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28 February, 2006

POPULARITY OF DRUG PLAN CREEPING UP

Who cares if Medicare's new drug plan is a bit confusing, Dixie and Frank Gulyas of Citrus Heights concluded. For the first time in their retirement, they'll have coverage to help pay for prescription drugs. "It's going to save us a lot of money," said Dixie Gulyas. "I feel good about it." Overshadowed by the troubles that have plagued the Medicare Part D drug plan since its Jan. 1 start is the fact that many Medicare beneficiaries who have been paying out of pocket for expensive prescription drugs can get help. Even consumer advocates who complain that the implementation has been disastrous don't want seniors and disabled persons who can benefit to be deterred from signing up.

New enrollment figures released Wednesday by Mike Leavitt, the U.S. Health and Human Services secretary, show 1.3 million more people have enrolled since Jan. 13, bringing the number of Medicare beneficiaries with some type of drug coverage now to 25 million nationally. Among the 4.3 million Californians on Medicare, the number who signed up for stand-alone drug plans increased from about 155,000 to 235,000. The number in managed-care plans with drug benefits remained about the same. "Enrollment is up, the price is down, the system is working better every day," said Leavitt at a press conference in Pensacola, Fla., to encourage Medicare beneficiaries to sign up.

About 1 million Californians were required to switch from Medi-Cal to Medicare for their prescriptions on Jan. 1. Declaring the problems that ensued an emergency, California said Medi-Cal will continue to pay for drugs until problems can be worked out with Medicare. From now until May 15, all other Medicare beneficiaries will have to decide if they want to buy the coverage. Some may choose to remain with other drug coverage if they have a similar plan through their former employer.

Sacramento's Health Insurance Counseling and Advocacy Program, HICAP, is still busy trying to help those making the switch from Medi-Cal who ran into lots of trouble getting their prescriptions filled, said assistant director Margaret Reilly. But those problems don't mean that all Medicare beneficiaries should stay away from the new benefit, she said. "If you have a limited income and limited assets, you could benefit," she said. "If you don't have prescription drug coverage now and haven't had it in the past, you could benefit."

For example, she recently enrolled an 84-year-old woman who uses only two prescriptions whose income wasn't low enough to qualify her for free or reduced-cost coverage. Reilly explained her reason for signing up. "You look at it as a traditional health or insurance plan," she said. While the woman doesn't need much help in paying for her prescriptions or use many drugs now, she probably will in the future. "You're looking at the future, not so much what your needs are today," said Reilly, who pointed out that beneficiaries who sign up late will face lifelong penalties for their delay in enrolling. "That's going to become important."

That's exactly why Leslie Farrell of Sacramento signed up her 85-year-old mother on Medicare's Web site even though the older woman is in good health and uses few prescriptions. Her mother, who had no drug coverage, will save about $200 a year on her current prescriptions through her drug plan, she said. But Farrell was more concerned about making sure the drugs her mother might need as she ages are covered.

Leavitt said seniors need to consider their future drug needs and remember that like any insurance plan, it will cost more if they wait until after the May 15 deadline to enroll. He also urged those wanting to change plans not to wait until the last of the month to avoid delays in getting their coverage.

While Medicare's 24-hour telephone help line now has a wait time of one minute or less, the new drug plans need to make more improvements in their customer service.

The Gulyases decided to sign up for the Secure Horizons Medicare Advantage plan, which will provide both managed-care health coverage for their medical care and prescription drug coverage. Instead of paying $300 a month for health insurance alone with no drug coverage, they'll now pay $37 per person per month for medical care that also provides drug coverage. Dixie Gulyas, 73, is healthy and still works part time, but she said her 69-year-old husband takes eight prescriptions and suffers from circulatory problems, high blood pressure and other chronic problems. The drug coverage has relieved her worries about how to pay for future prescription drug costs. "It's one less thing I have to worry about. With my husband's condition, you never know," she said. "Something is going to get all of us one of these days."

Source



Australian health insurance price rises not as bad this year: "Private health fund premiums will climb an average of 5.7 per cent from April 1, adding $3 a week on a typical family policy. But the increases - which will fall to an average weekly slug of $2 after the federal Government's 30 per cent rebate - are the lowest annual price hikes for five years. Health funds say increased payouts to members, which rose 8.1 per cent to almost $5.9billion for hospital benefits alone in 2004-05, are one factor behind the rises. Other drivers were said to be a 20 per cent rise in payouts for prostheses and the popularity and spread of "gap cover" products that in some cases paid the doctor's entire fee. Private health fund membership is increasing. There are now about 8.8 million Australians with hospital cover - 43.1 per cent of the population - and 8.6 million with ancillary cover. Almost all the increase is among people aged more than 60, who place the greatest pressure on health funds."

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

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

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27 February, 2006

THE ELDERLY ARE JUST A NUISANCE IN BRITAIN'S NHS

Best if they get a bug and die

Barbara Yeo died in March last year, and time has not yet been able to diminish for Harriet the distressing, haunting images of her mother as she lay breathless and in pain in her hospital bed. An 83-year-old former hospital matron who, in her working life, specialised in care of the elderly, Barbara had not been in the peak of health, but nor was she terminally ill. And yet her own admission to hospital for routine treatment of leg ulcers was to prove fatal. Barbara died of viral gastroenteritis - a stomach bug that she contracted from a highly infectious patient who was placed next to her on the ward. As her condition rapidly deteriorated, the acronym DNR - for Do Not Resuscitate - was placed on her notes.

'I told the doctor that that would be going against her wishes. Because she was a nurse, it was a conversation we had had many times. But they did it anyway. They treated the age, not the patient, and it cost my mother her life,' says Harriet.

The story of Barbara's demise is one that will resonate with many. We are living longer and, consequently, more likely to become frail and vulnerable through age. Two thirds of patients in hospital wards are over 65. Most of those who have had to care for an elderly and sick relative understand that resources are limited. But care, sympathy and dignity shouldn't be, and yet you do not have to canvass hard to find those who, in some way, feel let down by the system.

The problem is that, too often, frustration is swiftly overwhelmed by grief. Rather than kick up a fuss, families find themselves slinking away in bitter resignation. Harriet Yeo, however, is not a slinker. A strident woman who stands six feet tall, she is used to making her presence felt as a councillor in her home town of Ashford, Kent, as a former trades union official, and also as someone who has served on three National Health Trust bodies.

Shortly after her mother died, she was appointed a member of the Labour Party's National Executive Committee - a position that brings her into direct contact with Government ministers. And shortly after that, she found herself launching 'Forgetmenot' - a campaign that will very possibly clash with Party policy but will also, she hopes, give a strong voice to those who feel alone and powerless. 'I'm not saying that all hospital care for the elderly is bad, but a lot of it is,' she says. 'The more I talked to people about what happened to my mother, the more I realised that older people are being discriminated against, not just in my hospital, but all over the country. 'It is too big a problem for any one individual, but by creating a national force, we can be heard. And I am not going to be cowed, because speaking out is the only way I can feel some good might come of my mother's death.' ......

In November 2004, Barbara's GP arranged for her to be admitted to the William Harvey Hospital in Ashford with suspected constipation. In fact, tests revealed that there was nothing wrong with her bowels, but doctors did then advise that she undergo intensive treatment on her leg ulcers - painful sores that are usually caused by circulation problems and are common in the elderly.

Barbara was given morphine for pain relief, and from that point, according to Harriet, her condition rapidly deteriorated. She became dehydrated and delusional and remained in pain because, says Harriet 'it was the wrong sort of pain relief for the arthritic pain she had'. Following complaints from Harriet, Barbara was taken off the morphine, and within 48 hours, the delusions had stopped. But her weight appeared to have dropped drastically - although how drastically Harriet cannot be sure because Barbara was not weighed. 'With hindsight, I would have insisted she was weighed on admission, as all elderly patients should be.'

Barbara came home for Christmas, during which time she ate enough to go up two dress sizes, and was re-admitted in January to continue the leg ulcer treatment. As the weeks passed, the ulcers improved, but Harriet was less than impressed with the more general care her mother received. 'She was catheterised as soon as she was admitted, despite being fully continent. Why? Because it is easier, of course, if a nurse doesn't have to attend when she needs to go to the bathroom. But by keeping her still, they were depleting her mobility. 'During two months in hospital, she had her hair washed just once, and that was because we insisted and paid a hairdresser to do it. My mother was a woman who went to the hairdressers every week. Not enabling her to maintain her appearance was an affront to her dignity.'

Barbara died four days after contracting what staff in the hospital were referring to as the 'winter vomiting bug'. When Harriet questioned why an infected patient had been put next to her mother, she says she was told that the consultant and the infection control nurse had deemed it 'an acceptable risk'. The matter is now the subject of a police complaint, and also a complaint that Harriet has lodged with the General Medical Council. Both cases are unlikely to be resolved for many months.

More here



Playing politics puts mothers' and their babies' lives at risk

Comment from Miranda Devine in Sydney, Australia

The tragic case of baby Natalia Lalic, who died five days after being born at Camden Hospital in 2003, should serve as a warning of the potential consequences of political and ideological meddling in childbirth. The increasing demands by feminist ideologues for "women-centred" birth centres with midwives providing exclusive care neatly dovetail with the desire by the State Government to cut health costs while appearing to deliver new facilities in marginal seats.

