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30 April, 2006

The cost of free health care

(From The Other Club)

From the Fraser Institute. The link below permits you to read the whole thing:

Total Tax Bill for the Average Canadian Family has Increased 1,600 Percent Since 1961

The total tax bill of the average Canadian family has increased by 1,600 percent since 1961, according to a new book, Tax Facts 14, released today by The Fraser Institute. That translated into an additional $26,792 in taxes for the average Canadian family.

Canadians’ total tax bill now accounts for more of the family budget than shelter, food, and clothing combined. In contrast to the jump in taxes, expenditures on shelter increased by 1,006 percent, food by 481 percent and clothing by 439 percent over the same period.

The other cost of "free" health care is rationing; as Small Dead Animlas has been documenting, here

The family of a 57-year-old Meath Park woman says it will take at least three months before their mother gets to see a Saskatchewan oncologist who can tell her if her cancer is treatable or fatal.

and here.

18 month old Paige Hansen is currently in a hospital in Edmonton. Her family finally decided Thursday to seek help elsewhere (doing so without "permission" from SaskHealth, and therefore at their own expense) after waiting three weeks for diagnosis of her pain in Saskatoon. The child was "screaming every waking minute", and had stopped walking 6 days earlier. In the meantime, they were advised to give her children's Tylenol.

According to a family member being interviewed, the care they received in Edmonton began immediately, testing was done during the first night there. This morning they have a preliminary diagnosis of leukemia.

SaskHealth is the Province of Saskatchewan's monopoly. Saskatchewan is run by socialists - literally. Edmonton is in Alberta. It's like this: If you lived in Toledo your health"insurance" wouldn't pay for treatment in Ann Arbor even if all the hospitals in Ohio were refusing patients.

Supply and demand can be regulated fairly by markets; they cannot be fairly regulated by government.

Artificial limitation of supply to control prices never works. From price caps on gasoline in the 70's that produced interminable gas lineups, to 3 month waits to find out if your cancer is (now going to be?) fatal: This is your government, and it's here to get re-elected by appealing to your ignorance and gullibility.



Health fund reforms will benefit all Australians

An editorial from "The Australian" newspaper

When it comes to paying for their healthcare, Australians enjoy a system that for the most part strikes a sensible balance between the laissez-faire market of the US, that leaves millions unprotected, and the dangerously bureaucratic and inefficient socialised medicine schemes of nations such as Canada and Britain. But this does not mean there is not room for improvement. When Medibank, which later became Medicare, was first introduced in 1975, it was a breakthrough that provided universal healthcare and cost containment. But its creaky big-government model became as out of date as national wage cases, and led to long queues and rationing, and Australians have since sought - and received - far more choice in their healthcare.

After the policy changes of the late-1990s designed to increase the take-up of private health funds, enrolment numbers are once again flagging with 43 per cent - just under nine million people - of the nation covered by private medical coverage. Sensible reforms, such as those proposed this week by the Howard Government, can help reverse this trend. Scheduling out-patient treatments and preventative as well as lifestyle measures such as gym memberships once considered "extras" under basic hospital cover should reduce hospital admissions while saving money and lives. Diabetes claims 3300 Australian lives a year and costs $1.2 billion a year. Obesity is thought to cost the nation another $1.2 billion. And smoking kills 19,000 Australians a year through various preventable diseases, at a cost of some $21 billion. To save even 10 per cent of these costs and lives would be a boon for the health system and the country.

Other reforms are similarly encouraging. Dropping lifetime health cover penalties for fund members who retain their coverage for more than a decade removes another disincentive to signing up. And greater transparency about out-of-pocket costs is also a big win for consumers. Some 43 per cent of health fund members who stay in a private hospital wind up with a bill averaging $720, often not realising they will be slugged with extra charges. In addition to all this, the Government is also set to put Medibank Private up for sale. This is a sensible move for a host of reasons, not the least of which is that it removes the conflict of interest inherent with having a health insurance policy-maker owning a private insurance company.

With these reforms completed, the next step will be clear - namely, the Government should stop meddling in the rates set by private health funds. The industry is already competitive and price-sensitive, and at least one health fund's current advertising campaign uses its history of modest premium increases as its primary selling point. And given that health fund membership is reasonably elastic, it is in the health funds' interests to stay competitive with one another lest members get fed up with the cost and hop back into the public pool. There is no reason to require private health funds to continue to get approval for their premiums from Canberra.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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29 April, 2006

MORE NHS WASTE

A hospital that is 3 million pounds in the red has spent 359,000 pounds caring for two elderly patients who have no medical need to be there. Both women have been fit enough to leave the Royal Hampshire County Hospital in Winchester since April 2004, but have remained on a general ward for the past two years at a cost of 246 pounds a day each. The hospital has begun legal action to have one of the women moved to a home, and has sought solicitors' advice in the second case.

Winchester and Eastleigh NHS Trust blamed "complicated family and funding issues" for patients not being discharged. It said that lawyers had been called in after negotiations failed. The hospital is currently accommodating 25 "bed blockers" who are healthy enough to leave.

Vera Hill is stranded as an inpatient until Hampshire County Council organises the two home carers that she needs to help her to dress, wash and prepare meals. The 92-year-old widow has been in hospital for nine months, and was declared fit enough to leave a month ago. She said: "I want to go to my own home. I want to be independent. I will go daft if I don't get out of here."

Powers established in 2004 mean that NHS trusts can fine councils that fail to provide care facilities for patients when they are ready to leave hospital, and last year Winchester and Eastleigh presented Hampshire County Council with a 120,000 pound bill. In total the council paid 625,200 pounds in delayed discharge fines to healthcare trusts around the country.

Patricia Banks, the council's executive member for adult social care, said that "great headway" had been made in reducing delayed discharges, and that 500 extra nursing home beds would be made available under a new scheme this year. "Our priority is always to ensure that the most appropriate care packages are in place to suit each patient's individual needs. Delays may occur when it is not possible to locate timely care."

Winchester and Eastleigh NHS Trust said that bed blocking was a "double-edged sword", that incurred costs in terms of capacity as well as the purely financial. Joanna Paul, the trust's director of operations and performance, said: "The national fining system does help a little but in some cases the real obstacles are family and funding issues. "Not all types of hospital beds are included and the fine of 100 pounds per day is less than half the actual cost." Ms Paul refused to comment in detail on individual cases but said: "Royal Hampshire County Hospital is an acute hospital; once patients are fit to leave it is right that they do so. "Our aim is for patients to get the right care and if that means going down the legal route then that is what we will do."

More here



LOS ANGELES CORRUPTION

The city's oldest hospital faces a federal investigation into its shuttered liver transplant program and is laying off nearly 8 percent of its staff, officials said. St. Vincent Medical Center said in a statement that it is "fully complying" with a subpoena received earlier this year from the U.S. attorney's office, which is probing possible criminal activity in the liver program.

The hospital, which is celebrating its 150th anniversary, closed the program in September after officials admitted that doctors in 2003 improperly arranged for a Saudi man to receive a liver intended for a higher-priority patient, who ultimately died without undergoing a transplant. Federal officials say staff at the 347-bed hospital tried to cover up the ethical breach by falsifying documents. Spokesmen for the hospital and the U.S. attorney's office declined to comment further on the investigation.

St. Vincent also is in financial trouble, having lost $12.2 million in the last fiscal year and more than $15 million in the first eight months of this one, according to a March 29 report from Standard & Poor's. The medical center said it gave layoff notices to 97 people on Monday, including managers and support staff. The hospital has been losing patients for several years and is having trouble recruiting doctors, and the problems were exacerbated by the revelations about the liver transplant program. In recent months, the hospital replaced its chief executive and was handed an unprecedented public sanction by the United Network for Organ Sharing. St. Vincent has said it will challenge the sanction in court.

Another Southern California hospital, the University of California, Irvine Medical Center, also is being investigated by federal agencies for possible fraudulent billing related to its now-closed liver transplant program.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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28 April, 2006

Desperate dentistry in England

Where socialized medicine ends up. Brits are told that they are entitled to "free" dentistry but the pay the NHS offers to dentists is so lousy that there are fewer and fewer NHS dentists around. So Brits pay for health insurance but cannot collect what they have paid for. Very often their only option is to pay a second time -- to go to an expensive private dentist

A woman told today how she got a friend to pull out one of her teeth with a pair of pliers and filmed the gruesome process on a mobile phone after failing to find an NHS dentist. Diane Hunter, 45, described how she became so exasperated after two years of toothache she opted for a DIY option. "In the end I just got really drunk and got a friend to pull it out with a pair of big pliers," she told the Bradford Telegraph and Argus. "There was a lots of blood but I just needed the tooth out - it was causing me great pain and it still is."

Miss Hunter, who lives in the Listerhills area of Bradford, said she has not seen a dentist for more than 20 years and failed in her search for any offering NHS care. She said she first tried the old schoolboy trick of tying one end of a piece of string around her tooth and the other around a door handle before slamming the door but it did not work. Miss Hunter told the paper she would never pull her own teeth out again. "I was going to do it again but I showed a nurse at the doctor's surgery what I had done and she said it could cause a heart attack," she said.

She even went to hospital for help at one point but was never given anything more than paracetamol. Her friend performed the DIY dentistry about six months ago.

Source



More dangerous public medicine bungling in Australia

Melbourne's busiest trauma hospital is rebuilding its intensive care unit to eradicate a potentially dangerous fungus that has troubled it for four years. Just six years after it was opened, the State Government is spending $20 million upgrading The Alfred's intensive care unit, which the hospital expects to be completed in 2008. The Government initially announced the upgrade in October last year but failed to mention the aspergillus problem of 2002, instead alluding to "a range of challenges", citing emerging infectious diseases.

The airborne aspergillus fungus is no threat to healthy people. But it has the potential to harm people with vulnerable immune systems after a bone marrow, heart or lung transplant. In 2002, the hospital's intensive care unit had levels of aspergillus two to three times higher than acceptable. The hospital said levels were now "acceptable", and no patient was at risk.

The Alfred responded at the time by creating a separate intensive care unit with six beds for patients who had had transplants. Other patients are not believed to be at risk. The Alfred monitors levels of aspergillus each month and has changed the airflow management to increase the pressure within the unit and reduce the entry of outside air which may contain aspergillus.

But now the hospital wants to operate a single intensive care unit, bringing patients in from the secondary unit. The hospital's chief executive, Jennifer Williams, said a series of reviews had recommended that the safest solution was to rebuild it. "We very much want to get back to the situation we were in in 2002, where we had one intensive care unit," she said. "We don't want to put at risk those particularly sick patients in case the levels were to go up again, but they haven't gone up again. There have been no aspergillus infections since 2002 and we want this to continue."

Canberra Hospital director of infectious diseases, Peter Collignon, said aspergillus affected people when they breathed it in. It can often then form a lung infection and sometimes via the blood go to other parts of the body, but that only occurs in people who are very immuno-suppressed," he said. He said most major hospitals that cared for people with damaged immune systems would have infections caused by aspergillus, but it was difficult to know whether they picked it up in hospital or elsewhere.

Ms Williams said the unit would be built on the same site as the existing one. Planning is under way and the hospital will relocate patients when construction begins. She said it would be designed to minimise the chances of aspergillus entering the unit. "It's a matter of ensuring that the roof and the perimeter walls are completely sealed and the air-conditioning system is replaced with increased levels of air filtration capability," she said. The redesign will also boost the hospital's capacity to treat more patients, with more beds and facilities to deal with infection control, and new technology.

The Alfred acknowledged the elevated levels of aspergillus in 2002 when a patient with a compromised immune system died of aspergillus pneumonia. But it cannot be determined whether the patient contracted it in hospital or in the community. The fungus was also found in 41 other patients, but they were not infected with it. There have been no deaths or infections since.

Ben Hart, spokesman for Health Minister Bronwyn Pike, said The Alfred had tried a number of measures to solve the aspergillus problem, including building works to the air-conditioning and the roof. "But following that, it became apparent after a number of years that those measures weren't solving the problem and so therefore expert consultants were brought in to provide advice on what was the best course of action and The Alfred formed a view that the best course of action was a total rebuild," he said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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27 April, 2006

FDA DISCOURAGES DEVELOPMENT OF NEEDED DRUGS

Amid all the buzz about a possible avian-flu pandemic (and more noise soon as another season of West Nile virus infections begins), America is already ex periencing another perilous epidemic. The Centers for Disease Control and Prevention report that as many as 2 million patients nationwide contract bacterial infections in hospitals each year - and 90,000 die. The death rate in such cases is alarmingly high not because the patients are initially very ill, but because hospital germs increasingly are resistant to multiple antibiotics. Thus, the infections are difficult to treat.

But antibiotic resistance in hospital germs is merely a worst-case version of what is happening in the broader community in non-hospitalized patients - in common lung, skin and sinus infections, for example. That is, germs are becoming more resistant to the antibiotics we have - which means that we need new ones.

Federal health officials have adopted four main strategies - prevent infection, diagnose and treat infection, use antimicrobials sparingly and prevent transmission - but they have paid little attention to the shortage of new antibiotics. For decades we've relied largely on slight variations on old drugs to combat rapidly evolving pathogens. The last 37 years have brought just two new antibiotics with truly novel modes of action - Zyvox in 2000 and Cubicin in 2003 (and Cubicin is only used for skin infections).

Right now, the prospects for more are bleak. Over the last decade or so, all the major drug makers have dramatically trimmed or eliminated their antibacterial research programs, to focus instead on drugs that treat chronic ailments and lifestyle issues. Research costs are equally high - it now costs more than $800 million to bring an average new drug to market - and these other drugs are more likely to repay the investment. Whereas antibiotics cure a patient in days, and may not be required again for years, someone taking Lipitor for high cholesterol or Levitra for erectile dysfunction might pop these expensive pills every day for decades.

Congress hasn't managed a remedy. Legislation was proposed last year to create tax incentives for companies that develop new antibiotics, limit their liability for side effects (as has been done for childhood vaccines) and extend patents to compensate for time lost while awaiting FDA approval. But the bill also included an added feature, "wild-card exclusivity" - that turned out to be too wild. This would allow a firm that markets a new antibiotic to extend the patent on any product in its portfolio by up to two years, with the approval of federal officials.

The idea was to give, for example, Pfizer the incentive to discover an important new antibiotic, and so win more time to market Viagra before generic manufacturers could legally produce the drug. But, as written, it might have let companies reap such lucrative gains even for antibiotics little different from existing ones. Better policy - and politics - dictates that "wild card" antibiotics both be intended for treatment of serious or life-threatening conditions and address unmet medical needs.

We need also to adopt the kinds of critical FDA reforms suggested by the Infectious Diseases Society of America - to speed up clinical trials, goose regulators and encourage more innovative research.

The two novel antibiotics introduced since 2000 won't be enough to keep rapidly mutating pathogens at bay for long - and once a resistant bug appears, it will spread rapidly. Soon, there might not be any more "routine," easily treated infections.

Unless we create economic incentives for companies to develop antibiotics, it's unlikely that we'll see many more wonder drugs in the near future. Think about that the next time you or a loved one is hospitalized with a flesh-eating bacterial infection - or even if you've recently taken an antibiotic for bronchitis or a skin infection as an outpatient.

Source



NHS targets are the real waste

Once again the NHS is in crisis. Essential staff are sacked, beds closed, GPs are scolded for "over production" because they have exceeded their targets. When will the mandarins realise that patients are not widgets on a production line for which targets can be imposed and delivered? If a patient needs a half hour of a doctor's time to help him/her come to terms with an unexpected cancer diagnosis, that is what the doctor will do because the professional ethos demands it.

All targets do is waste valuable time. Already nurses spend 40% of their time on computers, much of it designed to capture data needed for targets which also encourage managers to be deceitful and massage figures and make desperate efforts to rob Peter to pay Paul.

The alarming rates of hospital acquired infections that we now suffer (and die of) could be more easily avoided if staff had the time to practise the aseptic techniques that prevent HAIs.

This government is too fond of suggesting useless ideas to improve patient care; I don't know whether to be horrified or amused at the appointment of "dignity nurses" given that treating patients with dignity should be central to the job of a nurse. Unfortunately, some modern nurses have not been properly trained in the skills needed to treat elderly patients with dignity. I fear for the existence of a once superb institution which I have always been passionate about.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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26 April, 2006

U.K.: ANOTHER KID NEARLY KILLED BY SOCIALIZED MEDICINE

Peter Owen, 19, was in agony for a week as he tried SIX times to have a tooth out. He was eventually rushed to hospital after an abcess on the tooth swelled so much that it blocked his windpipe. Peter had an emergency tracheotomy - where a breathing tube is inserted through a hole in the throat - and was on life support for two days.



Mum Wynn, 47, said last night: "Peter nearly died because there is a shortage of dentists. "It is shameful that someone should be taken to hospital fighting for his life just because of toothache." Peter was not registered with an NHS dentist when he developed raging toothache. Wynn rang NHS Direct who told her there were NO available dentists near their home in Colwyn Bay, North Wales. The nurse who answered suggested the emergency dentist at Royal Alexandra Hospital in Rhyl could see him - but not for six days.

Next day Peter went to a dental centre in his home town who told him the tooth must come out. But he was quoted a total of 121 pounds which he could not afford on his Jobseeker's Allowance. The next day he went to Colwyn Bay Community Hospital - but was told they were not taking any more dental patients. The day after that Peter's pain was becoming unbearable as his mouth began to swell.

Wynn called her doctors' surgery saying her son needed antibiotics for the pain. But she was told they did not deal with dental matters. Desperate, the pair then went to Glan Clwyd hospital where a nurse said he HAD to see a doctor. But after waiting two hours they had to go as Wynn was in agony with a shoulder problem. The following day Peter saw the dentist at Royal Alexandra Hospital who confirmed he needed the tooth out.

He prescribed antibiotics - and Peter made an appointment for an extraction four days later. But his condition got worse and the next day Wynn rang NHS Direct again, saying: "You're going to kill this lad." That night Peter could not breathe and dad Gareth rushed him back to Glan Clwyd, near Rhyl, where surgeons performed the emergency surgery. He was eventually allowed home a week later.

Wynn said: "It's a terrible story. These kids can't afford a private dentist and there are no NHS dentists anywhere. "I also blame the Welsh Assembly for the shortage of dentists in our area."

Conwy and Denbighshire NHS Trust said: "We can't discuss individual cases. But if Mrs Owen contacts patient services at the hospital we will discuss her concerns." A Welsh Assembly spokesman said: "Steps are being taken to address the issue of dentists."

Source



BRITISH NURSES FED UP WITH CONSTANT "CUTS"

National industrial action is being considered for the first time by nurses, amid mounting concern over job cuts, NHS deficits and the pace of reforms. As Tony Blair admitted that the health service faced a "challenging year", nursing leaders said that growing uncertainty in the NHS, and the fear that valid nursing concerns were simply being ignored, had pushed the profession into an "unprecedented position".

With Patricia Hewitt, the Health Secretary, receiving a rough ride as she spoke to a Unison conference, the Royal College of Nursing said that while it would not sanction full-scale walkouts, nurses refusing to work unpaid overtime was now a possibility. Beverly Malone, the RCN's general secretary, said that the action equated to an extra day's work per week for each nurse. "The reality gap between what the Government is saying and what we are experiencing at coalface level is very wide," she said.

