The blogspot version of this blog is HERE. Dissecting Leftism is HERE. The Blogroll. My Home Page. Email John Ray here. Other sites viewable in China: Greenie Watch, Political Correctness Watch, Dissecting Leftism, Australian Politics, Education Watch, Gun Watch, Recipes. The archive for this site is here or here. (Click "Refresh" on your browser if background colour is missing)
************************************************************************************



31 December, 2006

AMUSING OPTIMISM IN TENNESSEE

The more "painless" it is, the more it will be overused and the more costs will skyrocket!

Gov. Phil Bredesen says his new healthcare program hit a "home run" Tuesday. BlueCross BlueShield of Tennessee won both of the contracts to offer health insurance to the working poor Tuesday in a new state plan, providing a benefits package that Bredesen said is a "no-brainer" for those eligible to enroll. The contracts were awarded for CoverTN, the main part of Bredesen's Cover Tennessee health insurance plan. CoverTN is targeted at the uninsured, working poor who are employed by small businesses.

Bredesen announced BlueCross BlueShield as the winner at a mid-afternoon news conference at the state Capitol. "I don't always get to stand up here and say `This is a home run,'" Bredesen said. "But this is a home run." Premiums for the benefit will be targeted at $150 a month, with the state paying $50, an individual's employer paying $50, and the individual chipping in $50. Of the $150 average premium, BlueCross BlueShield will devote $140 toward providing benefits, which is one of the main reasons the Chattanooga-based company won both contracts, Bredesen said. "This exceeds my fondest hopes," Bredesen said. Under the two plans offered to the uninsured working poor, benefits will include:

* Enrollees will pay an $8 or $10 co-pay for generic prescription drugs - depending on the plan selected - and a $25 co-pay for brand name scripts. Those covered will be subject to a $250 per quarter spending cap on the drug's costs.

* Coverage up to $15,000 for an enrollee admitted to a hospital who is receiving medical, surgical or psychiatric care. That comes with a $100 co-pay per admission to the hospital.

* One free adult physical exam per calendar year, subject to a five-visit limit for medical, surgical or preventative services.

The $50 average monthly premium for an individual could change, however, based on their age, weight and tobacco use. Bredesen said the premium could be as low as $34 a month or up to $99 a month. "If you're old and smoke and overweight, it'll cost you $99, but you probably won't be around that long," Bredesen quipped.

Dave Goetz, state commissioner of the Department of Finance and Administration, which has oversight of Cover Tennessee, said the two plans offer a "full complement of health benefits." "For the 600,000 people who are uninsured in this state, this is a great result," Goetz said.

Enrollment will start in the first few months of next year. State officials hope to have 45,000 Tennesseans in the program by June 2008. The state has budgeted $34 million this year to pay for Cover TN, but doesn't expect to spend that much. Goetz said it will cost about $30 million a year when 45,000 people are enrolled. Cover TN is mainly targeted at small businesses whose owners can't afford to offer their employees health insurance. Small businesses can qualify if they employ 25 or fewer full-time employees and have at least 50 percent of their workers earning less than $41,000 a year. Gary Selvy, the state director of the National Federation of Independent Business, said the price of the monthly premium is "very comfortable" for small businesses, especially. "This looks, on the surface, to be very attractive," Selvy said.

Source

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

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 Pages are here or here or here.

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



30 December, 2006

NHS takes cash meant for charity

They've got a lot of bureaucrats to support

A pioneering scheme to help mental patients may have to close because the Department of Health has pocketed money promised by the Treasury. Dame Elisabeth Hoodless, the executive director of the charity Community Service Volunteers, said it was outrageous that £3.7 million had disappeared into the NHS and that all attempts to extract it had failed. Appeals to ministers have been ignored, and only recourse to lawyers and a threat to tell the press what had happened produced any response.

Yesterday the Department of Health said that the money would be with CSV by the end of January — ten months late — although Dame Elisabeth is not counting on it. The money is the final tranche of a £7.3 million grant made by the Treasury in 2004 under the “Invest to Save” programme, designed to show that by investing money to improve services, more can be saved.

CVS won the grant for Capital Volunteering, in which people in London who have suffered mental illnesses such as depression or bipolar disorder are encouraged to get involved in voluntary activities. This can include acting as helpers for other sufferers of mental illness, or activities such as gardening, sports and music. Its results are promising, with 25 per cent saying that they are gaining skills and 17 per cent reporting improved confidence.

At the end of March the Treasury passed £3.7 million to the Department of Health. It should have filtered through to the project via London Strategic Health Authority, Camden and Islington Primary Care Trust, Islington Mental Health Trust and the London Development Centre — a procedure that Dame Elisabeth describes as “pure Yes Minister”.

Somewhere along the line the cash-strapped NHS decided it would hang on to the money. “What authority had it got to do this?” Dame Elisabeth asked. “It is an abuse of power.”

CVS’s efforts to extract the cash have also been worthy of Yes Minister. It approached the Treasury, who condemned what the Department of Health had done as unacceptable. But nothing happened. Dame Elisabeth then went to a higher level in the Treasury, who agreed that the situation could not continue. But it did. Next she went to Ed Miliband, Minister responsible for the Third Sector (voluntary organisations) who said that he was anxious to help.

Hilary Armstrong, the Cabinet Office Minister, then spoke to Ivan Lewis, Economic Secretary to the Treasury. Nothing happened. “On Monday we took the decision to ask lawyers to sort it out,” Dame Elisabeth said, “and we also said we would be talking to the press.

“Things began to happen. We were told it would be in the ‘next bundle’ at the end of January. That’s not acceptable. Even if we get the money, we have lost £90,000 in interest it would have earned us, and which we need.

“What is distressing for us is that the Government is all the time saying it wants partnerships with the voluntary sector, but our trustees are now asking if this is a risk we want to take. “We’re not alone. There are a number of other organisations who have been let down by the department.”

Dame Elisabeth — the author of Getting Money from Central Government — is not in a mood to compromise. She wants the money, plus interest, immediately, before some of the staff face redundancy.

A Department of Health spokeswoman said: “They will get the money in January.” She made no mention of interest.

Source

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

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 Pages are here or here or here.

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



29 December, 2006

Obese may be denied priority NHS care: Patients with 'self-inflicted' illnesses face discrimination

No word yet, however, about fatties, smokers and drinkers being refunded their compulsory health insurance payments

Smokers, people with alcohol problems and the obese could be denied priority treatment on the NHS if they do not try to change their lifestyle. The Cabinet is discussing the controversial idea as part of a drive by Tony Blair to secure his domestic political legacy by pushing through a final round of public service reforms before he departs next year.

Ministers will confront a panel of 100 ordinary people with some of the "tough choices" facing the Government under a consultation exercise giving the public a direct say in the new policies. One question will be whether people whose lifestyle makes them ill should get the same priority as other patients. This would mean changing NHS guidelines saying that people should not be discriminated against "even if their illnesses are to some extent self-inflicted".

A Cabinet review group on public services was shocked by the scale of the burden caused by people's lifestyles. "Ministers were shocked by the fact that half of all years of healthy life are lost as a result of behavioural factors (e.g. smoking and diet)," a Government source said. Ministers want a "cultural change" in public services so the state can support and encourage people to change their behaviour to improve their life chances and well-being. They also want to extend the number of "contracts" between the citizen and the state, such as the 30 pounds -a-week education maintenance allowances paid to over-16s who remain in further education.

Experts warned this month that obesity, which costs the NHS 7 billion a year, could bankrupt it if left unchecked and predicted that the proportion of obese adults would rise from one in five to one in three by 2010. Smoking-related diseases cost an estimated 1.7bn a year, with the same amount spent on alcohol-related problems. The treatment of alcohol-related harm, such as violent crime and traffic accidents, costs an estimated 20bn.

Downing Street sources said no decisions had been taken on whether to change the guidelines and stressed that the public would be asked their views on the issue first. The suggestion is bound to provoke criticism. Forest, the pro-smoking group, has claimed that some smokers have already suffered discrimination. It argues that tobacco revenues, which bring in 7bn a year for the Government, dwarf the cost of smoking-related illness.

The cabinet group, one of six drawing up the Blair Government's last policies, will also look at how public satisfaction measures can improve state-run services. Ministers will try to learn lessons from retailers like Tesco, which has used the technology behind its Clubcard system to offer a more personalised service. The 100 people, a representative cross-section of the British public, will be recruited across the regions in the new year and organised lobby groups will be excluded. In February, they will see the papers discussed by the six cabinet groups and, in March, a public services summit will be held in Downing Street at which the "people's panel" will reach decisions. These will be presented to the Cabinet in mid-March.

Hazel Blears, the Labour Party chairman, is looking at other ways in which the public could influence government policy and the way that services are run. A Blair aide said: "This process of public engagement recognises that politics is changing. The public level of expectations is rising both in terms of the provision which they receive and the right which they have to influence those services. It will identify in more detail the areas which the public want us to focus on and develop a series of radical and progressive solutions."

The cabinet reviews have already provoked controversy. A paper for the security, crime and justice group, leaked at the weekend, suggested that crime could rise for the first time in more than a decade as economic growth slows, and that the prison population, already at a record 80,000, could rise to 100,000 over the next five years. The Government has promised an extra 8,000 prison places but it is not clear how they will be funded. The Treasury has frozen the Home Office budget in real terms from 2008-11 other than for spending on security and anti-terrorism work.

Yesterday David Davis, the shadow Home Secretary, challenged the Chancellor, Gordon Brown, to address the "chronic shortage" of prison places. He said: "All we have seen from Gordon Brown has been a miserly approach which, as well as putting the public at risk, is short-sighted. The cost of having a serious criminal free on the streets to commit crime far outweighs the cost of imprisoning and rehabilitating that individual."

Source. Tangled Web has some comments.

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

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 Pages are here or here or here.

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



28 December, 2006

BRITAIN: A LESSON FROM VETERINARY MEDICINE

Our small dog was in a bad way – vomiting, and with a dreadful case of the ‘scoots’ as we say in Scotland. We thought he had eaten something nasty, and it would soon pass. But by 6pm we realised that we needed a vet.

It was Sunday evening. Indeed, it was Christmas Eve. But the vet answered the phone straight away, and told us to come round to the surgery. Ten minutes later, he was examining the dog, and fifteen minutes after that, he had diagnosed the problem, given him three injections, bottled up a week’s dose of two different kinds of medicine, told us he would recover just fine, swiped 34 pounds off our credit card, and assured us that it was just fine to call him on Christmas day if we had any further problems. That’s what I call good service.

By contrast, as I say, a few weeks back I needed to see the doctor. It was a Friday evening, and a recorded message told me that the surgery was now closed until Monday. If I had a real emergency I could leave a message and someone – obviously not my regular doctor – would call me. It wasn’t an emergency, so I called back on Monday, and managed to get an appointment ten days later (though in honesty, I could have seen another doctor in a shorter time). The doctor wrote me a prescription, again for two medicines, but I had to walk half a mile up to the chemist to get them. They cost me around £14 (the standard NHS medicines charge), almost half what the vet charged me for his whole on-the-spot consultation and prescription.

Why do vets give such better service? I am sure that doctors are just as dedicated to their vocation. But with the vet, the link between serving your customers and getting paid by them is immediate. It concentrates the mind on giving good service. In the NHS, remuneration is negotiated and paid by government quangos. There is no clear link between getting paid and giving a good service to your customers.

Doctors should be remunerated like vets. And if some people cannot afford their fees, then those people should be subsidized through the welfare system. The rest of us should pay cash. We might grumble at that thought: but we would get such a better service that overall, we would probably grumble far less.

Until that happens, though, next time there is something wrong with me, I shall be consulting a vet.

Source

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

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 Pages are here or here or here.

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



27 December, 2006

"Healthy Americans" Act: More Good news than bad?

Excerpts from an article by Steve Trinward that appears to have been censored at its original source

A new national healthcare plan was revealed this week, sponsored by Sen. Ron Wyden, a Democrat from Oregon. On first glance, it may appear to be just another variation on the Hillarycare model for socialized medicine, and in some ways it seems to be being promoted that way. However, this may be a case where marketing undercuts the reality, the way so many Hollywood films of recent vintage have done. (Who could have known how sensitive Adam Sandler's characters in Spanglish or 50 First Dates could be . based on the same old slapstick shown in the previews?)

Is it possible to craft a program that can blaze a path toward a true reform in healthcare? Let's find out, by examining the major ideas being brought forth in the Wyden plan. To begin with, let's summarize (details below): The Good News: (1) The program focuses strongly on wellness and prevention as a paradigm for healthcare; (2) It stresses self-responsibility, and offers a way out of the "employee benefit" box; and (3) It pushes for "portability" and individual ownership and control of that wellness. The Downside, at least for many libertarians, is: (a) how many mandates there are for government involvement in making this happen, requiring compliance from many segments of society, including those same individuals and their employers; (2) the fullscale trampling of the Tenth Amendment, mandating state creation of local coverage programs and monitoring of the results; and (3) perhaps most significantly, the lack of mention of Medical Savings Accounts, or other methods for funding self-responsible wellness, as part of its prescription.

Aside from this, however, there's a lot to recommend here. From the very first sentence, although the title is "Guaranteed Private Coverage," the explanatory statement following it (in the summary document) reads, "Within two years of enactment States must create a system as outlined in the bill to provide individuals the opportunity to purchase a Healthy Americans Private Insurance (HAPI) plan that meets the requirements of the Act." Notice how it says, "provide individuals the opportunity," not "require" them to; unless this is just more politico-speak, there's clearly some element of choice here.

On the other hand, the next section DOES use some coercive language: "Adults (over age 19, U.S. citizens, not incarcerated) must enroll themselves and dependent children in a plan offered through the state-wide Health Help Agency (HHA) [emphasis added] unless . [a laundry-list of specific exceptions]." It also then calls for a penalty for non-compliance, based on the period of such non-compliance times the average monthly premium for an appropriate plan, plus a 15% penalty, payable to the given state's HHA.

This seems coercive, and indeed it is; however, given the incentives for getting on board with the program, this might be considered almost forgivable. Note that the Senator does not mandate all of this in a vacuum. He begins by promoting the idea (long overdue, and presented several times in this space of late) that employers should stop providing health insurance for their hired hands, and should instead reallocate their funding of current programs to pay-raises, so the employees can do so themselves.

The catch is, those employees would then be expected to put that extra money into paying for their own health coverage, choosing among existing plans and those newly created under the program. The good news is, Wyden is encouraging self-responsibility for able-bodied, employable individuals, offering them an incentive to take charge of their own wellbeing. The bad part: As mentioned in the summary at the top, there's no reference anywhere in the document to medical savings accounts, or to combining high-deductible coverage with an MSA, or permitting any unused windfall (provided the person has maintained proper checkup and screening appointments, and been found hale and hearty thereunder) to become one's own "property" at the end of each year. Both concepts would not only allow for some intelligent decision-making for each of us, but would also enhance both cost savings and personal responsibility in the process.

There's also a very strong precedent already in place, in the existing employee programs at Whole Foods Company: The owner no longer pays insurance premiums, but pays the deductible amount on the policies of his workers - at the beginning of each year, and directly into their hands, to do with as they choose, while they remain responsible for maintaining their own wellness by whatever means possible. If at year's end, there is money left over, it's the employee's to spend as (s)he chooses. (Also, we might note, since this natural foods store-chain has both progressive and libertarian roots, one might think Sen. Wyden would already know of this program.)

As noted above, the Senator also would infringe further on the 10th Amendment to the Constitution, by mandating what each state should provide - "at least two plans that meet the requirements of the Act" - as well as in dictating what such plans may include: "(1) plans similar to the Blue Cross Blue Shield Standard Plan provided under the Federal Employees Health Benefit Program as of January 1, 2007; (2) plans with additional benefits added to the standard plan so long as those benefits are priced and displayed separately; and (3) actuarial equivalent plans to the standard plan." States-rights activists might not buy into this idea - however well-intended it may be - yet that intention is pretty clean on its surface......

An entire section of the HAPI plan addresses the division of "responsibilities" (thereby setting it far apart from almost every other government program within this editor's awareness). The requirements on individuals are simple: Enroll oneself and family in an approved plan, and pay the premiums required. If you wish to be subsidized for all or part of your premiums, you must turn in the proper paperwork, and keep the local HHA aware of any changing conditions or addresses. Otherwise, it's up to you to pay your premiums and use the services as needed. (Here's a chart showing the projected relative effect on various types of people in this plan.)

From employers, Wyden seeks an annual (relatively small, compared to paying health insurance premiums) administrative fee (based on the number of employees) and a transition from paying those insurance premiums, to paying workers more directly, so they can do so for themselves. (Companies above a certain size that aren't now providing such benefits would be expected to find a way to begin paying their workers some sort of increase, or suffer rather large fines. Here, the details are somewhat fuzzy.)

Moreover, says Wyden in no uncertain terms, "Individuals own their medical records." He wants us to start taking control of our own documentation, which is not all that burdensome, if we're getting regular preventive care from a chosen set of healthcare providers. (This chart shows the relative effect on various levels of employer-status.)....

And finally, the role of the Feds themselves is spelled out [paraphrasing here]: (a) fund insurance-premium subsidies; (b) establish a new "Healthy Americans Public Health Trust Fund" to feed with premiums and employer contributions (Wyden apparently believes in the "lockbox" concept that's worked so well for Social Security); (c) create a tax credits system for employees and employers who comply immediately with the new programs (as well as for retirement coverage); (d) create a Healthcare Standard Deduction for all citizens (mitigating or offsetting taxes on money spent on your own wellness), based on the level of coverage taken on; and (e) generally getting out of the way otherwise.....