Natalia was born five days after the 2003 state election in Camden Hospital's new $3.5 million maternity unit, which had been opened with great fanfare six weeks earlier. Camden was a marginal seat, and the only seat the ALP won from the Liberals. At the time, then health minister Craig Knowles, member for the neighbouring seat of Macquarie Fields, was under siege from whistleblower nurses. Though Camden was just a 20-minute drive from Campbelltown Hospital's fully staffed maternity unit, which could have done with the extra money, the Government opened the new ward against the advice of the South Western Sydney Area Health Service board, which was concerned about duplicating resources and a shortage of specialists. When no anaesthetists could be found for Camden, a bureaucrat was flown to South Africa to recruit. No expense was spared.

But, as the NSW Medical Tribunal has heard, there was no pediatrician on hand to resuscitate Natalia when she was born without a heartbeat after a difficult labour in which the umbilical cord was wrapped around her neck. Some anaesthetists on roster lived 40 minutes away and pediatricians 30 minutes away. Crucially, the hospital required 69 minutes to set up an emergency caesarean section. So even when it was clear the baby was in distress, the obstetrician on duty made the decision that it would be faster for her to be born by assisted vaginal delivery. She died five days later.

The doctor has since endured three debilitating years of blame for the judgement calls he made that terrible morning. The Health Care Complaints Commission alleged he should have organised a caesarean and called a pediatrician earlier. Last week the obstetrician, whose name has been suppressed, was cleared of any wrongdoing by the tribunal. There was no guarantee the baby would have lived if a caesarean had been ordered.

But an anaesthetist who works in northern Sydney says Natalia might have had a better chance in a bigger hospital. When an emergency caesarean is needed, the ideal time from "decision to incision" is less than 20 minutes, not 69 minutes, he says. At a hospital such as Royal North Shore a woman can be on the operating table in 10 minutes.

And yet, a recent review of maternity services in the Northern Sydney Central Coast Health service area has recommended fewer births at RNS (down 15 births a month to 200) and more at smaller, less-resourced units, such as Mona Vale and Ryde. The anaesthetist says health bureaucrats want to reduce the 2400 annual births at RNS by 600 or 700, for budgetary reasons. The amalgamation of northern Sydney with the Central Coast in January, he says, has led to a transfer of resources from northern Sydney's budget to the Central Coast, where, he cynically points out, Gosford is a marginal Liberal seat that Labor is targeting. "Politicians use obstetric services as a vote-winner," he says.

The review has not addressed specialist concerns about safety at small units and makes only politically palatable recommendations, he says. While it states that duplication of obstetric services between Manly and Mona Vale is "not sustainable", it advocates the "development of shared positions across the two sites". Specialist doctors also feel the review report was released stealthily, on January 2, "when everyone is on holidays", with comments due by January 16. The report states that "volumes of births across the seven sites are not sufficient to support seven traditional maternity units" with full services of obstetricians, anaesthetists and midwives. But it does not recommend closing Ryde and Wyong obstetric units, as many specialists think should happen.

If the safety of mother and child were paramount, common sense would dictate that you would make most use of hospitals such as Royal North Shore, instead of using every means to reduce births there. And just because there is an anaesthetist across the corridor ready for an emergency caesarean or to provide pain relief, doesn't mean a mother can't have a drug-free natural birth. It just means she has a choice.

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

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

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26 February, 2006

SOUTH AFRICA: NEW DESTINATION FOR SURGICAL TOURISM

The market can work in medicine too if it is allowed



The number of foreigners having plastic surgery in South Africa has shot up dramatically in the past year. "In December 2004 we had six patients and last month we had 25," said Peter Rodway, managing director of Mediscapes, which sells cosmetic surgery packages, mostly to foreigners on holiday in Cape Town. The packages include the procedure, accommodation, tourist excursions and the assistance of therapists and nurses during recovery. While foreigners wanted a wide range of procedures, Mr Rodway said: "Without question the most popular is breast augmentation." The next most popular procedures are tummy tucks, rhinoplasty, liposuction and facelifts. And even though the rand has strengthened, Mr Rodway said the cost of plastic surgery in South Africa remained 60-65 per cent cheaper than in Britain or the US.

Johannesburg company Surgeon and Safari has also noted a marked rise in demand. "We were booked up completely in January," chief executive Lorraine Melvill said. "On average last year we had 30 clients a month and in 2004 we had about 15 a month." The number of bookings made through a competitor, Surgical Attractions of Johannesburg, has also grown significantly. "Foreigners are encouraged by the exchange rate, medical expertise and the anonymity," chief executive Ingrid Lomas said. All three companies reported that most of their clients were from England.

Cosmetic surgery had been demystified by extreme makeovers on television and in the press, said plastic surgeon Stuart Meintjes, of the Rose Clinic. The plastic-surgery craze has annoyed some surgeons in Britain and the US, from where many citizens also travel to Croatia, Belgium, Poland, Thailand or Argentina for cheaper prices. Mr Rodway said that after a successful trip to a plastic-surgery convention in London last year, he was asked not to return because companies like his were siphoning off British clientele.

Source

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

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

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25 February, 2006

U.S. HEALTH INSURANCE CHANGE HAS TO COME

Cutting the tax deductibility tie to jobs and cutting the maze of bureaucratic rules that tie up health care providers would be big forward steps -- among others

In today's world economy, health care costs are a drain on many businesses as they struggle to compete with overseas companies that pay workers far less and provide few benefits. Even unions that have fought to maintain generous health insurance for workers are beginning to make concessions. Last fall, the United Auto Workers agreed to health insurance cuts at General Motors in hopes that the $1 billion in annual savings would help revive the company. Workers and retirees will pay more in the deal, which will reduce the health care liability that GM has said adds $1,500 to the price of every car it sells. Ford recently struck a similar deal and Chrysler also wants concessions from the union. Given that GM and the UAW were pioneers in establishing job-based insurance, the agreement was a strong signal of just how troubled America's system is.....

Health care costs have made it attractive for employers to hire workers not eligible for typical employee benefits, including those who work through outside agencies or who are self-employed independent contractors. A recent report by the Iowa Policy Project, a nonpartisan research organization, found that one in four workers, or 34 million Americans in 2001, worked in temporary, part-time and contract positions. The report noted that our economy's shift to these kinds of jobs is "threatening to unravel the employment-based health insurance system in the United States and swell the ranks of the uninsured and underinsured."

In the face of rising costs, some business leaders are openly calling for an end to the job-based health insurance system. One is Robert S. Miller, chairman of Delphi, an auto-parts supplier and former GM subsidiary that recently went into bankruptcy. "Back in the days, when you worked for one employer till age 65 and then died at age 70, and when health care was unsophisticated and inexpensive, the social contract inherent in defined-benefit programs perhaps made some economic sense," he told the Wall Street Journal in October about his efforts to turn Delphi around. "Today, defined-benefit programs are an anachronism" ...

While some discuss how to replace the job-based insurance system, others are trying different ways to shore it up. There are proposals in Washington to make it easier for people to buy insurance on their own. Congress has appointed a citizens task force to hold town meetings around the country on the future of America's health care system. National initiatives are pushing the health care industry to expand its use of information technology, such as computerized medical records, in hopes of reducing costs.

Employers are offering wellness programs, discouraging unhealthful behavior like smoking and banding together to rate the quality of health care providers in hopes competition will ultimately lower their insurance rates.

There are also new "consumer driven" health plans that pair high-deductible health insurance with tax-free medical-savings accounts. Many economists predict that these plans, only beginning to be offered by employers, are the wave of the future. Supporters say such plans will save employers money, allow more people to obtain coverage, turn Americans into more prudent consumers of health care and improve the overall health care system by giving patients greater flexibility to shop for their own care. But critics say the higher deductibles and out-of-pocket expenses will cause some people to skimp on care and drain people with chronic conditions. "I am convinced that consumer-driven health plans will save money," Dr. A. Mark Fendrick, a professor of internal medicine and health management and policy at the University of Michigan, told employers gathered in Scottsdale in November at a National Business Coalition on Health conference. "But as you cost-shift, people will get sick and die."

Still, even the most optimistic experts say that these and other ideas will not be able to avert the crisis in health coverage that many predict in the next decade. America's aging population combined with the expense of new medical technology and treatments are likely to continue to drive care costs up. And, as costs rise, the job-based insurance system will continue to unravel, overwhelming hospitals and public-assistance programs.

Tommy Thompson, secretary of the U.S. Department of Health and Human Services from 2001 until January 2005, supports many of the new cost-cutting initiatives. But he believes they will not be enough to avert a crisis. He said more drastic measures are necessary, including major reforms of Medicaid and Medicare, government assistance to help employers provide insurance and programs to cover the nation's 46 million uninsured. "We have eight years to make some dramatic shifts in the transformation of health care," Thompson predicted. Without significant changes, spending on health care in the United States is projected to climb from $1.9 trillion this year to $3.4 trillion in 2013. "I don't think the system can afford that."

More here

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

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

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24 February, 2006

Can you put a price on compassion?

I have witnessed the very poor and the very well off get terminally sick and get lousy heath care from a hospital or a doctor, and rich or poor, in so many cases they die in horrible conditions. Money isn't going to make people care more and do the right thing. Compassion should not come with a price.

My mom had a sister (my aunt) who woke up on her 17th birthday with some dreadful crippling disease. This beautiful young woman, Eva, at the prime of her life, was ready to graduate and go on to nursing school, but instead she was struck down with a devastating illness. She could no longer get out of bed to stand up and walk, nor do anything for herself any more.