Josie Irwin, head of employment relations at the RCN, said that the "work to rule" action had been considered before in localised disputes, but never on a national scale. "Nurses are feeling the most insecure they have ever felt about their jobs . . . there is clearly a temperature out there where members are considering the possibility of action in light of the redundancies, deficits and disappointing salary rises," she said. "The discontent has not been as widespread before, which does indicate a mood change across the NHS among the membership . . . this is the first time it has ever been discussed by the general secretary." Ms Irwin said that under RCN rules, members could not act in a way that was detrimental to the wellbeing of patients. She said that if the action occurred, health trusts would have to pay for agency staff or pay for nurses' overtime.

The nursing leaders were speaking on the second day of the RCN's annual conference in Bournemouth. Ms Hewitt is scheduled to speak to the conference tomorrow after facing sustained criticism for describing how the NHS had enjoyed its "best year ever". Yesterday 1,000 delegates sat in stony silence when Ms Hewitt was introduced at Unison's health workers' conference in Gateshead. She was heckled, booed and hissed during her speech. She slightly modified her claim, saying that it had been the "best year for patients". Her compliments and assurances were met with angry cries of derision and frequent interruptions from delegates. She said that she understood the concerns of those threatened with job losses, but change and reform were necessary if the founding ethics of the NHS were to be preserved. She said: "We've written a very big cheque for the NHS. But it's not a blank cheque. Overspending hospitals and organisations do have to put their houses in order."

After addressing the conference she faced a barrage of angry questions from delegates, who reeled off lists of ward closures and service cuts. Earlier Dave Prentis, the Unison general secretary, said that his union would not stand by and watch staff suffer "in a climate of fear". Unison would support members who had no option but to strike, he said, adding that patients would be hit by the cuts.

Mr Blair defended Ms Hewitt yesterday as he insisted that there had been significant improvements in the NHS since Labour came to power. He said that waiting lists had never been lower, cancer and cardiac care treatment was the best it had been, and there was a record number of extra doctors and nurses. He acknowledged difficulties as the service entered the next phase of its ten-year plan. "Whatever the challenge - and the next year will be very challenging - there have been improvements," he said. David Cameron, the Tory leader, criticised the Government's "arrogant" manner in blaming the crisis on health bosses. He said: "Nine thousand people are threatened with redundancy in the NHS and hospitals are threatened with closure. "This is not caused by reform but by a lack of reform and mismanagement."

Source



Australia: Semi-urgent patients missing out in Victoria's public hospitals

One in four patients waiting for surgery is not treated within the Government's benchmark times, according to the Australian Medical Association. AMA state vice-president Dr Doug Travis said doctors were tired of telling patients their surgery had been postponed or they would have to wait months for an operation because of a shortage of hospital beds and doctors. Dr Travis, a surgeon in the public hospital system, claimed analysis of the State Government's Your Hospitals report released last week showed the Government aimed to treat only 80 per cent of semi-urgent patients within 90 days compared with the national benchmark of treating 100 per cent within 90 days. But he said the Your Hospitals report showed only 73 per cent of patients were treated within 90 days. "Doctors list patients as semi-urgent because they need to have their surgery within 90 days, but the Government does not seem to care that more than one in five people can't access the surgery they need in the time frame they need," he said. Dr Travis said it seemed the Government had decided to lower the benchmark to make the figures look good instead of investing in more doctors, nurses and beds.

The AMA has asked the State Government to include an extra $100 million in Victoria's 2006-07 health budget to pay for 300 extra beds and help ease demand in emergency waiting rooms and minimise elective surgery cancellations. Opposition health spokeswoman Helen Shardey said the report's presentation was dishonest. "If you're going to have a performance indicator, that's what you need to report on," she said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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25 April, 2006

UK: ELDERLY SUFFER

Patients are being put at risk by NHS cuts as hospitals try to reduce services that have less demanding government targets, it was claimed yesterday. Nursing leaders said that “easy victims” in the NHS, such as care for the elderly and mentally ill, were bearing the brunt of widespread job losses, bed closures and other service reductions because of a 700 million pound deficit. New figures show that more than 13,000 job losses have been announced by hospitals and health trusts over the past six months. At least one third of the lost jobs are expected to be nurses.

Senior nurses and politicians condemned comments by Patricia Hewitt, the Health Secretary, that the NHS had had its “best year ever”. Sylvia Denton and Beverly Malone, two of the country’s top nurses, said that the dismissal of health staff was having a severe impact on patient care. “NHS deficits are hitting patient services and to claim otherwise is simply wrong,” Dr Malone, general secretary of the Royal College of Nursing, said on the eve of the organisation’s annual conference. “These are real services for real people with real illnesses, and we have to stop treating them as statistics on a balance sheet.”

A survey by the college of 660 hospital-based senior nurses revealed that almost half had seen redundancies or a reduction in nursing posts where they work. Nearly 60 per cent of hospitals said that they did not have enough staff to give their patients the standards of care they would like. Figures compiled by the college show that job losses in the NHS were more than twice the level of 6,000 that had been reported. Dr Malone said that cuts to community hospitals, beds and services for older patients were already having a serious impact.

The Royal College of Nursing cited a range of examples of threatened hospital closures reported by its members, including in areas such as Wiltshire, Gloucester, East Yorkshire and Oxford. Vulnerable elderly patients were being moved frequently from bed to bed around hospitals as trusts struggled to find them specialist care, risking serious consequences for their health, Dr Malone added. She described the cuts — which included the loss of specialist beds for older adults recovering from falls, strokes and surgery — as “kneejerk” and that there was no strategy to cope with the repercussions for patients.

Other patient groups being affected include young cancer sufferers in the West Country, and research teams working on life-saving treatments such as cardiothoracic surgery.

The claims come as Ms Hewitt admitted that the Government was “not on track” to meet a number of public health targets. The Prime Minister was told in a progress report last week that 11 out of Labour’s 26 key targets, known as public service agreements, were showing “red” or “amber” lights, indicating there was little prospect they would be met by the intended date of 2008 unless urgent action was taken. They include the promise of a CAT or MRI scan for any patient needing one, cutting waiting times for cancer treatment, cutting MRSA rates in half within 18 months, ending inequalities in infant mortality, reducing smoking rates in poorer households, raising life expectancy in deprived areas and reducing rates of teenage pregnancy and childhood obesity.

“Despite the headlines, actually the NHS has just had its best year ever,” Ms Hewitt said, adding that the Government had come through one of the coldest winters for decades without bed emergencies and had cut waiting times to the lowest level ever.

Dr Malone and Mrs Denton, president of the Royal College of Nursing, said that the minister’s view was without credibility. “If this is the best ever year I would not like to see the worst. It is as simple as that,” Mrs Denton said. She added that the cuts had left nurses “not just demoralised, but really angry”. Politicians including David Cameron, the Tory leader, echoed the nurses’ surprise at Ms Hewitt’s claims, saying that the NHS faced an emergency created by the Government. Christine Beasley, the Chief Nursing Officer, defended the Government’s record. “We have 80,000 more nurses than in 1997, with starting pay rising by 55 per cent in the same period,” she said.

Source



NHS PAY BUNGLE

Miscalculations in salary packages for NHS staff have led to a pay bill more than 600 million pounds higher than expected, it has emerged. The Department of Health acknowledged it had underestimated the financial impact of the so-called Agenda for Change package for nurses' pay by 220 million, while the cost of new consultants' contracts was 90 million more than expected.

The figures come on top of the 300 million overspend on GPs' pay admitted earlier this month by Health Secretary Patricia Hewitt, who said the department had not expected family doctors to be able to rack up 20-25% pay hikes under a new payment-by-results points system. Large salary increases resulting from the renegotiated contracts have been blamed for financial deficits running into hundreds of millions of pounds which have seen hospitals forced to sack thousands of staff. But despite the financial difficulties, Ms Hewitt insisted last night that the NHS was enjoying its "best year ever".

Some 7,000 job losses have already been confirmed in the NHS and there are predictions that the final figure may reach as high as 13,000, as managers struggle to cope with a total deficit estimated at more than 600 million.

But Ms Hewitt insisted that the deficit amounted to no more than 1% of the NHS's total budget and was "not a crisis", while job cuts were, in many cases, allowing the service to operate more efficiently. The figures on overspending on pay were uncovered in the Sunday Telegraph, which said Ms Hewitt was planning a series of speeches to shore up public confidence in the NHS.

Shadow health secretary Andrew Lansley told the paper: "The Government has totally lost control of the NHS's finances. No amount of rhetoric about reform will cover up the Government's gross mismanagement." Ms Hewitt insisted she was not "complacent" about the cash problems which have seen staff laid off and wards closed.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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24 April, 2006

BRITISH NHS NURSES SEE THE DECLINE

Almost half of senior nurses have seen cuts in staff or training posts in the last year in the trust where they work, the Royal College of Nursing (RCN) has revealed. On the eve of its congress, the RCN said 60% of senior nurses did not have enough staff to give patients the care they would like. Almost two-thirds (62%) of ward sisters and matrons feel they are under too much pressure, and 40% would resign if they could.

Eight out of 10 work unpaid overtime several times a week - with 30% doing so every shift. The poll of almost 1,000 senior nurses comes as the RCN said it believed 13,000 posts had been identified for cuts since October last year.

Since March 1 this year, more than 7,000 cuts have been announced by trusts up and down the country. The NHS is struggling with a deficit expected to top 623 million pounds this financial year.

In the survey, the nurses also said they wanted more resources, more time to spend with patients, and more time to educate staff and develop good practice. Dr Beverly Malone, general secretary of the RCN, said: "Put simply, this survey shows that senior nurses are under pressure, under-resourced and under-appreciated. "Patient care is suffering because of the huge pressures and demands these nurses are facing. They are working extremely hard in difficult circumstances, in a whirl of deficits and relentless reforms." She added: "Government actions on deficits and the headlong rush into reforms is leaving disaffection and disillusionment in its wake. When nearly half of the senior nurses surveyed want to quit, the Government has got to sit up and take this issue seriously.

Chief Nursing Officer Christine Beasley said: "I appreciate how anxious some nurses will feel at present and how demanding their job is. "I would like to reassure them that the threat of redundancy will be contained to as few people as possible and in many cases changes will be achieved through cutting down on agency staff, freezing non-essential vacant posts and redeploying staff into other roles."

Source



British nurses taking their skills elsewhere -- to Australia

Hundreds of British nurses will be lured to NSW as the State Government plans to take advantage of the cash crisis in the British health system. The recruitment drive, to start next month, comes after 300 British nurses, also enticed by the Government, relocated to NSW last year. The state urgently needs an extra 1800 nurses and retiring NSW chief nursing officer Kathy Baker said the Government had "no choice" but to poach nurses from Britain. Three British recruitment agencies have been awarded contracts by the Government and a team from NSW will spend about three weeks in Britain next month, hiring more than 200 nurses.

Britain's cash-strapped National Health System is expected to slash at least 13,000 jobs in coming months. More than 7000 jobs have already been lost and dozens of hospitals are millions of dollars in the red.

Although the Howard Government recently announced an extra 1000 university undergraduate nursing positions, Professor Baker said she wasn't confident NSW would be allocated any. NSW Health Minister John Hatzistergos said the shortfall in Commonwealth-provided university training places was a major setback for staffing in public hospitals.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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23 April, 2006

AMERICAN MEDICINE GETTING RESULTS

In what appears to be an amazing success for American medicine, preliminary government figures released Wednesday showed that the annual number of deaths in the U.S. dropped by nearly 50,000 in 2004 - the biggest decline in nearly 70 years. The 2 percent decrease, reported by the National Center for Health Statistics, came as a shock to many, because the U.S. is aging, growing in population and getting fatter. In fact, some experts said they suspect the numbers may not hold up when a final report is released later this year. Nevertheless, center officials said the statistics, based on a review of about 90 percent of death records reported in all 50 states in 2004, were consistent across the country and were deemed solid enough to report.

The center said drops in the death rates for heart disease, cancer and stroke accounted for most of the decline. "We were surprised by the sharpness of the decrease. It's kind of historical," said statistician Arialdi Minino, lead author of the report. The government also said that U.S. life expectancy has inched up again to 77.9 years, a record high but still behind that of about two dozen other countries.

The preliminary number of U.S. deaths recorded for 2004 was 2,398,343. That represents a decline of 49,945 from the 2,448,288 recorded in 2003. U.S. deaths ordinarily rise slightly each year. The last decline in annual deaths occurred in 1997, a modest drop of 445 deaths from 1996, Minino said. The number of deaths has not dropped this steeply since 1938, when there were about 69,000 fewer than in 1937. A drop in 1944 came close - about 48,000 fewer deaths than the previous year. Health officials could not immediately say why the number of deaths fell so sharply in either of those years. "These are preliminary data," said Paul Terry, an assistant professor of epidemiology at Atlanta's Emory University. "But if it holds up, it's obviously very good news."

To see such a giant drop after years of annual increases was a little hard to swallow for some. "We will not make much of this until the final data come out," said Elizabeth Ward, director of surveillance research for the American Cancer Society. Overall, age-adjusted death rates fell to a record low of 801 deaths per 100,000 population in 2004, down from almost 833 deaths per 100,000 in 2003.

Heart disease continues to be the leading cause of death, accounting for 27 percent of the nation's deaths in 2004. Cancer was second, at about 23 percent, and strokes were third, at 6 percent. The good news: The age-adjusted death rate for all three killers dropped. The heart disease rate declined more than 6 percent, the cancer rate about 3 percent, and the stroke rate about 6.5 percent. Improvements in medical care, particularly in medications aimed at preventing heart disease, at least partly explain the improvements in the heart disease death rate, said Ken Thorpe, an Emory professor of health policy. Also, the flu season for 2004 was milder than 2003, which helped explain the more than 7 percent drop in the influenza death rate, Minino noted. The death rates for 11 of the 13 other leading causes of death also declined, with only Alzheimer's disease (the No. 7 killer) and high blood pressure and kidney disease related to high blood pressure (No. 13) inching up.

Even officials at the National Center for Health Statistics were "really kind of concerned" when they first saw their own numbers, said Bob Anderson, the agency's chief of mortality statistics. But the fact that decreases in the death rate were found nationwide gives them confidence that the findings are legitimate, and not the result of something like changes in data collection.

The government also reported that a baby born in 2004 could expect to live to nearly 78 - an increase of almost half a year from 2003. Women now have a life expectancy of 80.4, up from 80.1. Male life expectancy is 75.2, up from 74.8. The life expectancy for whites - 78.3 - was up only slightly from the previous year. The increase for blacks was larger, with a rise from 72.7 to 73.3. The government also reported that the infant mortality rate has dropped to 6.76 deaths per 1,000 births, down from 6.85 the year before. But a huge racial disparity persists. The rate for whites was 5.65 per 1,000 births, for blacks, 13.65. Japan, Monaco and San Marino had the highest life expectancy, 82 years, in 2004, according to World Health Organization statistics. Australia, Iceland, Italy, Sweden and Switzerland have a life expectancy of 81. Canada, France, Israel, Norway, Spain and Britain are among the other countries with life expectancies above 78.

Source



Sydney Hospital on life support

Historic Sydney Hospital is sitting on some of the most valuable real estate in the heart of Sydney. Work out for yourself what the gleam in the eye of the NSW government might be



Sydney hospital's capacity has been run down to the point where half-a-million people living and working in the city have been left far more exposed to the consequences of a terrorist attack or a bird flu outbreak, a hospital administrator has warned. The chairman of the Department of Medicine at Sydney Hospital, John Graham, told a biosecurity workshop last week that he had appealed to the Federal Government to remove the hospital from state control and declare it a "national security hospital". He said there was consensus among intelligence experts that the No. 1 terrorist target in Australia was the Sydney CBD. The first case of avian flu in Australia was also likely to walk through the doors of Sydney Hospital, most probably in the form of a visitor staying in a hotel.

Yet the state's health administration had run the hospital down to the point where it had only 100 beds left from an original 550, while its general and orthopedic surgeons had been ordered to work elsewhere. Dr Graham said the hospital needed an extra 100 beds, the restoration of its intensive care unit and the rehiring of up to 20 general and orthopedic surgeons to handle a terrorist attack or big infectious diseases outbreak. "I am the canary down the coalmine and I am asphyxiating," Dr Graham told the Herald yesterday. "It doesn't matter if I fall off my perch, but it matters if the half-a-million who come into the Sydney CBD every day have their health jeopardised. I, for one, am not prepared to let the NSW Health Department sit back and do the wrong thing."

A discussion paper on Dr Graham's proposals has been sent to the Prime Minister, and Dr Graham said he had met the federal Minister for Health, Tony Abbott, late last year to discuss the issue. A briefing note seen by the Herald from Dr Graham to the Deputy Commissioner of NSW Police Andrew Scipione says some senior NSW health officers privately agree that Sydney Hospital in its present state cannot adequately deal with a disaster in the city. However, the head of the NSW Health Counter Disaster Unit, David Cooper, said yesterday that state planning was "not about one hospital; it's about the whole network".

The biosecurity workshop, which looked at threats from infectious diseases and bioterrorism, was sponsored by the University of Sydney. A workshop speaker from the Prime Minister's Department, who did not want to be named, said the likelihood of a terrorist attack involving biological agents was low, but could not be ruled out. The former federal co-ordinator of emergency services David Templeman issued a warning about the ageing of the 500,000 volunteers whom the emergency services rely on. The average age of volunteers had risen to 47, from about 37 10 to 15 years ago. This was due not just to an ageing population and declining birthrate, but to a decline in the volunteering tradition among younger people.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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22 April, 2006

PREMATURE BABIES ANOTHER BIG PROBLEM FOR BRITAIN'S NHS

An alarming rise in the number of women giving birth prematurely risks overloading the NHS and may be linked to increases in obese and older mothers, according to doctors. A study of more than 600,000 births over the past decade found that the number of deliveries occurring before nine months of pregnancy had increased by almost a quarter. Researchers also found that among women without factors that normally increase the chances of a pre-term birth - such as fertility treatment, an earlier premature birth or cervical surgery - the rate had increased more than 50 per cent.

Leading obstetricians yesterday gave warning that the rise was likely to be replicated in "similar societies" such as Britain, although comprehensive data has yet to be collated. They said that the trend carried serious implications for the NHS with chronic illnesses such as diabetes, high blood pressure and heart disease linked to early deliveries. Pre-term babies are also at greater risk of developing severe mental and physical disabilities. A quarter of babies born after 25 weeks or less have such problems, and a high number of children born at 32 weeks have educational and behavioural problems by the age of 7. Although premature deliveries account for fewer than 1 in 10 births, they result in 75 per cent of neonatal deaths and most neonatal intensive care admissions.

Writing in an editorial accompanying the Danish study, published this week in the British Medical Journal, doctors said that it was essential that the exact causes of the growth were investigated. Andrew Shennan, Professor of Obstetrics at King's College London School of Medicine, at St Thomas's Hospital, said that the growing number of women deciding to postpone having children and increasing female obesity were "good candidates" to explain the trends. More accurate ultrasound dating of conceptions might also play a role, he added. "We know about the problems encountered with severely premature births, but I worry about the more subtle things that are clearly happening to a much larger number of babies, such as educational problems and chronic conditions like diabetes and hypertension," Professor Shennan said. "If you want really to address the big health problems affecting society, this is where to start."

Professor Shennan and his co-author, Susan Bewley, concluded that if the findings from Denmark were accurate the implications for neonatologists, health economists, teachers, parents, and children were worrying. "Premature babies are at great risk of death and disability, and the total health burden to the population will not change unless the number can be reduced," he said.

The Danish study included four national birth registries of 646,000 deliveries - almost all live births - in Denmark between 1995 and 2004. The authors said that the prevalence of several premature birth risk factors - IVF, high maternal age, first-time mothers and elective early deliveries - have changed in recent years and may explain the increases in pre-term deliveries.

