedures have only marginal effects. This apply to diagnostic procedures, quite a number of tests give little additional information. And there isn't always that much difference between treatments either. Example: treating the elderly for hypertension with drugs don't affect prognosis very much. It's not obvious what should be done. Therefore recommended treatment have changed over time, and will also vary between countries.
- economy for sure, which strikes in both directions, it may lead to too few patients treated or too many.
- lobbying. Some diseases get more attention than others, and have pressure groups more outspoken than others. This does affect priorities and will again differ between countries.
- other things, making my list complete.
And, while I can't say anything specific about sleep apnea, in general tests performed at home isn't necessarily worse compared to in hospital tests, quite the opposite. Tests done at home are done the natural environment of the patient and will quite often give a more representative picture of the patient's problem.
One very simple example, diagnosis of hypertension: Blood pressure measured at the doctor's office, is quite often higher than it really is. For several reasons. 24 hour readings, where the pressure is measured automatically during a 24 hour period where patients do whatever he/she normally does, is much more reliable for moderate levels of hypertension.