Wyden also seeks to establish a baseline income-level, below which one would be eligible for total subsidy of such policy premiums, setting the current "poverty level" ($9,800 individual, $20,000 for a family of four) as that marker, with a sliding scale of subsidies extending up to the $40K ($80K per family) income-level. Again, by meshing a program that pushes people toward self-responsibility with one that subsidizes them directly, he tempts the fates to lose all perspective. Charitable work should not be conflated with pay-your-own-way and "hand up" ideas, lest both efforts be attenuated by the lack of clear intention.

Is this idea perfect? No, it still includes some very coercive features, which must be eliminated before it could truly become a self-responsible system. Does it address the major problems of the present healthcare mess? Yes, emphatically so. It also shows some promise for leading to a future where the vast majority of us are healthy, wealthy . and a lot wiser about what we do to our own bodies - that keeps them going longer, stronger and less in need of all that expensive "end-care" that is bankrupting us all. Senator Wyden is to be complimented on a very strong and extensive first step on this issue.

More here or here

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

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 Pages are here or here or here.

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



26 December, 2006

THE STRANGE PRIORITIES OF GOVERNMENT MEDICINE IN CALIFORNIA

Jail inmates, most of whom are citizens, go without medical care while non-citizens get a huge amount spent on them. Government medicine always has to prioritize but these priorities don't seem to be medical at all. Two reports below from one newspaper on the same day.

Inmates

Treatment errors and other breakdowns in medical care have contributed to the deaths of at least 14 inmates in the Los Angeles County Jail system since 1999, according to a newspaper report. The jail system lacks enough doctors, nurses and other medical workers, resulting in long delays in treatment for conditions ranging from hernias to heart disease, the Los Angeles Times reported in Sunday editions. Inmates sometimes have wait weeks for exams they're supposed to receive within 24 hours of making a request.

Officials acknowledge that 20 percent of inmates who ask to see a doctor are released from jail without ever being examined, according to the Times. Jody Kent, a court-sanctioned monitor who for three years walked the county's cellblocks documenting complaints for the American Civil Liberties Union, said inmates showed her gaping wounds from infections, broken bones and bulging hernias. "I basically saw grown men crying because they were in such pain," Kent said.

Sheriff's Lt. Stephen Smith, who oversees the jail system's medical services bureau, said treating prisoners is difficult because some conceal a medical condition while others feign illness or are mentally ill. "We face unique challenges, and we do the best we can," Smith said. "These are difficult, angry, messed-up people. We try to treat people with the respect, not that they necessarily deserve, but that human decency demands."

A large problem is understaffing. In a confidential 2004 report, a consultant said an additional 720 jail medical workers were needed to meet minimum state treatment standards. At the time, the work force stood at about 980. "The county incurs significant liability for continuing a system of care that clearly is not working," the consultant said in the report to the Los Angeles County Board of Supervisors. Spurred by those findings, officials began to bolster the ranks of doctors and nurses, but several hundred medical workers are still lacking. An average of about 200,000 people enter the county jails each year. On most nights, the population hovers around 18,000, with more than a third requiring medical care.

The county Sheriff's Department, which runs the jails, is required by law to provide basic medical care to all inmates. When inmates are booked, they are questioned to determine if they are physically or mentally ill. About half require additional screening or treatment before being assigned to a cell. If inmates develop medical problems later, there are daily "sick calls" in which they can sign up to see a nurse. The volume of inmates, coupled with a shortage of doctors and nurses, has resulted in a backlog of hundreds of inmates waiting to be examined. "I could have every doctor in the county of Los Angeles here, and it still wouldn't be enough," said Sander Peck, chief physician in the jail system. "I don't know what 'enough' would be."

Source

Illegals

More than 100,000 undocumented women each year bear children in California with expenses paid by Medi-Cal, according to state reports. Such births and related expenses account for more than $400 million of the nearly $1 billion that the program spends annually on health care for illegal immigrants in California, the Los Angeles Times reported, citing state reports. California long has been one of the more generous states in offering such benefits to illegal immigrants, covering everything from pregnancy tests to postpartum checkups.

Many illegal immigrants who might otherwise shy away from government services view care associated with childbirth as safe to seek. "I wasn't afraid at all," said Sandra Andrade, an illegal immigrant from Colombia who recently gave birth at a Los Angeles hospital. "I'd always heard that pregnant women are treated well here."

Nationally, a debate is simmering about the costs of providing medical care to illegal immigrants. Anti-illegal immigration groups argue that "birthright" U.S. citizenship for babies born in America is an incentive for illegal immigrants to have their children here. "I think most Americans think that while they certainly don't want to do anything to harm children you cannot have a policy that says anybody in the world come here and have a baby and we have a new American," said Ira Mehlman, a spokesman for the Federation of American Immigration Reform, an immigration control group based in Washington, D.C.

Prenatal care is one of the most controversial aspects of providing health care to illegal immigrants. While labor and delivery long have been considered emergencies, entitled to some federal reimbursement, federal officials have often balked at covering prenatal care. Generally, the state and federal governments share the cost of Medicaid programs, called Medi-Cal in California. Advocates of such coverage say it's cheaper to pay for prenatal care than risk complications that could saddle the government with huge medical bills. "Without prenatal care, there's a serious risk that a child will be born with severe disabilities," said Lucy Quacinella, a lobbyist for the Los Angeles-based social service nonprofit group Maternal and Child Health Access. "The cost of caring for that child over a lifetime is astronomical when you compare the cost of having provided the prenatal care."

Still, investing in pregnant illegal immigrants is costly. Births and prenatal care are the biggest single outlay by Medi-Cal for illegal immigrants' health care, with the rest going for various other emergency treatments, limited breast and cervical cancer treatment, abortions and some nursing home care, according to the state. In Los Angeles County's public and private hospitals, undocumented women accounted for 41,240 Medi-Cal births in 2004, roughly half the deliveries covered by the public program. In the four county-run hospitals alone, undocumented women and their newborns will receive more than $20 million in delivery, recovery, nursery and neonatal ICU services this year, according to a county estimate.

Source

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

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 Pages are here or here or here.

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



25 December, 2006

AUSTRALIA: WOMEN PAY FOR CONSTANT LITIGATION AGAINST OBSTETRICIANS

By Bettina Arndt

The battle was supposed to be won more than 30 years ago when the women's movement pushed for the right to make informed decisions about their health care.... Women emerged determined to no longer be passive recipients of over-medicalised health care, particularly during childbirth. But those of us old enough to remember those days are blown away by what's happening in today's obstetric care.

Recently a 50-something Sydney midwife spent a few days working in a Sydney private hospital. She was amazed that of the 30 to 40 new mothers she cared for, only a handful had vaginal births and many chose elective caesarean with no medical indication. How can so many women have been hoodwinked into thinking that a caesarean is the best option for them and their babies?

What's happened is the doctors have been burnt. There have been some major payouts for medical negligence over cases where it was argued obstetricians should have done a caesarean, or done one sooner. The result is obstetricians are fast losing the skills to handle the difficult cases.

This all gives the impression that caesareans are a safer method of delivery, for women and their babies. Yet, a recent French study suggested caesarean delivery more than triples a woman's risk of dying in childbirth compared to vaginal delivery. Luckily these risks are small, but they rise significantly with each caesarean. These babies are more likely to suffer respiratory distress; labor prepares babies for breathing by massaging respiratory organs and aiding elimination of mucus from their systems.

Yes, there are horror stories but many women are being conned into thinking caesareans offer an easy way out. Even the broken coccyx I experienced during my son's natural birth was nothing compared to the ordeal of recovering from my two caesareans. For every mother on the internet claiming the caesarean was a breeze, there are others talking of horrible post-surgery pain, the problems looking after a new baby with a painful scar, difficulties with healing, long-term complications.

It's hardly surprising there is evidence caesarean births mean mothers are more likely to have early parenting difficulties and post-traumatic stress. Yet our caesarean rates are soaring. The caesarean rate hit close to 30 per cent in 2004, increasing to 38 per cent for women in private hospitals, according to figures released by the Australian Institute of Health and Welfare. If these figures keep rising, it may spell the end of normal vaginal births. There simply won't be the skilled obstetricians or midwives available to help if the going gets tough.

And more mothers and babies will die as a result. Countries like Brazil, which have already gone down that route, are showing increases in maternal and child mortality. In affluent areas of Brazil, there are hospitals with more than 80 per cent caesarean rates. Across Australia, maternity hospitals are already feeling the strain, as elective caesareans add to the burden on theatres, surgical and nursing resources.

Women contemplating elective caesarean, without good medical reasons, need to understand the risks to themselves and their babies. The majority of Australian women believe women's bodies were made to give birth without a knife.

Source

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

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 Pages are here or here or here.

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



24 December, 2006

CALIFORNIA HEALTH CARE PLAN A RECIPE FOR DISASTER

State Senate President Don Perata has a plan to provide all uninsured working Californians with health insurance at an estimated cost of $5 billion to $7 billion without a tax increase. OK? The Perata plan would force businesses that do not provide health insurance and their employees, through a payroll deduction, to pay into a state agency that would attempt to negotiate for "affordable" coverage. When paying taxes, workers would have to show proof of medical insurance. This is just plain wrong on so many levels. Let me count the ways.

A plan that is estimated to cost $5 billion to $7 billion will, if past government program estimates are any guide, cost a lot more than first advertised. One only has to look at the Bush prescription benefit plan as a reminder.

Apparently our state's second-most-powerful elected official believes there is such a thing as a free lunch. He should know that a plan that compels businesses to lay out more for labor than its market value is a tax on those businesses. It will cost businesses and, as the increased costs are passed on, it will also cost consumers, too. Employees, many working at low-wage jobs, will see a reduction in their paychecks. Just like the other taxes they pay, this health insurance charge will translate into less take-home pay.

As the cost of employment goes up, workers are likely to face a second problem: fewer jobs. What is worse than no health insurance? No health insurance and no job. And proof of insurance to pay taxes? This would only force one more nuisance, clerical mandate on a public already overwhelmed with nuisance mandates from government.

And a state-run program is a recipe for disaster. Anyone who has had dealings with an unaccountable bureaucracy like the DMV or the post office knows what a headache even a minor problem can become.

Perata justifies his plan as cost-effective because, he says, taxpayers already pay the health care costs for the uninsured when they end up in our emergency rooms. But the senator ignores the elephant in the room. The additional burden that is breaking the back of our emergency health care system is illegal immigrants. Our neighbors to the south are "outsourcing" their health care demands. As long as the federal government takes a lackadaisical approach to border enforcement, this problem will continue. Solving a health care problem, a major component of which is caused by those who are in the country illegally, should not be the financial obligation of small businesses, their work force or of California taxpayers.

This is a federal responsibility, and now that California representatives have new positions of power in Washington, D.C., Perata would be well advised to press fellow Bay Area Democrat, and soon to be speaker of the House, Nancy Pelosi, to see that the federal government makes good on its obligations. However, the issue of state-mandated and supervised health care is part of an even larger problem. That problem is powerful politicians who are committed to a government that is all things to all people, and who believe this can be accomplished without cost.

Source

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

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 Pages are here or here or here.

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



23 December, 2006

FDA may ease access to new drugs

A small step forward or more bureaucracy?

The Food and Drug Administration said Monday that it is proposing to expand access to experimental drugs for seriously sick patients, and would allow drug companies to charge for as yet unapproved therapies. For decades the FDA has allowed some patients to take drugs that are still under investigation and awaiting government approval. But the guidelines for when those drugs could be used were not explicit or broad enough, the FDA said, nor was there enough awareness among doctors and patients of what options were available.

The new rules are intended to give physicians clear directives on when to grant access to medications, even perhaps at the very earliest stage of development, in cases in which the potential benefit is deemed to outweigh the risks. The goal, the FDA said, is to give "many more patients" access to unapproved medicines. For example, until now the rules limited the use of such drugs to certain groups.

Additionally, the FDA said it was moving to address "inequities in access" to experimental drugs. In situations outside the most sophisticated teaching hospitals, it has been possible for viable treatment options to get overlooked. "We expect that clearly articulating procedures and standards for expanded access will result in more patients with serious or immediately life-threatening diseases or conditions getting the earliest possible access to these therapies," the FDA said.

In some situations in recent years, according to patient advocates, drugs that appeared to give significant hope to the seriously ill were withheld for further testing. One example they cite is Erbitux, which was not widely distributed until final FDA approval even though it had shown efficacy early on in treating some forms of cancer.

Use of these unapproved drugs, even those of unknown safety, will be reserved for the most grave medical problems, said Dr. Rachel Behrman, deputy director of the FDA's office of medical policy. "We are not talking about the temporary relief of minor pain," Behrman said. "We are talking about serious diseases." The FDA would also allow researchers to charge patients for experimental drugs to recover the costs of development, but not a profit. This is intended to make drugs more available in cases in which their high cost might deter a small pharmaceutical company from offering an unproven treatment.

"FDA hopes this proposal will increase awareness in the health-care community of the range of options available for obtaining experimental drugs for seriously ill patients," said Dr. Janet Woodcock, the agency's deputy commissioner for operations. The proposal, which is open for comment for 90 days, codifies and makes formal policies that have grown up over the years.

Use of unproven drugs has been a hot-button issue for decades. AIDS activists have long complained that the approval process for drugs is too slow. The FDA noted that tens of thousands of patients have already received unapproved drugs for treatment of HIV, cancer and heart disease. However, the existing regulations did not adequately describe the full range of programs available, the agency said in statement.

One health advocate sounded a warning about the proposal to use drugs that have not been proven risk-free. "None of these drugs do we know are safe and effective," said Dr. Sidney Wolfe, editor of WorstPills.org, a part of Public Citizen. "You may be doing people more harm than good," he said. Wolfe noted that experimental drugs for cancer and AIDS often have toxic side effects that can present a danger to patients.

But Frank Burroughs, president of the Abigail Alliance for Better Access to Developmental Drugs, said the FDA does not go far enough in assuring quick access to all drugs that could help patients. Burroughs said that in many cases it is quickly apparent that a drug is safe and effective yet still is not made available to people who would benefit from it. "A good example is Erbitux," Burroughs said. He said that Erbitux quickly displayed effectiveness in treating cancers of the head, neck and colon. "Abigail was my daughter," Burroughs said. "She died in 2001 after being unable to get Erbitux."

Next year a federal court is scheduled to hear a case brought by the Abigail Alliance and the Washington Legal Foundation aimed at making experimental drugs more accessible to patients.

Source



TWO YEAR WAIT FOR SOME IN BRITAIN

Some patients needing orthopaedic surgery are still waiting more than two years for treatment, according to new figures.

The latest official statistics on NHS performance with regard to the 18-week waiting times target showed that some specialities were performing particularly poorly.

In what is widely considered to be the most ambitious target for the health service, the Government has pledged that no patient should wait more than 18 weeks from GP referral to the start of treatment, whether they are an in-patient or an out-patient, by the end of 2008.

Figures released yesterday by Andy Burnham, Health Minister showed that most specialities - including gynaecology, dermatology and cardiology - treat between 30 per cent and 50 per cent of in-patients within 18 weeks. But that figure falls to below 20 per cent in trauma and orthopaedics - which includes hip replacements and broken bones - where the average patient waits an average of 39 weeks for treatment. The new figures show that an average of 70 per cent to 80 per cent of patients who do not require hospital admission are treated within 18 weeks.

When it comes to patients needing hospital admission, only 35 per cent are seen within the target.

Source

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

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 Pages are here or here or here.

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



22 December, 2006

NHS BANNING NECKTIES

In an attempt to deflect blame for MRSA from where it really belongs -- dirty hospitals and negligent staff

Doctors have been banned from wearing ties in an effort to contain the spread of superbug MRSA. An NHS trust has told hospital staff, including senior consultants, that the wearing of ties and "other superfluous clothing" could result in disciplinary action. The rules have been introduced by the Brighton and Sussex University Hospitals NHS Trust in a bid to reduce its rate of MRSA infection, which is one of the highest in England. The new dress code policy also bans staff involved in direct clinical care from wearing jewellery, watches, scarves and wraps.

But doctors say the new rules stem from political correctness rather than scientific evidence and fear that patients will have less confidence in casually dressed medics. One consultant, who works for the trust but did not want to be named, told the Sunday Times: "If you come to see a consultant, you will be greeted by an open-neck-shirted doctor who will look as if he is the hospital DJ, but will in fact be the consultant." Dr Michael Dixon, chairman of the NHS Alliance, which represents primary care trusts, and wears a bow-tie at his GP surgery, told the paper: "This is political correctness rather than science. Patients need to be able to respect and trust their doctors and going around without ties might damage that relationship."

Earlier this year the British Medical Association suggested that doing away with functionless items of clothing such as ties may help reduce rates of MRSA and other hospital acquired infections. Over 3,500 cases of MRSA blood-stream infection were reported in NHS hospitals between October 2005 and March 2006 and the number of deaths where the superbug is mentioned on death certificates has increased each year from 1993 to 2004. A spokeswoman for the trust said action was needed to improve infection control rates and that the new measures were introduced following consultation with staff.

Source



Harmed in NSW public hospitals: 500 errors a record

NSW is Australia's most populous State

Almost 500 medical errors in NSW public hospitals either seriously harmed patients or could have done so in 2005-06 - the highest number in the three years the statistics have been collected. Problems with diagnosis, treatment and specialist referral topped the list of incidents judged to be in the most serious category, followed by 137 suicides that occurred outside hospital within a week of the person having been seen by a mental-health professional. Birth problems and avoidable falls also figured prominently, and 36 operations or X-rays were either performed or planned for the wrong person or part of the body. Instruments were left in the body after 11 operations. There were four serious problems with medication or intravenous fluids in the reporting period to June 30.

In a separate notice distributed to area health services in April, the Health Department informed doctors and managers of a "near miss" involving the leukaemia drug vincristine, which is intended for intravenous injection and is almost always fatal if injected into the spinal canal.