Concerns have been raised by many gynaecologists and obstetricians about the health impacts of the rapid rise of career women becoming pregnant later in life. Fertility problems increase after 35, and greatly so for women over 40. According to the Office for National Statistics, the over-35s have the fastest-growing birthrates. Women having babies in their forties have nearly doubled in ten years. The number in their thirties is up by two thirds and outstrips those in their twenties. Charlotte Davies, of the baby charity Tommy's, said that research was urgently needed. "If this increase continues, and is extrapolated to the UK, then it's very concerning and means that we need, more than ever, to work out exactly why it's happening and bring in preventive measures."

Source



A truly insane public medicine system

It has spent $2 million to sort out a $300 matter. It shows how nasty and irresponsible bureaucrats can be



A $300 overtime claim by ambulance staff has led to a five-year, $2 million legal and wages bill -- paid for by Queensland taxpayers. And the wrangling between Queensland Ambulance Service management and the officers could go on for at least another year.

The saga started in 2001 and has seen four separate investigations, numerous court cases and staff suspended on full pay pending decisions. The wages bill alone for three staff suspended on full pay for three years and eight months was between $600,000 and $800,000. A source said the QAS legal bill had topped $1 million "a long time ago" and that the State Government spent hundreds of thousands of dollars flying relieving staff into Mount Isa and Doomadgee to cover the suspended officers.

The Industrial Relations Commission will soon hand down a finding in relation to a paramedic claiming unfair dismissal for his part in the overtime claim. Ken Gramm, 52, a decorated ambulance officer, was fired last year for allegedly falsifying records. Mr Gramm strenuously denied all allegations. He was suspended on full pay of $85,000 a year in February 2002. A Mount Isa magistrate ruled there was no evidence of dishonesty, and the Crime and Misconduct Commission also found no case to answer. But Ambulance Commissioner Jim Higgins ordered another internal investigation, and Mr Gramm was found guilty on five of 14 counts relating to overtime claims involving just over $300. Sources said the QAS rejected an early offer by Mr Gramm to repay the disputed amount.

Another court case begins on April 24, when a former communications operator takes on WorkCover after it refused a medical payout following his sacking from the QAS. Greg Haddow, 43, was also suspended on full pay in 2002 amid claims he helped Mr Gramm falsify the overtime. Mr Haddow -- who denied any wrongdoing -- was also cleared by the courts, the CMC and an internal investigation. But sources said QAS bosses "medically terminated" Mr Haddow last year after he had been on stress leave and Workcover refused a payout. Mr Haddow appealed against that decision, and his case is due to be heard in Townsville Magistrates Court.

The only officer who admitted a role in falsifying overtime claims was not sacked -- he has been promoted. He also had been suspended on full pay. QAS declined to comment, as Mr Gramm and Mr Haddow's cases are before the courts.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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21 April, 2006

BRITISH HOSPITALS HURT INFERTILE WOMEN

Hundreds of infertile women could be spared the most distressing side effects of IVF by a drug regime too rarely used in Britain, a leading specialist said yesterday. Newer fertility drugs that act quickly without triggering menopausal symptoms can be as effective as standard therapies but are offered by only one in twenty British clinics, according to Bill Ledger, Professor of Obstetrics and Gynaecology at the University of Sheffield.

Gonadotrophin-releasing hormone (GnRH) antagonists were developed in the 1990s and are used in 80 per cent of IVF cycles in Scandinavian countries. They halve the length of a cycle and avoid side effects of hormonal drugs such as hot flushes, night sweats, mood swings and insomnia. They also significantly lower the risk of ovarian hyperstimulation syndrome, the most dangerous complication of IVF apart from multiple births.

Despite these advantages, GnRH antagonists are unpopular with British fertility doctors, who consider that they slightly reduce the chances of a successful pregnancy compared with traditional long-protocol IVF drugs. Professor Ledger said that many clinics were too frightened of falling in the success-rate league tables. Early clinical trials of GnRH antagonists found that they produced an average of 1.0 to 2.3 fewer eggs and 0.2 to 0.5 fewer good-quality embryos in each cycle. Pregnancy rates were slightly lower, but not statistically significant. Professor Ledger said the studies took place before most doctors had experience of the new drugs.

Success rates in clinics that regularly use GnRH antagonists are now comparable to those using older drugs. The one trial that examined clinics experienced in the new regime had found no appreciable difference in pregnancy rates. "The uptake of these drugs has been slower because of the conservative nature of IVF in Britain," he said. "Clinics are terrified of a drop of a few points in their success rates if they switch."

IVF involves stimulating ovaries to over-produce eggs, so that a dozen or so can be harvested and fertilised at the same time. For this to happen, it is necessary first to stop the normal menstrual cycle using drugs that block the action of GnRH, traditionally done with a class called GnRH agonists. These drugs stimulate a flare in hormone levels before they fall, and must be given for two to three weeks before the ovaries can be stimulated and egg collection can begin. This long period is responsible for the menopausal symptoms.

GnRH antagonists work differently, neutralising the hormone's action completely so that the pituitary gland cannot respond. There is no hormone spike and a cycle is "downregulated" much more quickly. This means that GnRH antagonists can be given six days after a woman has started taking drugs to stimulate her ovaries. Treatment continues only for the critical period in which downregulation is essential, about five days, and does not continue for long enough to cause side effects.

Source



If Medicare Were a Country

Most health care reform proposals assume that it is the private health care system that needs fixing. However, over the past 25 years, government spending on health care has been increasing at a faster rate than private spending on health care. Medicare accounts for more than 15 percent of health care spending in the United States. Fiscal projections for the middle of this century show that the looming cost of Medicare is by far the biggest problem for the federal budget. And yet, in too many discussions of health care reform, Medicare is ignored.

The implicit assumption is that policy changes are required in other parts of the health care system, but Medicare ought to be left alone. That may be comfortable politically, but simple arithmetic will show that it is not realistic if we wish to rein in health care spending. We are not going to achieve meaningful progress in curbing health care spending without touching Medicare.

In 2004, health care spending in the United States totaled $1.9 trillion, an average of $6,280 per person. Many observers put this figure in perspective by using other countries as a benchmark. For example, in 2003, health care spending in France was only $2,900per person.

Along these lines, the table below treats Medicare as a country, and compares its budget to the health care budget of France. In the table, health care spending in France is multiplied by the ratio of population in the United States to the population in France. This provides an estimate of what France would spend if its population were 300 million people, as in the U.S.

France:* 900 ($ billion)
United States: 1,900
Medicare: 300
Non-Medicare: 1,600

*scaled up by the ratio of population in the United States to the population in France [Sources: for France, OECD Health Data 2005; for U.S., Centers for Medicare and Medicaid Services, press release Jan. 10, 2006 and author calculations]

This division between the countries of Medicare and non-Medicare provides some perspective on the limitations of health care reform if we leave Medicare alone. For example, suppose that the goal of health care reform is to reduce our health care budget to the level that would prevail if our per capita health care spending were the same as in France. That would mean our total health care budget would be $900 billion. If we leave Medicare at $300 billion, our non-Medicare spending would have to be cut from $1600 billion to $600 billion, a 67 percent reduction. This little exercise in arithmetic brings out some important truths:

1. Although other countries use single-payer health care systems and those countries have lower per capita health care expenditures, a single-payer system in the United States would not necessarily reduce our health care expenditures.

The country of Medicare already is a single-payer system, and yet it is part of the problem of extravagant U.S. health care spending, not part of the solution. Indeed, Medicare expenditures on Americans age 65 and over exceed France's expenditures on that age group by the same ratio that spending on Americans under age 65 (which is predominantly privately financed) exceeds spending on the non-elderly in France.

2. Whether we attempt to move toward a market solution or a government solution, if the goal of health care reform is to put our nation's health care spending on a diet, seniors will have to participate in the reduction program.

Many people claim that the American health care system wastes money compared with other countries' health care systems. However, what this exercise shows is that waste in the American health care system is not confined to that part of health spending that is privately financed. Resources are not managed any better under Medicare than under private health insurance. Proponents of health care reform must face that reality.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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20 April, 2006

CHEAP MEDICATIONS ONLY FOR NHS PATIENTS

A row over a “breakthrough” treatment for diabetes broke out yesterday as it was rejected for NHS use by the Government’s drug watchdog on the grounds that it was not cost effective. The new product, insulin that is inhaled, could transform the lives of sufferers, who have to inject insulin up to five times a day. However, it costs about £500 a year more per patient. This latest example of “drug rationing” came as Tony Blair insisted that the NHS was not facing disaster despite thousands of job losses and cutbacks in expensive treatments as a result of a financial squeeze. Mr Blair also defended soaring pay rises for doctors that will see some earn more than £250,000 this year. The Prime Minister admitted that the NHS was at a “crunch point” but insisted he was still on course for an historic “end to traditional waiting” by 2008.

About 800,000 people in Britain use insulin injections to control symptoms of diabetes, a disease that can have very serious effects. Health experts are giving warning of an explosion in type 2 diabetes of 10 per cent of cases a year as the population becomes fatter and takes less exercise. Inhaled insulin has been heralded as the greatest potential advance in treatment for 80 years. Simon O’Neill, director of care and policy at Diabetes UK, said: “The Government has put patient choice on the NHS agenda. Diabetes UK is disappointed that the guidance on inhaled insulin does not reflect this as we believe it could offer an alternative treatment in improving the lives of some people with diabetes. “We believe that new treatments should not be restricted because of costs and greater emphasis should be placed on patient choices and preferences.”

The draft guidance, from the National Institute for Health and Clinical Excellence (NICE) was “perverse and short-sighted”, said Pfizer, the drug company that markets Exubera, the first form of insulin that can be inhaled rather than injected. “NICE must not be allowed to undermine clinicians’ ability to work with their patients to improve management of this debilitating long-term condition,” it said.

Diabetes UK also urged NICE to reconsider the guidance, which is now up for consultation before a final decision is taken. “This is a medical breakthrough and it is the potential first step to improving the lives of some people with diabetes,” the charity said. “It will be unfortunate if people in England have limited access while it becomes available in other countries.”

Ever since the 1920s, diabetic patients have had to inject themselves with insulin, sometimes as often as five times a day, to control the disease. Exubera represents an alternative approach in which insulin in a fine, dry powder form is taken from an inhaler. Pfizer argues that its trials show inhaled insulin to be as effective as injected insulin, and that many people who are developing diabetes are too slow to acknowledge and control it. They do not want to start injecting insulin, but are willing to start inhaling it. “The choice here is quite simple,” Pfizer said. “Force patients to keep enduring the burden of multiple daily injections, or give them an alternative. In a clinical trial, three times as many patients chose to start on insulin therapy when the inhaled option was made available.”

Kate Lloyd, Medical Director of Pfizer UK, said: “This is a terrible decision. It could deprive clinicians of the opportunity to benefit patients by starting insulin much earlier and cutting future costs of diabetes and its complications including heart disease, amputation, blindness and kidney failure. “NICE has rejected Exubera on the grounds of cost-effectiveness. But if people aren’t willing to inject, injected insulin can’t be cost-effective either. “They accept that inhaled insulin might be effective for some patients, but say it is difficult to identify them. We find that desperately concerning. NICE takes the view that because they can’t identify suitable patients, nobody else can.”

In its draft guidance, NICE says that using injected insulin is “not usually a concern for the majority of people with diabetes, given the availability of patient support and education, modern small needle types and insulin pens.” It adds that inhaled insulin would not fully replace the injected form and that people would still need to use needles for measuring glucose levels in the blood. It accepts that inhaled insulin is as effective as the injected form, and says it would cost just over £1,100 per patient per year, about twice the average cost of injected insulin. Patients might prefer it, but patient preferences were only relevant if they translated into real health benefits. The fact that patients who need insulin are more likely to take it if they can get inhalers “is insufficient to provide support for a cost-effective use of this therapy”.

Source



Canada's Socialized Health Care Is Not the Model to Follow

American politicians on the stump are fond of citing Canada's socialized health care system as a superior alternative to the mixture of public and private health spending in the United States. Such rhetoric may attract votes, but we Canadians, trapped in a broken and deteriorating system, have reasons to disagree. In 1967, when Canada adopted the British socialist model, our country was near the top of international rankings for the effectiveness of our medical spending. The U.N.'s World Health Organization now places Canada about 30th on that list.

Vancouver's Fraser Institute recently released a comprehensive study that measured Canadian Medicare's performance. Called How Good Is Canadian Health Care? An International Comparison of Health Care Systems, the report included only countries that have publicly funded systems with universal access. It excluded the United States and Mexico, which do not.

Of the countries in the Organisation for Economic Cooperation and Development, only Iceland spends more on an age-adjusted basis than Canada does on health care. No other countries follow Canada's model of monopolistic public provision of health insurance. Canada is the only OECD country that outlaws privately funded purchases of basic medical services.

* With respect to hard indicators of performance, Canada's record is alarming for a prosperous country:

* How many doctors per capita does Canada have? We rank 16th out of 23 OECD countries.

* What about access to high-tech diagnostic tools? We rank 15th for MRIs, 17th for CT scanners and eighth for radiation machines. We are tied for last for lithotripters (devices that destroy stones in the urinary system).

* What percentage of our total life expectancy will we live free of disability? We rank 14th.

* What are the rates for infant and perinatal mortality? We rank 16th and 12th.

* What about potential years of life lost to disease? We rank ninth.

* What is our incidence of breast cancer mortality? We rank sixth.

By only one measure is Canada's performance commensurate with its rate of spending: It has the lowest incidence of mortality from colorectal cancer per dollar spent. Ultimately, the researchers conclude that the Canadian health care model is inferior: "It produces inferior age-adjusted access to physicians and technology, produces longer waiting times, is less successful in preventing deaths from preventable causes and costs more than any of the other systems that have comparable objectives."

The problem is progressive. For 13 years, Fraser has been tracking waiting lists for common medical procedures. Its latest findings indicate that waiting times for surgical and other therapeutic treatments in Canada increased in 2003: "Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, rose from 16.5 weeks in 2001-02 to 17.7 weeks in 2003."

The structure of Canada's system is dictated by the federal government, but most health services are delivered by the provinces. Waiting lists and spending levels therefore vary quite widely from province to province. Manitoba spends 12 percent more per capita than the Canadian average. Despite significantly higher spending levels, comparative data on the current state of hospital crowding, waiting lists, delays and denials of medical procedures indicate no significant difference in health care outcomes.

Although the average wait in Manitoba for a primary joint replacement is about nine months, many of the top surgeons have patients who wait for two years, according to the Winnipeg Free Press: "The longer they wait, the more trouble they have, partly because they are in worse condition when they have the surgery."

This dynamic is the unmeasur-able cost of Canada's socialized health care. Because timely treatment is routinely denied, people cannot work or lead normal lives. The costs in lost production - never mind the losses due to pain and suffering - are difficult to quantify. Economists have calculated the cost of adverse consequences for cardiac patients waiting for surgery. They broadly estimated it at from $1,100 to $5,600 annually per patient.

When you consider last year's average of 17.7 weeks of waiting for all treatments, the staggering hidden price Canadians pay for socialized medicine becomes clearer. This does not include the people who die while waiting for bypasses, radiation or chemotherapy, or because treatment was started too late.

When the results are considered, it is hard to understand why anyone would advocate the Canadian model. Americans should be more cautious when they extol its virtues. You may get what you ask for.

Source. The full Fraser Inst. report is here (Big PDF).

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************



19 April, 2006

CHILDREN HIT BY NHS COST-CUTTING

Four children's hospitals have warned ministers that they face large deficits and cuts in services as a result of the latest NHS reforms. The chief executives of Great Ormond Street Hospital for Children in London, Alder Hey in Liverpool and Sheffield and Birmingham Children's Hospitals say in a letter that the operation of the tariff - the list of fixed prices for NHS procedures - will leave them about 22 million pounds a year worse off.

The tariff is a key feature of payment by results, one of the NHS reforms the Prime Minister is expected to extol in a speech today. Payment by results means that hospitals are paid for what they do, according to the fixed prices laid down in the tariff. Specialist hospitals have long argued that the tariff is insufficiently sophisticated to take account of the greater complexity of the operations and other procedures they carry out.

There have been discussions about adding special supplements to the tariff for children's hospitals to try to reduce the losses, but in a letter sent to Lord Warner, the Health Minister, and Sir Ian Carruthers, acting chief executive of the NHS, the hospitals say that this has not been done in the latest version of the tariff. Based on calculations that they have made so far, Great Ormond Street expects to lose 5.93 million in 2006-07, Alder Hey 11.03 million, Sheffield 2.5 million, and Birmingham Children's Hospital at least 2.6 million - a total of 22 million. These forecasts "pose fundamental problems for business continuity and access to specialist services", the letter says. "It has been clear to us for some time that these problems are largely the result of an inaccurate and highly insensitive tariff."

To make ends meet, the hospitals say, they will have to identify those services on which they stand to lose most money and stop providing them. Obvious candidates include heart, brain and spinal surgery. "We are extremely concerned that vital specialist paediatric capacity, particularly in surgical specialties, will be lost at regional and national levels this year, which will lead to public concern," the letter says. "The new opportunities presented by choice and through payment by results should be benefiting children and young people, but quite the opposite seems to be the case."

Steve Webb, the Liberal Democrat health spokesman, said: "The whole process of NHS reform is being conducted at breakneck speed, simply in order to guarantee the Prime Minister a `legacy'. "On present form, the Prime Minister's legacy risks being a decimated NHS, thrown into chaos by over-hasty reform and permanent revolution."

The letter could not have come to light at a worse moment for the Prime Minister. In his speech today to the New Health Network, Mr Blair will herald the new tariff system as central to the government health reforms as he attempts to shift the focus away from the financial deficits that have forced hospitals to cancel operations and make redundancies. He will claim that his structural changes to the NHS have reached "crunch point" and will vow not to back down.

The first phase of Labour's health reforms, in which ministers used strong central targets to improve services and bring down waiting lists, is complete, he will say. The Government is now embarking on the second stage in which the idea of an old monolithic NHS will be abandoned and replaced with one that is more decentralised.

Source



Australian public health officials 'unreceptive' to superbug concern

Federal health authorities have been "unreceptive" to concerns about an evolving epidemic of new strains of golden staph, a senior public health official says.

Dr Keryn Christiansen, of Royal Perth Hospital (RPH), says community acquired methicillan resistant staphylococcus aureus, or CA-MRSA, is increasing for unknown reasons in some parts of Australia and particularly Western Australia. Dr Christiansen and co-authors of a study published in this month's Australian Medical Journal, surveyed 2,600 golden staph isolates (germs) collected from around Australia. Nationally, the appearance of the CA-MRSA strain rose from 4.7 per cent to 7.3 per cent of the sample, compared with similar surveys in 2000 and 2002. WA had a quarter of all national cases of CA-MRSA, between July 2004 and February 2005. The article refers to the issue as an "evolving epidemic".

But Dr Christiansen, head of microbiology and infectious diseases at RPH, says she has had trouble drawing the issue to the attention of federal authorities. "Unfortunately we've been unable to engage the federal government in this," she told AAP. "They've got other things on their agenda like pandemic flu and bio-terrorism and they're really putting a lot of money into that and not looking at this."