It was 1929, in Scalplevel, Pennsylvania. Her father (my granddad) worked as a caretaker in a hospital in Pittsburgh, a job many would have killed to have in those days, when jobs were scarce. For tests, whatever tests they did in 1929, they took her to the hospital where her father worked, where a score of doctors saw her.

They thought she had a form of polio, but they were not sure. At first they kept Eva at home, because in those days that's what people did. They had a special bed delivered from the hospital, and put her in the front room where it was sunny and there was a big window to see out. There was really no therapy then, for someone who was bedridden from a crippling illness like that, so they did what doctors told then to. They wanted her home as long as possible.

Eva's now-diabetic mom and very strong-willed father did the best they could for their ailing daughter, with help from my mom and her four sisters. Family was always there, to help take care of her. And when Eva was 36 -- yes, 18 years later -- she went to the care facility at the Pittsburgh hospital. She lived there until she passed away at the ripe old age of 78.

From what my mom told me, Eva was a saint. She never complained, and she insisted on having sick children come into her room to see her and talk with her. She loved visitors, and family members always had time for her. Never a day would go by when one or more would not make the 30 mile trek to see her and make sure she was being treated right.

And as far as I know, the hospital staff loved Eva, too. They had their yearly group pictures taking with her, and she never had a complaint. She was a giving soul. For some reason her hands and wrist and arms were not afflicted; she loved to crochet and that she did! Her colorful afghans (blankets) were all over the hospital's beds, everyone had one. All the family members had them. At one time she would turn out one afghan a week, and they sold some too.

Eva was an amazing human being. I got the chance to meet her while growing up, but since my mom and dad moved to New Jersey when they married it was only on vacations twice a year that we'd go back home to Pennsylvania. Always, the first thing we would do was see Eva, and I always felt truly blessed to be in this woman's company. She was always smiling. I hold back the tears as I recall the memories of our visits. I only regret that there were not enough of them.

My grandfather Henry passed away in 1951, before I was born. He was fortunate to have a steady job and keep his large house during the depression, when most people were out of work. Don't get me wrong, it was back-breaking work what he did at the hospital! He burned medical waste and took care of the grounds around the hospital, and from what my mom has told me sometimes he was there 14 hours a day! He'd lost his left leg when he was 18, when a barn door fell on him, but it certainly didn't slow the man down for long. He never liked the prosthetic leg they gave him, so he made his own leg out of wood and whatever else he contrived. I've seen photos of him, and he looked pretty damn hearty and feisty, I wouldn't want to mess with him.

Did my aunt Eva get the care she needed? I think she did! Did it cost her family lots of money? I don't think so -- they did not have much money in the first place! People just pulled together and did the right thing, and people who were in the position to serve the sick and needy enjoyed their chosen professions. They were good compassionate human beings, and you can't put a price on that.

Source

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

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

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23 February, 2006

Self-Deception about Medical Care

Sloppy thinking can make intelligent people say stupid things. Take Christine Cassel. She has been a physician specializing in geriatric medicine for 30 years and recently published Medicare Matters, a brief against privatization of the huge, brittle government program. Interviewed recently on National Public Radio, she made this argument for public support of Medicare: It is not simply a program for the elderly, she said. “It is a family program. If Medicare didn’t exist, we’d be paying those bills.”

I don’t know who Dr. Cassel thinks is paying the bills now, but I have a pretty good idea it’s you and I and anyone else who pays taxes. I truly can’t imagine what Dr. Cassel thought she was saying. It’s possible she was engaging in sophistry, but she might really believe what she said. For many people, government’s distribution of money is completely unrelated to its collection of money. On days they are thinking about distribution, the furthest thing from their minds is collection. It’s self-deception, but it’s effective.

This may be why such people can’t see government for what it is: a massive transfer machine. In the end, all government can do is move money from one person to another. Whether you think that’s right or wrong, let’s at least agree on what it does. Government takes from A to give to B, and it uses the threat of physical force (such as incarceration) to ensure that A will surrender whatever is demanded of him. Government looks a lot less attractive when described in those terms — which may be one reason why people such as Dr. Cassel don’t want to think of it that way. It’s too unpleasant.

Once we see the nature of government clearly, her fallacy becomes glaring. Not everyone has sick elderly parents. Obviously, they would not be paying additional medical bills if Medicare did not exist. Many people have sick elderly parents who would have had medical insurance had Medicare not existed. Those people also would not have had additional medical bills. True, some people have sick elderly parents who would not have had medical insurance. Does that justify Medicare? How so? Ordinarily, we think that being unable to afford something does not justify taking it from someone else. Why is this principle suspended when it comes to medical care?

A large part of Dr. Cassel’s erroneous thinking lies in her failing to realize that if you change one thing, you will necessarily change others. She looks at all the elderly people on Medicare and imagines that if government is subtracted from the picture, all medical care is subtracted with it. Not so. Most people, knowing the government was not going to pay for their care, would have bought private insurance. But that’s only the most obvious answer. Long before there was Medicare and Medicaid, many people of modest and low income received decent medical care through fraternal organizations. Lodges would sign contracts with doctors, in effect buying services in bulk that, throughout the year, would be distributed to members and their families at affordable prices. The system made medical care accessible while maintaining self-responsibility and cost-consciousness.

It was so successful that other doctors, fearing that competition would reduce their incomes, got their government-backed medical societies to crack down on “lodge practice.” Who would argue that today’s precarious method of providing medical care and insurance — through government and bosses — is superior?

Source

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

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

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22 February, 2006

New Study Finds Medicare’s Administrative Costs Are Underestimated

It is frequently asserted that Medicare’s administrative costs are only 2 percent, compared with more than 20 percent for the private sector—and concluded that a “single payer” system would produce enough cost savings to cover all the uninsured. A study just released by the Council for Affordable Health Insurance (CAHI) shows that Medicare’s costs are underestimated, and private costs overestimated. Moreover, the additional private costs do return some value. If hidden administrative costs are added in, Medicare’s costs are seen to be about 5.2 percent. Private sector costs, calculated in a comparable way, are 8.9 percent, or 16.7 percent if commissions, premium tax, and profit are included.

Because the percentage is calculated as administrative costs divided by total claims, Medicare is favored because it covers older and sicker people with average claims of $6,600 per year, compared to $2,700 for privately insured persons. Correcting for this factor, Medicare’s administrative burden would be in the range of 6 to 8 percent for a population similar to that covered by private insurance.

Private companies spend more in scrutinizing claims before payment. Medicare relies more on post-payment investigation, and such costs are allocated to law enforcement rather than administration. While private insurers pay commissions to bring in premiums, the government forces employers to collect and process Medicare “premiums.” Additional costs of raising money for Medicare (such as interest on government debt and the cost of collecting the general revenues that subsidize Part B) are large but not estimated in the study.

CAHI concludes that the real issue is not which sector has the lower administrative costs, but which does the better job of providing good coverage for the best price. Even with the price controls imposed by the government, CAHI believes that the private sector provides much better value for money.

The study does not consider the administrative costs imposed on physicians and hospitals, the costs of fraud by carriers and providers, the economic consequences of the taxes required to support Medicare, or the other effects of Medicare on the medical market.

Source

One of my medical correspondents adds:

No doubt,. if they were all considered, costs would far exceed private costs and profits as well:

1. Cost for "Joint Comission" and all the White Coat nurses on the "Compliance" payroll are not included.

2. Costs for employer to collect Medicare tax are not included.

3. Costs for "Medicare Fraud" investigations are included in Law Enforcement budget - not included.

4. Costs for "Private Insurance" to make up for below-cost Medicare reimbursement are not included.

5. My hospital had a "Corporate Integrity Agreement" because of "Medicare Fraud" - included a whole office of "compliance" -attorneys, high priced admninstrators; Lectures on "Compliance" etc.. Cost at least as much as alleged fraud. Not included.

6. Quite a number of Medicare claims are "denied" for no apparent reason at all - then paid following re-submission. Much extra work for billing companies. Costs not included.

7. Career Health Care Financing beurocrats and legislators who make new rules are already on the Government payroll. Costs not included.

This is just the "tip of the iceberg" .

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

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

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21 February, 2006

Five-year wait for dentist

Even with very limited eligibility

Waiting times for basic check-ups in Queensland's public dental services can be as long as up to five years, according to the Australian Dental Association. This is despite the State Government spending more on public dental services than any other state, allocating about $132 million compared with NSW, which spends about $100 million. Yet Queenslanders still have the worst teeth in the nation, while the government and councils are engaged in an argument over the provision of fluoride in drinking water.

Figures provided by Queensland Health and Health Minister Stephen Robertson confirm the length of time people were waiting for public dental services. He said that it should be noted that the majority of dental services in Queensland are provided by the private sector. "Queensland has the most generous eligibility criteria for public oral health services of any state or territory," he said. "Around 1.8 million Queenslanders, adults and children, are eligible for free oral health care."

Mr Robertson said consultant Peter Forster's Health Systems Review acknowledged the high demand for oral health services and the difficulties experienced in meeting that demand. "Workforce shortages [Translation: Measly wages for dentists] are a significant issue in meeting demand. The shortage of dentists is a national issue. Queensland Health currently has about 300 full-time dentist positions. In January 2006, 20 per cent of these positions were vacant," he said.