The Minister for Health, John Hatzistergos, said the increase - to 499 serious incidents from 429 the previous year - did not mean hospitals were less safe, and instead reflected an increased willingness by health workers to record incidents they witnessed. As well, the reporting program had been extended to the ambulance and prison health services.

Cliff Hughes, the chief executive officer of the Clinical Excellence Commission responsible for analysing the cases, said the increase in reports "tells us the system has a desire to improve". "The aim is to be proactive in preventing serious adverse events from harming our patients," he said. The reports demonstrated health workers' confidence in bringing dangerous incidents to light in a no-blame environment, he said, and represented "a huge culture change".

The commission was formed as a supervisory body for public hospital treatment standards after a group of nurses at Camden and Campbelltown hospitals revealed numerous medical errors. Its analysis found policies and procedures were to blame for a quarter of the errors and near misses. These included inadequate training requirements for some staff. Another quarter were attributable to communication problems, particularly when patient care was handed over to a different medical team or between shifts. Incompetence or outdated skills were behind almost 100 cases, and inadequate ratios of medical staff to patients, or rostering of junior doctors into senior roles, was at the heart of about 70 of the problems. Equipment failure was much less common.

Some improvements could be made by basic changes to practice, Professor Hughes said. Hospital infection rates had been reduced after the provision of bedside alcohol-based gels for cleaning hands, instead of requiring health workers to go to the sink to wash. New protocols were being developed to identify people most at risk of falls - the over-65s and those taking multiple medications - so they could be given extra assistance in hospital.

But Mr Hatzistergos said a certain level of human and system error was unavoidable. "We haven't reached a stage where we have infallibility or perfection in medical science," he said. The collection of data would be further expanded to take in private hospitals in NSW, which perform the majority of colonoscopies and some other procedures.

Source

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

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 Pages are here or here or here.

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



21 December, 2006

SECOND BABY KILLED BY NEGLIGENCE ABOUT CLEANLINESS IN A LOS ANGELES PUBLIC HOSPITAL

Very reminiscent of the problems in Britain's dirty public hospitals

A baby died Monday after being infected by a virulent bacterium during an outbreak that prompted officials at an East Los Angeles hospital to stop accepting patients to its neonatal intensive care unit. The infant was among five patients at White Memorial Medical Center who were infected by Pseudomonas aeruginosa - a common but potentially deadly bacterium for those with weak immune systems. An autopsy was under way, although hospital officials said it was likely the baby died because of the infection. The infant is the second to die since the bacterium was detected Nov. 30. No autopsy was conducted on the first baby, although the infection was believed to be the likely cause of death, said Dr. Rosalio Lopez, the hospital's chief medical officer. "We want to express our sincere sympathies to the families affected, and ensure the public that we take the health and safety of our patients very seriously," Lopez said in a telephone interview, adding he was confident the outbreak has been contained.

The source appears to be improper cleaning of laryngoscope blades, a piece of medical equipment used to insert breathing tubes, hospital and county health officials said. In a letter to the hospital Monday, county officials noted a preliminary investigation had determined the blades had previously been disinfected by a "central supplier" as part of a manufacturer recommendation. For reasons not immediately known, the practice was changed in March and the unit's staff began cleaning the instruments. "These blades may have become contaminated due to inconsistent and improper cleaning practices that were in place between March and December 4," said Dr. Laurene Mascola, director of the county's acute communicable disease control unit, which is investigating the outbreak.

The others who were infected by the germ were treated with antibiotics and "continue to improve," Lopez said. They include two older children in the pediatrics intensive care ward who were not infected by the equipment, he said. The source of their infection has yet to be determined.

The hospital temporarily ceased new admissions to its pediatrics intensive care ward last week. It was back to normal operations Monday after hospital officials sterilized the unit and found no further trace of the bacterium. The hospital was working with county and federal health officials to determine when to reopen the neonatal intensive care unit, which was closed to new patients Dec. 4, Lopez said. He said most babies treated in the unit are either born prematurely or have multiple medical problems. In her letter to the hospital, Mascola said there was no evidence of further contamination and recommended reopening the unit.

Source



MORE DETAILS OF THE LATEST NHS SUPERBUG DISGRACE

As I predicted on 19th, it was due to a failure of asepsis -- negligence about cleanliness, in other words

The husband of a nurse who became the first person in Britain to die from a new deadly strain of MRSA contracted in hospital described the heartbreak yesterday of bringing up their newborn baby alone. Maribel Espada died four days after undergoing an emergency Caesarean at the University Hospital of North Staffordshire, where she had worked as a nurse for four years.

Health experts believe that Mrs Espada had previously picked up the Panton-Valentine leukocidin (PVL)-MRSA bug while working at the hospital. But it got into her bloodstream during the emergency operation last September.

Wen Espada, 30, told The Times that he was devastated at the thought of bringing up their son, Arwen, alone. "This was our first child and the only comfort I have is that Maribel got to see him and spent six days with him before her death. The doctors never mentioned MRSA and they had not mentioned to my wife that there had been an outbreak of MRSA even though she worked at the hospital."

Mr Espada, a warehouse worker, said that Maribel became ill four days after Arwen was delivered on September 20. Doctors told Mr Espada that his wife had died of an infection, and a postmortem examination confirmed PVL-MRSA.

One other patient at the hospital is known to have died there in March from the bacterium and an internal investigation carried out after Mrs Espada's death has identified a further nine cases at the hospital. Mr Espada said that he had instructed a firm of solicitors. "If the hospital has tried to cover this up, they should be made to pay for it," he said. The University Hospital of North Staffordshire refused to comment on Mrs Espada's death.

Source

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

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 Pages are here or here or here.

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



20 December, 2006

MRSA OUT OF CONTROL IN NHS HOSPITALS

The hospital where two people, including a previously healthy nurse, died from a new strain of MRSA was named yesterday as it was revealed that three further cases had been identified. The University Hospital of North Staffordshire NHS Trust in Stoke-on-Trent confirmed that a healthcare worker and a patient had died after falling victim to a form of the toxin Panton-Valentine leukocidin (PVL) earlier this year.

The pair fell ill in March and September after becoming infected by a bacterium that had not been seen previously at the hospital, the trust said. Six colleagues and housemates of the health worker were found to carry the bug, after staff who had direct contact with the nurse were screened after the outbreak.

There have also been three further cases, one of which was a former patient. The hospital said: "No current patients have been identified as affected. All those affected have been informed and there is no need for any other patient to be concerned. Where screening swabs from members of staff are positive for this, or any other strain of MRSA, they are being given decolonisation treatment and followed up by the occupational health department before returning to work. "With the exception of one infection, it is not clear at this stage whether transmission has occurred within the hospital or, as is more common, in the community which it serves." The hospital said that it was taking advice from the Health Protection Agency (HPA).

Figures for the first seven months of the year show that up to 47 of the 55 patients treated for MRSA-related illness at the hospital contracted the bug within the 1,200-bed site. The eight other patients are thought to have been carrying the infection before admission. The commonly known "hospital-associated MRSA" strains, which do not produce PVL, typically affect elderly hospitalised patients. But PVL attacks white blood cells leaving the sufferer unable to fight infection and putting healthy people at risk. The HPA said that strains of MRSA that produced PVL had been seen in Britain, but usually in the community rather than in a hospital. It added: "This outbreak is the first time transmission and deaths due to this strain are known to have occurred in a healthcare setting in England and Wales." Andrew Lansley, the Shadow Health Secretary, said: "It is time for us to take on the threat of new and more dangerous bacteria."

Source



AUSTRALIA: ANOTHER DODGY PUBLIC HOSPITAL DOCTOR

It's a lottery what you'll get when you go to a public hospital. The "regulators" say almost anyone with some sort of medical degree is OK. It's the only way they can find "enough" doctors. Paying more and training more are too hard

Coroner Tina Previtera, inquiring into suicides, will report the actions of an overseas-trained doctor to the Queensland Medical Board. Coroner Previtera said yesterday she would provide information to the board on Errol Van Rensburg, who discharged a severely depressed patient, Patrick Lusk, from Cooktown Hospital in April 2005 without adequate assessment. Lusk, 66, a taxi driver, committed suicide two days later.

Ms Previtera, who inquired into the deaths of Lusk, Yarrabah resident Charles Barlow and Kuranda teenager Emily Baggott (Dr Van Rensburg only treated Lusk), also made strong recommendations that Queensland Health, as a matter of priority, "actively implement" its own policies and guidelines for reducing the incidence of suicide. "What the situation now dictates is that everything cannot stay the same," said Ms Previtera. She said Barlow, 36, who hanged himself an hour after being refused a transfer to the Cairns Mental Health Unit, had not been assessed at all "due to pressure on resources". Baggott, 16, and Lusk had been inadequately assessed.

Ms Previtera said Lusk had gone to Cooktown Hospital with his ex-wife, Cheryl Prigg, on the advice of his GP who also provided Cairns Hospital records of his treatment for a previous major depressive illness. "Not only was Dr Van Rensburg's assessment inadequate, but no written referral to the mental health service was made or actively pursued," Ms Previtera said. She also said Dr Van Rensburg had been unable to recall Lusk's death in a sentinel review less than a month after the death. Ms Previtera said Dr Van Rensburg, appearing in the coroner's court, had been observed to be "disoriented, confused, evasive, obtuse, avoidant and vague during his evidence".

She said Dr Van Rensburg had been granted "special purpose registration" by the Queensland Medical Board after moving to Australia in 2002. He had relocated from Cooktown to Cairns on June 14, 2005. On June 30, a doctor wrote to the Cairns Base Hospital medical director expressing "significant concerns" about Dr Van Rensburg's capacity to practise "competently and safely". A Cairns Base Hospital spokesman said Dr Van Rensburg continued to work there under supervision.

Source

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

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 Pages are here or here or here.

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



19 December, 2006

DEADLY NEW STRAIN OF MRSA FOUND IN NHS HOSPITALS

An almost inevitable outcome of dirty hospitals and negligence about aseptic procedures

A healthy hospital worker died after contracting a deadly new strain of MRSA that had never before been reported as a cause of death in hospitals. Four other workers at the same hospital also contracted Panton-Valentine Leukocidin-positive (PVL) MRSA, with two of their friends, said the Health Protection Agency. An investigation subsequently found that the strain had killed a patient at the hospital earlier this year.

The strain, which is particularly virulent, attacks healthy young people and can cause symptoms ranging from minor infections in the skin and soft tissue to a form of pneumonia that can kill in 24 hours. The outbreak, which has only just been reported, was identified when a previously healthy female healthcare worker, named only as “Case One”, developed a severe MRSA infection and pneumonia and died after emergency surgery in September, the agency said. The bacterium that she had contracted, PVL-positive MRSA, had never been found to cause a death inside a hospital. It was contracted by at least three other workers in two wards in a West Midlands hospital, and two of their friends. It was also found to have caused the death of a patient at the hospital in March.

A statement from the agency said: “Eight cases of PVL- positive community-associated MRSA have been identified among individuals in a hospital and their close household contacts in the West Midlands. Four of these individuals developed an infection, two of whom subsequently died.” The agency declined to give further details but said that extensive contact tracing had not identified more cases at the hospital. However, the strain has been found in other hospitals, including the University Hospital of North Staffordshire, which is understood to have identified two non-fatal cases of the bug.

The discovery is significant as hospital-acquired MRSA has tended to affect elderly and infirm patients rather than younger people. PVL is a toxin that destroys white blood cells, which are the key to fighting infectious diseases. It occurs in about 2 per cent of strains of the common bacterium known as staphylococcus aureus, which is termed MRSA when it is resistant to the antibiotic methicillin.

Although it is rare, a small number of cases of PVL- positive MRSA have been reported across England and Wales — however, these have usually been in the community rather than a hospital. The strain is thought to have caused the death of a Royal Marine recruit, Richard Campbell-Smith, 18, in 2004. Forty-eight hours before the young recruit died, he scratched himself on a gorse bush during a training exercise and contracted an MRSA-related infection.

Infections caused by PVL-positive MRSA normally cause skin abscesses or boils and inflammations, but they can cause more severe invasive infections such as septic arthritis, blood poisoning, flesh necrosis and pneumonia. Screening of patients and staff on the ward where Case One worked revealed that one of her friends, a hospital employee who had previously reported skin abscesses caused by MRSA, was carrying the same strain.

Four housemates of the two workers had also contracted the strain. One of these, Case Five, worked in the hospital on a different ward and is thought to have infected another worker there, who detailed a four-month history of recurrent infection of the eyelids. One further case was identified in March 2006 through retrospective analysis of MRSA samples kept in the laboratory. The patient (Case Eight) developed a suspected hospital-acquired pneumonia while in the ward where Case One worked, and died within 24 hours of the positive blood sample being taken.

A spokesman for the Health Protection Agency said that PVL-MRSA was “more toxic than other strains of MRSA”, but it could still be treated with antibiotics. Angela Kearns, an MRSA expert, added: “When people contract PVL-producing strains of MRSA, they usually experience a skin infection such as a boil or abscess. Most infections can be treated successfully with everyday antibiotics, but occasionally a more severe infection may occur. “The Health Protection Agency is advising the hospital on outbreak-control measures, and will continue to monitor MRSA infection nationally.”

PVL-producing strains are more commonly contracted in the community and generally affect previously healthy young children and young adults. This contrasts with the hospital-associated MRSA strains, which do not produce PVL and are more commonly associated with causing wound infections and blood-poisoning in elderly hospital patients.

Source

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

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 Pages are here or here or here.

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



18 December, 2006

Comment from a senior American anesthesiologist about yesterday's post

The scenario sounds to me like the sinus infection had spread beyond the eye socket, perhaps downward into the pharynx (behind the tongue), making inserting a breathing tube more difficult, perhaps stirring up bleeding or pus, which would make visualizing the airway more difficult or impossible. If Ms Bromiley was overweight, the large tongue might make intubation difficult. With repeated attempts at intubation, the airway may become swollen. Awakening the patient before this point may have saved her; we have done this on occasion; inconvenient, but life-saving. Careful preoperative examination of the airway may have alerted the anesthesiologist to the precarious conditions present.

Actually, a tracheostomy is NOT the preferred treatment - this takes several minutes. A "cricothyrotomy" - a needle through a membrane, takes seconds, and the patient can be ventilated for a while before a better airway is established. We practice doing cricothyrotomy on dummies.

Of course, if the infection extends all the way to the throat, a tracheostomy or cricothyrotomy may not be possible. For such cases, a flexible fiberoptic device may enable the anesthesiologist to see around corners, and place the breatihing tube. Again, careful preoperative discussion between anesthesiologist and surgeons may make for better planning.

Here in the USA, we have a "difficult airway algorithm". See here

We drill our trainees (and ourselves) many times about these guidelines, on paper, with test questions, and on an electronic simulator (PC verson, and life size rubber dummy connected to a computer). This is standard practice here. This pilot would be stunned if he could see the level of our training on this issue. We have airway workshops where we can practice fiberoptic intubation on dummies, and we do it on patients as well. See here

Having a TV screen is a giant step forward (our institution is too cheap) - it allows the instructor to see what the trainee sees, and speeds up the teaching process.

ASA has close claims data, the best source of complications. I believe there has not been a case (or, more likely, too few to count) of airway disasters where a difficult airway has been diagnosed preoperatively; such cases alert the anesthesiologists to use more care or special methods (like fiberoptic). The most litigation is in emergency C-sections in (usually morbidly obese) where the airway is lost. This is why regional (spinal, epidural) anesthesia is so popular (but there are times and conditions where regional anesthesia is not possible. Hopefully, if intubation is abandoned after multiple attempts, the "cannot intubate cannot ventilate" scenario will never occur; if it does, surgical airway is a no brainer.

Pulse oximeters are a standard of care. When the oxygen in the skin drops, we are alerted that something must be done - NOW. One recently developed device is the Laryngeal Mask airway (LMA). This device allows maintaining an airway in a patient where the larynx cannot be visualized; it has been a lifesaver.

I had a recent emergency C-section in a fat lady where I couldn't intubate her. I could have maintained ventilation, but that would not protect her from vomiting and aspiration. All contraindications are relative; I used a LMA because I believed the small risk of vomiting and aspiration was less than the risk of airway obstruction from further attempts at intubation.

The anesthesiologist is normally in charge of the airway. If we must, WE request the surgeon to establish a surgical airway. The senior anesthesiologist is "in charge". Unfortunately, nervous surgeons may confuse the issue at times. I believe the British pilot would be pleasantly surprised at the level American doctors do such things. There is ACLS (advanced cardiac life support, both for adults and children); ATLS (advanced trauma life support) courses, exams, computer drills, ethc.

I am amused at nurses who claim an exclusive as "patient advocates". I am very proud what anesthesiologists have done to improbe patient safety. We are "patient advocates" as well. It was anesthesiologists who raised hell with hospital administrations to buy equipment to make anesthesia safer. Much of our improvement in safety has been with the initiatives of anesthesiologists, not Government mandates. When the Government demands better safety, then we must begin to worry.

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

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 Pages are here or here or here.

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



17 December, 2006

Robust NHS patient killed by disorganized and poorly-trained doctors

Elaine Bromiley kissed her husband Martin and their children Victoria, then six, and Adam, five. "Bye-ee," she called to them, waving as she was wheeled down the corridor towards the operating theatre. The otherwise healthy 37-year-old had suffered for years from chronic sinusitis, an inflammation of the nasal passages. Then, early in 2005, one of her eye sockets became infected. The threat of permanent damage to the optic nerve led her surgeon to recommend a minor operation to straighten the inside of the nose - a possible contributory factor.