Methicillin-resistant Staphylococcus (MRSA), or Golden Staph, has long plagued hospital patients but other virulent related strains are now infecting people who have had no hospital contact. "In the past when we've seen the resistant strains, we've seen them in hospitals and they've been resistant to many, many antibiotics," said Dr Christiansen. "What we're seeing now is something completely different. "These patients have had no contact with hospitals, have never acquired these organisms from hospital contact and when you look at the organism genetically, they are quite distinct from the hospital variety. "Our other concern is that some of these strains contain a toxin called Panton-Valentine leukocidin (PVL), and this toxin actually breaks down white blood cells."

Dr Christiansen said they were not sure why the number of cases in WA was so high, but the state had a rigorous reporting process, not in place in other states and territories. "Every single MRSA that's isolated in this state is notified and we collect at my lab - we actually get the organism and we test it," she said. "We're not really sure why they should be so high ... we've got a few studies going to try and look at reasons for our high rates. "Our concern is that it is becoming more and more resistant and therefore will be difficult to treat," Dr Christiansen said.

Symptoms of community-acquired MRSA could be sores that turned into large abscesses or carbuncles, or wound infections that did not respond to treatment. A federal department of health spokeswoman said the department had met Dr Christiansen and there was ongoing discussion with expert committees on the best way to address community-acquired infections

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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18 April, 2006

SECRECY IN CALIFORNIA PUBLIC HOSPITALS

In a little more than a year, four patients have died at hospitals in Santa Clara County alone due to medical errors that could have been prevented, according to state Sen. Elaine Alquist's office. Not that anyone would know. California doesn't have an easy system for providing public information about hospital safety records. To check the records, residents must go to a state office and look through paper files. Meanwhile, state inspectors charged with enforcing safety regulations visit hospitals only once every three years.

Alquist, D-Santa Clara, says public accountability at hospitals needs to improve. She has introduced SB 1301, which would require hospitals to start reporting medical errors - such as giving a patient the wrong medication - directly to the state Department of Health Services within 48 hours after they occur. It would require the state to put the information on a public Web site. And it would require state inspectors to monitor hospitals annually. The bill would also shorten the time the state has to respond to complaints about hospital care. Right now, inspectors have six months to follow up on a complaint. Alquist wants to reduce that to 45 days.

There's been a lot of public scrutiny of whether the state does a good enough job monitoring nursing homes and non-medical facilities such as child-care centers and homes for the elderly. Now, Alquist says, it's time to focus on acute care. "My goal is not to castigate anyone," Alquist said. "My goal is simply to see that hospitals are a safe place for sick people. ... We have a lot of good people who work in hospitals who are trying to do their best, but sometimes the systems have broken down." Citing various medical studies, Alquist's office estimates that there are an average of five to 10 fatalities due to mistakes at each hospital every year. The California Hospital Association opposes the bill, but not the idea of increased public awareness.

The group, a membership organization of hospitals throughout California, would support the measure if the public data were not hospital-specific and if it could not be used as evidence in a lawsuit, said Debby Rogers, vice president for quality and patient safety at the organization. "We want to create an environment where people are willing to talk about their mistakes," she said. "There may be some that would see posting the outcomes on the Internet as not necessarily the environment we want to create." Rogers said the hospital association and other groups are already working to improve public information about hospitals - and to improve hospitals' awareness of how to prevent mistakes. "The more we look at issues, the better we can get at identifying them," she said. "We're catching things we may not have caught five years ago."

The Schwarzenegger administration has not taken an official position on the bill, said Lea Brooks, a spokeswoman for the Department of Health Services. But the administration is in the midst of improving inspections of health facilities, and has included funds to hire more than 100 inspectors for hospitals and nursing homes in the proposed budget for next year, Brooks said. The ultimate goal, Alquist said, is to reduce errors. "The public believes they are safe in hospitals," she said. "And I want them to be safe."

Source



FEDS CRIMP MASSACHUSETTS AIM TO GIVE FREE CARE TO ILLEGALS

Under a provision of the Deficit Reduction Act of 2005, as of July 1 all US citizens who sign up for Medicaid or renew their benefits will have to provide documentation of their citizenship. Eligibility rules for legal immigrants have not changed. Almost all of the state's poorest residents will have to show proof of US citizenship to continue getting medical care by July 1, under a little-noticed federal law that could endanger coverage for many, as Massachusetts is trying to expand access to healthcare.

Born out of ongoing efforts in Washington to clamp down on illegal immigration, the new federal requirement compels anyone seeking Medicaid coverage to provide a birth certificate, a passport, or another form of identification in order to sign up for benefits or renew them. No such proof is required now. The requirement was tucked into the Deficit Reduction Act of 2005, which President Bush signed into law earlier this year

The measure was part of an effort to limit the skyrocketing growth of federal entitlement programs. It has surfaced as Massachusetts begins to implement its sweeping healthcare plan, which aims to bring health coverage to almost all of the state's uninsured, in part by enrolling those in Medicaid who are eligible but who have not signed up.

Healthcare specialists voiced fear that because many Medicaid recipients -- including the homeless and the mentally disabled -- won't be able to easily produce documentation of their citizenship, they will have difficultly receiving care at community health centers, hospitals, or anywhere else. ''So we've got people in nursing homes, people in the [state Department of Mental Retardation] institutions, we've got the homeless, we've got the . . . mentally ill who now will have to come up with some verification to prove that they're citizens," said Victoria Pulos, health law attorney at the Massachusetts Law Reform Institute. ''It's ironic that this is happening in the state where part of the health reform plan is to make sure that everyone who's eligible for Medicaid is enrolled."

The new federal requirement, which all states have to comply with, would apply to the vast majority of the more than 1 million people on MassHealth, the Massachusetts Medicaid program. The intent is to prevent undocumented immigrants from posing as citizens and taking advantage of taxpayer-funded healthcare benefits that are afforded only to legal residents. (Under federal law, undocumented immigrants can receive only emergency Medicaid care; Massachusetts has 40,000 on such a program, which is called MassHealth Limited.) Less than three months before the new citizenship requirement takes effect, though, Massachusetts and other states are waiting for guidance from the federal government on how it will work

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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17 April, 2006

ANOTHER CRITIQUE OF THE MASSACHUSETTS INNOVATIONS

Initially I was inclined to give Governor Mitt Romney the benefit of the doubt. In a scramble to have a major accomplishment he could tout in his run for the White House, he agreed to a bad piece of legislation that is supposed to reform health care in Massachusetts. But after reading his op-ed in the Wall Street Journal Tuesday, I'm feeling a lot less charitable. Instead of trying to play up some of its arguably market-based components, Romney spins it in a manner worthy of Bill Clinton.

Romney claims that his health care reform "will need no new taxes, no employer mandate and no government takeover [of health care]." The "no employer mandate" is a sop to those conservatives who opposed the now infamous Wal-Mart Law in Maryland. And now that Romney has item-vetoed the $295 penalty that a business must pay for each employee it doesn't insure, it is technically true that there is no employer mandate. It's also irrelevant, because the reform mandates that all individuals must purchase health insurance. For Romney to acclaim the lack of an employer mandate is like being in an area flooded by a river and hyping the fact that it wasn't hit by a tsunami.

Romney puts the best face on the individual mandate by claiming it is based on the "personal responsibility principle." Yet forcing individuals to make the right decision flies in the face of personal responsibility. Personal responsibility once meant that individuals were free to choose, but would suffer the consequences of choosing poorly. If an individual decided to forego health insurance and then got sick, he would be responsible for the cost. But in health care, as in so many areas these days, government shields individuals from such consequences by picking up the tab for uncompensated care. Thus, it should come as little surprise that policymakers feel they should have the power to compel people to buy insurance.

Yet Romney engages in some sleight of hand by suggesting that residents of Massachusetts still have a choice: "I proposed that everyone must either purchase a product of their choice or demonstrate that they can pay for their own health care" [emphasis added]. That implies that if a resident can show that he has enough money to cover major medical expenses, he is off the hook. The new law states otherwise. If a person does not show on his tax return that he has health insurance, then "the tax shall be computed on the return without benefit of the personal exemption." In other words, he must either buy insurance or face a tax penalty.

That provision also makes dubious Romney's claim that this reform was enacted with "no new taxes." So does the provision that imposes new taxes on services provided by acute care hospitals and ambulatory surgery centers to help fund something called the Health Safety Net Trust Fund. Perhaps those don't count as taxes since the law refers to them as "surcharges."

Equally hard to digest is his statement that the reform is not a "government takeover" of health care. If it's not a takeover, it is certainly a big expansion of government into health care. The reform creates 11 new councils, boards, commissions and bureaus. One of the new boards, the MassHealth Payment Policy Advisory Board, yields a sense of how much Romney gave away to the liberals in the state legislature. It must include a member appointed by the Planned Parenthood League of Massachusetts.

The law's creation of the Health Care Quality and Cost Council makes clear that it is state government, not the market, that will be steering the health care boat. The law states that the "council shall establish health care quality improvement and cost containment goals. The goals shall be designed to promote high-quality, safe, effective, timely, efficient, equitable and patient-centered health care." To track those goals, the Council can force insurers and health care providers to submit data to the Council. Those that fail to do so "may be required to pay a penalty of $1,000 for each week of delay" up to a maximum of $50,000. Furthermore, the Council will be able to micromanage the enactment of those goals:

The council shall develop and coordinate the implementation of health care quality improvement goals that are intended to lower or contain the growth in health care costs while improving the quality of care, including reductions in racial and ethnic health disparities. For each such goal, the council shall identify the steps needed to achieve the goal; estimate the cost of implementation; project the anticipated short-term or long-term financial savings achievable to the health care industry and the commonwealth, and estimate the expected improvements in the health status of health care consumers in the commonwealth.

Who said social engineering was dead? Perhaps the worst feature of this law is the likelihood it will create a constituency for single-payer health care. The law subsidizes health insurance costs, on a sliding scale, for the working poor not eligible for Medicaid. But now that all residents of Massachusetts are forced to buy insurance, it seems likely many will think, "If the government is requiring me to purchase insurance, why shouldn't it subsidize me as well?" Such sentiment could lead to even greater government subsidy of health insurance. As government pays more of the cost, it inevitably leads to greater regulation. Greater regulation will lead to higher insurance costs. Higher costs will lead to even more calls for subsidy. If that vicious circle goes around enough times, Massachusetts may be the first state to have taxpayers fully fund health insurance.

Less freedom, higher taxes, more bureaucracy: Romney's reform moves Massachusetts further down the road toward HillaryCare. If conservatives don't want it repeated on the national level, they should cast a skeptical eye toward the Bay State governor as 2008 approaches.

Source



A Health bureaucracy strikes back

A doctor who two years ago blew the whistle on unsafe medical services at a country hospital - prompting a review and sweeping changes - now claims he is being victimised by the health authorities. "Everywhere I go in the system now, I am victimised," said Kadina GP Dr Piet du Toit this week.

The claims are listed in a notice of complaint to the Equal Opportunity Tribunal, dated March 31. It lists concerns he raised between October 2003 and August 2004 about Wudinna Hospital on the West Coast, including;

* OVERDOSES of medication

* DEFICIENT obstetric services that compromised patient health and safety.

* INAPPROPRIATE prescription of large doses of antibiotics, failure to provide midwifery support, failure to obtain adequate specimen and provide appropriate blood results, with such failures compromising the health of patients.

* NURSING staff deficient in their knowledge of CPR and defibrillation.

Dr du Toit's concerns, which he claims in his notice of complaint were an "appropriate disclosure of public information" under the Whistleblowers Protection Act, led to a clinical review of conditions at the hospital.

The review found, among a series of deficiencies, that medical and nursing care did not meet contemporary standards and that "improvements were required in areas of patient management systems".

But 2 1/2 years after Dr du Toit first raised the alarm, his statement to the Equal Opportunity Tribunal alleges he was threatened with the sack and deportation to his native South Africa. He alleges the actions "amounted to an act of victimisation within the meaning of the Whistleblowers Protection Act."

Dr du Toit had arrived in SA in 2001 under a temporary visa. In 2002, the Mid-West Health Service became the sponsor for the visa and it employed him under contract in May, 2003. After detailing his complaints in writing between October 2003 and August 2004, Dr du Toit resigned from the service on November 8, 2004 - sparking a petition from 543 residents for his return and a clinical review of the situation at Wudinna Hospital. He now works as a GP at the Kadina Medical Centre.

In his statement to the Equal Opportunity Tribunal, he states the then chairman of Eyre Regional Health Services, Terry Mullan, and fellow director Gary Stewart had concerns about his ongoing complaints concerning Wudinna Hospital. "Stewart threatened to terminate (my) contract of employment," his statement states. "Further, Stewart said . . .'if I advise the board to terminate the arrangements with you, you are out of here. You are back to South Africa . . . they're currently your sponsor and you have 28 days to leave the country under the current (arrangements)'."

Dr du Toit's claim alleges the period of victimisation caused him to suffer denigration and humiliation, causing him to resign.

The clinical review, conducted in 2004 and released in November last year, confirmed most of Dr du Toit's concerns. It listed 13 recommendations to overcome the problems, and noted: "It is imperative that urgent attention was given to this matter to ensure that further deterioration did not occur."

Health Minister John Hill referred Sunday Mail inquiries to Eyre Regional Health Service general manager Tom Neilson. He said that recommendations from the review "have all been implemented and the situation at Wudinna is positive".

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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16 April, 2006

NHS STILL GOING ROUND IN CIRCLES

Plenty of huffing and puffing but nobody has got a blind clue how to fix it. One day they may realize that it is unfixable and that privatizing it all is the only solution

The time for excuses is past, the Health Secretary told the NHS yesterday. Failure to tackle long-standing problems was no longer an option, Patricia Hewitt declared after a seminar at No 10 chaired by the Prime Minister. The Government, rocked by the large deficits run up by some NHS trusts despite a doubling of NHS spending, is struggling to retain credibility. Yesterday it organised a carefully staged event at which some of those responsible admitted errors and promised to do better.

No magic elixirs emerged. Sir Ian Carruthers, the acting chief executive, rehearsed money-saving strategies familiar to a generation of NHS managers - more day surgery, quicker discharges, better use of operating theatres, reducing admissions from accident and emergency departments and cutting agency costs - while Tony Blair nodded sagely.

The "narrative" remains that the bulk of the NHS is in balance and relatively few trusts are responsible for most of the deficits. But nobody explained why an NHS harried by targets and with managers lurking on every corridor had been unable to implement basic changes of the type outlined by Sir Ian.

Mr Blair concluded the seminar by saying that retreating from the reform plans was not an option. "We have to hold our nerve and be confident that the changes will deliver a better service," he said. "We have a huge ambition: to end the process of waiting in the NHS. There is no way we are going to do it by the old way of working. If we back away, we are doing no favours to patients at all. It will be a challenging year, there's no doubt about that at all. But turnaround can be done and has to be done."

The seminar's participants came from organisations that had been in trouble but had recovery plans in place. Tom Taylor, chief executive of Shrewsbury and Telford Trust, said: "No change is not an answer. We could not carry on losing 10-12 million pounds in public expenditure every year." Duncan Newton, medical director of Bradford Teaching Hospitals NHS Foundation Trust, said that managers should talk to clinicians. "They know where the problems are," he said. "They've known about it for years. If it were industry, these problems would have been sorted out years ago." Anthony Sumara, chief executive of North Staffs NHS Trust, said: "You don't need to be a rocket scientist to see how to improve." But he offered no explanation of why such changes had not been made before.

The Department of Health announced approval of two new Private Finance Initiative contracts, at University Hospitals Birmingham Foundation Trust and St Helens and Knowsley Hospitals, worth more than œ1 billion. Ms Hewitt also announced a new structure of ten enlarged strategic health authorities, each covering a region in England. These bear a remarkable similarity to the regional offices of the NHS abolished in 2001.

Andrew Lansley, the Shadow Health Secretary, said that billions of pounds had been given to the NHS without increasing productivity. "It is clear that the meeting was cobbled together at the last minute in an attempt by Downing Street to get a grip after the Department of Health lost control over NHS finances," he said. "The NHS needs reform, which is what Blair and Brown promised years ago. But, even today, reforms are confused and inconsistent."

Gill Morgan, chief executive of the NHS Confederation, said: "We hope that today's announcement will signal the start of a proper debate about the challenges and opportunities that the service faces." Niall Dickson, the chief executive of the King's Fund think-tank, said that reorganising the strategic authorities was the right policy at the wrong time. "This reorganisation, the latest in a very long line, has simply thrown the NHS into even greater turmoil."

Source



Public hospital surgery up under political pressure

This shows what could have been happening all along if they had not been spending all the money on bureaucracy. The facilities and the staff were obviously available

Queensland's two largest hospitals performed a record amount of surgery last month, Health Minister Stephen Robertson said yesterday. Despite the news, Mr Robertson warned it might take some time for surgical waiting lists to significantly improve. Statistics released to The Courier-Mail show the Princess Alexandra Hospital operated on more patients in March than at any other time in its history. Additionally, the Royal Brisbane and Women's Hospital set a March record for surgery. More than 1700 patients were operated on at the PA Hospital in March, including 441 emergency cases and 1271 elective cases. "At no point in the history of the PA Hospital has so much surgery ever been performed in one month," Mr Robertson said. "The previous record was 1540 cases in February this year." The volume of patients was a marked increase from the six-month average of 1450 patients a month. Other figures released yesterday showed the RBH operated on more than 2000 patients last month, up from 1956 in March last year and 1664 in March 2004.

Mr Robertson said the surgical records were a result of additional funding for more beds and more doctors and nurses at both hospitals. While he expected surgical activity would increase further, Mr Robertson cautioned that surgery waiting lists may not return to normal for some time. "Over the next five years we will pour an additional $259.7 million into elective surgery and an extra $280.3 million into our emergency departments," he said. "However, we continue to face high demands for elective surgery and it may take some time before waiting lists return to a more acceptable level."

In the most recent waiting list report released in February this year, the number of people waiting more than 30 days for urgent category-one surgery in the last quarter of 2005 increased by more than 500 per cent compared to 2004. Also the number of people waiting more than 90 days for semi-urgent category-two operations increased by 281 per cent in the same period last year. The latest waiting list report is due in the next few weeks.

Coalition health spokesman Bruce Flegg described the data as "meaningless" and accused the Government of picking figures they could put a positive spin on to run an overt political agenda. He said the real reason for the increase in surgery was because emergency cases were being funnelled to the RBH and PA from struggling nearby emergency departments. "They haven't released the waiting list data, they haven't released the number of elective surgery operations across the state," he said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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15 April, 2006

NEGLIGENT BRITISH PUBLIC HOSPITAL SUCCESSFULLY SUED

They would be even more financially destroyed than they already are if all such cases were successfully sued. There should be more of it. The award is still only a fraction of what would have been obtained in the USA, however

A hospital trust was fined 100,000 pounds yesterday after it admitted failing to supervise doctors at a hospital where a man died after a routine operation. Sean Phillips, 31, died from toxic shock syndrome after a knee operation at Southampton General Hospital. Despite his high temperature, high pulse rate and low blood pressure, doctors left in charge of Mr Phillips failed to diagnose the condition or seek help after making eight assessments over two days in June 2000.

Mr Justice Cresswell, sitting at Winchester Crown Court yesterday, described the breach as an "extremely serious offence" that had resulted in a tragic and unnecessary death. He said that medical care was a "solemn duty" that the doctors, and the hospital, had failed to perform. "Common sense dictates that a reasonable standard of care must pertain seven days a week, fifty-two weeks a year," he said. "A fine, healthy and much loved person has died unnecessarily. Anyone listening to this matter can have nothing but the deepest sympathy for the family and friends of Sean Phillips." Southampton University Hospitals Trust was also ordered to pay 10,000 pounds in costs.