"Patients with dental emergencies are generally seen within 24 hours. Those with non-emergency conditions will wait longer. "It is unlikely that waiting times for non-urgent care will improve greatly in 2006."

Opposition health spokesman Dr Bruce Flegg said public dental services were effectively being rationed. "There is a means test and only people with pension or health care cards can access the service," Dr Flegg said. "It would be a pretence for the state government to say we have a universal free dental service because we do not."

Source

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

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

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20 February, 2006

A GOOD COMMENT ON YESTERDAY'S POST:

From a reader with a memory

The interesting thing about all the reductions in beds in Qld Health now seems to be a flawed "modelling." If you believe that then I have parking spaces to sell on Sydney Harbour Bridge and Ocean Front Land at the base of Uluru. Two things intrigue me. Why can't the Australian Public have the names of these "modelers?" If we had them we might not be so confident that the same people can get it right this time. If they are not the same people who are they? Are they clinicians -- almost certainly not. The unfortunate truth of Medical Administrators are that they are failed clinicians (at least it keeps them away from the patients) or non-clinicians whose backgrounds are quite suspect.

Queensland two decades ago had an enviable health system [Under a long-term conservative State government]. Now it runs close to a third world country standard. Bundaberg, Caboolture and Patel are merely symptoms of a very sick system created by a "model" (for model read delusion) that we can budget-drive hospitals rather than needs-drive them. Awful language but there you are. Of course we need to have a good eye on budgets but they should be the driving force. With an increasing population in Queensland there should be more beds not fewer. Not really rocket science is it? And if you think that Bundaberg and Caboolture hospitals are bad, just wait for the exposures to come. Unfortunately many of those who could expose the problems are either dead or in the "shut yo mouth" group. Fradulent waiting lists, surgery lists not allowed to proceed even when the surgeons were willing to work on (they were sent to libraries and paid to do nothing), outspoken critics muzzled and threatened, (even the Forster report was flawed as the people "assisting the inquiry" were in some cases the worst bullies in the system), a rise of manager numbers coinciding with a fall in real clinicians (remember a lot of so called clinicians are not hands on clinicians -- which has never come out), the increasing scourge of excessive documentation and reduction in care/ treatment giving, and so on. The bus is moving but without drivers. In all good remedies it is important to realize that the incumbents were and are part of the problem. They will merely change the decor and documentation. They have no real will to work or practice medicine.

Now to medical graduate numbers. Even with the figures looking bad you must remember that now medical school intakes have 50% plus female graduates. There is nothing wrong with female medicos IF they practice full time. Many don't - quite apart from maternity leave many choose now to work 2-3 days a week and even restricted hours at that. Of course they have that right BUT medical graduates are expensive for the community to train, unlike lawyers and other courses who simply need a barn, a few talking heads, and access to the internet (why we don't even need a good Law Library these days - just access to the internet). As to the problem of country needs and medicos, it could be solved simply by giving a 3x factor to medicare rebates for remote areas and defined areas of need and reducing the benefits to urban medicos. I can hear the howls of "unfair and conscription" already.



Universal Insurance Mandate Leads to Political Interference in Private Health-Care Decisions

Republican Governor Mitt Romney is proposing that all citizens of Massachusetts be required to purchase health insurance, join a government-subsidized program, or face a financial penalty. His plan is being touted as a free-market alternative to proposals being pushed by advocates of single-payer health care. Its compulsory feature is similar, in some ways, to the mandate proposed by congressional Republicans after the Clinton administration called for universal coverage in the fall of 1993. What's wrong with the government mandating individuals to purchase health insurance?

The Cato Institute analyzed the Republican's 1993 plan and pointed out why a mandate is dangerous to liberty. Following are excerpts from that Cato Policy Analysis:

* "Once we presume that government is ultimately responsible for guaranteeing that every American has health insurance, we also guarantee a permanent role for politicians in determining an accompanying set of issues. Once government mandates insurance coverage, it must define what constitutes `adequate' insurance coverage for each citizen."

* "By endorsing the concept of compulsory universal insurance coverage, [the bill] undermines the traditional principles of personal liberty and individual responsibility that provide essential bulwarks against all-intrusive governmental control of health care."

* ".[The bill] makes the fatal mistake of endorsing compulsory, government-defined, universal insurance coverage. That fundamental feature...opens the door wide to extensive political interference in private health care decisions."

* "Sweeping every American into a mandatory health insurance dragnet is not only offensive on philosophical grounds; it is also impossible to achieve.... Even under Canada's system of national health insurance, an estimated 2 to 5 percent of the population in the province of British Columbia is uninsured. Despite 41 state laws that require motorists to purchase automobile liability insurance, one in seven automobile drivers remains uninsured."

* "It is also rather difficult to enforce mandates on people who fall between the cracks of government databases. Not even heavy reliance on tax penalties can overcome the Internal Revenue Service's inability to track down millions of Americans who refuse, or fail, to file tax returns. And every 10 years the Census Bureau demonstrates that it cannot locate several million citizens."

* "Thus, one can expect that any...enforcement offensive to coerce the voluntarily uninsured into signing up for a mandatory coverage scheme will become both prohibitively onerous and politically pointless at the margin."

* "When those costs are added to the havoc that further political control of the entire health care market would wreak, even subsidizing the full amount of uncompensated care with public funds looks like a better buy for American society."

Of course, this is not to say that a single-payer system for the uninsured would be better than mandated insurance. As noted in an article titled "Universal Health Care Won't Work-Witness Medicare," (written by Sue Blevins and published by Cato in 2003):

* "At first glance, many Americans might find the idea of single-payer health insurance appealing, given current economic conditions and high health insurance costs. However, before we accept such a drastic shift in national health policy, we should examine how single-payer health insurance could affect all individuals' health care costs, choices and privacy."

* "If history is any indication, any single-payer initiative will end up costing much more than advocates claim. That, in turn, will lead to higher taxes and/or rationing under which the government will determine which medical treatments will and will not be covered. How do we know this will happen? Because single-payer health care has already been empirically tested on seniors in the United States."

Medicare is the largest single payer of health care in the United States and the world. Thus, for Americans to understand how a compulsory program would affect them, they need only look to Medicare to see its impact on individual freedom. They can see clearly how a universal mandate for health insurance leads to political interference in private health-care decisions for all.

Source

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

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

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19 February, 2006

Growing population but shrinking hospitals? -- that's government!

Australian public hospitals show the way

Queensland has almost 500 fewer hospital beds than when the Beattie Government took office in 1998, figures released late yesterday show. Health Minister Stephen Robertson provided the data following questions this week and admitted he had given incorrect information to Parliament on the subject. He said the information supplied to him by his department about bed numbers at the end of last financial year had inadvertently included neonatal cots in the count. So rather than 9994 available beds as Mr Robertson told Parliament, the figure was actually 7017. The number compares with 7515 when Labor took office.

Mr Robertson said bed numbers had been reduced because of health care models that predicted a reduced reliance on overnight hospital stays. "Advice from hospital experts at the time was that less beds would be needed in future because many people requiring simple surgery would be in hospital for a matter of hours instead of occupying beds for several days." Premier Peter Beattie acknowledged last month that the modelling had been flawed.

The Opposition this week attacked the Government for promising to open an extra 66 beds to address problems in emergency departments, when it had shut down hundreds since coming to office. Liberal leader Bob Quinn last night said the figures highlighted why patients struggled to get their surgery on time in Queensland hospitals. "Under this Government, there's been a loss of 500 beds and at one stage they were actually 800 beds down," Mr Quinn said. "When you combine the closure of beds with the exodus of doctors out of the system, you see why people can't get their operation on time, while the waiting lists have blown out and why emergency departments have been closed. "All of this points to how badly the hospitals have been managed by Labor in the past seven years. "This loss of 500 beds has occurred at the same time that Queensland's population has increased by 500,000."

Mr Robertson said the number of available beds had also declined under the Coalition government, falling by 149 in 2« years. But he said bed numbers was "a very poor measure of hospital system performance, because it is subject to significant estimation error". "There is also no way of verifying data from earlier years to determine whether current definitions were rigorously followed.

More here

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

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

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18 February, 2006

A SOP to Socialized Medicine

Maine has to raise taxes to pay for all the "savings" of its health-care program

Welcome to the Pine Tree state, where a program that the governor claims has saved the state millions of dollars means that your taxes go . . . up. Maine is the home of Democratic Gov. John Baldacci's Dirigo Health, which regulates the state's health-care system and includes a subsidized health-insurance program. (Dirigo is the state's motto, Latin for "I lead.") When the law creating Dirigo Health was signed, proponents said it would reduce cost-shifting and health-system costs and ultimately cover all 130,000 uninsured Mainers within five years, including 31,000 uninsured in year one.

It hasn't worked out that way. Through the first nine months only 1,600 previously uninsured individuals enrolled in Dirigo Health's insurance product, called DirigoChoice. The other 6,000 who enrolled simply traded their private health insurance for taxpayer-subsidized DirigoChoice. The program continues to spend millions subsidizing insurance for those already insured.

Gov. Baldacci promised that his new program would insure the uninsured and save the state money. It's a bit hard to see how, when it cost $19.5 million to cover 1,600 previously uninsured people. Nevertheless, the governor says that it does--and that now Mainers must pay it all back! The reasoning goes like this. By enrolling the uninsured, Dirigo Health would reduce "cost shifting," which happens when unpaid bills are passed along to other paying patients in the form of higher costs. So when individuals have coverage, the insurer pays most of the bills, reducing the chance of unpaid bills. This reduction in bad debt would become savings--which Maine could claim for the state.