Once they'd said their goodbyes, Martin and the children went home to wait for word that Elaine was awake and ready to see them all again. It never came. Two hours after she'd gone into theatre, Martin received a call from the Ear, Nose and Throat (ENT) surgeon to say Elaine was having difficulty waking up. Even then, Martin wasn't unduly worried. But when he arrived at the hospital, he was told Elaine was in intensive care, and, because she'd been deprived of oxygen during the operation, there was a risk of significant brain damage. The next few days were a blur as, numb with shock, Martin, with the help of friends, did his best to care for his family. Desperately anxious about his wife, he tried to maintain as normal a life as possible for the children, who continued going to school.

Meanwhile, Elaine was put into a medically-induced coma for three days to give her swollen brain a chance to recover. "I spent every minute I could with Elaine, holding her hand and telling her how much I loved her," says Martin. "The day after the operation was the 21st anniversary of our first date. I was told that the eventual outcome could be a full recovery, or that my wife could be alive but in a vegetative state - or any point between the two extremes. "My head was spinning. I couldn't grasp how life could change so quickly and in such a devastating way. I really couldn't see past the next day and had no idea what the future held for us."

Five days after the operation, a brain scan indicated little if any activity and Martin was told Elaine had suffered brain death. "It was like a TV screen covered in static: no shape, no texture, no colour to show that anything was working," he recalls. "Years ago, Elaine had told me that she did not wish to live as a vegetable. I made the decision that life support should be withdrawn and I prepared myself for a life without Elaine that I could not begin to imagine." Mrs Bromiley was observed for three days and then taken off life support. She survived for another four days, dying in the middle of the night when Martin was at home with the children. "I'd decided that they were the priority now," he says.

He had kept the children informed of their mother's progress, telling them "first that Mummy was going to be ill, just like Granny was when she had a stroke, but that she will get better". Then he had to explain that "Mummy wasn't going to wake up, she was going to die". Martin recalls those desolate days. "I just couldn't imagine how life would go on," he says. What Martin hung on to, he says, was his professional work ethic as a pilot. He took it for granted that - as is routine in aviation - an investigation would automatically be carried out. His hope was that at the very least lessons would be learnt to protect other patients in the future. He felt, if anything, comradeship with the operating team responsible. "I was 99.9 per cent sure that what had happened to Elaine could not have been predicted and that when the emergency occurred, the team did what they believed to be right but things just didn't work out."

When he discovered that no inquiry would be carried out unless he sued or made a complaint, he walked into the hospital chief executive's office to insist there was one. The subsequent investigation was headed by Professor Michael Harmer, a former president of the Association of Anaesthetists. The inquiry revealed that Elaine's operation was a textbook example of how surgery, carried out by technically proficient professionals, can go horribly wrong. The cause: human error. So much is made of the latest medical advances that it comes as something of a shock to learn that human error still figures significantly in modern healthcare.

Yet last month, the Chief Medical Officer, Sir Liam Donaldson, warned that the odds of dying as a result of clinical error in hospital are 33,000 times higher than those of dying in an air crash. "In the airline industry, the risk of death is one in 10 million. If you go into a hospital, the risk of death from a medical error is one in 300," he said. And yet it seems little is being done to improve those odds. Five years after chairing the inquiry into the deaths of 29 babies during heart surgery at Bristol Royal Infirmary, Sir Ian Kennedy, now chairman of the Health Commission, drew attention to the lack of progress. "It is almost as though avoidable deaths and injuries are accepted as part of the risk of care and treatment," he told a meeting of clinicians in London in July.

And it gets worse: the National Patient Safety Agency (NPSA), which was set up by the Government in response to the Bristol inquiry, with a brief to ensure that patient safety was a priority within the NHS, was recently described as "dysfunctional" by the National Audit Office. The agency has no idea how many people die each year as a result of medical error. It is currently under investigation, with a report on its future due out this week. The National Audit Office estimates that there may be up to 34,000 deaths annually as a result of patient safety incidents. But in reality the NHS simply does not know.

Contrast this with the approach taken by other high-risk industries. For years, businesses from motor racing to oil refining have recognised the dangers of human error, and the importance of communication and teamwork in dealing with emergencies. They have introduced what is known as Human Factors (HF) training, which teaches basic skills designed to promote safety. While much-prized technical skills are essential, they are not always enough in a fast-moving, high-risk situation. At critical moments, organisational and social skills are just as important. This means good communication and an ability to work together with each member of the team.

It appears that moments after being sedated, Elaine's airway collapsed, preventing adequate levels of oxygen from reaching her brain. Though potentially an emergency, the event is a recognised risk during an anaesthetic and, as such, should be manageable. Surgeons and anaesthetists are drilled to follow a series of steps at this point - beginning with a non-invasive attempt to get the patient breathing normally, and ending, as a last resort, with an emergency surgical procedure. This is usually a tracheotomy - where the surgeon cuts through the windpipe, inserting a tube directly into the airway through the throat.

At first the drill was followed impeccably. But then a problem arose: the surgical team tried to get a tube into the airway to help Elaine breathe, but encountered some kind of blockage. According to the drill, this was the time to consider doing a tracheotomy. Elaine, by this point, was turning blue in the face and one of the nurses fetched tracheotomy equipment. A second nurse phoned through to the intensive care unit to check there was a spare bed available.

But the three consultants appear to have made the sort of human error that is horribly common in crisis situations. They became fixated on what they were doing. The consultants also appear to have ignored the junior staff and remained intent on finding a way to insert a tube into the airway. The minutes ticked by. After 25 minutes, they were finally able to get a tube into her airway -but even then, the team failed to secure the tube and it was a full 35 minutes before adequate oxygen levels to the brain were restored.

At the inquest, held in October last year, the lead anaesthetist admitted that he had lost control and there was a dispute over exactly who was in charge of the procedure, making life-and-death decisions.

All of which could have been the end of the investigation. But Martin Bromiley had an unusual insight into the factors that led to his wife's death. He is both a pilot and a specialist in HF training, which has been mandatory for British pilots and crew since the mid-1990s. "Fixation is a normal reaction to stress. HF training teaches people that it's normal to carry on trying to take the usual action, even when it's clearly not working," he says. "But at some point, a decision has to be made to break out of that pattern of behaviour. The way to ensure that happens is for all members of the team to see it as their duty to speak out to keep the patient safe." There was no comfort in knowing that two of the nurses knew how to save his wife's life. "What they didn't know - and what HF would have taught them - is how to broach the subject with their bosses," he says.

"The same problem used to exist in aviation. It was common for the evidence from black boxes to show that junior members of staff had been aware that a mistake had been made and had either kept quiet or been ignored." Clinicians tended to view human error as a sign of weakness or the result of poor performance, says Martin. "Yet high-risk industries have shown that by accepting that it is normal to make mistakes, it becomes the team's responsibility to watch out for errors and catch them before they cause significant harm."

Martin began to ask questions and soon found that he was not the only person to be concerned about the risks of modern surgery. Indeed, for the past year the Royal College of Surgeons has been developing HF training courses in which surgeons have worked with experts from the aviation industry. Last month, it also organised a conference where leading doctors, nurses and managers heard speakers from the military, the oil industry and motor racing, among others, all described the dramatic impact on safety levels following the introduction of HF training. Martin himself also addressed the conference. "Patients want surgeons who can communicate well with them and effectively with members of the team,' says Tony Giddings, the Royal College of Surgeons council member responsible for patient safety issues and a former surgeon and trained pilot. "And there is a growing understanding of their importance within the profession. These skills are not unique to medicine; they are skills for life itself. They enable people to be confident and self-assured yet acknowledge they are not infallible. "Unless people have these skills intuitively, they need to be trained. Surgeons, anaesthetists, nurses and other members of the team can be trained together to develop these essential skills."

However, unless such training is mandatory, the surgeons who need it most won't participate, says Mr Giddings. It also needs funding. HF training could save thousands of lives every year, yet he says there is a reluctance at government level to commit resources to a scheme which could cost millions of pounds every year. "But however expensive mandatory training is, there is considerable evidence that human error in medicine is far more costly, both in human and financial terms." For Roger Goss, co-director of campaign group Patient Concern, there is no question that HF training must be implemented. "If the aviation industry uses this type of training, then that's good enough for me: flying is the safest mode of transport," he says. "Patient safety must become a priority in health care. It's not at the moment. Chief executives are constantly being criticised for failing to make it a priority, and instead focusing on keeping within their budget. The NHS has a moral obligation to do anything humanly possible to minimise the risks of surgery."

This week, Martin is meeting the Deputy Chief Medical Officer to discuss a number of initiatives. As he approaches a second Christmas without his wife, he is determined that his family's terrible experience will have a positive impact on the culture of surgery. "There is no question in my mind that Elaine's death will bring enormous change to clinical practice," he says with quiet determination

Source

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

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 Pages are here or here or here.

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



16 December, 2006

NHS spend 7 billion pounds of taxpayer's money on 'private consultants'

And it's not medical consultants we are talking about

More than 7 billion pounds [Yes. That's billions, not millions] of taxpayers' money was lavished on private consultants in the public services over the last three years - thanks to soaring costs in the NHS. Spending on consultants in the Health Service has increased 18 fold in just two years, from 31million in 2004 to a staggering 578m in the 12 months to April - partly thanks to the spiralling costs of the new NHS computer system. That raised the total bill for consultants in the public services to 2.8bn last year - a rise of a third over the last two years.

The National Audit Office warned there is no evidence at all that taxpapyers have got value for money because Whitehall departments keep such poor records. A hard hitting report by the government spending watchdog found that ministers could save more than 1billion over three years if they put in place even basic controls to cut the number of consultants and get better value from their contracts.

The company cashing in the most is computer firm IBM, with contracts worth 275m pounds last year, while Accenture - the management company who have worked for Labour since before the 1997 election - raked in 175m. PA Consulting, who are presiding over the controversial ID card scheme, pocketed 102million last year.

The report slams government departments for paying consultants millions on a daily 'time and materials' rate which encourages them to spin out contracts to milk money from the public purse, rather making payments dependent on delivering successful projects. The worst offender is the Department of Education and Skills, which receives four 'red lights' for its failure to get a grip on consultant spending. After the NHS, the biggest slice of the bill comes from local government, where consultants earned 386m last year. The Department for International Development, despite being a small ministry, ran up a gigantic bill of 255m. The Ministry of Defence spent 213m and the Environment department 160m.

Among the contracts singled out for criticism is the Home Office's ID cards project, where more than 2m a month was being funnelled to PA Consulting last year. The report complains that the department rather than the consultants 'bear the costs for increases in project duration', which have exceeded original estimates. The NAO concluded that most departments do not bother to 'make a proper assessment of whether internal resources could have been used instead of consultants' or 'collect adequate information on their use of consultants'. Crucially their report said that departments do not talk to each other about which consulting firms and partners at those firms do a good job, nor do they make sure consultants train up civil servants to do the job once they have left. It concludes: 'Fewer than half of central government organisations collect information on how the consultants have performed against what they were intended to do.'

Keith Davis, director of the NAO efficiency centre which compiled the report, said: 'The way that Government is managing consultants doesn't represent value for money. Part of the problem is there is no clear information.' Edward Leigh, chairman of the Public Accounts Committee, said: 'Today's report from the NAO confirms what many of us have long suspected: the external consultancy gravy train continues full steam ahead, courtesy if the public purse. 'In the past three years, 7.3bn of taxpayers' money has gone to big consultancy firms. Too often departments hand over a signed cheque to consultants without first looking to see what skills they have in-house. 'Perhaps the most damning finding is that, time and again, departments fail to keep an eye on how these companies perform or if they are delivering.'

Sir John Bourn, head of the National Audit Office, branded progress in government 'disappointing'. He said: 'Departments need to think ahead about what skills they should have, so they don't have to rely on consultants year after year. Peter Hill, chief executive of the Management Consultancies Association said: 'The increase in the use of management consultants is against a background of unprecedented public sector reform which requires skills and competency not available in sufficient numbers in the public sector.' CBI director of public services Dr Neil Bentley said: 'Consultants offer expertise and experience often not found in the public sector, but government departments need to make a clear business case for using them if the taxpayer is to get value for money. 'As the NAO rightly suggests, this does not always happen.'

Source

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

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 Pages are here or here or here.

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



15 December, 2006

PLENTY OF MONEY FOR NHS LOGO -- TOO BAD ABOUT PATIENT WAITING LISTS

As always, "administration" (the bureaucracy) comes first in a call on funds

Hundreds of thousands of pounds of taxpayers' money is being spent on 'managing' the NHS logo despite the cash crisis gripping the Health Service. Official figures reveal that the bill for protecting and promoting the 'NHS identity' has more than doubled in the last four years - reaching almost 334,000 pounds last year. The money would have paid for 75 extra hip replacements - or the salaries of 15 nurses.

Instead, a special website has been set up setting out the 'core identity guidelines' on use of the NHS logo - three simple white letters set against a blue background. It advises hospitals and other NHS bodies to ensure it is printed in 'NHS Blue - Pantone 300' and 'always positioned in the top right corner' of stationery. The NHS 'official typeface' - called Frutiger - should always be used where possible, it insists, while a strict 'exclusion zone' should be observed around the edge of the logo. An NHS 'branding team' is on hand to offer advice, and an NHS 'identity helpline' has been set up.

Health Minister Ivan Lewis revealed in a written Parliamentary answer yesterday the total cost of the project since the NHS logo was developed and introduced in 1999. In 2001-02, it was 179,807, but by last year it had risen to 333,996, he revealed.

The Tories said the rising bill was extraordinary given the financial pressures facing NHS trusts across the country, which have let to job cuts and closures. Shadow Health Secretary Andrew Lansley, whose questions uncovered the figures, said: "While the NHS brand is important and has value the last thing it needs is over 300,000 to be spent on it. "The NHS needs every penny it has to spend on patient care. "I have asked the Government to explain why - like many things in the central administration of the NHS - spending has more than doubled.'

The NHS branding website insists the organisation's identity is 'important'. It adds: "It is largely formed by what we do - treating illness and promoting health. As the NHS is changing, it is vitally important to use our identity consistently and correctly. "We need to help the public and patients navigate a more diverse healthcare system, whilst maintaining their confidence that NHS values and quality will still be observed." The NHS logo has a '90 per cent spontaneous recognition rate' among the public, it adds - suggesting money has been spent on surveys to test reactions to the branding.

In the past, different NHS organisations had around 600 logos. The Health Department believes many patients were confused by some of the individual logos and could not tell if hospitals were part of the NHS. Only hospitals with a logo that pre-dated the foundation of the Health Service in 1948 were allowed to retain their brand. The department insists that 'millions of pounds' have been saved by the single branding system for letterheads, signs, uniforms and offices. A Health Department spokesman insisted: "This is not a waste of money. "The spending on the logo safeguards one of the world's most recognised and trusted brands, and stops people not allowed to use the NHS logo from using it, therefore protecting patients from organisations who may fraudulently purport to provide NHS care."

Source

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

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 Pages are here or here or here.

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



14 December, 2006

Not enough nurses in NSW (Australia) hospitals

Note how the Left-leaning newspaper quoted below tries with its opening words to let a Leftist State government off the hook

Caught in the midst of a worldwide nursing shortage, the [NSW] Government has been forced to close hospital beds and defer elective surgery because there are too few staff to care for patients, a NSW Auditor-General's report says. [Getting nurses to nurse instead of doing "administration" (paperwork) all the time will not be considered of course] At the same time, an ageing population and a surge in chronic health conditions such as diabetes, obesity and heart disease is placing enormous strain on hospitals, it says.

Although the number of nurses had increased by 5500 in the past four years and resignation rates had fallen from 16 per cent to 14 per cent, there was still a chronic shortage, said Peter Achterstraat in his performance audit of NSW Health. [Because they are all busy doing paperwork.]

The report acknowledges NSW Health has used a number of successful strategies to increase nurse numbers, and overall has "done well to attract and retain nurses". "The department improved nurses' wages to make them the highest paid in Australia, recruited over 1000 nurses from overseas and attracted nearly 1500 ex-nurses back to the public health sector," it says. "These are all positive initiatives, but it is too early to judge whether they will ensure that the nursing workforce in public hospitals will be adequate in the future." While more nurses have been employed, 45 per cent of them work part-time, forcing the department to rely on overtime and agency nurses to fill the gaps, the report says.

The general secretary of the NSW Nurses' Association, Brett Holmes, said the Government was seeking to recruit 1200 nurses to fill vacancies. "Thirty per cent of our nursing workforce are over 50, so there needs to be a long-term plan for their replacement and a large proportion . need to be registered nurses," he said. "We can further improve recruitment. There are clearly still more nurses who have maintained their enrolment but who aren't working. The Government has been successful in getting more than 1500 of those back already."

The Minister for Health, John Hatzistergos, laid the blame at the feet of the Federal Government, saying more than 2000 extra university places were needed to keep pace with demand. "We are going to be substantially short on nursing numbers, and we will have to go overseas to recruit," Mr Hatzistergos said. He dismissed claims by the Opposition health spokeswoman, Jillian Skinner, that the Government had inflated the increase in nurse numbers by double counting agency staff. Only permanent full- and part-time staff had been included in the figures, he said.

Problems in recruiting and retaining nurses would remain difficult to resolve unless both federal and state governments reviewed the role of all health-care workers, including nurses, doctors and allied health workers, said the executive director of the College of Nursing, Professor Judy Lumby. She said other health sectors had been affected, indicating a need to move away from old structures and divides. "We have to rethink the way in which we care for people, with more focus on primary care and preventative health," Professor Lumby said. The Auditor-General recommended NSW Health improve its monitoring of the nursing shortage, reduce reliance on overtime and agency nurses and develop better plans to manage its nursing workforce.

Source

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

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 Pages are here or here or here.