Amit Misra and Rajeev Srivastava, two senior house officers, were convicted of manslaughter by gross negligence at Winchester Crown Court in 2003. Both were sentenced to eighteen months in prison, suspended for two years. In a rare move, the Crown Prosecution Service then charged the trust. During the hearing this week the court was told that Mr Phillips was admitted to Southampton General Hospital to repair torn knee ligaments. The operation went well and he was expected to leave the next day but an infection set in and toxins built up in his body. Despite the clear indications of deteriorating health, Misra and Srivastava failed to diagnose the condition or seek help and advice from senior doctors even though they visited Mr Phillips eight times over two days.

The court was also told that in the days before Mr Phillips died there had been concerns about the competence of senior house officers in the trauma and orthopaedic department where Mr Phillips was being treated. On the day that he died a senior nurse had sent a report about the concerns, involving Misra in particular, to a consultant. Other senior doctors admitted that they had little direct contact with senior house officers and left it to senior registrars and nurses to deal with problems.

Hywel Jenkins, for the prosecution, said that if the hospital had organised daily visits by a registrar the chances of Mr Phillips's condition being missed would have been lessened. Richard Lissack, QC, said that the trust was not responsible for the death and that it had quickly set up an automated early-warning system to monitor patients' vital signs and trigger an automatic response. There had been a change in the training of senior house officers and improvements in communication, including thorough ward rounds or advice seven days a week by senior doctors. Mark Hackett, the chief executive of the trust, which overspent by 6 million pounds last year, said that it had not yet decided whether to appeal.

Source



The number of hospital jobs cut in the NHS could reach 24,000 according to a new analysis

Since the NHS has over a million employees, this does not mean much of itself. But it is care-deliverers who will be cut, not bureaucrats, so it will be noticeable

Job losses over the past month now exceed 6,000, after news of the 200 posts cut by York Hospitals NHS Trust. Yesterday it emerged that health chiefs at East Kent Hospitals NHS Trust had approved plans to cut 160 beds at five hospitals. A quarter of the trusts thought to have serious financial problems have announced job cuts so far.

The Liberal Democrats said last night that, on current trends, job losses could reach 24,000. Steve Webb, the Liberal Democrat health spokesman, said: "Every day brings further news of more job cuts which will undoubtedly affect frontline patient care. Staff morale and public confidence in the NHS will continue to crumble until ministers take action to reverse this trend. "Money is being wasted on a costly and damaging permanent revolution in the health service. Taxpayers' money is also being spent paying the private sector over the odds for treatments in order to hit waiting-list targets. Meanwhile, trusts are being forced to make short-term cuts to tackle problems that have built up over decades. "What is needed is long-term planning in the NHS, not a series of short-term initiatives and sudden policy shifts."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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14 April, 2006

LIFESAVING DRUGS CUT OFF FOR NEEDY BRITS

Patients will be denied access to drugs at the forefront of medical research after a landmark judgment on the breast cancer treatment Herceptin. The Court of Appeal ruled yesterday that it was illegal for health trusts to discriminate against patients by funding expensive unlicensed drugs case by case. The ruling means that trusts will now either have to agree to pay for a new drug for any patient whose doctor recommends it - with serious implications for NHS budgets - or refuse the treatment for the entire population it serves. Dozens of drugs that do not yet have a licence for certain uses - including treatments for life-threatening conditions - which are prescribed by doctors could be affected.

The decision came as Tony Blair and Patricia Hewitt, the Health Secretary, held an emergency meeting at No 10 to address concerns about spiralling health service deficits, which are expected to pass 800 million pounds for the past financial year.

The hearing at the Court of Appeal came after a lengthy legal battle between Ann Marie Rogers, a grandmother from Swindon, and her primary care trust (PCT). The PCT had decided not to pay for Mrs Rogers's treatment with Herceptin on the ground that she was not an exceptional case. Ruling in favour of Mrs Rogers, the court said that the trust's policy of judging patients case by case was "irrational and unlawful".

Health leaders last night gave warning of the unintended uncertainty that the judgment would create for future drug provision. Gill Morgan, chief executive of the NHS Confederation, representing more than 90 per cent of NHS organisations, said that the decision held "significant implications for the prescription of all unlicensed drugs - not just Herceptin".

Herceptin is licensed for treatment of women with advanced breast cancer but is unlicensed for treating early-stage sufferers. Swindon PCT had argued that Mrs Rogers, 54, was not an exceptional case deserving of a drug that had neither been licensed in Britain for her condition nor appraised for NHS use. Many of the 300 PCTs in England and Wales follow a similar policy.

Mrs Rogers, who has received Herceptin during her legal battle, will now be allowed to continue taking the drug while Swindon PCT addresses its policy. The trust's policy was to fund Herceptin without regard to financial considerations in cases in which it was prescribed by a clinician and it was decided that there were exceptional clinical or personal circumstances.

The Court of Appeal ruled that in considering what might be such an exceptional case, personal circumstances "are irrelevant as soon as financial considerations are disregarded". In a unanimous judgment, the Master of the Rolls, Sir Anthony Clarke, Lord Justice Brooke and Lord Justice Buxton said that the court could not - and should not - order the PCT to provide Herceptin.

Jan Stubbings, the chief executive of Swindon PCT, said that in terms of the law, it had a statutory requirement to balance its books. "The jury is still out, so we need to make sure we do not overhype Herceptin," she said. "It is one of many new treatments."

Research suggests that Herceptin, which has been shown to halve the chances of a tumour returning, would be highly beneficial for early-stage sufferers. It targets the HER-2 protein - which can fuel tumour growth - present in about a fifth of sufferers. However, it has been linked to heart problems and, at 20,000 pounds a year, is a severe drain on NHS budgets.

Outside court, Mrs Rogers, 54, said the "humanitarian" ruling had given her back her future. "I feel I've taken on the world and beaten it, not just for me but for everyone else."

Source



ANOTHER SQUINT AT MASSACHUSETTS AND TENNESSEE

Massachusetts will likely soon become the first state in the nation to force everyone living within its borders to buy health insurance or pay a tax for walking around uninsured. Gov. Romney says by signing such a mass mandate into law, he will achieve the Democrats' goal of universal health coverage on Republican market-oriented principles. Uh-huh.

After HillaryCare was defeated a decade ago, the fight for "universal care" moved to the states, where lawmakers are pushing for it piecemeal in two ways: broad new government mandates, and incentives for employers to cover more people. It's now clear which approach Mr. Romney favors as he considers running for the Republican presidential nomination in 2008.

If there is one redeeming value to his approach, it is that it starts with the presumption that even the poor should pay something for their health care. That's not a trivial point. Today many uninsured patients skip out on their bills and leave their health-care tabs for everyone else to pay in the form of bigger hospital bills and higher taxes.

And it's not a presumption many on the left have been willing to grant. Tennessee was hit hard with the exploding cost of health care after it expanded its Medicaid program in the 1990s to cover anyone in the state who couldn't afford or didn't qualify for health insurance (due to pre-existing conditions or other reasons). Initially the eligibility rules were so loose that some individuals earning $100,000 a year were able to sign up. Not surprisingly, within a few years TennCare was eating up a third of the state's budget and consuming almost all of the new tax revenue the growing economy was sending to the state treasury. Gov. Phil Bredesen, a Democrat, was elected in 2002 in part on a mandate to restrain TennCare and not to create an income tax to pay for it.

After taking office, he managed to remove tens of thousands of people from the rolls, but he soon realized that it was impossible to manage costs without also requiring nearly everyone to pay something for the care they received. Otherwise, as he told me, it's like shopping in a grocery store that doesn't have any price tags and where you don't have to pay the bill at the checkout counter. Requiring consumers to pay at least part of the bill is essential to striking a reasonable balance between consumption and total cost. That means copayments for drugs and doctor visits, deductibles, or other fees.

For pointing this out, Gov. Bredesen has been blasted by Sen. Ted Kennedy and other Democrats. Gov. Bredesen is now pushing his own new health-care program that's based on incentives. He wants the state to pay for a third of the cost of premiums for those who work for companies with fewer than 25 people. He estimates coverage would cost about $150 a month for insurance with reasonable deductibles, copays and other fees--leaving the state with a bill of $50 a person. He proposed his plan in recent weeks, says he'll consider it a success if it enrolls 100,000 people (the state has about 600,000 uninsured residents), and is making it a centerpiece of his re-election campaign.

What Tennessee and Massachusetts now have in common is that as lawmakers look for health insurance plans that are cheap enough for most people to afford, they're going to run headlong into the reality that buying health coverage is very expensive. The reason isn't just that health care across the country is expensive. It's also that health insurers are prohibited from offering coverage that pays for only catastrophic events, such as a serious injury or heart attack. Rules vary by state, but in most places insurers are forced to cover everything from routine checkups to chiropractic care. Remove these mandates, allow deductibles and "copays" to be raised high enough, and in an instant the price for some health plans would fall to about that of dinner out and a movie for two.

Tennessee's approach is to create a new government program that will likely claim more taxpayer dollars down the road, starting with new tobacco taxes. True, as one lawmaker put it recently, the governor isn't promising the "Cadillac" of health coverage. Instead lawmakers are starting from the assumption that the program will cost the state $50 a person and are shopping around to see what kind of coverage can be bought at that price. If in the process Tennessee removes the government controls that increase the cost of health coverage and opens the market for insurance aimed at low-income workers, the Volunteer State may yet become a laboratory for market-oriented health care policy.

But Massachusetts' Legislature is unlikely to remove the rules that push up the price of health insurance and is looking instead to cover the working poor the old-fashioned way, with government subsidies. In addition to making health insurance mandatory (taking away tax deductions for those who don't buy insurance), the legislation Gov. Romney is about to sign expands the state's Medicaid rolls, levies a $295 per-employee "fee" on businesses that don't offer health insurance, and sets up a government board to approve new health plans.

The rhetoric from the Bay State's governor notwithstanding, RomneyCare will turn out to be not only expensive but also a mandate for more government spending and more government intrusion.

Source



CANADA: SOCIALIZED MEDICINE IS GREAT FOR CANCER!

Michael Savage began having trouble swallowing in December. Under Canada's system of socialized medicine, the wait for an MRI - which detected the tumor - was six weeks. By then, the cancer had grown and spread to Savage's lymphatic system, and swallowing was almost impossible. The surgery involved removal of the tumor from the esophagus and heart, plus removal of one-third of his stomach.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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13 April, 2006

BRITAIN'S NHS IS SQUEEZING EVERY COST EXCEPT THE BUREAUCRACY

Tony Blair is to be told today that hospitals must make drastic cuts in spending on drugs and agency staff. Sir Ian Carruthers, the acting head of the NHS, will present his plan for reducing the estimated 750 million pound NHS deficit at a No 10 seminar. Sir Ian, who took over after Sir Nigel Crisp’s resignation, believes that there is considerable scope for cuts in the 10.3 billion pounds spent every year on drugs and the 1 billion on temporary staff. This will raise fears that some patients will not be given expensive treatments from which they could benefit.

Last year the Department of Health negotiated a cut of 7 per cent in the profits that drug companies can make from the NHS, but Sir Ian believes that too many hospitals still have a “misplaced brand loyalty”, which adds to costs. His review for the Prime Minister comes as a report predicts that NHS staff levels will fall by 100,000 as reforms bite. A smaller, more effective and flexible workforce should emerge, according to the market- orientated think-tank Reform. With young doctors emerging in ever greater numbers from medical schools, the report predicts “severe medical unemployment” and calls for a review of training plans. “There is little point in pulling more able young people into training with heavy costs when their employment chances are poor,” it says.

By 2004 the total NHS staff had risen to 1.33 million, an increase of 45,000 a year since 1999. As deficits hit hospitals, jobs are beginning to be shed — about 7,000 in the past few months — but new policies will accelerate the process, says the Reform team, led by Nick Bosanquet, Professor of Health Policy at Imperial College, London.

The costs of the expansion are one reason why the health service is being driven into deficit, the report says. Now the Government’s “highly welcome reform agenda” is likely to have widespread effects across the NHS. The reforms include payment by results, patient choice and the spread of foundation hospitals. The centralised “silo” mentality — pile up manpower regardless of cost or quality — will be replaced by more local initiatives. These could include an end to centralised contract negotiations, a key feature of recent NHS history.

Professor Bosanquet said yesterday that he expected the reforms to benefit staff as well as patients: they will gain from increased choice, higher morale and the satisfaction of working in smaller, more independent organisations; but he is concerned about job prospects for young doctors. Given the expansion in medical school places, the number of funded training posts needs to rise by 1,768 between 2004-05 and 2007-08. “Realistically this scenario is unlikely to be met as the funding situation worsens,” the report says. “New medical graduates are already facing serious obstacles to getting jobs. This pressure is likely to increase dramatically in the next few years as graduate numbers outweigh retirees massively and the financial situation of the NHS causes a dramatic slowing in recruitment and even a reduction in staffing numbers.”

So far most graduates do seem to be finding jobs. A survey for the General Medical Council found that only 2 per cent of those wanting to work as doctors were without jobs. There are still a few areas where the NHS is short of staff, including midwifery and radiography. Some parts of the country find it hard to recruit GPs, and mental health services find attracting staff of the right calibre difficult. The think-tank does not recommend that NHS staff should be paid off, but it says that this will inevitably happen if the Government’s current reforms are pursued.

Source



NHS: YOUR LUXURY CAR SUPPLIER (IF YOU ARE ON THE GRAVY TRAIN)

Senior health managers and consultants are being provided with luxury cars including Jaguars, Mercedes and even Porsches at a cost of millions to the National Health Service. As hospitals across Britain face job cuts, new figures show that executives are receiving subsidies of up to 6,600 pounds a year to lease cars that they can subsequently buy at a discount. All maintenance costs are included in the agreements, while some authorities and hospital trusts also cover the costs of insurance premiums. The bill for leasing the 35,000 cars for NHS staff is now close to 90 milion pounds, while the cost for new leases rose by more than 3.5% last year, according to government figures.

It coincides with a growing cash crisis in the NHS with total deficits estimated at more than 800 million and trusts cancelling operations and threatening more than 5,000 job cuts. Katherine Murphy, of the Patients Association, a charity campaigning for a better health service, said the issuing of luxury cars was "morally wrong". "Here we are with the health service in severe financial crisis with deficits everywhere, redundancies threatened and wards closing and these executives, who are on hugely inflated salaries anyway, are driving around in lovely top-of-the-range cars obtained with NHS money," she said. "It is morally wrong and gives completely the wrong message."

NHS officials say the "company car" perks enable the service to compete with the private sector. However, many health trusts eschew such schemes as an unnecessary expense. Last year the government tried to rein in the cost by paying outside consultants - at an estimated 2,000 pounds a day - to review the scheme nationally. Despite the exercise, the average annual cost of leasing each company car rose by 175 pounds.

The Department of Health admitted the extra expenditure following the consultants' exercise was because the vehicles now being bought by the NHS were of a "generally higher specification". In the 12 months until March this year, figures show that the NHS has started new lease-hires on 428 Audis, 260 BMWs, 101 Mercedes, 35 Jaguars, 28 Land Rovers, 88 Saabs, 10 Lexus and even a Porsche. Masterlease, one of nine lease-hire companies that have agreements with the NHS to supply vehicles over three-year contracts, is providing two Porsches to executives. A spokesman confirmed the company is leasing a Porsche Cayenne - a 4x4 model with prices ranging from 35,560 to 81,565 pounds - and a Boxster two-seater sports model, which retails at 32,640, to the NHS.

Because of the preferential rates negotiated centrally through the NHS's purchasing and supply agency, a Cayenne can be leased for about 6,000 pounds a year while a Boxster costs about 5,000 annually.

Most NHS staff who are entitled to company vehicles are given an allowance based either on their status and salary or the number of miles they drive. They are then entitled to choose any car they like. If their choice exceeds their allowance, they can top up the NHS subsidy with their own money. Other costs, such as road tax, are often paid by the driver, who is also sometimes expected to contribute towards the insurance. Petrol is paid for by staff and reimbursed through claims for mileage. Some trusts and health authorities are providing such generous allowances, however, that topping up is not necessary.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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12 April, 2006

U.K.: EVEN THE NHS COMPUTER SYSTEM IS A BUDDING DISASTER

Leading academics called yesterday for a formal audit of the National Health Service’s 6.2 billion pound IT scheme over fears that it is behind schedule, over budget and not secure. In a letter to the Commons Health Select Committee, 23 professors raised questions about the system, its progress and whether it will work.

The concerns were brushed aside by the Department of Health but are an index of growing doubts about the system, called Connecting for Health, which is designed to allow instant access to patient records and for patients to make appointments with consultants online from GP surgeries. The letter, reported in Computer Weekly, amounts to the most heavyweight challenge yet to the programme, announced four years ago by the Prime Minister. Connecting for Health, previously known as the National Programme for Information Technology (NPfIT), will link more than 30,000 GPs in England to 300 hospitals by 2012. It involves an online booking system, a centralised medical records system for 50 million patients, e-prescriptions and fast computer network links between NHS organisations.

The academics’ letter, signed by professors from Oxford, Cambridge, the London School of Economics, Edinburgh, Birmingham, York and many other departments, says that the project has been managed in a secretive way. “Concrete, objective information about NPfIT’s progress is not available to external observers,” it says. “Reliable sources within NPfIT have raised concerns about the technology. We suggest an assessment should ask challenging questions and issue concrete recommendations.”

Concerns have been heightened by a delayed report from the National Audit Office, that was expected last summer and will not be published until this summer at the earliest. “My instinct is that had they had anything good to say about it it would not have been delayed so long,” said Martyn Thomas, a computer consultant and a visiting professor at Oxford University, who is one of the signatories. “In this case there has been a lot of pressure and a political timetable set by ministers from outside. There has not been enough scrutiny.” He said that the UK Computing Research Committee, an 80-strong expert group, had offered to help, but nobody from NPfIT had been interested in talking to them.

The Department of Health responded: “The National Programme for IT is under constant review, scrutiny and audit by Parliament and government bodies. We remain confident that the technical architecture is appropriate and will enable benefits to be delivered for patients, whilst ensuring value for money to the taxpayer.”

Source



MORE ON MASSACHUSETTS: FINANCING DOUBTS

Massachusetts politicians just built the healthcare McMansion of their dreams. Now, where do they get the money to underwrite the mortgage? Like many a thrilled new homeowner, they're not sure. Governor Mitt Romney, legislative leaders, and healthcare lobbyists are congratulating one another and basking in favorable media reaction. At the same time, they hope there is enough money to cover commitments made in this sweeping healthcare package -- especially the commitment to extend health insurance coverage to 95 percent of the population within three years.

But to some degree, the foundation for this plan is a mixture of euphoria and hope. And that's not enough. ''If Massachusetts is the national leader in setting up a new healthcare model, we have an extra-special responsibility to be sure that what we legislate will stand the test of financial scrutiny," said Ellen Lutch Bender, a longtime healthcare analyst.

Even some unabashed supporters of the package have their doubts: ''This is cutting-edge conceptual healthcare policy," said Democratic state Representative Harriett L. Stanley of West Newbury, a member of the legislative healthcare financing committee who voted for the measure. ''But we don't yet know what it's really going to cost us or where we're going to get the money from. To some extent you might call it a Hail Mary pass."