The Dirigo Health board of directors hired an outside firm to examine health-care system spending in Maine to determine Dirigo Health's savings. Initially, the governor claimed that Dirigo saved the system about $137 million. That didn't seem right--how could a program that covered a mere 1,600 uninsured people save $137 million?

The insurance commissioner revised the claimed savings to approximately $44 million. Ultimately, less than $3 million was attributed to reductions in uncompensated care. Most of the rest was due to Dirigo regulations that asked the state's hospitals to cap their cost increases at 3% a year. Maine hospitals did so, accounting for almost $34 million in savings, compared with what the governor projected costs would have increased.

Looking further into the issue, one consultant tested the formulas that Maine used to calculate the hospital-generated savings by feeding in data from New Hampshire--which does not have Dirigo Health regulations or subsidies for uninsured health insurance, and which should presumably not show any savings at all. Nevertheless the model showed tens of millions in savings for New Hampshire hospitals. This puzzling result raised questions about the accuracy of the savings that resulted from Dirigo Health. But for now, the $44 million figure stands--and Gov. Baldacci has used it as the excuse to raise taxes.

The Dirigo board is levying a Savings Offset Payment, or SOP--a remarkably innovative name for a new claims tax--to "recover" every dollar that the state says it has "saved." This SOP is similar to a sales tax; a 2.4% surcharge is added to all paid health-care claims. When applied, this new tax will cost the average individual about $70 and the average family about $200 a year--at a time when most individual insurance policyholders are already absorbing a 16% increase in their insurance premiums.

But, you may ask, if the program is saving all this money, why is a new tax necessary? The answer is that without the SOP, Dirigo Health's high costs would bankrupt the program.

The SOP, effective last month, applies only to individuals, small businesses and other businesses buying health insurance from a Maine insurer or using a third-party administrator. By raising insurance costs, this tax may end up compelling some individuals to drop their coverage. But, hey, maybe they too can get subsidized coverage under Dirigo.

Currently, SOP is being challenged in court, for both the calculations of the savings and the ability of the state to tax certain large employers. Some insurers have included a notice on policies highlighting the new tax--and consumers are furious. On Tuesday the Legislature held a public hearing for a bill that would forbid insurers from passing along the cost of the SOP to policyholders. Gov. Baldacci supports this proposal even though it sets the dangerous precedent of the state limiting a private business's ability to pass along a cost of doing business. It also threatens the very financial viability of the private insurance market in Maine. The legislative proposal shows their political concern over the public's reaction to the SOP.

A better alternative for uninsured individuals in Maine is Health Savings Accounts, a tax-deductible personal fund coupled with a high-deductible health-insurance policy. The savings account permits a person to take federal income tax deductions for account contributions and, in most cases, state income tax deductions--though not in Maine. The high-deductible insurance plan, like all insurance, protects the insured from financial loss. And HSAs would cost the state far less than Dirigo.

If Dirigo truly saved money, the program's benefits would exceed its costs. Elementary math indicates that this is not the case; every dollar questionably identified by the state as having been "saved" is taken from consumers thanks to the SOP. Perhaps not surprisingly, several other states are asking whether Maine's Dirigo Health could be a model for them. It could, if they too want to increase taxes, meanwhile doing virtually nothing to help the uninsured. "Dirigo" might come to mean "Don't be misled."

And if legal attempts to challenge it fail, then the Dirigo Savings Offset Payment will probably become permanent and grow in future years. The cry in Maine soon may become "Dirigo, your savings are too taxing."

Source

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

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

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17 February, 2006

By the Grace of God, Free Markets Are Healing the Blind

In the Bible, one of the miracles used by the Prophets, Jesus and the Apostles to demonstrate their divine calling was the healing of the blind. One of the plagues of the fallen creation is the loss of the ability to see. I have numerous friends and relatives with vision problems, including an uncle who was totally blind. Since 1975, I have been continually reminded of the blessing of sight because I have been unable to see clearly in my right eye. As recently as last summer, I was told that nothing could be done to remove the scarring from my right cornea short of a $50,000 cornea transplant that had a significant chance of failure. One entrepreneur has changed all of that.

Dr. Ming Wang of Nashville, Tennessee performed a procedure that lasted a scant 20 seconds and even though the recovery period is supposed to be two to four months, I was seeing like I have not seen in 30 years in less than two weeks. Dr. Wang developed the procedure and is continually developing new procedures and hardware to do things that are still believed impossible in some places. The best news is that it cost me less than one tenth of what a cornea transplant would cost and the success rate is much higher to boot.

The really amazing story is that of the entrepreneurial spirit of Dr. Wang, the business model for his Wang Vision Center, and how he came to be a Surgeon and a Laser Physicist. Dr. Wang grew up in Communist China. Although his parents were physicians, they refused to join the Communist Party and were ostracized. As a result, their son, Ming, was denied the opportunity for a formal education after he turned 14 and had graduated from junior high school. In the days of the Cultural Revolution, people not destined to be educated were shipped to the remote provinces to become peasant agricultural laborers. One method of avoiding this fate was to acquire and practice a skill that was approved by the Communist Party. Displaying a flash of his developing entrepreneurial spirit, young Ming Wang learned to play the Er-hu, an ancient Chinese stringed instrument known here as the Chinese violin. This did not get him a comfortable seat in the national orchestra, however. While avoiding peasant labor, he had to play the Er-hu on a street corner in Beijing 15 hours per day rain or shine.

As the Cultural revolution waned and the restrictions eased, Ming was afforded the opportunity again to further his education. He still faced an obstacle. He had to pass entrance examinations. Because he was now years behind in his formal education, he would have been at a severe disadvantage except that he had been receiving instruction at home. Yes, apparently homeschooling worked well even in Communist China. With tutoring from his parents and their colleagues at the medical institute where they taught, he placed fourth in the nation and was admitted to higher education.

After a chance meeting with an American college professor, Ming was given the opportunity to come to The United States. He arrived on February 3, 1982 with $50 in his pocket and as he puts it, "faith in the American Dream." Like the runner who has been shackled with weights for years and suddenly finds himself free of them, he ran like the wind. What was once his handicap is now his strength. Ming Wang graduated magna cum laude from Harvard Medical School and MIT with an M.D. and a Ph.D. in Laser Physics.

Now Dr. Wang has his own business called the Wang Vision Institute. Of all of the doctors' offices I have visited, this one is a model of efficiency. There is no great wall (no pun intended) of medical records primarily kept to satisfy insurance companies. In fact, The Wang Vision Institute will not file insurance claims. Did you ever wonder what that small administrative army costs in you local physician's office? There is also a big difference from the many doctor's offices in Tennessee that are choked with TennCare patients with minor sniffles or other trivial ailments because seeing the doctor is "free" (Tennessee got Hillary's heath care plan even if the rest of the nation escaped it and it has been an unmitigated disaster to the quality of health care in the state). Dr. Wang's staff is extremely professional and courteous. His staff includes several ophthalmologists, and technicians who I am sure he has hand-picked for their skill and proficiency.

Dr. Wang also partitions his time such that he is able to perform initial evaluations, surgeries, and followup visits as well as research into pioneering new procedures and surgical tools. This would not be possible except that he runs his office as a business. I would hope and pray that more physicians would take up this model

Source

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

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

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16 February, 2006

LIFESAVING PILL TOO EXPENSIVE FOR BUREAUCRATIZED MEDICINE

A proposal to give every person a pill that combines aspirin, a statin, three agents that lower blood pressure and folic acid could save thousands of lives in Britain each year. But researchers have found that, despite its potential to reduce health problems dramatically, it would not save any money. The daily "polypill" is seen as a possible "magic bullet" for cardiovascular disease (CVD), Britain's biggest killer. Doctors believe that, if taken preventatively, it could slash the risk of coronary artery disease by 88 per cent and stroke by 80 per cent in those aged between 55 and 64.

However, a study by Dutch researchers suggests that even if the polypills cost nothing to make, giving them to everyone, or even only those at moderate risk of CVD, would not save any money because of the huge administrative costs of prescribing them to millions of people. The study, published today in the Journal of Epidemiology and Community Health, found that the polypill could drain global health budgets unless it was carefully targeted and cheap. The formulation, first suggested in 2003, has not been tested on a large number of people, and how the pill's ingredients interact is not known.

To calculate the potential costs, the authors looked at the risk of developing coronary artery disease in different age groups, as well as medical and treatment costs. They used data from the Framingham Heart Study, which monitored more than 5,000 Americans aged between 28 and 62 for heart disease and stroke for almost half a century.

The team from the Erasmus Medical Centre in Rotterdam found that giving the pill to people over 60 or those with a high risk of coronary heart disease would be most beneficial. This proposal was underpinned by analysis of earlier trials of drugs that can lower the risk of cardiovascular disease. More than 750 trials were assessed.

The polypill would be designed to lower the four key risk factors for heart disease: cholesterol, high blood pressure, high homocysteine blood levels and blood platelet function. A statin would reduce high levels of the "bad" low-density lipoprotein cholesterol, cutting the risk of heart disease, while three drugs that lower blood pressure would reduce stroke risk. Folic acid in the pill would cut high homocysteine levels, which can encourage the build-up of fatty plaques in arteries. Aspirin would regulate the function of blood platelets.