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



13 Dec, 2006

NOW IT'S THREATS (EMPTY THOUGH) BEING USED TO MAKE THE NHS WORK

Hospitals will face renewed pressure to save money, cut waiting times and tackle superbugs under new performance targets to be set today by the Government. In his first report as chief exective of the NHS, David Nicholson has compiled a list of priorities for the next financial year, including a target for a 250 million pound budget surplus by March 2008. He will also demand faster access to treatment and less of a “postcode lottery” of health inequalities. A new benchmark is to be set for the 18-week waiting times target — widely regarded as the most ambitious of all NHS targets — that almost all hospitals will treat patients within that time by March 2008. The Government has pledged to have all patients treated within 18 weeks of a doctor’s referral by the end of that year.

Mr Nicholson’s target for a 250 million surplus comes amid rising levels of debt in the NHS. Funding has more than doubled in ten years, but the total NHS deficit has also risen. Thousands of job losses and other cost-cutting measures have already been announced to make savings, but Patricia Hewitt, the Health Secretary, said yesterday that hospitals that did not meet the 18-week target could be penalised with further financial sanctions. About half of all hospital patients are currently treated within 18 weeks, but further progress has been limited by bottlenecks of patients waiting weeks for scans or test results.

Meanwhile, nearly a third of hospitals and a quarter of all 570 NHS organisations failed to balance their books in 2005-06, leaving the NHS with a net deficit of 547 million pounds. The latest figures show that 120 of 548 NHS organisations are now predicting deficits for the current financial year, with 90 per cent of the estimated gross deficit originating from 71 trusts. Despite this, ministers are confident that the NHS will generate a profit by next year, but that will become even more difficult to achieve after 2008 when extra funding supplied by the Treasury is due to dry up.

John Appleby, chief economist at the King’s Fund, the health think-tank, said that the new surplus target was intended to provide a “buffer” to the anticipated drop in the rate of growth, from a 10 per cent year-on-year cash increase to between 2.5 to 3.5 per cent by 2008-09, he said. “There’s a paradox of lots of money going into the NHS but trusts still overspending and going into debt. It is possible that across the NHS the system can generate a surplus by 2008, but whether the system can meet that at the same time as meeting other performance targets is open to question.”

A Department of Health spokesman said: “Only by managing finances efficiently can NHS organisations develop and improve services. The majority of organisations are delivering on finance and patient care, but more need to generate surpluses to recover historic overspending.” Hospitals affected by the latest superbug, Clostridium difficile, will be able to bid for grants of up to 350,000 pounds each from a 50 million fund to combat infection rates. The grants could pay for measures such as extra basins for hand-washing in an attempt to stop the spread of C. difficile — which kills three times as many patients as the better-known MRSA, Ms Hewitt said.

“MRSA has been coming down, thanks in part to the target we set some years ago,” she told The Sunday Edition on ITV. “C. difficile, this new and very nasty bug, is bad in some hospitals but not in others. “So we want local hospitals to look at their own performance and, where they are not doing well enough, to set a local target agreed publicly with their local NHS. We are backing them up with more money — up to £350,000 for each hospital organisation.”

Source



Reality debunks myths about Australian private health insurance

Some comments by a health insurance spokesman. Health insurance is normally taken out by individuals directly in Australia -- rather than through the employer, as in the USA

With the introduction to Parliament on Thursday of the Government's legislative changes aimed at broadening the scope of care for which private health insurance funds can pay, it is a good time to reflect on what benefits broader health care may provide, and why things need to change.

The National Health Act was introduced 50 years ago, but medical practice has altered dramatically (for the better) over those 50 years. However, until now this Act has constrained the health funds from providing some of the most appropriate care options for members. People who are opposed to improvements in the system are acting against the interests of those 10.2 million Australians who have chosen to take out private health insurance. The consumer expects to receive the most appropriate health care in the most appropriate setting. It is common sense that expanding the opportunity for an efficient private health insurance industry to cover the full range of modern treatments will result in improvements in clinical outcomes. Innovative care options, offering perhaps a substitute for expensive hospital care, or a shortened length of time spent in hospital - or even preventing people from going to hospital in the first place - could be introduced.

The truth is that the proposed private health insurance legislation allows for all these options, thus providing a modernised framework to deliver the most exciting advances in health care in 50 years. However, myths abound, which promote a different story. So, what are these myths about the present and the proposed systems?

The first, and most common, myth about the present system is that the 30 per cent rebate offered to Australians who have taken out private health insurance is a waste of public money, providing no benefit to the public system. The facts tell a different story. Figures showing the number of public beds available per 1000 uninsured Australians (ie those Australians reliant on Medicare), indicate that the 30 per cent rebate has freed up 1.3 beds per 1000 people (see chart). These "extra" beds are now available in the public system for Australians without private health insurance to use -- a direct benefit flowing from the 30 per cent rebate.

Equally, those Australians who have chosen to take out private health insurance in fact are utilising their insurance (thus relieving pressure on the public system), with an additional 900,000 operations per annum being performed in private hospitals since 2000 (the year the rebate was introduced). All Australians know the public system could not cope with another 900,000 admissions each year.

Another myth is, of course, that those people having private insurance, and undergoing treatment in the private system, don't really need that treatment. In fact, private health funds pay for more than 50 per cent of the surgical procedures performed in Australia. This includes 54 per cent of major procedures for malignant breast conditions, 55 per cent of chemotherapy treatment, 64 per cent of major joint replacements and 68 per cent of same-day mental health treatment - procedures that can be life-saving. Without the 30 per cent rebate, there would be an immediate influx of these non-discretionary surgical procedures into the public system.

In the face of criticism as to whether the "value proposition" of private health insurance is accepted by Australians, one needs only to realise that over the last 12 months the number of Australians taking out private health insurance has grown by 220,000. Pleasingly, the most recent figures show the percentage of 20 to 35-year-olds with private health insurance (traditionally a market regarded as rejecting private cover) has grown by 2.1 per cent in the September quarter. Another myth debunked.

So, what of criticism - such as that from Stephen Leeder (Weekend Health, November 25) - that the broader health care legislation will advantage those with private health insurance over those without? This is another myth ripe for debunking. Leeder and other critics of private health insurance would be interested to know that the Advanced Community Care Association of South Australia (an organisation delivering excellent out-of-hospital care in the public system) spoke at the annual conference of the Australian Health Insurance Association, and it was lauded for its initiative. There is a strong possibility that a model used in the private sector may emulate a model such as this from the public system. The fact that such a system is already operating successfully in South Australia's public hospitals is not only a credit to the organisation, but also a direct rebuttal to the claim that such options will be available only in the private sector.

However, if such an innovative program were implemented, allowing privately insured patients being treated in public hospitals to be treated in a more appropriate setting under a broader health care initiative - and in the process, freeing up resources and beds for other public patients with myriad other illnesses - most would judge this to be a good thing, both for the privately insured patients and for the public system which will have more resources available. To suggest otherwise seems perverse. Via these newly introduced legislative reforms, private health insurance will be provided with a great opportunity to advance the health care of Australians, and the benefits will flow to both components of the mixed health care system that operates in Australia. The private health insurance industry is excited about the possibilities. The changes are positive, and are worthy of widespread support. If people look past the rhetoric of the myths they will find a private health insurance industry which is capable of, and intent on, delivering improved health outcomes for consumers.

Source

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

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 Pages are here or here or here.

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



12 Dec, 2006

Solving the health-care "crisis" means not more government involvement but less

About 10 years ago, I broke my leg playing basketball. After I came out of surgery, with a cast stretching from my ankle to the top of my leg, an orderly asked me whether I had ever used crutches before. I hadn't, so he showed me what to do, swinging through them from one end of the room to the other. The whole lesson lasted about 90 seconds. When I got my hospital bill, I saw that I had been charged $150 for "gait training on crutches." I did what all insured Americans do: I forwarded the bill to my insurance company. Why should I care? I wasn't paying for it.

One of the problems with American health care, as David Gratzer notes in "The Cure," is precisely a payment system that takes the patient out of the equation. In the early 1960s, the average American paid out of pocket one of every two dollars that he spent on health care; today the figure is one dollar in seven. The inevitable effect is hugely wasteful spending (and inflated hospital bills like mine). In fact, per-patient costs have gone up almost exactly in inverse proportion to the share of spending borne by the consumer.

Dr. Gratzer cites a remarkable Rand Corp. study that tracked health-care spending by 2,000 families over eight years. The families who got free health care spent 40% more than the families with cost-sharing arrangements. And yet the health outcomes for the two groups were the same. The lesson: Market-based health insurance systems, such as health savings accounts, cut out inefficiencies and lower costs without compromising quality.

Dr. Gratzer, a physician from Canada and a fellow at the Manhattan Institute, is painfully aware, thanks to Canada's single-payer government system, of how inefficient and limited health care can be when the market is kept almost completely out of the calculation. He has seen the effects firsthand. In Canada, the average wait between a doctor visit and prescribed surgery is 17 weeks. American patients are twice as likely as Canadians to get lifesaving treatments like dialysis, three times more likely to get a coronary bypass and four times more likely to get coronary angioplasty. The survival rate for leukemia, breast cancer, colon cancer and heart disease is much higher if you are treated in a U.S. hospital than in a Canadian one or, for that matter, in a European one.

And it isn't only health-care "delivery" that is affected by suppressing market forces. Dr. Gratzer rightly spends part of "The Cure" celebrating the medical marvels that a dynamic, capitalist economy has helped to make possible by allowing capital to flow in productive directions. "Death due to cardiac disease has fallen by nearly two-thirds in the past five decades," he writes. "Polio is confined to the history books. Childhood leukemia, once a death sentence, is now almost always curable. Depression and mental illness are now treatable. . . . The death rate from heart attack and heart failure has fallen by more than half since 1950." In short, the medical progress of the past 50 years has been breathtaking.

For some, including Dr. Gratzer, the costs are breathtaking, too, even when they are corrected for the payment dysfunctions that he analyzes so well. Are we suffering from a kind of runaway health-care inflation, as Dr. Gratzer at times suggests? Perhaps. But it can easily be argued that medicine, because it is subject to hyper-technological change, is hard to gauge by traditional inflation measures. The current treatments for disease aren't really comparable with those of a quarter-century ago.

To complain about the cost of heart surgery or cancer treatment by comparing it to the inflation-adjusted price in the 1960s or '70s is to miss the point: You died 30 years ago, and you live today. The cost of my leg surgery would have been a lot cheaper in the 1960s, but I wouldn't be able to play tennis or even run after the surgical repair was done, as I can now. How much is it worth to a family with a child who has leukemia to be able to treat her and give her a full life? The families I know who have seen their children recover say that they would have given up everything they own for today's miracle cures. Yet it's become a great American pastime for patients and politicians to whine about the "high cost of drugs" and other treatments that save lives.

All of which can lead to demagoguery and calls for a nationalized health insurance system of the sort that Hillary Clinton and Howard Dean are always so keen to recommend. Such calls may grow louder soon: America is clearly at a crossroads in medical care. Within the next decade we will get either some version of Hillary-care or more free-market medicine, starting with universally available health savings accounts. Let's hope that our nation's policy makers read "The Cure" before they decide. They will learn that the government route flattens costs only by holding back the pace of technology, artificially controlling its price and rationing its use. That is not a prescription for better health.

Source



South Australian public hospitals failing too

The rot is not confined to Queensland, New South Wales and Victoria

An extra 80 patients a day were admitted to public hospitals in the past year while more people were forced to wait longer in emergency departments as health system demands intensified. The Health Department's annual report, tabled in Parliament this week, shows on a daily average 1035 patients were admitted to hospitals, up from 955 in the previous financial year. Thirty-seven per cent of patients waited more than four hours in emergency departments before being seen, up from 30 per cent in 2004-05.

Each day, an average 1358 people were treated in accident and emergency departments, compared with 1300 the year before. A total of 328,572 people attended emergency departments, up from 310,661 in 2904-05. There were 896 on an elective surgery waiting list for more than 12 months, down from 1045 in 2004-05.

Health Minister John Hill said the demands on public hospitals were at "their greatest level", mainly because of SA's ageing population. Opposition health spokeswoman Vickie Chapman, who is waiting on Freedom of Information data on each hospital, said it was "pointless to conceal individual hospital information when it is important to identify which of the hospitals are really struggling".

Source

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

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 Pages are here or here or here.

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



11 Dec, 2006

ANOTHER LAWSUIT TO CHALLENGE CANADIAN BASTARDRY

Even with a brain tumour, it's "wait your turn" in Canada -- even if the wait could kill you. The only thing Canada is quick with is promises

Timely Medical Alternatives Inc., a leading Canadian medical broker, today announced that it intends to launch a lawsuit against the Ontario Provincial government on behalf of a 66-year-old Newmarket resident, Lindsay McCreith. Seeking damages as well as reimbursement for medical, travel and rehabilitation costs, the decision to launch a lawsuit comes after the Provincial government refused to pay the costs for private magnetic resonance imaging (MRI) and subsequent surgery to remove a cancerous tumour in Mr. McCreith's brain at a Buffalo hospital on March 6, 2006. The Ontario Health Insurance Plan informed Mr. McCreith that since he didn't get pre-approval for his out-of-country procedure, they would not reimburse him for the services he received. The "catch 22 "is that the pre-approval process routinely takes significantly longer than the four and half weeks between Mr. McCreith's initial MRI and his life saving surgery.

McCreith, a retired small business owner, is seeking a larger role for private health care in Canada: "I had hoped that the Government would carefully consider my case. I didn't feel I had an option to wait for my medical treatment, given the possibility the tumour was malignant, and had to pay out of pocket to have my brain surgery. The health system has let me down and I don't want to see other individuals go through the pain and anguish I have suffered," said McCreith.

Timely Medical Alternatives, which will lead fundraising efforts for the court challenge, said that Canadians are still not receiving timely health care despite record levels of health spending and numerous commitments made by provincial and federal governments. Richard Baker, President of Timely Medical Alternatives, said: "This case is not about creating a second tier of health care. Instead, it's about the provincial government's refusal to provide timely medical treatment for Mr. McCreith, as well as the restrictions on private insurance. In Mr. McCreith's case, it really was a life or death situation."

In the opinion of Dr. Gary Magee, Mr. McCreith's family physician of 35 years, Mr. McCreith could not afford to wait to receive treatment: "Brain surgery needed to be expedited. Lindsay might not have made it if he had to wait the likely eight months it would have taken him to have a MRI, see a specialist and have surgery."

Timely Medical Alternatives is asking Ontario patients who have been adversely affected by waiting for medically necessary services as well as by restrictions on private insurance and have had to pay for their own medical treatment to contact the Company as soon as possible to be considered as part of the lawsuit.

Like the landmark Chaoulli case in 2005 when Montreal patient George Zeliotis and physician Jacques Chaoulli won a Supreme Court of Canada battle for the right to buy private medical insurance, Timely Medical Alternatives' lawsuit will argue that the provincial government's actions violate the Canadian Charter of Rights.

News of the Timely Medical Alternatives lawsuit could ignite a political debate over long waiting times for medically necessary services, a debate which would be welcomed by Ontario patients as a call to action for the government.

Mrs. Mariana Rosero, a 56 year old Ontario patient whose debilitating back pain grew so severe she could no longer walk as she waited to see a specialist, finally chose to have immediate surgery in Buffalo, again with the help of Timely Medical Alternatives. She hopes the lawsuit will generate changes: "This is a David versus Goliath struggle. If filing a lawsuit on behalf of Mr. McCreith is what it takes to get the government's attention and make timely medical treatment a priority, then I fully support it and hope the government does something to fix the system."

Timely Medical Alternative President, Richard Baker, added: "The Canada Health Act is arguably responsible for more misery, suffering and even death, than any other domestic legislation in Canadian history. It's time that Canadians no longer be asked to sacrifice their health in the name of supporting this Act."

Backgrounder: Lindsay McCreith's Medical History

- In January 2006, Mr. McCreith suffered his first seizure. The Newmarket Hospital diagnoses his seizure as epileptic and prescribes anti-seizure drugs. Mr. McCreith has a MRI scheduled for May 27, 2006.

- During the month of January 2006, Mr. McCreith continues to suffer from headaches and seizures on an almost daily basis. Mr. McCreith decides to seek a second opinion.

- On February 2, 2006, Mr. McCreith contacts Timely Medical Alternatives and the next day has an MRI in Buffalo and is diagnosed with a brain tumour.

- On February 13, 2006, Mr. McCreith returns to Buffalo for a specialist consultation.

- On March 6, 2006, Mr. McCreith returns again to Buffalo for a scheduled biopsy, during which time doctors decide immediately to perform surgery and remove tumour.

- On March 14, the pathology report concludes that Mr. McCreith's tumour was malignant.

- On May 23, 2006, OHIP rejects Mr. McCreith's application for refund of medical costs of $27,600 ($US) that he paid out of pocket to the Buffalo hospital.

- In November 2006, Mr. McCreith is cancer-free and agrees to begin process of filing lawsuit against Ontario provincial government.

Source. A video interview with the people involved is here

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

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 Pages are here or here or here.

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



10 Dec, 2006

The Leftist "Big Pharma" myth

It is a Leftist kneejerk to hate any big business

The winds of political fortune have brought the Democrats into power in both houses of Congress, and high on their 2007 agenda is tightening the regulatory screws on the pharmaceutical industry. It seems highly likely that the new Congress will seek to intervene on such hot-button issues as FDA oversight of drug safety, patent protection, and drug pricing. The implicit premise behind this looming regulatory offensive is that Big Pharma (an epithet) is a 900-pound gorilla in need of domestication. In recent years, notable authors such as Arnold Relman, Marcia Angell, and Jerome Kassirer -- all former editors in chief of the New England Journal of Medicine -- have penned searing indictments of the industry.

These and other critics treat the industry's multibillion dollar profits as a sure sign of its permanent robust economic status. But those numbers conceal deep vulnerabilities. It is no accident that the shares of major pharmaceutical houses have been hammered over the past three of four years, even as profits appear to be at record highs. Wall Street values companies not only on current earnings, but also on long-term prospects, which are cloudy at best for research pharmaceutical firms. Just this past week, for example, Pfizer announced plans to cut one-fifth of its United States sales force, with a promise of further restructuring in January.