After a State House rally to celebrate passage of the legislation, John McDonough, a former state legislator who heads the advocacy group HealthCare For All, declared this package ''good enough for now." But, he, too, acknowledged, ''There are questions about the financial stability. The financing is plausible, but it could go awry." On his blog, which provides daily, informative analysis of the ups and downs of the healthcare bill, McDonough lists these concerns: ''The level of employer responsibility is minimal and does not come close to the cost borne by employers who do cover their workers; the bill leaves in place the unfair $160 million assessment on employers who do cover their workers; the individual mandate does not define clear affordability for when workers would be penalized. This will be a vitally important standard moving forward." As Judith Meredith, another healthcare advocate who celebrated passage of the legislation, said: ''The funding part worries us all."

The cost of extending health insurance coverage to an additional 515,000 people will be shared by business, individuals, and the government. Businesses with more than 10 workers that do not provide insurance will be assessed up to $295 per employee per year. Individuals who can afford insurance but don't have it are subject to state income tax penalties. And government subsidies will help poor families.

The state contribution -- coming from the Massachusetts General Fund -- is pegged at $58 million for the first year; it increases to $125 million for each of the next two years. Meanwhile, the so-called free-care pool stands to remain in the $500 million to $800 million range for at least the next three years -- and maybe longer, some healthcare specialists predict.

The expectation is that revenue generated from the business assessment and individual mandate compelling people who are uninsured to get insurance will reduce the cost of free care. But what if the projected cost-shifting doesn't play out as predicted? ''One of the stated goals was to decrease dependency on the free-care pool. Whether there will actually be a decrease in funding for the free-care pool has not been adequately answered," said Representative Jeffrey D. Perry of Barnstable, a Republican and one of only two House members who voted against the healthcare bill.

If the financing mechanism behind this conceptually-impressive legislation turns out to be inadequate, who will suffer? The hospitals and insurers will get their money. But, if the money runs out, the poor won't get the insurance coverage that makes this proposal worthy of so much excitement and media attention. ''The only redeeming part of the bill is that it says it will provide absolute coverage for the very poorest citizens. If there isn't enough money to meet those obligations, then what?" noted Secretary of State William Galvin, a critic of other aspects of this package.

This legislation pegs Massachusetts as a healthcare innovator. It may look like the most beautiful piece of property on the block. But, until the inspector declares the foundation sturdy, the acquisition may not be worth the purchase price.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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11 April, 2006

AN INTERESTING CRITIQUE OF THE MASSACHUSETTS BRAINWAVE FROM THE LEFT

It's a stirring scene. The Governor, legislative leaders and leaders of Health Care For All standing in the State House Rotunda declaring victory in the fight for universal health coverage. Unfortunately, this week's tableau merely repeats one from 20 years ago when Governor Dukakis was celebrating passage of his universal healthcare bill. That plan imploded within two years, and today about 250,000 more people are uninsured in Massachusetts than the day it was signed. Unfortunately, Massachusetts' new health reform legislation looks set to repeat that disaster.

What's in the New Bill? The new bill includes three key provisions meant to expand coverage. First, it would modestly expand Medicaid eligibility. Second, it would offer subsidies for the purchase of private coverage to low-income individuals and families, though the size of the subsidies has yet to be determined. Finally, those making more than three times the poverty income (about $30,000 for a single person) would have to buy their own coverage or pay a fine.

To help make coverage more affordable, a new state agency will connect people with the private insurance plans that sell the coverage, and allow people to use pre-tax dollars to purchase coverage (a tax break that mostly helps affluent tax payers who are in high tax brackets). This new agency is also supposed to help design affordable plans.

Businesses that employ more than 10 people and fail to provide health insurance will be assessed a fee (not more than $295) to help subsidize care. Additionally, hospitals won a rate hike assuring them better payments from state programs, and several provisions were included that are meant to attract additional Federal funding to help pay for the Medicaid expansion.

What's Wrong With This Picture? First, the politicians assumed that only about 500,000 people in Massachusetts are uninsured. The Census Bureau says that 748,000 are uninsured. Why the difference? The 500,000 figure comes from a phone survey conducted in English and Spanish. Anyone without a phone or who speaks another language is counted as insured. The 748,000 figure comes from a door-to-door survey carried out in many languages (including Portuguese and Haitian Creole, common languages in Massachusetts). In sum, the reform plan wishes away 248,000 uninsured people who don't have phones or don't speak English or Spanish. It provides no funding or means to get them coverage.

Second, the linchpin of the plan is the false assumption that uninsured people will be able to find affordable health plans. A typical group policy in Massachusetts costs about $4500 annually for an individual and more than $11,000 for family coverage. A wealthy uninsured person could afford that - but few of the uninsured are wealthy. A 25 year old fitness instructor can find a cheaper plan. But few of the uninsured are young and healthy. According to Census Bureau figures, only 12.4% of the 748,000 uninsured in Massachusetts are both young enough to qualify for low-premium plans (under age 35) and affluent enough (incomes greater than 499% of poverty) to readily afford them. Yet even this 12.4% figure may be too high if insurers are allowed to charge higher premiums for persons with health problems; only half of uninsured persons in those age and income categories report that they are in "excellent health".

The legislation promises that the uninsured will be offered comprehensive, affordable private health plans. But that's like promising chocolate chip cookies with no fat, sugar or calories. The only way to get cheaper plans is to strip down the coverage - boost copayments, deductibles, uncovered services etc.

Hence, the requirement that most of the uninsured purchase coverage will either require them to pay money they don't have, or buy nearly worthless stripped down policies that represent coverage in name only.

Third, the legislation will do nothing to contain the skyrocketing costs of care in Massachusetts - already the highest in the world. Indeed, it gives new infusions of cash to hospitals and private insurers. Predictably, rising costs will force more and more employers to drop coverage, while state coffers will be drained by the continuing cost increases in Medicaid. Moreover, when the next recession hits, tax revenues will fall just as a flood of newly unemployed people join the Medicaid program or apply for the insurance subsidies promised in the reform legislation. The program is simply not sustainable over the long - or even medium - term.

More here

The solution these authors propose for the problems they identify is to bring in a single-payer health insurance system. And their grounds for arguing that? They argue that having the government take over would REDUCE bureaucracy. I kid you not: They actually do argue that having the government do something would reduce bureaucracy. What an incredible poverty of ideas they suffer from to propose something that goes against all human experience!



U.K.: Discharge NHS patients sooner and save cash, says Hewitt

Some hospitals are keeping patients up to four times longer than others for simple operations, draining resources and adding to the financial pressures on the NHS, the Health Secretary said yesterday. Patricia Hewitt called on all trusts to become more efficient at discharging patients and to reduce the substantial discrepancies in hospital stays. She spoke as two more trusts announced more than 500 job losses to try to tackle spiralling debts. A total NHS deficit of more than 800 million pounds has led organisations across England to rein in spending in recent weeks and announce more than 5,000 job cuts.

Surrey and Sussex Healthcare NHS Trust yesterday became the latest organisation to confirm that it will lose staff, with 400 jobs expected to go to help to reduce a monthly 2 million pound overspend. The trust, which manages Crawley Hospital and East Surrey Hospital, has a long history of financial problems and estimates its total debt for this financial year at 41.2 million pounds. The trust said that though 400 posts would go, permanent staff numbers would drop by only about 100. On Monday the Medway NHS Trust said that up to 160 jobs would go at the Medway Maritime Hospital in Gillingham, Kent. The trust needs to cut its spending by up to 11 million in 2006-07 and claw back a 1 million overspend from 2005.

Ms Hewitt, who has faced sustained pressure recently to explain the mounting debts on the back of six years of unprecedented NHS funding, said that money could be saved and care improved by reducing some patient stays. According to analysis by the NHS Institute for Innovation and Improvement, the best trusts treat a broken hip in less than 11 days, while the slowest performers take 45 days. Many of the longer stays targeted in the report were not offering more thorough care but, rather, were being less efficient and failing to prepare for the departure of patients from hospital.

Hip replacements varied between 7.4 days in the top 10 trusts to 29 days in the lowest-performing trusts, while stays for acute strokes ranged from 13 to 55 days. Knee replacements varied from 6.4 to 20 days. "The NHS is treating more people more quickly than ever before, but there are still parts of the system that can and should be far more efficient in speeding up the patient journey," Ms Hewitt said. "Cutting the variation between hospitals in patients' length of stay means patients can leave when they are clinically ready, freeing up capacity and time to deal with new patients coming in. This firstly improves services for patients, but will also help the NHS to save thousands of bed days a year." Ms Hewitt made her comments when visiting a number of hospitals in the North West yesterday.

More here



This is the sort of "care" you get from socialized medicine

Three times Pamela Dale has prepared herself for potentially hazardous brain surgery, only to have it cancelled minutes before her operation because of bed shortages. Her surgery was scheduled at the Royal Brisbane and Women's Hospital. The mother-of-three has a brain tumour which is causing her blackouts. It was first diagnosed in August 2004, and in early March she was scheduled for surgery to remove the tumour. "That was cancelled half an hour before we were due to leave home due to a lack of beds," Mrs Dale, 34, said.

"The next time I was scheduled was March 27. I was told it was cancelled because there was not enough time to complete the operation." An RBWH spokeswoman said: "Hospital staff can plan to a certain point, but cannot predict when patients requiring high-dependency or intensive care will come through the emergency department, or if patients already in wards in the hospital will deteriorate and need such care."

Medical groups have claimed that Queenslanders requiring urgent surgery are continuing to be turned away by the state's public hospital system because of a bed shortage crisis and it is unlikely to be fixed soon. Besides turning away patients requiring surgery, the bed shortage often leaves public hospital emergency departments overcrowded and patients needing to be transferred to hospital wards. In his report in September last year, State Government consultant Peter Forster estimated Queensland Health would require an additional 170 beds each year for the next 20 years just to meet future demand. A Queensland Health spokeswoman said an additional 99 beds had so far been opened this year. The Government also had identified scope to open a further 170 beds in 10 public hospitals around Queensland at a cost of $36.6 million a year, the spokeswoman said.

But Australian Medical Association Queensland president Dr Steve Hambleton said overcrowding continued to be a big problem. "I have just come back from Mackay and Cairns where they are suffering from bed block - Mount Isa is the same," Dr Hambleton said. "We need 200 beds on the Gold Coast urgently. It is going to take five years to bring enough bed numbers online."

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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10 April, 2006

There's always plenty of money for bureaucrats

Taxpayers have forked out an extra $94 million for pen-pushers in WA's beleaguered health system since Labor came to power. While thousands of patients are waiting for surgery and Treasurer Eric Ripper has threatened tax rises because of a health spending blow-out, the Government has employed an extra 604 administration staff. There are now nearly three times as many health bureaucrats earning $80,000 or more - 435 in 2005 compared with 148 in 2001.

Opposition health spokesman Kim Hames said it was disgraceful that the extra funding, which could have employed 1700 nurses or provided more doctors and hospital beds, had gone to bureaucrats. "It's an administration out of control caused by mismanagement and the blame lies at (Health Minister) Jim McGinty's feet," he said. There are now 6297 health bureaucrats compared with 5693 in 2001, despite former premier Geoff Gallop's promise of a leaner public sector. Their wages cost $299 million of the $3.6 billion health budget. Dr Hames said he was amazed that in the past financial year there was $20 million extra spent on bureaucrats and $17 million of that had gone to 190 additional staff earning $80,000 or more. "How many hip replacements and knee replacements would that fund?" he said. There was a desperate need for more nurses, but Mr McGinty had rejected his repeated calls for a nursing summit to address the issue. The Government claimed it had reduced surgery waiting lists down from about 18,000 two years ago to about 15,000, but he believed figures had been manipulated. He estimated another 31,000 were waiting to see specialists, with a view to being put on a waiting list for surgery.

Australian Medical Association WA president Paul Skerritt said priority had been put on the Government's long-term overhaul of the health system, but day-to-day management was being neglected. Acting Health Department director-general John de Campo took the heat for Mr McGinty, who is overseas, saying the number of public clinical staff employed between 2001 and 2005 far outweighed the increase in administrative staff. He said in June, 2005, there were 22,094 doctors, nurses and health staff in the public health system compared with 18,508 in June 2001.

Source



The Queensland public health system shows it arrogance and incompetence once again



Two paramedics who said they were unable to treat a youth because he was so drunk and obnoxious have been punished by their Queensland Ambulance Service bosses. Sources told The Sunday Mail that frontline staff were furious at the disciplinary measures taken by management. Ambulance staff said that they believed the officers were "in the right". One of the officers recently quit in disgust, accusing the QAS internal investigators of "intimidation and standover tactics."

The incident happened on the Sunshine Coast early this year after a young man who had been drinking was punched in the head during a brawl. The paramedics said the drunken man refused a proper assessment of his injury and would not let them take him to hospital. They say the man's sober girlfriend agreed to keep watch on him and take him to a doctor. But the man later complained to Emergency Services that he had been "refused" proper treatment. He said officers simply put a butterfly clip on a badly cut lip and sent him home, and he needed to get hospital treatment for a head wound the next day.

The paramedics were condemned by the QAS probe and given three-month "diminished performance" reports, which reduced their responsibilities. "One experienced paramedic has been forced to resign . . . they were subjected to a completely intimidating investigation that was protracted over many weeks," a source said. He said that investigators had overlooked evidence about the man's drunken behaviour. "All of these facts were reported in the patient report form," the source said.

The Sunday Mail reported a similar case late last year, which resulted in a paramedic being investigated by the Crime and Misconduct Commission after a doctor, who was arrested for drunken behaviour, claimed the ambo refused to treat him. The paramedic was disciplined by QAS bosses and could face criminal charges. Angry ambulance colleagues rallied to his support. "A professional doctor behaves like a drunken hooligan, gets arrested for assault, refuses to be assessed and puts a paramedic through all this," said one ambo. The CMC is still investigating the doctor's complaint.

Ambulance Employees Australia union secretary Steve Crow said paramedics were advised not to put themselves in danger. They had "zero tolerance" to violence from intoxicated patients. "At the end of the day, if people do not want to be treated, you cannot chase them up the road forever," he said. A spokeswoman for Ambulance Commissioner Jim Higgins said the Sunshine Coast matter had been investigated and "internally managed." [So that's what you call bullying!] She declined to comment further.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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9 April, 2006

GERMAN INSANITY

This week in Berlin, the government will be advocating a series of health care reforms similar to Gordon Brown's unsuccessful and over-bureaucratic attempts to reform the UK National Health Service. One of the more draconian proposals is a "bonus malus" penalty system for doctors who prescribe too many expensive drugs to German patients. This new system is designed cut public expenditures for prescription drugs by making physicians personally liable if they exceed their quarterly budgets. For instance, physicians will have to cover 50% of the excess spending out of their own pocket if they exceed their budgets by more than 30%.

At first glance, making anyone stick to a budget may sound like sound financial policy. The problem is that in this case the budget does not necessarily reflect real world demand. The allocation of funds for medicine is not driven by patients and doctors but by politicians – much like the production targets for Soviet tractor factories were set by bureaucrats in Moscow with little regard to the needs of Russian and Ukrainian farmers.

Germany will be on its way to a shortage of medicine if the government gets its way. The government's goal is to reduce the annual pharmaceutical costs by 400 million euros starting in 2007, and German patients are already receiving too little medicine. For example, only 30% of Germans with osteoporosis receive treatment, and the German sick funds do not cover preventive medicine for osteoporosis patients. This means that middle aged and elderly women with osteoporosis often have to experience a debilitating hip or other bone fracture before they receive the medicine they need.

A shortage of medicine means that patients will no longer be able to trust doctors to prescribe them the medicine they need. The medical needs of the individual patient will take second place to the budgetary considerations of the doctor. One possible consequence is that patients will be inclined to exaggerate the symptoms they have in order to move up on the doctor's list of priorities; and doctors will tend to dismiss more patients as hypochondriacs. These diverging interests will lead to distrust between patients and their doctors and undermine the open doctor-patient dialogue that is required for early detection of health problems and successful treatment.

The lower use of drugs and the worsened doctor-patient relationship could end up costing the German economy more than the 400 million euros the government hopes to save. Without the right medicine, patients are more likely to spend time in expensive hospital care and to be absent from work due to health problems. Add the time and resources that will be wasted on legal expenses and handling objections from doctors and patients, and it becomes evident that managing German health care like a Soviet tractor factory is not very cost-efficient.

In addition, there are long-term costs to consider. Germany has more medical students per capita than any other European country. What will these future doctors think about working in a system that penalizes them for doing the job they have been trained for, namely curing patients? Providing second class care to patients and being denied access to the latest advances in medical research is hardly a very encouraging prospect. Chances are that the best and brightest of Germany's future physicians will add to the brain drain and join the 400,000 European researchers that currently live in the United States. When the brains leave, so do the prospects for investments in research and development. Without such investments, Germany will have to rely on old economy products based on heavy industry. Again, the Soviet tractor factory comes to mind.

More here



At long last: Australia recognizes the only solution to substandard foreign doctors from India and elsewhere

The Commonwealth Government is to spend $250 million to train more doctors and nurses over the next four years. Prime Minister John Howard said today that extra funding will pay for 400 new medical school places a year, with some starting in 2007 and the full 400 in 2008. Mr Howard said 120 places would go a new medical school at Deakin University in Victoria with Monash University's new Gippsland branch receiving 40 additional places. The remaining 240 places will be distributed among all the states and territories, including Victoria.

Mr Howard told the Victorian Liberal Party's state council he expected the state governments to match the funding and pay for the training of new nurses, care assistants and Aboriginal health workers. "I make this announcement today so that universities can prepare to introduce these places without delay," Mr Howard said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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8 April, 2006

NASTY SECRET PLAN BY THE NHS

Patients are being denied appointments with consultants in a systematic attempt to ration care and save the NHS money, The Times has learnt. Leaked documents passed to The Times show that while ministers promise patients choice, a series of barriers are being erected limiting GPs’ rights to refer people to consultants. The documents reveal that health trusts across London have drawn up plans to establish panels that will “monitor” how many patients are referred to hospital by GPs. Local health trusts have been told that they must cut GP referral rates to those of the lowest 10 per cent nationally. This, the document claims, would save 25 million pounds a year in the capital. Consultant-to-consultant referrals are also being limited, in many cases denying patients a second opinion.

Patients who use hospital accident and emergency units to obtain care that could be provided by GPs are also targeted. Emergency care practitioners in A&E departments will “redirect” 40-70 per cent of patients back to GPs or walk-in centres. Hospitals that treat people who ought to have been sent to their GPs will not be paid.

It is not known how many similar schemes are in existence, but the British Medical Association has confirmed it has found examples in Kent, Oxfordshire, Dorset, Wiltshire, Surrey, Sussex, Cornwall, Shropshire, Suffolk, Lancashire and Yorkshire, as well as London. The draft paper, headed Pan London Demand Management Arrangements 06-07, says that Hammersmith and Fulham has found that a fifth of consultant-to-consultant referrals are “clinically not necessary”. Matching that across London would save another 7 million pounds, the paper says. But the bureacracy needed to screen all the referrals will itself cost 1.6 million. The London paper says that primary care trusts (PCTs) which cannot demonstrate that their referrals match the lowest 10 per cent nationally will be required to help to set up “review panels” in dermatology, ear, nose and throat, gynaecology, ophthalmology, rheumatology, trauma and orthopaedics.

These panels will review referrals by GPs, and cut them back. What this means is that patients will be denied appointments that their GPs believe they need. The language of the document makes no pretence that this will improve care, and emphasises cost savings throughout. “It is imperative that London balances its books overall,” the first paragraph says. It also indicates that the measures proposed are “the bare minimum that we expect all PCTs to be doing”. Urgent consultant-to-consultant referrals will be audited. “All urgent clinical referrals found to be clinically inappropriate will not be paid for by the PCT,” the document says.