The researchers say that giving the polypill to everyone over 60 would prevent between 76 and 179 heart attacks per thousand people and between 11 and 33 strokes per 1,000 people in this age group. "However, this would also imply the medicalisation of a large section of the population and the exposure of otherwise healthy subjects to unwanted adverse effects," they said.

To be cost effective, the annual cost per patient would have to be no more than 208 pounds for those aged 50, and no more than 282 pounds for those aged 60 at high risk of coronary artery disease. The researchers said: "(It) may be the preventive method with potentially the greatest impact on public health in the Western world, but is everything that glisters gold?"

The World Health Organisation has suggested that a 2 per cent annual reduction in chronic disease death rates in Britain, such as from CVD, would result in an economic gain of 1.14 billion pounds over ten years.

Source

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

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

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15 February, 2006

Europe's drug industry is model for the US to avoid

What happened to Europe's vibrant drug industry? Just a decade ago, more than two-thirds of all drug research was conducted in Europe. Now, 60 percent is conducted in the United States. Major European drug makers--such as Aventis, Novartis, and GlaxoSmithKline--have shifted significant portions of their research operations from the Continent to the U.S. and beyond. Human talent is following the research money: Some 400,000 European science and technology graduates now live in the United States, with thousands more leaving every year.

For all this, European investors, scientists, and patients have their own political leaders to blame. Deliberate government policy, in the form of price controls imposed by national health care systems, is slowly choking off a once-thriving economic sector. Europe's government-run and -dominated health care systems are virtually monopsonies. As the primary buyers in their national markets, they have the power to set drug prices 40 percent to 60 percent lower than the free-market prices in the United States. These price controls have a serious negative effect on innovation.

Price Controls Hamper Research

Research and development are expensive. Researchers at Tufts University in Boston determined drug makers spend at least $800 million just to develop a new medicine, and there is a high risk that a drug could fail after years of testing or flunk the government approval process. In the United States, companies are allowed to recoup their investments and make a profit by charging a price that incorporates their research costs. In Europe, that is seldom the case.

The loss to research caused by price controls was quantified in a recent study by the U.S. Department of Commerce. The study looked at the impact of pharmaceutical price controls in 11 countries, including Holland, France, and Germany, and found they caused a $5 billion to $8 billion annual reduction in funding for drug research and development. What could that amount buy? According to the study, it could lead to the discovery of three or four new potentially life-saving drugs each year. So it's no surprise that from 1998 to 2002 there were only 44 new drug launches in Europe, compared to 85 in the United States.

U.S. R&D Threatened

But now is no time for Americans to be smug. Ironically, there is a bipartisan move afoot in the United States to implement the same policies that have dried up pharmaceutical research in Europe, by having the government "negotiate" drug prices. The U.S. Congress passed legislation in 2003 that added a new prescription drug benefit for the disabled and elderly participating in the country's Medicare program. It also created a novel system to deliver the drug benefit, encouraging private, competing companies to negotiate the best prices they can with drug makers.

Congress included in its legislation a "non-interference" clause that preserves the right of these drug plans to negotiate prices freely with the drug companies, without intervention from the federal government. While Americans have mixed opinions about this gigantic government drug program, one thing is clear: Repealing non-interference would put the U.S. pharmaceutical industry on the European path. Yet it is a top priority of liberals in Congress, who plan to bring up such legislation this year. If non-interference is reversed, it will allow the federal government to step in and set prices for all 40 million Medicare recipients. Since they consume almost half of all prescription medicines sold in the United States, this would effectively amount to nationwide price controls.

Industry Driven East

We've already seen such policies force drug makers out of Europe. Roche Chairman Franz Humer has pointed out that the research-based pharmaceutical companies could just as easily move on to Asia, where technology and education are steadily improving. In fact, Roche has just opened a research center in Shanghai, while other drug makers are flocking to Singapore and India. Of course, if the United States gives drug makers a reason to go on the move again, European governments could make their own pitch by eliminating the interventionist policies that have been undercutting drug innovation in their countries.

Source

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

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

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14 February, 2006

Health Savings Accounts Work

In December 2003, President Bush signed a health-care law that had two major components. The first was the new Medicare prescription drug benefit that took effect last month. That big-government program has been widely panned as a disaster. The second was a new health insurance option called health savings accounts, or HSAs, which became available in January 2004.

Unlike the Medicare drug program, the response to HSAs has been overwhelmingly positive. In just two years, three million Americans have signed up for an HSA. More than one-third of HSA enrollees were previously uninsured, which means HSAs already may have reduced the number of uninsured by 1 million. Deloitte Consulting L.L.P. reports that, for two years running, insurance premiums for HSAs and similar plans rose at about one-third the rate of increase for other types of coverage. So in his State of the Union address, Bush proposed expanding and enhancing HSAs. His new Medicare entitlement? He didn't even mention it. Go figure.

Fortunately, his HSA proposals would make health coverage and care better and more affordable for hundreds of millions of Americans. HSAs couple high-deductible health insurance with a tax-free savings account (the HSA) for out-of-pocket medical expenses. Individuals and/or employers can contribute money to HSAs tax-free up to the amount of the insurance deductible. HSAs must be coupled with insurance that has a deductible of at least $1,050 for individuals and $2,100 for families. HSA funds may be withdrawn tax-free for any medical expenses. Once expenses reach the deductible, insurance takes over. Any funds that remain in the HSA roll over from year to year and grow tax-free.

Right off the bat, HSAs save money because high-deductible insurance is cheaper than low-deductible coverage. The Kaiser Family Foundation reports that the difference in premiums between the average HSA-compatible policy and the average for all types of insurance is $1,324. That is more than enough savings to cover the average annual HSA deductible ($1,901) in just two years. Sometimes, the savings covers the entire deductible in the first year.

HSAs also let consumers control more of their health-care dollars and decisions. Since consumers own the money that covers their out-of-pocket expenses, they can see any doctors they like, whenever they like. At the same time, patients scrutinize their medical bills and their doctors' recommendations more carefully because it is their money on the line. The chronically ill, however, likely would use up all their HSA deposits in a given year and have little opportunity to save for future medical needs. Even with HSAs, consumers without access to employer-sponsored insurance still pay a hefty tax penalty when they purchase health insurance on their own.

To address those problems, the President proposes essentially doubling the limits on HSA contributions and allowing people to purchase health insurance with tax-free HSA funds. The higher contribution limits ($5,250 for individuals and $10,500 for families) would help the chronically ill and their families by allowing them to put more money aside tax-free for their medical needs. Allowing HSA funds to purchase health insurance would provide tax equity to millions who are unfairly punished by the tax code.

Critics claim that HSAs are only good for the healthy or wealthy. If true, that would mean HSAs benefit only about 80 percent of the population. Not bad, that. But in fact, eHealthInsurance.com reports that half of HSA enrollees are over 40 years old, 20 percent earn less than $35,000, and 40 percent earn less than $50,000. Unfortunately, the President's proposals are unnecessarily complex and would continue to restrict HSAs to those who purchase high-deductible insurance. There is no reason why HSA holders should not be able to choose their health plan themselves. Nonetheless, Bush has made a solid proposal that would improve the quality and affordability of private-sector health insurance and medical care. As for Medicare, well...

Source

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

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

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13 February, 2006

A COUNTERPRODUCTIVE BRITISH GOVERNMENT HEALTH IDEA

The government's proposed 'health MOTs' will merely encourage more and more people to see themselves as ill and dependant says Dr Michael Fitzpatrick

One of the central features of last week's health White Paper is the plan to provide free medical check-ups at key life stages through the National Health Service (NHS). The proposal for periodic 'health MOTs' emerged as the 'top people's priority' in the government's much-vaunted consultation exercises.

Health ministers are keen to encourage people 'to look after themselves' and thus 'to reduce demand on conventional health and care services'. The latter aspiration is destined to be disappointed. The most likely outcome of the health checkups programme is that it will boost the ranks of the 2.7million people already claiming long-term incapacity benefit (a figure that another government programme is striving to reduce).

There is a paradox at the heart of the White Paper. It proclaims that people should play an independent role in relation to their health - yet it also insists that they need comprehensive professional intervention if they are to achieve the goals of healthy living: 'People want to keep themselves well, and take control of their own health. This came through clearly in our consultation. People asked for more help to do this, through better information, advice and support.' (p31)

'Support' is the key concept of the White Paper, recurring in every section and defining the relationship between an earnestly health-promoting government and the newly health-conscious citizen at every stage of life. This relationship of support is mediated by a burgeoning army of professionals, including not merely the familiar doctors, nurses and teachers, but extending to counsellors, therapists and the new 'health trainers', the barefoot doctors of the Blair healthcare revolution.