We shouldn't be surprised. The huge profits of major drug firms are often tied to one or two drugs, such as Pfizer's Lipitor or Viagra -- profits that evaporate when their patents expire and generics enter the marketplace. The Standard & Poor's review of pharmaceuticals thus starts somberly, noting that products with $21 billion in US drug sales are going off patent in 2006, with another $24 billion to follow over the next three years -- a sharp dent for an industry that today generates about $250 billion in revenue. All the while, the pharmaceutical houses also must absorb the legal and business risks needed to identify, patent, test, license, and market any new drug.

These trends should worry us all. Pharmaceuticals are not tobacco. There is no reason to rejoice in putting pharma on the ropes if its business reversals hurt the very consumers they are trying to serve. The medical advances of the past 30 years are not just a matter of dumb luck. They are very heavily dependent on the patent law, pricing freedom, and marketing strategies that have allowed these firms to bring a wide variety of vital products to market.

The champions of further regulation argue that their efforts won't limit innovations or curtail the widespread use of new drugs. But there are no free fixes. Too often ill-designed regulation gives us the worst of both worlds -- slower innovation and more limited drug use. We have much to fear in any new round of regulation. Bringing a new drug to market is already an arduous task. The FDA has consistently upped the number and type of clinical trials for companies seeking approval of new drugs, so that today as many as 60 separate trials are often required. Fewer drugs make it through these hurdles, and those that survive the ordeal cost ever more to bring to market.

Firms are thus caught in a two-way vise. They have to spend more to reach the market, yet once there they have a shorter period of patent exclusivity in which to recover their extensive front-end costs. (One consequence is that it has become ever harder to persuade companies to invest in drugs that attack diseases or conditions that afflict small populations -- thus exposing companies to the charge that they heartlessly put profits before patient health.)

The risks of marketing a new drug have been further compounded as the FDA has become more willing to remove drugs from markets at the first sign of any real or imagined dangerous side effects. But while such FDA actions often lead to accusations that drug companies have not come clean about a product's risks, it is usually the FDA that makes the incorrect risk calculation. Last year, for example, early clinical trials showed great promise for a cancer drug called Iressa, which was used with success by many patients. After the early successes were not replicated in further clinical studies, the FDA adopted a Solomon-like solution: It allowed current users to continue receiving the drug, but otherwise took it off the market. The FDA's rationale was that a new drug, Tarceva, worked better. Yet it could never explain why patients for whom all other therapies had failed should prefer one last-ditch option to two. What is needed is good information about Iressa's successes and failures. If that is supplied, surely oncologists can do a better job calculating the odds than the FDA, which has to deal with averages, not individual cases.

With other established drugs, like the antidepressants Zoloft and Prozac, the FDA leaves them on the market, but requires they be sold with severe "black-box" warnings that overstate the risks (in the case of Zoloft and Prozac, of suicide). Fearful physicians thus shy away from prescribing such drugs -- not because of the dangers the drugs pose, but because they fear the warnings expose them to greater risk of medical malpractice suits.

Pharmaceutical companies meanwhile have their own lawsuits to worry about. The liability risks of mass-marketed drugs have increased significantly in recent years. Consumer fraud class actions, now common, arise after drugs have been withdrawn for some adverse side effect. Nonetheless, litigants are often allowed to sue for refunds not only for unused drugs, but also for the drugs that were successfully used, on the grounds that if the truth about the side effects had not been concealed (itself a debatable proposition), the pills would never have been purchased in the first place. The resulting loss in revenue leaves drug companies with even fewer resources to cover the thousands of suits for compensatory and punitive damages for drug-related injuries, like the multiple suits brought against Merck for its drug Vioxx.

Personal injury claims are immensely expensive to defend individually and their outcomes are fraught with error. Often they are propelled by inflammatory trial techniques that obscure the scientific evidence, which lay juries find hard to assess in the first place. It is stark evidence of how dire the situation is for pharmaceutical companies that the FDA, typically no friend of the drug companies on safety issues, has now actively intervened on their side in personal injury suits that attack the adequacy of FDA approved warnings.

The common judicial refrain in tort litigation has long been that FDA oversight, no matter how comprehensive, supplies only a "minimum" set of warnings. In reality, however, excessive warning is the greater peril. The FDA faces fierce criticism from Congress, the medical profession, and the popular press whenever any approved drug exhibits adverse side effects. Yet these watchdogs offer little or no outcry when the FDA keeps a new drug off the market. Visible injuries are easier to track than lost opportunities for cure.

Perhaps the biggest threat on the horizon for the drug industry is mounting pressure to submit to price controls. One possibility is that the government will set uniform prices for all drugs. Another is that it would require a company to sell to all customers at the lowest price charged to any customer within the past year. But no matter how such controls are calculated, they could devastate the business. What's more, they're just not necessary.

Traditionally, patent holders could decide how much to charge for their wares. Public protection against excessive profits for drug companies came from three sources. First, the patent period is limited to 20 years, with about half that time used to shepherd a new drug through the FDA approval process. Once the patent expires, the entry of low-cost generics sharply reduces the cost of proven drugs. Second, the rapid pace of invention means that consumers frequently can choose between two or more patented drugs in the same class (Lipitor, Crestor, and Zocor, for example, are three statins used to lower cholesterol), effectively blunting the monopoly power of all patent holders. Third, antitrust laws make it illegal for any makers of the same or similar drugs to conspire to raise prices or reduce output.

Within these constraints, of course, the research pharmaceutical firms still must recover their huge front-end costs, which can run over $1 billion for a new drug, over an ever shorter useful patent life. In addition, their successful drugs must generate additional revenues to cover the predictable flops. Yet companies need to charge someone for the initial costs of production, not just for the small cost of producing additional pills.

One common argument for price controls is that drug companies should only spend money for research but not for lavish marketing. Yet that short-sighted argument assumes that pharmaceutical companies could sell the same quantities of drugs without advertising them. Of course, the cost of marketing raises the total cost of production, but by expanding the consumer base, it lowers the average costs consumers pay per unit. Any system of direct price controls would thus play havoc with both research and marketing, drying up the capital needed for innovation.

The overall picture today shows a research drug industry under constant pressure from all sides. Industry critics greatly fear letting bad drugs on the market, while simultaneously underestimating the real costs (in the form of forgone health benefits) of keeping good drugs off the market. In reality any sound risk assessment, whether by regulation or litigation, should take into account both kinds of error.

Critics also naively assume that investors and firms will continue to make huge investments in new products without any assurance of recouping their costs in the marketplace. But the drug business is too vast and complex to depend on individual altruism or government bureaucrats to fuel medical advances. As Adam Smith recognized long ago, the profit motive is the only constant and reliable spur to making the major investments on which the prosperity (and health) of any nation depends. Today's pharmaceutical industry is not exempt from that enduring insight.

Source



Australia: Useless government "child welfare" bureaucracy again

A malnourished baby girl died while under an intense supervision order of the Department of Child Safety. The child's mother, 35, will appear in the Brisbane Magistrate's Court today charged with the manslaughter of the four-month-old girl on the grounds of parental negligence for failing to provide adequate care and nourishment. Police will allege the baby gained only 500g in her four-month life and weighed 3300g when she died from bronchopneumonia at her mother's Brisbane home in July 2004. Her death was believed to be have been the result of complications from being malnourished.

The baby was underweight when she was born at 2800g and suffering from methadone withdrawal among other medical problems. She gained the 500g in the first five weeks of her life in hospital and did not put on any more weight while living with her mother under departmental supervision, government sources said yesterday. Upper Mt Gravatt detectives also charged the baby's father, 39, with her manslaughter and he will face court later this month.

Medical experts contacted by The Courier-Mail said the average growth rate of a normal baby was between 150g and 160g a week. It is understood police will seek a meeting with the Crime and Misconduct Commission over the Department of Child Safety's handling of the case. The department had left the baby in the care of her mother, who was placed under an intensive management plan and the supervision of a case worker. Government sources told The Courier-Mail last night that, under the plan, case workers were supposed to conduct random weekly visits, ensure the mother maintained medical appointments, as well as involve a community health worker. It is understood case workers instead often made pre-arranged visits with the baby's mother and, in the weeks when they could not attend, spoke to her over the telephone.

The sources said the mother had allegedly failed to keep some medical appointments and the department's last contact with her was a telephone call in the week before the baby died. They said a case worker's file notes show she had recorded the baby as "thriving" but they did not contain any information that showed the baby had ever been weighed. A spokesperson for Child Safety Minister Desley Boyle said an external review found no reason to conclude the department's actions in any way impacted on the child's death. He said allegations made to The Courier-Mail were at odds with departmental information.

Source

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

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 Pages are here or here or here.

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



9 Dec, 2006

FDA restrictions hurting sick babies

Like thousands of children in the U.S., Maggie Leaver has short bowel syndrome. These children can't absorb enough nutrients from food, and some need intravenous feedings to survive.

A baby's digestive system can adapt over time, but that may take months or years. Many of these babies can't wait. For reasons not fully understood, children put on intravenous nutrition may suffer liver damage. Some require liver and small bowel transplants, risky procedures that don't always work. Others die waiting for a transplant.

In July, in a paper in the scientific journal Pediatrics, researchers at Children's Hospital Boston reported on a small study that suggested a promising treatment. They found that by switching from the standard intravenous formula to a different kind -- called Omegaven -- babies weren't progressing to liver failure. Omegaven, used in Europe for adults, isn't approved in the U.S. and is considered experimental treatment. "The kids aren't dying anymore," says Mark Puder, a pediatric surgeon who was lead investigator on the study. "We think we have a good treatment."

But Dr. Puder's effort to get Omegaven widely used in babies has put him in an unusual conflict with the German company that developed the drug. Fresenius Kabi AG, which makes Omegaven, says it isn't interested in bringing the drug to the U.S. market. The company says it doesn't agree that Omegaven is the best drug for these babies and has a new product that it believes is better.

In 28 of 29 babies treated with Omegaven so far at Children's Hospital, Dr. Puder says they were able to stop further liver damage -- and damage that children already incurred seemed to improve. Some babies who were switched to Omegaven rebounded enough that they were taken off the waiting list for an organ transplant. At one point, Maggie Leaver's condition deteriorated so much that her surgeon thought she was going to die. Now the 18-month-old is thriving at home in Hingham, Mass.

. . .

Mr. Ducker says the company's new product, called SMOFlipid, "presents a better option for pediatric feeding." The company believes the new product does contain all the essential fatty acids babies need and can be used on its own. Fresenius Kabi says it doesn't want to invest the resources required to test both products for approval by the U.S. Food and Drug Administration. It hopes to eventually sell the new product in the U.S., Mr. Ducker says, although no timetable has been set and no trials are under way.

. . .

Because Omegaven is considered experimental in the U.S., if hospitals want to try it, they have to ask permission from the FDA for each individual patient. The FDA has regulations that enable doctors to use experimental drugs in certain (p. A15) emergency situations. If hospitals obtain the required permissions, they must then find a way to buy the drug on their own, since insurers typically won't cover Omegaven because it's experimental. The cost can run from $50 to $100 a day per patient. At Children's Hospital Boston, the surgical department has already spent close to $100,000 to buy Omegaven for babies.

. . .

Dr. Mooney says he wrestled almost from the beginning about whether to put Maggie on Omegaven. He knew about Dr. Puder's results, which he calls "amazingly great," but the number of children treated was still small. He worried about adverse effects. "It is so easy to get caught in the hype of new things," Dr. Mooney says. Maggie was already fragile. What if he put her on Omegaven, he says, "and there was a horrible side effect that could tip her over the edge?"

But when standard therapies failed, he felt "there was nothing else to do." Given that the treatment is experimental, Dr. Mooney says he believes it was right to wait. But he also feels Omegaven has made a difference. "Five years ago, every single one of the kids taking Omegaven would be dead by now, Maggie included," he says.

Source



UNIVERSAL HEALTH CARE GOES TO WASHINGTON

Newly elected Democrats and America's Health Insurance Plans (AHIP), the industry's trade association, have put universal health care at the top of their legislative agenda, says Investor's Business Daily (IBD). While Democrats have not developed a comprehensive plan, AHIP has outlined its formal strategy:

* The group wants the federal government to spend $300 billion over 10 years on the plan, which would expand federal-state programs -- including Medicaid -- to insure below-poverty-line children and adults.

* The organization also wants individuals to buy coverage through universal health accounts paid for with pretax dollars, with federal matching funds for working families.

But John C. Goodman, president of the National Center for Policy Analysis has his doubts: "There is no way to make health insurance really universal in the United States. To do that would mean everybody is in the same system, and you couldn't do that unless you make it free. A free system would mean runaway costs and reduction in quality," he explains.

Goodman's solution: Personal and portable insurance, similar to health savings accounts, which are engineered like the 401(k) retirement savings program, and allow individuals to buy their insurance with tax-free dollars and take it from job to job, city to city and state to state.

Source: Peter Benesh, "U.S. Health Insurers Expect Quick Action From Dem Congress," Investor's Business Daily, November 24, 2006.

Source

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

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 Pages are here or here or here.

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



8 December, 2006

"HEALTHY" STATES -- GARBAGE IN, GARBAGE OUT

The report below claims that various "blue" States are much healthier than "Red" (GOP-voting) States. You see why when you read what counts as an index of "health": "The report is based on factors such as personal behaviors, the environment people live and work in, decisions by public and elected officials, and the quality of medical care delivered by health professionals". Note that quality of medical care is only one inclusion. The other criteria are non-health criteria and appear to reflect the degree to which the States are Leftist in their practices. The report is in other words a quite childish attempt to "load the dice" and present "blue" States in a better light

An annual report released Tuesday put Minnesota at the top of its health rankings for the fourth straight year, while concluding that the nation’s health improved slightly. The report by United Health Foundation, an independent, not-for-profit foundation funded by the health care company UnitedHealth Group, said Americans are 0.3 percent healthier than they were a year ago.

The report is based on factors such as personal behaviors, the environment people live and work in, decisions by public and elected officials, and the quality of medical care delivered by health professionals. Examples include smoking, motor vehicle deaths, high school graduation rates, children in poverty, access to care and incidence of preventable disease.

Dr. Reed Tuckson, senior vice president of the United Health Foundation, called the report a “call to action for all of us” to make the nation healthier. “We can do better and our children deserve better,” he said. Minnesota, which has held the top spot in 11 of the 17 years of the survey, was cited for, among other things, its low rate of uninsured (8.4 percent), low percentage of children in poverty (10 percent), and low infant mortality rate (5.1 deaths per 1,000 live births).

Vermont was second on the list, followed by New Hampshire, Hawaii and Connecticut. At the other end, the report listed Louisiana as the least-healthy state, followed by Mississippi, South Carolina, Tennessee and Arkansas.

The report also points out states that have made the most progress in overall health since last year, as well as those that have regressed the most. Illinois saw the biggest gain in the past year, jumping three to a ranking of 25. The report credited the state for decreasing child poverty by 13 percent and the prevalence of smoking by 10 percent. Other states saw health gains. Ohio was cited for cutting smoking statewide by 14 percent and increasing immunization coverage by six percent. Wisconsin rose three places to a ranking of 10, largely due to lowering the number of children in poverty by 24 percent, its high rate of high school graduation and low violent crime rate. Kansas was also noteworthy for a low rate of uninsured, smoking and incidence of infectious disease, the report said.

Source



THE TANGO: THE LATEST NHS PRESCRIPTION

It's a prescription that has the charm of not costing the NHS anything

The unfit, overweight and elderly will be told this week to take up the tango in the interests of their health. Caroline Flint, the Public Health Minister, is expected to publish a new report showing that prescribing exercise is a cost-effective way of improving health. She will recommend that street dancing, tango classes and trampolining should be encouraged. "Anything you enjoy that makes you more active is good thing," a spokeswoman for the Department of Health said yesterday. "People love dancing." But the actual cost of a visit to the local disco or th, dansant would not be paid by the NHS, she said. It would be more a case of GPs making clear to their patients that all forms of exercise, not just working out in a gym, have their value.

The report to be published this week is the final evaluation of pilot programmes backed by the department, Sport England and the Countryside Agency to try to encourage people with a sedentary lifestyle to take more exercise. For at least a decade the department has been promoting "exercise on prescription" in local areas and as pilot programmes. But funding has been sporadic and enthusiasm from GPs not always wholehearted. And there is little evidence that the programmes are cost-effective. The 2.5 million pound local exercise action pilots began in 2004 and have been evaluated by Leeds Metropolitan University. Its report is expected to say that GP referrals to exercise and walking classes have worked for the older adults, while swimming works better for younger people. "Different categories of intervention engage users with different demographic profiles and baseline levels of physical activity," it found.

The evidence suggests that this kind of intervention can reduce the number of inactive people by about a third. The data also indicate that all those involved increased their activity levels to some degree. Sedentary people exercised about an hour-and-a-half more each week.

Ms Flint will emphasise that activity can take many different forms. One primary care trust sent teachers into schools to encourage girls between 10 and 16 to spend time dancing. While Ms Flint will not suggest that dancing classes are the solution to Britain's obesity epidemic, they have a role.

In another programme, over-50s were encouraged to box, skip and take part in a "tango warm-down". Yet others were taken for walks in the woods where they built shelters out of sticks.

Twenty or 30 years ago, higher levels of activity would have been considered part of a normal life, but Britain has become increasingly sofa-bound. A plethora of small initiatives, such as the promise of "personal trainers" paid for by NHS, has given the impression of government activity, but the rise in obesity has not been halted. The report is expected to make a series of recommendations about how physical activity interventions should be planned and organised in future. It says that such schemes require a broad mix of skills not easily found, and that consultation with the target groups and with community groups is needed to ensure that people participate. Participants also need to know that the schemes will not last for ever, but are simply designed to give them a short-term boost. They will need then to continue without support. The report is expected to conclude that more investment would be justified, as persuading people to be more active saves money in the long run. Ms Flint will announce that GPs will be asked to discuss physical activity with their patients, and complete questionaires recording how active they are.