The BMA yesterday condemned such schemes. Hamish Meldrum, the chairman of the association’s GP committee, said that they left patients in limbo, with no one clear where the responsibility lay if the condition worsened or the patient died. Jonathan Fielden, deputy chairman of the BMA consultants committee, said: “It’s clear that clinicians don’t know how these referral management systems aid improvements in clinical care. To them they are purely cost-saving. “The way they work is not transparent or clear. If clinicians don’t know, patients cannot know either. That certainly flies in the face of the Government’s Patient Choice agenda.”

Hospitals will also be penalised for the common practice of admitting people who have waited almost four hours in accident and emergency departments without being dealt with — thus avoiding the four-hour A&E target being breached.

More here



DOUBTS ABOUT THE MASSACHUSETTS BRAINWAVE

Post lifted from Claremont

The New York Times reports that Massachusetts Governor (and 2008 presidential hopeful) Mitt Romney is set to sign a bill that would make his state the first in the nation to offer universal health care. “The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.” Fortunately, we are assured by a Brandeis professor quoted in the piece that “‘It is not a typical Massachusetts-Taxachusetts, oh-just-crazy-liberal plan.’” What is the new mechanism, then? “Individuals who can afford private insurance will be penalized on their state income taxes if they do not purchase it.”

But that’s not all. “The Massachusetts bill creates a sliding scale of affordability ranging from people who can afford insurance outright to those who cannot afford it at all.” So, Massachusetts residents will be forced to buy insurance, the price of which will be set for them, based on what the experts think they should be able to afford, with government subsidies to cover the rest. In short, another bureaucratic scheme just waiting to be taken advantage of.

And what about the hospitals and drug companies? Will they be re-staffed with saintly folk devoted to public charity? Certainly a lot of people go into the health care system out of a sense of good will to care for people. (Well, that and the God-complex, the money, and the women, but let’s stick with the good will for now). In the end, it's a business like any other. It may be crass, but if there are no incentives in that business, the quality of care will go down, the research for cures will decrease, and ultimately, more people will suffer.

The larger question is: when did it become government’s responsibility -- or for that matter, my employer’s -- to see that I have health insurance? Why not home-owner’s insurance? I have a “right” to shelter as much as health, don’t I? And how about some car owner’s insurance? Heck, why not a car? I mean, how else am I going to get to work? In fact, why doesn’t my employer or his government-appointed representative come over in the morning to make me some breakfast (Brian: I like to start the day with some cottage cheese and fruit). After all, it is the most important meal of the day. Should I be taxed if I jeopardize my health by skipping breakfast? Only time will tell.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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7 April, 2006

MASSACHUSETTS TRIES MANDATORY PRIVATE INSURANCE

See here for the case AGAINST mandatory health insurance

Massachusetts is poised to become the first state to provide nearly universal health care coverage with a bill passed overwhelmingly by the legislature Tuesday that Gov. Mitt Romney says he will sign. The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance. It accomplishes that in a way that experts say combines methods and proposals from across the political spectrum, apportioning the cost among businesses, individuals and the government. "This is probably about as close as you can get to universal," said Paul B. Ginsburg, president of the nonpartisan Center for Studying Health System Change in Washington. "It's definitely going to be inspiring to other states about how there was this compromise. They found a way to get to a major expansion of coverage that people could agree on. For a conservative Republican, this is individual responsibility. For a Democrat, this is government helping those that need help."

The bill, the product of months of wrangling between legislators and the governor, requires all Massachusetts residents to obtain health coverage by July 1, 2007. Individuals who can afford private insurance will be penalized on their state income taxes if they do not purchase it. Government subsidies to private insurance plans will allow more of the working poor to buy insurance and will expand the number of children who are eligible for free coverage. Businesses with more than 10 workers that do not provide insurance will be assessed up to $295 per employee per year. All told, the plan is expected to cover 515,000 uninsured people within three years, about 95 percent of the state's uninsured population, legislators said, leaving less than 1 percent of the population unprotected. "It is not a typical Massachusetts-Taxachusetts, oh-just-crazy-liberal plan," said Stuart H. Altman, a professor of health policy at Brandeis University. "It isn't that at all. It is a pretty moderate approach, and that's what's impressive about it. It tried to borrow and blend a lot of different pieces."

Many states, including Massachusetts, have been wrestling for years with how to cover the uninsured, and several states have come close, according to the National Conference of State Legislatures. Hawaii passed a universal access law in 1974 requiring employers to offer health care coverage for employees working 20 hours or more a week, but nearly 10 percent of people remain uncovered. Efforts to cover all citizens in Minnesota and Vermont in 1992 and in Massachusetts in 1988 fell flat in the mid-1990s when the language in the bills concerning universal coverage was repealed.

In 2003, Maine enacted a law that significantly broadened insurance coverage and combined employer payments with expanded government programs. That year, California enacted a law that required employer contributions, but it was repealed in a referendum in 2004. Massachusetts would be the first state to require its citizens to have health insurance.

The Massachusetts bill creates a sliding scale of affordability ranging from people who can afford insurance outright to those who cannot afford it at all. About 215,000 people will be covered by allowing individuals and businesses with 50 or fewer employees to buy insurance with pretax dollars, and by giving insurance companies incentives to offer stripped-down plans at lower cost. Lower-cost basic plans will be available to people ages 19 to 26.

Subsidies for other private plans will be available for people with incomes at or below 300 percent of the poverty level. Children in those families will be eligible for free coverage through Medicaid, an expansion of the current system. The Massachusetts bill was hammered out with proposals and input from state Democratic legislators; Mr. Romney, a Republican; Senator Edward M. Kennedy, a Democrat; insurers; academics; businesses; hospitals; and advocates for the poor, including religious leaders. They were motivated in part by a threat by the federal government to eliminate $385 million in federal Medicaid money unless the state reduced the number of uninsured people. The state was supposed to have the bill completed by January, but state officials said they were confident that the federal government would approve of Tuesday's bill. "Whenever you can have the medical community, the business community and the advocates all applauding our efforts, I think that's indicative of a successful exercise," said State Senator Robert E. Travaglini, the majority leader.

Mr. Romney, who is considering running for president in 2008, said in an interview Tuesday that the bill, passed by a legislature that is 85 percent Democratic, was "95 percent of what I proposed." He said, "This is really a landmark for our state because this proves at this stage that we can get health insurance for all our citizens without raising taxes and without a government takeover. The old single-payer canard is gone." Mr. Romney pushed the idea of the "individual mandate," requiring people who can afford insurance to buy it. The bill makes it possible for employers to enable many of those people to use pretax dollars, saving them 25 percent or more. Individuals who fail to get health insurance by July 2007 will first lose their personal exemption on their state taxes. In subsequent years, they would have to pay a penalty that could be as high as half of what an affordable health care premium would cost.

Eric Fehrnstrom, the governor's communications director, said that for those people with incomes above 300 percent of poverty, "our assumption was that these would be mostly single mothers who just did not have the wherewithal to get insurance. It turned out it was mostly young males. In some cases they are making very attractive salaries. These are people who just don't imagine themselves needing care, but of course when they break a leg when they're out bungee jumping they go to the hospital and we end up paying for their care anyway."

One element that Mr. Romney and some legislators did not want was the fee for employers who do not provide health insurance. For several months the bill seemed stalled because the House and Senate leaders could not agree on the issue of charging businesses. One proposal of an $800-per-employee charge was reduced to a maximum of $295 that would go toward paying costs for the uninsured and would be reduced as more people became insured, Mr. Travaglini said.

Because the bill is part of a budget bill, Mr. Romney has line-item veto power. He said Tuesday that he would likely change the business fee provision in some way or veto it before signing the bill. Still, he did not seem that worried about it, saying he had been most concerned that the fee not be a payroll tax, as had been originally proposed. Mr. Travaglini said that if Mr. Romney vetoed the business fee, the legislature would override it. Bob Baker, president of the Smaller Business Association of New England, said his members seemed to accept the idea of the fee. "The notion of the level playing field, I think from an element of fairness and equity, people are O.K. with it, unless it impinges on their ability to pay for it," Mr. Baker said. "There hasn't been a hue and cry among our members."

Mr. Romney said that with more people insured, everyone would "get better health care" and that premiums for people who already had insurance might drop because "providers won't be pushing the cost of the uninsured onto the people who have insurance." James Roosevelt Jr., president and chief executive of Tufts Health Plan, agreed. "I think that will help both improve the quality of health care and lower the cost," Mr. Roosevelt said, but he added, "We would have liked more flexibility in the design of health plans to permit lower premiums that are affordable for all people."

The program, which was approved 154 to 2 in the House and 37 to 0 in the Senate, will cost $1.2 billion over three years, but only $125 million of that will be new state money. The rest will come from federal money and existing state money. After three years, lawmakers say, no new state money will be required. A new agency will administer the system.

Advocates for the uninsured held a victory rally at the Statehouse. "We're thrilled that this truly represents a commitment to the poor and the working poor," said Rabbi Jonah Pesner, a leader of the Greater Boston Interfaith Organization. Joseph Landais, 64, could use insurance for himself, his wife and three children. Mr. Landais, a retired hospital custodian, said his wife, a nurse's aide, makes too much for the family to be eligible for Medicaid but not enough to afford insurance. He had a hernia operation four months ago that he did not have to pay for under the free-care pool, but he had not been able to see a doctor since then, even though he is still not feeling well. "After years that you've been working that hard," Mr. Landais said, "I think you deserve something back."

Source



THE NHS CONCEPT OF PREVENTIVE MEDICINE

From Eamonn Butler

Sorry to keep going on about health, but the subject has been high in my mind recently. Because last week I had my annual check-up with BUPA, the independent healthcare insurer and provider.

It was just routine, and apparently I am fit as a flea - albeit a rather decrepit flea. I got an impressive battery of tests including heart and lung function, hearing, eyesight, and about 101 other things you can discover from the scrutiny of blood and various other samples you do not want to know about it.

The state-run National Health Service, bless it, did some public opinion polls a while back and discovered that the idea of a regular check-up was really popular among its patients and potential patients. People did not just want to fall sick and let the NHS look after them - they thought the NHS should be helping them to stay healthy.

So politicians a few months ago announced their next great policy. Regular check-ups on the NHS. Better late than never, you might think, and what an excellent use for the extra billions (about 35 extra billions, in fact) that the government has pumped into the Service.

Er, no. The much-vaunted `regular check-up' does not involve seeing a doctor for two hours, like I did on my BUPA examination. It does not actually involve seeing a doctor at all. No, their idea of a check-up is to send people a questionnaire form at four stages in their lives - after childbirth, at retirement, that sort of thing.

For some years, a number of us have been saying that we have a National Sickness Service and really we want a National Wellness Service. If a bit of form-filling is what they regard as a regular check-up, this vision remains a very long way off.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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6 April, 2006

Stop, think, rebuild; a prescription for the NHS

Two years ago few would have predicted that the centre of gravity of the health debate would move so quickly towards reform and value for money and away from higher spending. Yet on Sunday Sir Derek Wanless, the author of the landmark report on NHS financing used to justify higher spending, cautioned that all the extra money (in fact "slightly more" than all the money) has already been spent. Yesterday Aidan Halligan, the former Deputy Chief Medical Officer, commented: "We have learnt that throwing money at the problem only allows us to do more of what we have always done." The service has lurched from a deficit of 200 million pounds before Christmas to 800 million now, losing a chief executive and a head of human resources along the way.

The scale of the extra resources is not in doubt. After inflation, annual spending has increased by four-fifths since 1999-2000, taking spending beyond the European average. The increased spending per year amounts to an extra 120 billion pounds in total. But it is equally clear that the extra resources have not created a service of the standard of continental countries. Certainly some areas of the service have improved. The longest waiting times have been reduced, but improvements have tended to fall in areas of narrowly focused political pressure or where reforms, such as patient choice, have been implemented. Other areas of the service have been neglected.

The public is clear that spending has risen sharply but expectations have risen just as quickly. But the majority of extra resources has been absorbed in higher costs rather than being used to expand access or develop new services. As a result there is a widening gap between supply and demand. The reduction in the rate of spending increases after 2008, already announced by the Government, will only make the situation worse.

This raises the prospect of much greater rationing and longer waiting times that will come as a very unpleasant surprise to patients. It will also increase suffering, as a high proportion of patients' conditions deteriorate further while on waiting lists.

All the political parties need to undertake an urgent review of NHS aspirations in the future. We need a debate to identify which services should remain in a taxpayer-funded core and which areas are appropriate for a new partnership between the individual and the State. The latter areas will include the services where the NHS has failed to deliver on its guarantee of care. Despite the highest possible funding increases, the service as currently constructed does not deliver on its guarantee of universal care. For example, the British Society of Hearing Aid Audiologists showed last year that waiting lists for NHS hearing aids can reach up to three years. The National Audit Office has reported that only half of stroke patients receive proper rehabilitation in the crucial months after suffering a stroke.

Worse, the fiction that the NHS covers these areas of illness prevents new forms of funding and new providers from emerging. Where the NHS has recognised the limits of its coverage, such as in ophthalmology, a successful market has been allowed to develop. Standards of eye care have risen and - with several opticians on every high street - choice and access for patients have been transformed.

As well as supply and demand, the other fundamental divide is between consumer demand and society's need. As medicine advances and the population ages, consumers will inevitably want to spend more than society wishes to fund. In coming years numbers of young taxpayers will fall relative to the older generations. Will the young taxpayers of 2016 or 2026 wish to fund the health wishes of a much greater number of non-taxpayers? The days of an exclusively tax-funded health service are numbered.

The great prize of a reformed and balanced funding system is that the gaps in today's service could be filled and a modern, truly comprehensive service could emerge. People could be freed to put additional resources of their own into healthcare, as they increasingly will wish to do.

This new system will look and feel different. Alongside a new funding model will come new forms of provision based on out-of-hospital care much closer to people's homes. Pluralism - with private and voluntary sector providers delivering care on equal terms with the NHS - will be taken for granted. The gains to innovation will be immense. Co-payments and health insurance will be the new vocabulary of healthcare financing.

The review of NHS aspirations should be undertaken without political prejudices in any direction. We must certainly guarantee equitable access for healthcare for all in society. Healthcare free at the point of use is a cornerstone of the British system. But, as the Prime Minister himself said in 2003, the 1945 model of healthcare has never delivered equal access for people on low incomes. Equity is the first thing to go when healthcare is rationed by waiting lists because the better-off can push their way to the queue or jump it altogether by going private. If rationing does start to bite and waiting lists lengthen after 2008, equity and fairness will suffer.

Despite admitting the need for reform, politicians remain unwilling to face up to the debate on financing. The medical profession and their patients are all too aware of the need. Two thirds of the electorate agree that the NHS is unlikely to meet patient expectations, no matter how much is spent on it. The parties will find considerable support for some boldness.

(Article above by Dr. Karol Sikora of "Doctors for Reform")



MORE ON NHS REFORM

Doctors for Reform has a point. The NHS, as elegantly argued by Professor Karol Sikora, a leading Doctor for Reform, on this page yesterday, is going to face a widening gap between supply and demand and will have to choose which services to provide and which to leave to the open market, ie, for the rich.

Look at the pressures that will be wrought by an ageing population: in 1950, with the NHS barely a year old, there were more than five people of working age for every pensioner. By 2050 there will be just two. Then look at the potential (and cost) of new genetic technology. If a genetic test, for instance, could show that I have a 4 per cent higher than average chance of developing Columnist Repetitive Argument Pharyngitis, and should therefore, for my health, avoid opinionating in newspapers regularly, ought I to be allowed to have the tests to discover that on the NHS?

Say that a test, for which you may have to pay yourself, shows that you have a 15 per cent chance of developing a particular cancer, where the norm would be 3 per cent - should the NHS give you preventive treatment that would reduce your probability of contracting the disease to the 3 per cent average? Even if it costs tens of thousands of pounds?

When David Cameron declared in January that the Conservative Party now believes in a taxpayer-funded NHS free at the point of need, he embraced the cost of new genetic treatments as well as new cancer drugs. "The NHS can no longer ration these treatments as it used to," he declared. Really? Who is going to pay for them? With both main parties playing politics for idiots - you ask, we give - there is no check on consumer demand for the NHS. And consumer demand is limitless: it started with basic healthcare, grew to embrace mental health and fertility and now slimness, and would, given half a chance, stretch to beauty and energy as well. Permanent blondeness? Why not? Look at the expensive things people are prepared to pay for privately with only a slim chance that they might make a difference to their health - from reflexology to cutting-edge cancer drugs - and then ask yourself whether you want to fund all this on the NHS.

So, yes, Professor Sikora is right: the days of an exclusively tax-funded health service are numbered. But then they always were. What the NHS provides was limited from Day 1, and demand has always outstripped expectations. In its first year of operation, 1949, Bevan estimated that the NHS would cost 176 million pounds; it actually cost 437 million. A year after its launch, a shilling prescription charge was introduced, both to raise money and to reduce the "cascades of medicine pouring down British throats", in Bevan's words. Two years later, dental and optical charges had to be introduced. The rich always have and always will be able to buy a more expensive range of healthcare.

What Doctors for Reform seem to be demanding (it isn't entirely clear) is a completely different European-style funding system for the NHS, and it isn't necessary. What we do need is greater realism from politicians about the limits of the system, less encouragement from populist ministers to act like children demanding more sweets from the sweetie shop, and a serious attempt instead to decide where the lines should be drawn in future.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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5 April, 2006

Millions wasted as Australian public hospital waiting lists grow

Patients are waiting longer than ever for elective surgery, even though state governments have collectively wasted an additional $200 million a year on trying to fix the problem. Waiting times increased most significantly in NSW, Victoria and the ACT, while Queensland and South Australia showed some improvement. Figures obtained by The Australian from state and territory governments reveal that there were 143,000 patients across Australia needing elective surgery. And on average they waited longer for common procedures such as cataract removals and knee and hip replacements in 2004-05 than they did in the previous year.

The average wait for a cataract extraction jumped from 168 days to 218 days in NSW and from 152 to 176 days in Victoria. A third of patients in NSW and the Northern Territory waited for more than a year for a knee replacement. Ten per cent of patients in NSW and the ACT waited more than 600 days to have knee surgery and more than 400 days for a hip replacement. Tasmania, which had the longest waiting times last year, was the only state that would not release figures for 2004-05.

Australian Society of Orthopaedic Surgeons national chairman Gary Speck said state governments were wasting millions of dollars every year on non-essential services and paperwork. "Spending the money more appropriately would be a good start," Dr Speck said. "A lot of money is spent putting up new buildings and on administration, rather than being spent at the coalface." He said many patients suffered for years before they were placed on the official waiting lists. "There is a waiting list to get an appointment to see a specialist and, in some parts of Victoria, that could take 15 months," Dr Speck told The Australian. "Once they finally get to see a specialist, patients then wait another nine to 12 months before they have the surgery, so people needing hip and knee replacements often wait more than two years."

The executive director of the Health Services Association of NSW, James McGillicuddy, said that state governments were reluctant to invest in long-term strategies to restructure the public health system. Mr McGillicuddy said elective surgery should be removed, or dramatically reduced, from public hospitals that ran busy emergency departments, and relocated to designated public health organisations dedicated to elective surgery. "The current situation, where elective surgery is done in existing public hospitals, is unworkable and will lead to longer waiting lists as the population becomes older and demand for elective surgery increases," he said. "This proposal would involve increased investment in public health infrastructure, but in the long run it would pay dividends to both the Government and reduce waiting times for elective surgery."