The Life Check programme aims 'to help people - particularly at critical points in their lives - to assess their own risk of ill-health', by focusing on 'major risk factors', such as obesity, smoking, binge drinking, mental illness and stress, and sexually transmitted infections. It 'will be a personalised service in two parts'. The first part is an initial assessment, which people will complete for themselves. This is merely the prelude to the second part - a discussion with a 'health trainer' providing 'offers of specific advice and support on the action people can take to maintain and improve health, and, if necessary, referral for more specialist diagnoses for those who need it.' (p35)

Let's look more closely at the conception of health promoted in the White Paper and its consequences. Take this quotation from a participant at the Citizen's Summit in Birmingham: '[As a young person] I feel that better education is needed for young people.. We don't think about our health until it's not there. We need to encourage that way of thinking right from the start.' (p26)

This quotation - set out at the head of the section of the White Paper detailing proposals for implementing the Life Check programme in childhood - reflects the government's emphasis on the role of education in promoting awareness of the risks of disease and of the measures deemed necessary to achieve and sustain health from infancy onwards. (Indeed, the section opens with the statement that 'healthy living starts before we are born', and proceeds to indicate risks to be avoided in pregnancy.) But if health becomes the goal of life - as in the terms of the World Health Organisation (WHO) definition 'a state of complete physical, mental and social wellbeing' - then it becomes an unattainable ideal, a state of perfection that may be striven for but never reached. From this perspective, health becomes exceptional - and illness, understood as the inevitable failure to achieve the ultimate goal, becomes normal. This is the new doctrine that the government wants to preach in schools - and it has already persuaded many young people that this is the way forward.

The new approach to health and illness marks a dramatic break with tradition - but not a progressive one. In the recent past, health was regarded as the normal state of affairs and illness was considered an exceptional departure from normality, a transient state through which the patient passed - with the blessing of medical authority (even if no great benefit accrued from medical intervention ) - before returning to good health and a familiar level of social functioning. Now health has become a state that can only be attained through a high level of personal awareness and commitment to a prescribed lifestyle, through intense vigilance against health risks and through a willingness to submit to regular professional intervention in the cause of preventing disease (or at least of detecting it at an early stage). At the same time, illness has lost much of its stigma and even confers a series of socially approved identities - 'person with HIV/Aids', 'cancer survivor', 'sufferer from stress', 'victim of bullying' - confirmed by patient organisations, celebrity sponsorship, soap opera story lines, autobiographical accounts and other forms of media coverage.

If health becomes the goal of life, then when individuals encounter dissatisfaction and disappointment, these are likely to be experienced as forms of illness, which may well find expression in physical or psychological symptoms. 'Doc, I just don't feel well' is a familiar cry of existential distress in my surgery, uttered by ever-younger patients, and followed by the request, now endorsed by the government, for 'a complete check-up'.

According to the section of the White Paper on 'mental health and emotional well-being', 'there is much that can be done to reduce the frequency of the more common illnesses such as anxiety and depression, and the widespread misery that does not reach the threshold for clinical diagnosis but nevertheless reduces the quality of life of thousands of people' (p36). In fact, the 'much that can be done' amounts to little more than offering banalities about 'eating well' and 'valuing yourself and others' and 'getting involved and making a contribution'. Yet, once the sphere of therapeutic intervention is expanded to include everyday misery, then illness has become the universal condition of humanity and health a utopian - if not a celestial - vision.

As health awareness has grown over the past two decades so have a number of indicators of illness. Surveys reveal that more and more people report feeling unwell, the numbers of people consulting their GPs and other health professionals (and alternative practitioners) have multiplied and levels of sickness absence from work have increased steadily. The intensive promotion of disease awareness fosters a climate of fear around issues of health, as people worry about their risks (and the risks of their loved ones) of succumbing to cancer or heart disease as a result of their deviant or merely deficient lifestyles. The particular virulence of the campaign against obesity creates enormous misery among those designated overweight, who are the targets of unrestrained popular and medical prejudice.

Perhaps the most dramatic indicator of the rising tide of ill health is the number of people claiming incapacity benefit (for which they become eligible after six months sickness absence). The total is now 2.7million, more than three times the level when Margaret Thatcher became prime minister in 1979, and more than the number officially registered as unemployed. It is clear that the major explanation for this increase lies in the growth of conditions which are subjectively defined by the individual concerned and often cannot be objectively verified by any doctor - or welfare bureaucrat. More than one million people, some 40 per cent of the total, are claiming incapacity benefit with diagnoses of anxiety and depression and stress, a four-fold increase in 20 years.

The second leading cause of sickness absence is back pain; again numbers have increased steadily over recent decades - among non-manual workers as much as among manual workers. As it is often impossible to correlate complaints of pain and stiffness with the results of X-rays or other imaging techniques, the key judgement is the patient's - if they do not feel well enough to work, then they are eligible for benefits. Other claimants suffer from a range of 'unexplained physical symptoms', such as joint pains, fatigue, abdominal discomfort and distension. These may be described as 'fibromyalgia', 'chronic fatigue syndrome/ME' or 'irritable bowel syndrome' but these labels merely provide medical legitimacy for the experience of illness: they offer neither rational diagnosis nor effective treatment.

The government may take steps to tighten up the provision of incapacity benefit, but these measures will do nothing to stop the growth of illness that results from wider cultural forces that its wider health promotion policies have done much to encourage. Given the focus of official health promotion propaganda on young people, it is worth noting that half of all people on incapacity benefits are under the age of 50. Long-term incapacity is often a life sentence: though two thirds of claimants get a job within two years, those who do not are more likely to retire (or die) on benefit than return to work.

In a chapter entitled 'Enabling health, independence and well-being', the White Paper makes clear that self-monitoring of lifestyle in the cause of better health is not enough. 'Independence' here means subordination to health professionals, from antenatal clinic to residential care home; 'empowerment ' means surrender to the authority of the health trainer. At every stage of life the responsible citizen must seek professional assistance to discover the appropriate form of support for their needs.

The White Paper details the support required by prospective parents and by parents of young children, the support needed by children at primary school and in the transition from primary to secondary school and beyond - here 'joined up' or 'new integrated forms of support' will be provided by health, education and social care agencies. 'People of working age' also need support, whether they are in work or unemployed (when they need additional support). There is no respite for the elderly: 'older people' are the targets of programmes to increase exercise and of measures 'to increase uptake of evidence-based disease prevention programmes'.

In fact, there is little evidence for the efficacy of any of the disease prevention programmes included in the White Paper. Though it is true that smoking is bad for health and stopping smoking is beneficial, the evidence that either moral exhortation or therapeutic intervention is successful in reducing levels of smoking or smoking-related illness remains contentious. Despite four decades of anti-smoking propaganda and therapies, nearly a quarter of the population is still smoking. In relation to other lifestyle factors - such as diet and exercise - the evidence that these cause disease and or that campaigns to change behaviour in these areas have any preventive value is either weak or non-existent. By contrast, there is very good evidence that the approach to tackling obesity that has been pursued for the past 50 years by health professionals and is implicitly followed by the White Paper - telling people to eat less and exercise more - simply does not work: hence more people are overweight.

However, we should not worry too much about this, because it also apparent that we are living longer. The White Paper's claim, emphasised in bold print, that 'our children will not live as long as their parents unless there is a shift towards healthier living', is quite absurd. (The authority for this claim is the discredited 2004 House of Commons Health Committee report on obesity - see Choking on the facts, by Brendan O'Neill). In the USA, while obesity has steadily increased over the past 50 years, life expectancy has increased by more than seven years (2). The only modern case of a population in an advanced industrial society in which life expectancy has declined is the former Soviet Union, where a profound social, economic and moral crisis was accompanied by the collapse of the public health system.

It is not surprising to find that those deemed to be in most need of support are those on incapacity benefit. Having been supported into chronic invalidity, they must now be given extra support in the quest to return to the world of work. Pilot schemes have been established with an army of support workers - including personal advisors, job coaches, occupational health specialists, finance and debt counsellors - aiming to provide the systematic support deemed necessary to encourage the chronically ill down 'pathways to work'. While punitive measures to curtail benefits may succeed in intimidating some claimants, it seems likely that all this support will only further undermine the capacity of the long-term sick to pursue an independent life.

Behind the 'empowerment' rhetoric of health promotion lies the presumption of individual incapacity. The consequences of this approach are already evident in the trends of the past two decades: elevating health to become the goal of all human endeavour is making more and more people ill. It is causing an epidemic of subjectively defined ill-health, an increased demand for healthcare services in all forms and a growing burden of state expenditure on welfare benefits.

Source

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

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

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12 February, 2006

Consumer-driven health care

For aficionados of free markets, the idea of empowering consumers to take control of their own health care and health insurance needs sounds wonderful. After all, the dysfunctional system of third-party payments for employer-based health insurance (in which neither patients nor doctors have much incentive to keep costs under control) has led to ever higher health care expenditures. As a result, by 2004, U.S. health care spending rose to $1.9 trillion, or about 16 percent of the gross domestic product (GDP). Health insurance premiums have risen at nearly double-digit rates for the past several years, too. General Motors and Ford blame rising health insurance rates for making them uncompetitive and forcing them to fire thousands of workers to cut costs. These companies are now clamoring for a federal bailout for their health care obligations.

The idea of consumer-driven health care is appealing. In other sectors of the economy where consumers get to choose, one usually sees falling costs and increasing productivity. Why not open up health care to the same beneficial influences? Give consumers incentives to shop around for medical care and insurance and let them balance costs and quality to fit their desires..... If individuals enjoy the same tax breaks as people who get their insurance through their companies, employees will eventually demand that their employers just give them the money and let them pick policies for themselves. The second proposal—allowing people to deduct all health expenditures from their income taxes—puts more money in their pockets. This extra money would enable many of the currently uninsured to buy insurance. These are swell ideas and they should be enacted.