Source

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

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 Pages are here or here or here.

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



7 December, 2006

Massachusetts deception

RomneyCare, Gov. Mitt Romney's "revolutionary" healthcare initiative, was introduced earlier this year to applause from the mainstream media, Senators Hillary Clinton and Teddy Kennedy, and Families USA-all wild at the idea of universal healthcare in Massachusetts. Such endorsements were not the best of signs for conservatives, but they were certainly eye-catching, especially with the hunt for future presidential talent on. And many Republicans were wondering whether RomneyCare was the conservative solution to the problem of uninsured Americans that the party was looking for.

Almost immediately after the bill creating it was signed into law, the Wall Street Journal ran an op-ed, which claimed that, under RomneyCare, "the state is forcing people to buy insurance many will need subsidies to afford, which is a recipe for higher taxes and more government intervention down the road." Not so, said Romney. Despite the potential weight of RomneyCare on the public purse -likely to be exacerbated by the plan's focus on signing up the 20% of Massachusetts' population that is eligible for Medicaid, but not enrolled-Romney said he would not need to raise taxes to pay for the program.

Of course, he was right. RomneyCare has not even been fully implemented yet, and a cost overrun of $151 million in 2007 alone is already in the cards, perhaps because the RomneyCare financial model assumed the wrong number of uninsured in Massachusetts (the Census Bureau puts it at 748,000, but RomneyCare assumes only 500,000). But any needed hike in taxes won't be pushed through by Romney -he'll be out of office when the bill comes due, and when extra federal dollars will likely have to be allocated to Massachusetts to help cover the shortfall between RomneyCare's cost and its budget.

Yes, RomneyCare is reliant on federal funds. So imagine if, as Romney hopes, it is replicated in other states. Even if we do not have federally-mandated universal healthcare a la HillaryCare, we could easily end up with that option's badly behaved little brother-"state-specific" universal healthcare, funded in large part, and at greater than current levels, by the federal government.

That matters because it means more government intrusion into personal healthcare choices. Government will end up funding healthcare at a higher level, and in exchange, making mandates about the kind of coverage you must have, and who may treat you (RomneyCare mandates that individuals must purchase HMO coverage; PPO coverage, often better and more flexible, is not allowed). Moreover, government will end up dictating to businesses and requiring them to incur potentially great costs: RomneyCare mandates that employers with more than 10 workers must assume ultimate financial responsibility if employees or their immediate family members need expensive medical care, and that if such businesses do not insure their employees, they must pay a $295 per uninsured employee fee to subsidize healthcare costs. This threatens employment levels and discourages small businesses from growing.

Ultimately, the entire specter of government engagement in the realm of healthcare hits at a fundamental question. Is healthcare and health itself primarily an individual responsibility, the product of individual choices made in consideration of private matters, or is it a benefit to be assured by the government, without regard to the wishes of the individual?

Only an individual can know what their objectives are in terms of health and how best to ensure that they are met. For example, someone with a rare and difficult-to-treat illness may wish to carry PPO insurance, rather than HMO insurance. PPO insurance generally affords access to a wider range of physicians and treatments, yet RomneyCare bans taking it out. Alternatively, someone earning $30,000 a year-too much to be eligible for state-subsidized insurance under RomneyCare-might want to buy cheap, basic coverage, instead of insurance costing around $3,600 annually for an individual and $11,000 annually for a family, plus 10%-14% annual inflation on premiums. But buying cheaper, more basic insurance is not possible-RomneyCare didn't change Massachusetts' rules mandating coverage for chiropractic treatment and acupuncture, or allowing purchase on the day of diagnosis, which make insurance there so expensive, compared to less regulated states.

This is the big problem with RomneyCare. It represents an interventionist, big government approach toward what is a highly personal matter, and does virtually nothing to reform burdensome insurance regulation that is responsible for the problem of underinsurance.

Romney disagrees with this characterization. He claims that his plan (and make no mistake, he claims it as his), which is already costing more than intended, imposes criminal sanctions on individuals who do not buy what may be a totally unsuitable product, mandates significant costs and imposes obligations on businesses, and results in government guaranteeing healthcare as a virtual right, is a good, conservative initiative. He contends that there's nothing wrong with forcing people via government diktat to purchase health insurance, because states already force people to carry car insurance. But he ignores that it is not standard to require drivers to carry insurance for damage to themselves or their own cars-only for harm done to others. This may be stupid, but so is driving a Yugo, and yet we don't mandate that everyone drive a BMW, do we?

Romney also contends that, since hospitals are required to provide treatment for the uninsured irrespective of their ability to pay, underinsurance is a grave risk and government already is in the position of footing the bill for something that should be a matter of individual responsibility. Yet, as the Wall Street Journal's "RomneyCare" op-ed notes, the cost of covering the care of uninsured patients is low, and uses a very small proportion of governmental medical budgets. Plus, the uninsured that benefit from emergency-room treatment can always be pursued as debtors, just like people who default on loans.

It is a shame that Romney could identify no more market-friendly options to curb the problem of under-insurance. Surely, in a state where insurance must cover rather exotic treatments, un-mandating coverage for chiropractic treatment and acupuncture as well as in vitro fertilization, could and should have been pursued first. This would have enabled cheaper policies to be marketed in Massachusetts, the number of uninsured to be cut, and for Romney to have legitimately claimed responsibility for meaningful, market-friendly reforms in the realm of healthcare-something RomneyCare effectively prevents.

Source



BULL**** ABOUT BRITISH HOSPITAL ER CLOSURES

The closure of accident and emergency services at some hospitals is in the interests of patients, the Government said yesterday. Presenting them as part of a plan to create "super-A&Es" to deal with heart attacks, strokes, and aortic aneurysms, Patricia Hewitt, the Health Secretary, sought to halt a tide of opposition to the closures. They were not about saving money but about saving lives, she asserted.

If that were true, Andrew Lansley, her Conservative opposite number retorted, it could have been done before, not after, financial deficits in the NHS had come to light.

The Department of Health published two reports to support the claims by Ms Hewitt. They called for "reconfiguration" of A&E services, to allow specialist centres for the most serious conditions to be created, and enable more people to be treated in their homes. According to Professor Roger Boyle, the national director for heart disease and strokes, local A&E units are not the best places for providing good care for patients suffering from either of these conditions. Specialist centres might mean a longer journey for many people, but they would produce better results, saving the the lives of 500 people suffering heart attacks every year, preventing 1,000 further heart attacks and saving 1,000 more stroke victims from death and disability, he said.

Sir George Alberti, the national director for emergency access, said: "We have to be up front and tell the public that, in terms of modern medicine, some of the A&E departments that they cherish are not able to provide this type of care and cannot and will not be able to provide the degree of specialisation and specialist cover that modern medicine dictates the public deserves." It would be better, he said, for many patients to bypass the local hospital and be taken by highly trained paramedics to specialist centres. " `But won't I die on the way?' many people ask," he said. "No, you won't. Long ambulance journeys do not lead to more deaths."

Ms Hewitt said: "Whenever the A&E starts to talk about reorganising, people think it's all about money and it isn't. It's about saving more people's lives, it's about making care more convenient, it's about getting the money into the right place so that people get the best care from the right person at the right time."

The Government fears that it is losing the argument over NHS reconfigurations, which involve A&E and maternity services, among others. The reports, published yesterday, are designed to present the issue more positively, by showing that change might not mean worse care. But the argument assumes that the money saved by closing some A&Es is devoted to building others into specialised centres. That is not guaranteed. Karen Jennings, the head of health at the public sector union Unison, said: "The climate of debt in the NHS puts the development of new policy under suspicion. We are extremely concerned that these policies may be being driven by deficits, not what is best for patient care. "If we move towards more specialist units we still need to ensure that patients have access to really good local A&E departments."

Geoff Martin, of the campaign group Health Emergency, said: "Claiming that closing local A&E departments, trauma units and intensive-care facilities will improve services turns all logic on its head. People are fighting these closures in their tens of thousands up and down the country because they know that closing local services and increasing journey times puts lives at risk."

Mr Lansley did not dissent from the idea of specialist units, which he has championed for some years. But he said that the patients who would be sent to them represented, at most, 5 per cent of all A&E attenders. "I accept the need for specialisation, but this should not be used to justify taking accessible A&E departments away from district general hospitals," he said.

Ms Hewitt said that casualty services in future would divide into three kinds, with "super- A&Es" for people with the most serious conditions, local A&Es for most treatment and the A&E that "will come to you" for less serious injuries. "Financial problems are forcing people to look at changes they ought to be doing anyway, and in a few cases financial problems are driving people to make changes they should have done years ago," she said.

The report by Sir George Alberti arrives at a similar conclusion. "Finances may have been the issue that drew the media's attention, but they are not the reason for reform," it said. "Reforming emergency care is about responding to medical advances and providing new and better services in ways that allow the NHS to save more lives."

Beverly Malone, the general secretary of the Royal College of Nursing, said: "Any changes must be subject to full and proper consultation with staff, unions, patients and local communities - after all, it's our NHS and we all deserve a say in how it is run and reformed." The Government has not produced a list of trusts where A&E departments have closed or are threatened. But the Tories say they have identified hospitals in 29 NHS trusts

Source

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

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 Pages are here or here or here.

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



6 December, 2006

THE NHS AS "BIG BROTHER"

The Department of Health provoked uproar among doctors yesterday by asking GPs in England to send in correspondence from objectors who do not want their confidential medical records placed on the Spine, a national NHS database. Sir Liam Donaldson, the chief medical officer, said letters from patients who want to keep their private medical details out of the government's reach should be sent to Patricia Hewitt, the health secretary, for "full consideration". Campaigners who fear the national database will infringe patients' civil liberties said the exercise would give Ms Hewitt access to the names and addresses of patients most likely to be offended by government intrusion.

GPs wrote to the General Medical Council asking for a ruling on whether Sir Liam had broken the doctors' code of good practice by using his authority to encourage GPs to breach patient confidentiality without clinical justification. Sir Liam's letter complained about "misleading statements" in a Guardian article on November 1 that the police and other agencies might be able to access medical records once they had been loaded on to the national database. The article included a form of words patients could use to ask Ms Hewitt to refrain from uploading their records without their explicit consent. Sir Liam said patients were sending a similar request to GPs instead of the health secretary. He added: "If you do receive any such letters I would ask you to send them to the Department of Health so they may receive full consideration."

Hamish Meldrum, chairman of the BMA's GPs' committee, said: "The chief medical officer's intervention is not helpful and GPs should not forward these letters. It is possible that some patients might think this is a breach of confidentiality in that a letter sent to their GP is forwarded to somebody else without their consent." Paul Cundy, the BMA's spokesman on IT, said: "For a GP to forward such letters without the explicit consent of the patient would be a gross breach of privacy. In effect it is asking GPs to spy on his behalf. He should retract immediately. "Since these patients are objecting to the Big Brother society, this is an astonishingly incompetent gaffe."

Ross Anderson, professor of security engineering at Cambridge University, said: "It is not for the government to decide unilaterally to override the wishes of those patients who decide to write to their GP, but not to Ms Hewitt. For the chief medical officer to so recklessly put news management ahead of patient privacy is shocking." The government wants to start uploading a summary of patients' records in trial areas in the spring. Sir Liam reassured GPs: "There will be plenty of time to discuss patients' concerns with them before any data uploads ... in their areas."

Source



Unbelievable: Carelessness about meningococcal disease

What harm would precautionary antibiotics have done? A private doctor who failed to prescribe them in a risk situation would be sued for millions

The first rule to help doctors and nurses identify meningococcal disease is "listen closely to patients and friends", says an educational DVD that calls it the most rapidly lethal infectious disease known to man. But when George Khouzame raised concerns he might have passed on the illness to his girlfriend, Jehan Nassif, he was told he had probably only had the flu, the inquest into her death heard yesterday. Three days later Ms Nassif, 18, was dead.

Mr Khouzame and his cousin Elias had been overseas and both felt ill just before they returned to Australia. George's symptoms eased but Elias Khouzame became weak and had a headache, painful limbs and a fever. During a stopover he noticed red spots on his skin and suspected meningococcal disease. Back in Sydney, Elias went straight to hospital, while George attended a welcome-home party, where he kissed and cuddled Ms Nassif.

The next day a public health officer, Carla Ghezzi, spoke to George and his friends about their contact with Elias, who had been diagnosed with meningococcal disease, the inquest was told. George and his friends claim he told Ms Ghezzi he had had similar symptoms a day before his cousin and wondered whether he had passed the disease on to him. Ms Ghezzi allegedly told him: "If you had meningococcal you wouldn't be here now. You probably just had the flu." The inquest at Westmead Coroner's Court was told Ms Ghezzi also dismissed his concerns about Ms Nassif, though Ms Ghezzi had said she did not remember this part of the conversation.

Ms Nassif later briefly visited Elias in hospital, probably without wearing the prescribed face mask. National guidelines say anyone in close contact with a patient with meningococcal for at least four hours in the previous week should get antibiotics to prevent the spread of the disease, the court was told.

Source

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

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 Pages are here or here or here.

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



5 December, 2006

My health care is making me sick

Getting sick is high on my list of life's biggest hassles these days! Excuse me if I am sounding like an "old fogie" when I reminisce about the "good old days;" but, I can't help thinking back on my childhood (in the 50's and the 60's) when my mom and dad would call our family doctor who lived in the neighborhood.

Dr. Greenfield would keep my dad calmed down who was such a worry-wart that he would get sick along with me and my two sisters. Sometimes the doctor would just send a prescription, which I know is considered a no-no these days, however, I must confess to still being alive at the ripe old age of 55 and 7 months young! Other times we would go to his office, or would you believe he would even make a "house call." For those of you who are too young to have experienced this extinct phenomena . this is when the doctor actually comes to see you at home. Yes, you get to lie in bed in your jammies, under the covers watching TV and eating popsicles where you belong when you are sick. Such a novel idea.

I fondly remember the time I was about 12, I had some kind of bug that had me blowing chunks (my son's 90's term) for several days. As usual my dad got sick along with me, so my mom would have two people to clean up after. In comes Dr. Greenfield, trying as always to relax my worried father. (I see the two of them playing ping-pong in the dining room. Unfortunately, Dr Greenfield died shortly thereafter of a massive heart attack in his forties. There may have been a line between his overzealous medical practice and his untimely death, or maybe it was in his "genes?" I don't know what he charged for all of this, but there was no such thing as insurance and my parents were not wealthy. We just paid the bills as your health and your family are your own responsibility. After all, is that not what life is all about?

Needless to say, it was good while it lasted. Contrast that to medical care in the present.

The first question I get asked when I pursue medical treatment is who is your insurance company and the responsible party. There is no one who is willing to give you any simple advice or reassurance for fear of being blamed for wrongdoing or sued for malpractice. The doctor that I had for 25 years, all my adult life, recently quit taking my insurance provider. Sure, I could pay out of pocket for office calls or non-catastrophic expenses in order to stay with him, but what if the "big one" does hit? Then what? No one else knows my history or me.

I am really upset over this, as just when I am getting old enough to need a doctor BOOM-he is gone! I felt comfortable with Dr. John. I trusted him personally and professionally. We had worked together at a local hospital where I was a dietitian. He knew my family and husband. He knew my quirks and neuroses. He had seen me "au natural." This is a big deal to me - changing doctors. This is like getting a divorce and having to date again. I want my doctor back! I'm a person who won't even change grocery stores because I know where the food is.

A few (10) years ago when my father died, my mother in her grief called her health plan only to find the last doctor who had seen her was no longer there. My mother, at age 71, could not get anyone to give her a Valium during her crisis! For this kind of care we pay BIG BUCKS. Hundreds and thousands of dollars? I think we were all better off before the big insurance companies and the government came to rescue us concerning our health care needs.

I have heard that you can get antibiotics at pet stores for fish, and they are the same thing people take. I recently bought a ten-pack of penicillin pills at the local pet supplier for $3.89 because I have been sick with "whatever" for nearly a month. I wimped out and did not take them due to all the warnings on the label discouraging what I was about to do! (Some people actually do read warning labels) I guess logic did dictate that I was different from my Cichlids. I have saved the pills for the next case of "ICK!" in our tank.

But, alas, I have survived despite any medical treatment at all other than some aspirin, a little wine, a few over the counter remedies, and advice from my handy home medical advisor. I've read they are about to come out with a do-it-yourself PAP smear. I wish they would hurry up, as I am already overdue on that one too.

Source



Australia: Physiotherapy students victimized by a near-bankrupt health system

Pressure on public hospitals has become so extreme that [Queensland] physiotherapy students are being forced to travel thousands of kilometres at their own expense to secure clinical training. Gold Coast students Lauren McLune and Emma Armfield have spent the past six weeks sharing a cramped room in a Hobart backpacker hostel because Queensland's public hospital system cannot afford to provide the practical training they need to graduate.

The pair had only four days' notice of their Hobart placement - the closest available to Griffith University's Gold Coast campus. They estimate they have each spent at least $2000 on accommodation, food and travel while also maintaining their homes on the Gold Coast. Ms Armfield, 28, had to quit two of her three part-time jobs to take the Hobart placement. "We didn't know whether to laugh or cry," Ms McLune, 25, said. "We entered into this degree knowing that this could happen. However, four days' notice is a bit different to the month that people usually get given."

The students' plight reflects the growing pains afflicting the nation's medical workforce. And it is not just physiotherapy students. Australian Medical Association national president Mukesh Haikerwal said medicine and all allied health professions suffered similar problems because poorly funded public hospital resources were straining to provide patient care, leaving no money for training. "The universities are cash-strapped, the hospitals are cash-strapped and the quality of education is at risk," Dr Haikerwal said. "If you are looking at having 10 students standing around a bed, it's more difficult than having two students. And it wears out the goodwill of both the educators and the patients."