Mr McGillicuddy said private hospitals were also struggling to meet elective surgery demand. Forty-three per cent of Australians have private health insurance, but the 33 per cent increase in premiums during the past five years has forced many younger members to dump their health cover.

A spokesman for Victorian Health Minister Bronwyn Pike said an elective surgery centre would be opened on the grounds of Melbourne's The Alfred hospital in November to reduce pressure on the public hospital. "The $90 million centre, which is still part of the public hospitals, will have staff and beds dedicated to elective surgery only," she said. "It was designed to deal with the problem of elective surgery having to be prioritised in amongst the emergency demands."

A spokeswoman for NSW Health Minister John Hatzistergos said the Government was focusing on reducing the number of patients waiting longer than a year. "The long wait list has dropped from over 10,500 in February 2005 to 3400 in February 2006," she said.

However, Elizabeth Feeney, chairwoman of the Australian Medical Association's hospital practice committee (NSW), said the continued closure of operating theatres during public holidays would hamper efforts to reduce waiting times. "Ten years ago, hospitals used to close for a week between Christmas and New Year, but now some close for up to eight weeks over Christmas and three weeks over Easter to cut costs," Dr Feeney said. "To have all that money invested in equipment and instruments and only use it for three-quarters of a year is not what a business would do. "If BHP shut for a few months a year that would seem pretty odd."

Source



ANOTHER BRILLIANT SUCCESS FOR BRITAIN'S NHS

Hospital cleaning products may actually help a diarrhoea-causing bug to survive and spread, researchers claim. Some strains of Clostridium difficile became more resistant when exposed to two cleaning agents used in hospitals. Elderly patients are most at risk from Clostridium difficile, the major cause of hospital-acquired diarrhoea, with tens of thousands contracting it each year.

Researchers from Leeds General Infirmary and the University of Leeds treated the strains with five cleaning products. All the strains produced more spores when exposed to two chemicals that did not contain bleach. If a bug has more spores it means it may be able to survive for longer periods in hospitals. Professor Wilcox said: "These bacteria can form spores which survive for months or even years in the environment, in spite of hospital cleaning regimens. "We have shown that some commonly used hospital cleaning and disinfectant agents not only fail to kill bacteria, they actually promote spore formation."

In 2004, Department of Health figures showed there were 44,488 cases of the bug in those aged over-65. Clostridium difficile is not as deadly as the superbug MRSA but it has led to several deaths. Careful use of antibiotics and being able to isolate infected patients are two of the things that help to stop it spreading.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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4 April, 2006

U.K.: We must rethink NHS, plead senior doctors

The National Health Service is doomed to fail without radical changes in funding and approach, a group of almost 800 senior doctors says today

Doctors for Reform has written to the three main party leaders urging a fresh look at the NHS, pointing out that Britain has European levels of spending on health but still falls short of European standards. The doctors' letter is backed by an opinion poll showing that two thirds of voters believe that in its present form the NHS will never meet public demand, however much is spent on it. More than half of those questioned do not believe that the extra spending has resulted in real improvements to the NHS.

The initiative by Doctors for Reform comes at a critical moment. After huge spending and patchy improvement, large parts of the NHS are in deficit and laying off staff. Andrew Holdenby, director of Reform, the free-market think-tank that backs Doctors for Reform, said: "Now that the big spending increases are coming to an end, the NHS . . . still doesn't fulfil patients' rising expectations. We want to start a serious debate about where to go."

Since its launch two years ago, Doctors for Reform has grown from 500 doctors to almost 800. They come from all three political parties, disproving government claims that they are simply a stalking-horse for Conservative ideas. Professor Karol Sikora, one of the letter's signatories, a cancer specialist, said: "Doctors are apathetic, politically. Few belong to political parties, but they are getting to the end of their tether. The problem for the future is going to be matching the consumerist demand from patients, especially the young, with the social equity of the NHS. The system we have today is heavy on bureaucracy and poor on delivery. "It is doomed to fail, because with a single monolithic employer it cannot adapt to either technical or societal change. Compared to that, what we see in Europe are far more flexible systems that cost no more and deliver much better care."

Christoph Lees, a consultant in obstetrics and a co-signatory, said: "Centrally dictated targets do produce some results but they distort priorities. Those specialties outside the target areas become Cinderellas - mental health and maternity services are examples. The attempts to save money are undermining clinical relationships in an outrageous way. It's a doctor's obligation to act in the patient's best interests, but often we can no longer do that."

David Wrede, a consultant obstetrician and gynaecologist and a former Liberal Democrat parliamentary candidate, said: "Ministers talk the language of choice, but there is less choice now than there was years ago, when we could refer patients to anywhere we wanted," he said.

Doctors for Reform believes that only by opening up the NHS to different sources of financing will it be liberated, allowing "a modern, truly comprehensive system" to emerge. Andrew Holdenby believed that political leaders were reluctant to tamper with the NHS because they were convinced the public was devoted to it, but the Reform poll, carried out at the end of March by ICM, suggests that this is a myth.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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3 April, 2006

How to Get What We Want -- Better Health Care

By Arnold Kling (Arnold Kling is an economist and author of the forthcoming health-policy book "Crisis of Abundance")

In recent years, the approach to major policy issues has been for wonks to design proposals and for politicians to stage confrontations over those proposals. Sometimes, such legislation stalls, as with the Clinton health plan and the Bush Social Security plan. At other times it passes, as with Bush's Medicare drug benefit. Either way, the result can be considered a failure. The mistake has been to focus public attention on solutions without providing adequate background on the problem. An issue as challenging as health care requires a conversation, not a confrontation.

More people, both in Washington and in the country at large, need to be better educated concerning the trends, constraints and trade-offs involved in health policy. Some well-established facts are rarely brought up in the public debate, while myths, half-truths and rash promises are widely circulated. Here are some issues that Americans, liberals and conservatives alike, should consider: Our health-care system is pulled in different directions by competing objectives. For example, individual consumers would prefer to have health-care expenses covered for them, rather than worry about paying for health care. This is the objective of Insulation. However, we are concerned with the rising share of resources devoted to health care. This is the objective of Affordability. Finally, we do not like the idea of being denied health care because of a bureaucrat's decision. This is the objective of Accessibility, because we want to be able to access whatever our doctor recommends. These objectives conflict with one another. For example, managed care was an attempt to move toward Affordability, but it reduced Accessibility.

We cannot slow the growth of health-care spending in this country without changing health-care practices. Experts agree that new technologies make medical care more expensive. In addition, the rapid rise of physician specialization accounts for a large share of our health-care expenditure growth. Reining in health-care spending would require wrenching cultural changes. A market-based approach would be to reduce Insulation and instead steer people toward catastrophic health insurance, requiring them to pay more out of pocket for routine care. A government-based approach would be to set a national budget for health care and provide only the services that fall within that budget. The consequences of either approach are not well understood by policy-makers or the general public. The better plan would be to experiment with different approaches at the state level instead of suddenly lurching in one direction for the country. Perhaps California could be one of the states that attempts to experiment with a single-payer system. As a non-Californian, I would like to see that. My guess is that single-payer will require enormous tax increases and ruin the state's economy. Better that should happen in California than in Maryland, where I live.

We lack information about the effectiveness of health-care protocols. Critics complain about "information asymmetries," in which doctors know more than patients. But that problem pales in comparison to the information gaps shared by doctors and patients alike. For example, after a heart operation, no one knows how often a patient should be seen by a cardiologist. Is it cost-effective to be followed up once a month, once every six months or once a year? Researchers at Dartmouth University found that the main factor in determining follow-up visits was cardiologist availability. Cardiologists with a lot of room in their calendars will see a given patient more often than those with more crowded schedules. Overall, the researchers documented a shockingly broad pattern of differences in health-care practices that appeared to have no relationship to medical outcomes.

Those of us who propose market-oriented health-care reform need to spell out what this will mean for consumers -- how it will increase their responsibility to study the costs and benefits of alternative treatments. Those who favor universal government-provided health insurance also have an obligation to describe how health-care decisions will be made. If we cannot afford all the health-care services that everyone might want, then we are going to need policies for rationing health care.

Before electing to undergo surgery, we want the diagnosis explained, the alternatives described, the risks outlined and our responsibilities for contributing to a successful recovery made clear. By the same token, surgery on our health-care system requires a more thoughtful conversation than this country has had so far.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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2 April, 2006

Dangerous druggie doctors not stopped by regulators

Which shows how much use the regulators are.

Stephen Rabone was a known drug addict back in the early 1990s when he infected 11 patients with the viral disease hepatitis C at a South Australian country hospital. A South Australian inquiry into the Medical Board heard evidence that nursing staff alleged the doctor would order pethidine and other narcotic drugs, inject himself with them out of sight, return, and then inject the patient with the same syringe. Victims negotiated a confidential settlement in 2004. But today Rabone lives in Sydney's leafy, well-to-do suburb of Lane Cove, has full registration to practise medicine in NSW, and is a Fellow of the Faculty of Occupational Medicine with the Royal Australasian College of Physicians.

"Our hands are tied," says college chief executive Craig Patterson about the Rabone case, even though issues of drug addiction are "absolutely germane" in deciding whether to grant a doctor a fellowship. If these matters are proven, they are very serious indeed. (But) before we can strike or remove someone as a fellow . . . you need a properly constituted judicial or medical board hearing to have problems aired, facts need to be properly obtained and determinations properly obtained . . . that didn't happen in the Rabone case."

Just how South Australia's medical board handled the Rabone case was highlighted by a scathing inquiry ordered by the state's parliament, which released its report earlier this month. The report cited a handful of cases to illustrate how the Medical Board of South Australia failed to protect the health and safety of the public. "Deeply disturbed" inquiry members recommended the board be stripped of its powers to handle complaints, investigations and disciplinary proceedings. Such lack of confidence in the conduct of a bastion of the medical establishment comes on top of further scandals over how state-based medical boards deal with dodgy doctors.

Medical boards are statutory bodies responsible for registering doctors, monitoring their conduct and fitness to practise and when needed, handling disciplinary proceedings. But now the competency of doctors to manage their own is under fire. Queensland's medical board failed to identify problems with the paperwork provided by the rogue surgeon Jayant Patel, dubbed Dr Death. And in South Australia evidence revealed a litany of concerns. The board took as long as 10 years to deal with complaints, lacked transparency, and has provided two doctors alleged to have drug problems with certificates of good standing, one being Rabone, allowing them to work in NSW. These exposures are placing further pressure on the health sector to better control and manage the flow of doctors across state borders and from overseas.

In January a Productivity Commission report on the health workforce came out in favour of what many within the medical profession regard as an extreme solution: merging Australia's 90 existing registration boards for health professionals into one national entity, possibly swallowing up the eight state and territory medical boards. The report conceded that some functions, such as monitoring codes of practice and discipline "might best be handled on a profession-specific basis or possibly a regional basis". But the report made clear that medical boards should at least have their powers clipped. The radical proposals were discussed by state premiers at the February meeting of the Council of Australian Governments (COAG). Commonwealth and state governments are now considering the Productivity Commission's conclusions and recommendations, with a health working group due to report back mid-year.

Bob Sneath, the plain-speaking Legislative Councillor who chaired the upper house inquiry in South Australia, says it is "bloody dreadful" that shortcomings more than a decade ago allowed Rabone to move to NSW and continue his career with little disruption. Sneath says anything that ensures all information about a doctor's fitness to practise is known by any registering body would have his support. "I would not want to rock up there (in Sydney, to be treated by Rabone)," he says. "His patients would not have a clue."

South Australia's acting board president Mark Coleman also gave evidence that the board may have made a mistake in treating mentally ill, drug-addicted doctor Stuart Mauro, who admitted to a 10-cones-a-day cannabis habit. A coronial inquiry last year found Mauro provided "seriously inadequate" care to a public hospital patient who later died. Back in 2002 a medical board committee, headed up by some of Adelaide's most prominent and senior doctors, investigated patient complaints that Mauro had appeared to be under the influence of drugs while working as a locum. But as the parliamentary inquiry noted, the coroner found the committee "accepted Dr Mauro's denials without further inquiry". Mauro was also cleared to work in NSW, attracting complaints there. He then headed back to South Australia, and wasn't struck off until after the damaging coronial report was released and his case became public.

Dix is limited about what he can say about individual doctors practising in NSW who have addiction issues. In the case of Rabone, laws forbid disclosure of anything but the doctor's address and registration status. "I'm not sure if he's practising," Dix says. If any member of the public contacts the board to get information about Rabone, or any other doctor alleged to have had, or used to have, a drug-related impairment, state laws exclude these problems from being revealed. "We believe in giving a doctor rehabilitation rather than throwing him on the scrap heap," Dix says.

President of the Medical Practitioners Board of Victoria Joanna Flynn says procedures ought to allow effective transfer of information between the state medical boards. Flynn, also president of the Australian Medical Council, says "no doubt there are slip-ups from time to time". She believes a single national database for doctors would address that. But Flynn opposes a single national registration board for all health professionals. "I don't think that's a very good idea at all," she says, pointing the medical profession's "proud record of self-regulation".

But whether self-regulation has failed the public, as well as the medical profession, is open to debate. Those like Craig Patterson from the Royal Australasian College of Physicians believe that the transfer of data between medical boards is "variable". He says South Australia's medical board has been "cagey" with its information, and that the college, which admitted Rabone as a Fellow, needs to rely on medical boards, rather than media reports, to make decisions about their membership. The problems arising from the Rabone case are "the sort of issue that the medical boards need to be able to get on top of. What I can say is that national registration, a national database, is one of the things we have to start getting right . . . we call upon the medical boards to get it right, and it hasn't happened yet".

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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1 April, 2006

TOO BAD FOR YOU IF A SOCIALIZED MEDICINE SYSTEM CANNOT AFFORD YOU

With private insurance you have enforceable rights. But this kid was told to go away and die until publicity got the politicians involved

Fifteen-year-old diabetic Cruze Poupouare has been told there's no place for him at Queensland's largest clinic for teenage sufferers of the disease because of a funding crisis. His mother, Doreen Poupouare, was fuming yesterday that money had been put ahead of her son's welfare. But Queensland Health pledged last night to help Cruze. Southern area health services general manager Terry Mehan told The Courier-Mail: "We will deal with this."

Mrs Poupouare was told on March 15 by the Mater Hospital's Adolescents with Diabetes Clinic that it was unable to take on Cruze – even though he had been referred there by his GP. The young man has battled Type 1 diabetes since he was a baby, and needs twice-daily injections of insulin. The Mater's child diabetes clinics were "booked beyond a level we consider critical in order to offer you safe and effective care", Mrs Poupouare was told. The letter to her continued: "Until we can obtain further government funding to improve our significantly diminished staffing levels, we are unable to accept any new patient referrals. "I do appreciate the significance of this dilemma and that it leaves you and your child without specialist care."

An angry Ms Poupouare, a credit manager from Camira, west of Brisbane, said last night that she was "gutted" by the rejection. "I have never had treatment like this before . . . to be told you can't be seen at a hospital because of funding issues," she said. Recently arrived from New Zealand with Cruze and his sister, Alycia, 12, Ms Poupouare, 44, said she would have to consider returning there with her family. Their private health fund in New Zealand would not cover her son in Australia, and no insurer here would cover his existing condition , she said.

Mater Health Services said a doubling in four years of Type 1 diabetes patients, combined with the rising incidence of the lifestyle-related Type 2 form of the disease among overweight children, meant the adolescents clinic could not treat everyone referred to it. A submission had been lodged with Queensland Health to hire more staff at the clinic, Mater Health Services said in a statement.

But Mr Mehan said Queensland Health had given the hospital group $206 million in a block grant this year, up from $191 million, and it had been up to it how to allocate the bulk of the funding. The Department had not been aware of Cruze's plight until yesterday, Mr Mehan said. State Liberal leader Bob Quinn said Cruze's plight "puts another human face" to Queensland's public health crisis.

Chief executive of the Queensland branch of Diabetes Australia Joe Tooma said it was disappointing that "we have got to the point where an important facility for treating children can't carry the load put on it". An estimated 21,000 people have Type 1 diabetes in Queensland, about 8 per cent of whom are aged under 17. The case load of the adolescents clinic at the Mater has increased from 20 to 200 patients in the past decade.

Source



VHA Is Not the Way

Many on the right argue that market forces will fix America's health-care sector. The Left wants government to play a larger role in medical care. Obvious success stories on either side of that divide have been rare, but that is why the transformation of the Veterans Health Administration (VHA) makes such an interesting case. Fifteen years ago, the VHA consisted mainly of run-down, poorly managed hospitals. Doctors were inexperienced, layers of bureaucracy crippled the system, and patient satisfaction was low. After a major overhaul in the mid-1990s, much of that changed. The VHA as a whole was restructured to focus on outpatient care, rather than costly hospital stays. Nearly empty hospitals were shuttered, and smaller clinics were opened to focus on the chronic-care needs of aging veterans.

The reengineering seems to have worked. As Philip Longman detailed in the January 2005 Washington Monthly, the VHA now minimizes medical errors, coordinates care, and maintains patient records with some of the most sophisticated technology available. Doctors and nurses no longer waste time chasing down patient charts and test results; computerized records help them deliver the right care to the right patient at the right time.

A New England Journal of Medicine study found that the VHA beat Medicare on 11 measures of quality. An Annals of Internal Medicine study concluded that the VHA provided better care for diabetes patients than private managed-care systems. And veterans seem to like it too. Understandably, prominent columnist Paul Krugman now points to the VHA as a model for reforming the entire health-care sector, arguing that federal management has improved quality and has been "highly successful in containing costs."

Its recent makeover notwithstanding, persistent problems at the VHA suggest it might make a poor model for reform. First, the Government Accountability Office (GAO) reported this month that spending on the VHA "has increased substantially in recent years," and that the agency "does not have a reliable basis" for claims that it has saved or will save taxpayer dollars through management efficiencies. Second, as the GAO report suggests, programs like the VHA allow politicians to play politics with people's health. When politicians choke off resources, as they sometimes do, the VHA copes by freezing enrollment, increasing waiting times, and rationing access to the latest prescription drugs. A recent study by Prof. Frank Lichtenberg of Columbia University estimated that "increased use of older drugs" has reduced the average lifespan of veterans under VHA care by two months. Finally, the fact that VHA's successes haven't been replicated in the private sector is actually evidence of how badly government has mismanaged the private sector.

Those successes could easily be replicated by private insurers and hospitals. The problem is that few have the financial incentive to do so, because federal tax law makes employers — rather than individual patients — the real customers. Knowing that most patients skip from plan to plan as they go from job to job, insurers have little incentive to provide certain services — such as preventive care or electronic medical records — that provide long-term benefits to patients.

Were Congress to remove barriers that prevent consumers from obtaining portable coverage that stays with them over the long term, private insurers would take more of a long-term interest in their customers' health. Were Congress to allow consumers to control all their health-care dollars, private insurers would have to compete more aggressively on the basis of quality and convenience.

No one had to mandate electronic financial records or online banking: Banks offered those services to cultivate long-term relationships with customers intent on obtaining value for their money. With the incentives properly aligned, insurers might offer long-term health insurance. Knowing that their customers will be around for 10 or more years, insurers would be more likely to offer electronic medical records, preventive care, disease management, and other services for which the VHA is hailed. That the VHA outperforms the private sector in some areas makes it tempting to conclude that government could manage health care more efficiently. But to reach that conclusion, one would have to ignore how badly government has mismanaged the private sector.

So before we turn the whole enchilada over to 536 politicians, perhaps we should first try letting workers control the health-care dollars that employers now control. It may even hasten the day that we get to check our medical records online.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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