The commonwealth and states agreed to boost medical students numbers this year. Within a few years, the number of graduates will climb from about 1500 to 3200. "But where will they train?" Dr Haikerwal said. He said the inter-governmental agreement was "a furphy" because no consideration had been given to boosting the capacity of hospitals to provide hands-on training and internships.

While politicians had claimed credit for funding more university places, universities were stumped over how to turn out doctors and other professionals with adequate practical experience. Australian Physiotherapy Association president Cathy Nall blamed the commonwealth for under-funding university courses. "There's no subsidy provided for accommodation for physiotherapy students in the way that there is for medical students and no assistance with travel costs," Ms Nall said. She agreed it was common for students to take practical placements in Tasmania because it had no university physiotherapy course. But they usually came from South Australia or Victoria and were given months of notice.

Source

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

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 Pages are here or here or here.

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



4 December, 2006

"CARING" PUBLIC HOSPITALS

Three stories from the one day in one Australian State:

Kicked out (1)

A distressed woman was found close to collapse on a highway after hospital staff who treated her for a suspected heart attack refused to help her get home. The woman, 52, tried to walk the 20km from Atherton Hospital to her home near Yungaburra after explaining to staff she had no money and no one to pick her up. A Good Samaritan picked her up as she stumbled along the highway in her slippers and nightclothes in 30C heat. "They just don't seem to care any more," said the woman, who did not want to be identified. "The philosophy seems to be to get people in and get them out as quickly as they can."

An ambulance took the woman to Atherton Hospital after she woke with severe chest pains at 1am on Saturday, November 4. Doctors ruled out a heart attack, but could not identify the cause of her illness. She was told to go home later in the day.

"I went to the emergency counter and asked if they could help me get home," the woman said. "I didn't have any money on me for a taxi, my brother and daughter were overseas and my son was in Iraq. "I asked if an ambulance could take me, but she told me, 'No, the ambulance service is not a taxi service, madam'. I said I would just have to walk home. She shrugged her shoulders and turned her back."

The woman had walked for more than an hour when passing motorist Gail Fleming saw her in distress and offered her a lift. Ms Fleming, 58, from Atherton, said the woman was clutching her chest when she saw her walking up a hill about 4pm. "It was very hot and she was in a lot of stress," Ms Fleming said. "She just started crying straight away."

One Nation MP Rosa Lee Long raised the case in State Parliament last week to try to get more resources for hospitals in her Tablelands electorate. "She would never have made it home," Ms Long said. "These kinds of events cry out for an urgent roll-out of the promised extra funding, not in four or five years or even longer, but immediately."

Source



Kicked out (2)

Grandmother Gaynor Ralph was kicked out of Brisbane's Princess Alexandra Hospital with no shoes, no money and nowhere to go. Mrs Ralph, 75, was put in a taxi in only a hospital gown and her nightie despite telling staff she didn't know her son's new address. She had to be taken to a police station until officers could contact her son Charles. "I was appalled," he said yesterday. "She was told she had to go, even though they knew she had nowhere to go to." Mr Ralph was so stunned by his mother's treatment that he took pictures of her in the hospital gown after picking her up from the police station.

His mother had been in Europe when a medical emergency forced her to return to Australia for immediate treatment. She was flown to Brisbane because that's where her son lives. Mrs Ralph spent 60 hours in transit before being taken to the PA Hospital in a wheelchair with suspected deep vein thrombosis on Saturday, November 4. She was kept in hospital overnight, but a doctor examined her the next morning and told her to go home. Hospital staff gave her a taxi voucher and sent her packing.

"I had moved house and she didn't know where I'd moved to," Mr Ralph said. "Her mobile phone (battery) was flat and she didn't have any money because the hospital told us not to leave her with any valuables for security reasons."

Hospital staff said they were unable to reach Mr Ralph on his mobile phone, but police had no such problem. "I left late the night she was admitted, telling them I'd be back in the morning," Mr Ralph said. "As I arrived at the hospital I got a call from the police station to say that she was there. "I arrived at the station to find her in an ill-fitting hospital gown with no footwear."

His mother was in need of further treatment and should have been allowed to stay in hospital at least until he arrived, Mr Ralph said. "They knew I was coming and they still kicked her out," he said. "They will claim she agreed and she was willing to go. But they told her she had to go. "All she did as a frail old lady was comply to their demands." Mrs Ralph recovered at her son's home until she was well enough to return to her home in Tasmania.

State Opposition Health spokesman John-Paul Langbroek, who has been seeking answers for the Ralph family, said lives were being put at risk because under-funded hospitals were evicting patients too early. "It all comes back to 'bedlock'. Doctors are feeling pressure from above to clear the beds," he said.

Source



Wrong kneejoint fitted -- deliberately

An Ipswich grandmother who waited five years for a knee replacement has been told she needs the operation again -- because surgeons fitted the wrong joint. Marilyn Hohnke, 62, has been suffering pain in her left knee since 1999, when she was first put on the waiting list for surgery at the Royal Brisbane Hospital. She expected the operation in December 2004 would fix her problem, but was disappointed to find it made no difference. Now an examination has revealed her knee joint will never work properly because it is too big for her.

Mrs Hohnke is furious to be back on the waiting list for a second time, and says she feels let down by the health system. "It was terrible having to wait five years for this operation in the first place, but finding out that it was a complete waste of time is just so discouraging," she said. "I don't know how the doctors could have made such a mistake. "I was shocked when they told me that it was the only joint available on the day of the operation so they had to use it. "I am now at the back of the queue again and don't know how long it will be before I get it fixed. "In the meantime, I can't walk properly because it causes me great discomfort."

She has now opted to have the second knee operation at Ipswich Hospital and has been on the waiting list since May. Bosses at the Royal Brisbane Hospital said Mrs Hohnke was considered too young for the knee replacement in 1999, even though it was causing her pain. They said the operation had been a success...

Source

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

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 Pages are here or here or here.

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



3 December, 2006

HIGH-DEDUCTIBLE PLANS DO MAKE PEOPLE MORE CAREFUL ABOUT HEALTHCARE USE

People in a new kind of health plan that makes consumers pay for a bigger share of their care appear to be more cost-conscious than those in traditional plans, but half say they would switch if they had the chance, according to a survey released yesterday. The survey of 1,389 people by the nonprofit Kaiser Family Foundation found that 71 percent of those in the new "consumer-directed health plans" said the policies prompted them to consider cost when seeking health care, compared with 49 percent of those with more traditional employer-sponsored coverage.

For instance, people in the new plans were more likely to ask about the cost of a doctor's visit and inquire about the availability of lower-cost alternatives in treatments and tests. More than half, 55 percent, who sought care said the new plans have changed their approach to using health care.

Such findings are in line with assertions by the Bush administration and other advocates who say that the new plans will check spiraling health-care spending by giving consumers a financial incentive to shop around for the best care at a reasonable price -- and to get only the care they need.

"It's a cultural shift," said Devon Herrick, a health economist at the National Center for Policy Analysis in Dallas. "When you go to Wal-Mart you don't have to ask about price -- it's right there next to the good or service you are buying. Health care is not there yet, but it's getting that way. This is the early stages. We have the incentives to get people more responsible and asking about price."

In contrast with other plans that typically require $15 or $20 co-payments for visits to the doctor, the new plans can require consumers to shell out hundreds or thousands of dollars of their own money for medications, physicians' services and hospital care before most coverage kicks in. The plans have high annual deductibles, but their premiums tend to be lower.

Some consumers complain that the new plans are confusing, and the Kaiser survey found that the plans are not without problems. More than 60 percent of people in the plans said it is hard to find good information about the cost of doctors' services and hospital care; and about 50 percent said information on quality of care is hard to come by. Half of those enrolled in the plans said they would switch out if given the choice, compared with a third of those in traditional plans. And they were twice as likely as those in traditional plans to say that they went without care because of cost.

Gail Shearer, director of health policy analysis at Consumers Union, noted that the survey found that people in the new plans tend to be wealthier, healthier and more educated than their counterparts in traditional plans, and were more likely to be white. "Instead of our health system moving towards one where we're all in this together, this type of option is leading to more splitting the population into different segments and, to me, that's an unhealthy thing," Shearer said. She added that poorer, sicker consumers could get left behind.

The new plans are often coupled with special accounts that allow consumers -- or employers on behalf of their workers -- to set aside tax-free dollars to pay for medical expenses, with any unused money rolling over into the following year. About 3 million people are enrolled in such plans this year, and experts expect that number to grow. "The folks in the programs now are early adopters, pioneers," said Greg Scandlen, president of Consumers for Health Care Choices, a Hagerstown, Md.-based nonprofit group that favors the plans. "And they are really testing the waters, and I think they are already forcing a lot of change. . . . With any kind of new insurance plan it takes a while to figure out what it's all about."

Source

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

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 Pages are here or here or here.

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



2 December, 2006

BRITAIN: MORE CUTBACKS FOR THE SICK

On Britain's present trajectory, they will eventually just have bureaucrats and no medical staff at all

Hundreds of thousands of elderly people will no longer get home care services because of a funding shortfall and the widening impact of NHS cuts, the social care watchdog says. The Commission for Social Care Inspection reports today that nearly two thirds of the 150 councils that provide social services changed their criteria last year to provide social care only for the most dependent people. In more than 100 councils, elderly and disabled people who used to get regular help with cleaning, bathing, dressing and shopping will no longer be entitled to care unless they fall into the top two categories of "critical" or "substantial" risk. Only the very frail, immobile or those at risk of abuse will be entitled to these services, forcing other vulnerable people to rely on families or friends or to go without help.

The commission says that the situation is already getting worse in at least three authorities - North Yorkshire, Northumberland and West Berkshire - which are restricting home care to critical or life-threatening situations. It predicts that this situation will apply in many more authorities next year.

The number of households receiving home care has fallen by 174,000 since 1992 to 354,000 last year, a drop of 30 per cent. The commission says this is mainly because councils are concentrating scarce resources on the very needy. "People entitled to social care are getting better care," a commission official said. "But that leaves thousands of others with no care at all." Mervyn Kohler, of Help the Aged, said that withdrawing preventive services from less critical groups could affect their quality of life crucially. People who no longer had help with cleaning, shopping or dressing would stop inviting people round, lose their self esteem and stay in bed all day. "Councils will end up paying the price for restricting the criteria with more people becoming dependent. This is a foolish, short-term economy."

Councils are being forced to change their eligibility criteria because government grants for social services have failed to keep up with growing numbers of very elderly people, local authorities say. Many also complain that they are bearing the brunt of NHS cutbacks. In some cases they are treating people who would have been cared for in hospital, while in others primary care trusts are refusing to pay for services provided by local authorities where they would have done so in the past.

The commission's annual performance rating of adult social services for 2006 shows that three quarters of the 150 councils gained either two or three stars. Although no council was zero-rated, 33 got only one star; 24 of these had been given one star for the past three years. Ten councils went up to the highest three-star category, but nine dropped in the rankings to two stars. In total 25 councils improved their services, while 16 fell back.

Ivan Lewis, the Care Services Minister, said that a number of councils need to "up their game" as he announced plans to intervene in 21 councils which had failed to improve their ratings since 2002. "Adults and their carers who use services in this area deserve better, therefore I am asking (the commission) to work with these councils to develop improvement action plans by March next year," he said. Social care leaders broadly welcomed the latest league tables. John Coughlan, president of the Association of Directors of Social Services, said: "We cannot ignore the fact that these improvements have been made in the teeth of one of the most severe financial squeezes social care has experienced for a long while."

Source



The return of Hillarycare?

In the wake of the Democratic victory in the midterm congressional elections, Hillary Clinton announced that Democrats would once again make health care reform a top legislative priority. "Health care is coming back," Clinton said, apparently giddy with triumph, adding, "It may be a bad dream for some." Indeed, it may well be a nightmare for American health consumers. No one knows for certain what the new Democratic majority has in mind, but its initial proposals -- expanding Medicaid and the Medicare prescription drug program -- are certainly steps in the direction of more government interference in the medical marketplace.

Perhaps it has been so long that Americans have forgotten exactly what Hillarycare was. If so, it's worth reminding them. Under the Clinton plan, the government would have taken control of nearly one-seventh of the U.S. economy. It would have established the world's largest government program -- dwarfing even Social Security -- created a huge new bureaucracy and required massive tax increases.

The entire idea behind the Clinton health care plan was that government knew best -- better than businesses, better than doctors, and better than patients.The Clinton plan would have required every business in America to provide health care coverage to its employees, regardless of cost. The mandate would have devastated small businesses and cost thousands of jobs. Clinton's plan would also have forced Americans to give up their current health insurance, even if they were happy with it, in return for a government-designed standard benefit package that could be far more expensive. What the policy covered would be determined not by consumer preference or even medical necessity, but by the lobbying power of various special interests.

Such policies would have been "community rated," meaning that people would pay exactly the same premium regardless of whether they were healthy or on their death bed, practiced healthy lifestyles or smoked six packs a day. That would have meant a huge premium increase for young and healthy people.

The plan established rigid price controls through a series of premium caps and other measures. That, in turn, would have forced insurers to ration the care they provided. Clinton apparently hoped that indirect rationing through managed care would avoid the direct rationing that results from price controls under every other national health care system in the world. But just in case, the proposal would also have established a National Health Board, with back-up authority to ration health care directly if indirect rationing failed to reduce costs sufficiently. And the Clinton plan would have forced all Americans into managed care, effectively denying them the ability to choose their own doctors. Indeed, the Clinton proposal actually included criminal penalties for people who tried to pay for unapproved health care out of their own pockets.

There is no doubt that our health care system is badly in need of reform. Too many Americans lack health insurance. We need to do more to lower health care costs and increase access to care. The system is riddled with waste and the quality of care is uneven. Government health care programs like Medicare and Medicaid threaten future generations with an enormous burden of debt and taxes. But the answers to these problems lie with more choice and competition, not less. More government regulation, subsidies, and control would simply drain the medical marketplace of the quality, dynamism and innovation that save lives. Hillarycare would have put the health care equivalent of FEMA in charge of our health care system. Surely this is not what the American people voted for on Nov. 7.

Source

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

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 Pages are here or here or here.

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



1 December, 2006

Canada: Waiting-times failure a worry

Federal Health Minister Tony Clement says the fact that patients at nearly half of Canada's cancer treatment centres are not getting critical radiation treatments within the target period of four weeks bolsters his argument for guaranteed waiting times. A study by the Canadian Association of Radiation Oncologists found that only 50 to 60 per cent of the centres are able to provide radiation treatment within the four-week period. Prostate cancer patients were among the least well served: 70 per cent of Canadian hospitals could not deliver the radiation treatment within four weeks. And breast cancer numbers were also disturbing, with only 53 per cent of hospitals meeting the target.

Mr. Clement said the waiting-time figures, which were obtained by The Globe and Mail, are a worry. But they prove the need for provinces to promise to pay to send patients elsewhere for treatment when it can't be delivered locally in a timely manner, he told a news conference. "Benchmarks and targets without recourse is an empty promise," said Mr. Clement, whose government has made reduced waiting times the centrepiece of its health-care strategy. "That is why we have sought to engage the provinces and territories, not just to create benchmarks, but to take the next logical step, which is to have the recourse which creates the guarantee."

Clinically acceptable standards for radiation and four other priority treatments were agreed upon in December of 2005 at a meeting between provincial health ministers and Ujjal Dosanjh, who was then the Liberal minister of health.

The Conservatives were elected a month later on a promise that they would get the provinces to set targets to meet those standards by next month -- and they said they would work with the provinces to bring in the proposed guarantees. But the provinces have been less-than-willing partners in the push for guarantees because the federal government is offering them no extra money for the initiative. Mr. Clement will meet with his provincial and territorial counterparts at a meeting in Moncton in two weeks and the discussion around guaranteed waiting times promises to be heated.

Les Vertesi, a councillor with the Health Council of Canada, a federal-provincial-territorial body that monitors the revamping of the health-care system, said yesterday the radiation oncologists' study confirms that "we had a problem all along." But he stressed that all the provinces are taking the issue of waiting times very seriously. Canada's waiting-list problem -- not just for cancer services but for all priority areas -- is "bigger than people anticipated and it's going to take a lot longer to clean up than people have thought."

Bill Hryniuk, past chairman of the board for the Cancer Advocacy Coalition of Canada, said he didn't understand why the federal government would select a waiting time of four weeks -- double what the radiation oncologists recommended. "Everybody who has to wait with cancer suffers mentally and that has to be a No. 1 consideration," Dr. Hryniuk, a medical oncologist, said yesterday. "It's frustrating for patients," Dianna Schreuer, past president of the Canadian Breast Cancer Network, said in a telephone interview from Halifax. "It doesn't meet the standards and it's frustrating for the oncologists delivering the service." She called the figures from the Canadian Association of Radiation Oncologists a "call to arms," describing it as a problem that's going to take some time to fix.

Opposition members in the House of Commons, meanwhile, have taken up the attack. Ruby Dhalla, the Liberal health critic, said the waiting times for radiation outlined in The Globe were indicative of the Conservative government's failure on the file. The report shows that cancer patients "are taking out loans, racking up financial debt and worrying about financial ruin, all in an effort to pay for their treatment that they so desperately need," Ms. Dhalla told the House of Commons. "The Conservatives promised to reduce wait times for cancer patients but, instead, the patients are waiting longer than ever."

Mr. Clement countered, saying that, under the Liberals, the average waiting time from specialist consultation to treatment doubled from 9.3 weeks in 1993 to 17.8 weeks in 2003.

Source

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

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 Pages are here or here or here.

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