But the main idea behind consumer-driven health care is a proposal to expand the use of high-deductible health insurance policies combined with health savings accounts (HSAs). With HSAs, consumers can put pre-tax money to pay for routine medical expenses into IRA-like accounts. Insurance policies qualify beginning with a deductible at $1,050 for an individual and $2,100 for a family. Individuals may annually salt away in HSAs any amount below or matching their deductible up to a maximum of $2,700. For families the limit is $5,450. This encourages Americans to invest in high-deductible policies, which typically cost about 40 percent less than traditional indemnity insurance policies.

Such policies do save companies and individuals money, according to a report released last week by the consultancy Deloitte Center for Health Solutions. The study found that premiums for high-deductible health insurance policies rose an average of 2.8 percent between 2004 and 2005 compared to an average of 7.3 percent for all types of health insurance plans. That means the high-deductible premium increase was less than the rate of inflation (3 percent) in 2004. So far, so good.

However, health insurance works by having the healthy pay for the treatments of the sick. A 2004 case study looking at when Humana Inc. began offering a high-deductible option found that this scheme broke down. The employees who chose to enroll in the high-deductible plan were, on average, 60 percent less likely to have used a variety of medical services in the prior year. In other words, healthy employees chose to take the high-deductible option and squirrel away some pre-tax money in HSAs. This finding supports critics who worry about the problem of adverse selection. They fear that people who expect to remain relatively healthy will overwhelmingly pick the cheaper high-deductible policies and leave the sick to pay ever higher premiums for traditional low-deductible policies.

My advice to President Bush on how really to jumpstart consumer-driven health care: mandatory private health insurance. Poor Americans would be offered a voucher with which they would buy private health coverage. Such vouchers could be paid for by abolishing Medicaid and the State Children's Health Insurance Programs. A similar system already works in Switzerland where, Harvard Business School professor Regina Herzlinger notes, "The Swiss enjoy excellent health status, ample capacity, and high quality resources at costs 30% lower than those of the United States." Mandatory private health insurance would avoid the problem of adverse selection, provide insurance for the currently uninsured and make consumer-driven health care work for every American.

More here

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

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

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11 February, 2006

DENTISTRY COVERUP IN BRITAIN

Ministers embarrassed by the sight of long lines of people trying to sign up for an NHS dentist have come up with a simple solution: they have banned queues [lining up]. In an interview with The Times, Rosie Winterton, the minister in charge of dentistry, disclosed that an edict had gone out to local primary care trusts to make sure that future registrations take place over the phone or by appointment.

Ms Winterton, who is locked in a battle of wills with the British Dental Association (BDA) over government reforms, admitted that queueing for an NHS dentist was unacceptable. “Of course we want to confine the queues to history,” said Ms Winterton before talks with the BDA over a new dentists’ contract that she hopes will save NHS dentistry. The Government wants to reform the way in which dentists are paid. They will be asked to take on more NHS patients in return for an £80,000 salary, £80,000 in expenses and a new monitoring system.

Dentists say that the contract does not allow enough time for preventative work. They also want the monitoring suspended, claiming that it is too complicated. Ms Winterton is determined that the reforms should go ahead from April 1 despite threats of a mass exodus of dentists to the private sector. Hanging over the reforms is the pledge made by Tony Blair in 1999 that within two years everyone would be able to see an NHS dentist. It did not happen.

Ms Winterton defended her boss, saying that NHS Direct and 53 new dental access centres meant that people were able to get emergency NHS treatment. Under the reforms, six-monthly check-ups will end, with healthy patients told not to return for three years.

Source



OFFICIAL WAFFLE ABOUT MENTAL HEALTH IN AUSTRALIA

They haven't got a clue and virtually admit it by passing the buck to the bureaucrats. Simple principles such as people should be judged by their behaviour only rather than by some arbitrary and generally speculative diagnosis seem way beyond their ken

Experts will deliver by mid-year a blueprint on how to reform mental health as state and commonwealth leaders today agreed to a $1.1 billion injection for health reforms. After a meeting of the Council of Australian Governments (CoAG), Prime Minister John Howard announced the strategy for dealing with improvements in mental health. "We made a major commitment together to address the huge challenge of mental health," he said. "We will by not later than June ... have from our officials an assessment of individual areas of change and reform needed in mental health. "Both the Commonwealth and the states recognise that additional resources are needed." Mr Howard also paid tribute to former WA premier Geoff Gallop, who was not at the meeting because of his personal fight with depression.

Mr Howard said the mental health campaign would look at cannabis and amphetamine abuse. "We need as part of the campaign on mental health to address amphetamine and cannabis abuse," he said. He also said they had approved a new national health telephone network. It would include support services for mental health. "As part of the health reform program we're going to have national health telephone network which will have triage system to ensure efficient use of available GPs on a 24 hours, seven day a week basis," he said. "And as a major component of that we're going to include support services for mental health.

"We seek to engage the major non-government organisations such as Lifeline and Kids Healthline, both of which along with other organisations of a similar kind are often in receipt of calls from people who have mental health problems."

More here

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

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

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10 February, 2006

MORE ON THE EXODUS OF GERMAN DOCTORS: YOU THOUGHT THE BRITISH SCENE WAS BAD!

German doctors are packing their scalpels and seeking their fortunes abroad, lured by the prospect of far higher pay and driven away by stifling bureaucracy in their country's health service

A little tower adorns the roof, and ivy surrounds the entrance to the elegant manor house in the northern English town of Chorley. From outside, there is nothing to indicate that Euxton Hall is a working hospital rather than a place of contemplation, tea and bridge. If it weren't for the old man on crutches struggling to get into a taxi with the help of a nurse. Markus Froehling, 49, the hospital's orthopedic surgeon, watches the scene. "Patients in England are tougher than in Germany," he says. In Germany a patient would have insisted on being taken home in an ambulance, he's sure of that.

Froehling keeps noticing differences between the British and German health systems. In Euxton Hall hospital, an hour's drive north of Manchester, the walls are covered with flower-patterned tapestries, there's a cappuccino machine for guests, everything appears welcoming and civilized. Above all, it's quiet, there's a very British atmosphere of calm. "You'll never get a bellowing chief physician around here," says Froehling, and he looks relieved about that.

But the comfortable atmosphere ends in the operating theater. When the muscular German grabs his scalpel, he starts working as if he were on a production line. The expert in hip surgery rams up to five new joints into the thighs of his patients each day. In Germany he rarely had to conduct two of these complicated operations a day. Froehling has been working in England for over a year, he's one of 2,600 German doctors in Britain who escaped from the woes of their country's health service to greener pastures. Away from Germany, the land of bad pay, long working hours, all-encroaching bureaucracy and rigid organization.

He operated on over 2,000 knees, hips and spines in Germany before he made up his mind. Like all guest workers, it was the money that initially lured him away. But escaping the insufferable self-importance of his superiors was almost as important, as well as fleeing the creeping loss of status of his profession in Germany. These days, the former demi-gods in white have to take to the streets like the steel workers to demonstrate for improved working conditions and better pay. In the old days, young doctors would allow themselves to be exploited during their training because they knew they could make big bucks later on. Now, it's no longer worth it.

Doctors used to tolerate the condescending treatment at the hands of their bosses because they hoped to be giving the orders themselves one day. But the chances of getting lucrative positions further down the line are steadily waning. That's why many trainee doctors end their careers before they even start. Only just over half of students starting medical degrees will end up as practicing doctors in Germany. Many become bureaucrats in the health service, find jobs in industry or emigrate. Froehlich comes from a family of doctors. When he started as an assistant doctor in a hospital in the northern city of Bremen in 1982, he still believed in "the healing function of my profession". But after just a few shifts he came to the sobering realization that in everyday hospital life, the interests of the patients come last -- that is seen as the job of the head physician who "rules like a monarch."

When Froehling once alerted his superior to a mistake in how a patient was being treated, he was treated as if he had insulted royalty. He was yelled at. For the following three weeks his name did not appear on any operating timetables, and doctors who don't operate during their training fail to qualify for exams. Embittered, he came to terms with his superior's fantasies of omnipotence and went on to become senior physician at the orthopedic clinic at Frankfurt University.

He worked 60 hours a week, did mammoth shifts around the clock, fulfilled the demands of his superiors. That was reflected in his pay: alongside his standard salary he received additional payments for shift work, fees for medical reports and a share of the money from the treatment of private payments. But then his superior demanded a bigger share of the fees for medical reports and a row over money ensued.

The dispute says a lot about the unfair distribution of the 240 billion Euros spent on the German health service. While most medical staff work like dogs, the profits are pocketed by the few. The medical law in the western state of Hesse, where Froehlich was working, states that head physicians must distribute about 80 percent of proceeds from private patients to the clinic and to the doctors who treat them. But at Froehlich's Frankfurt clinic the boss was paying them smaller amounts.

The doctors knew their superior wasn't keeping clean accounts. But they also knew that such bevavior was standard practice in the German health service. No one said anything. Until one day a woman complained that she had paid cash but been treated as if she weren't a private patient. The head physician had taken the money but the computer database claimed she was insured under the public system. Research showed what the Marburger Bund doctor's association has suspected at many university clinics but hasn't been able to prove: head physicians had pocketed around 1 million Euros per year in this way. An auditor found that more than 10 million Euros was missing. The doctors got back only a fraction of that, Froehlich got around 155,000 Euros. He was the only one to leave.



When he got an offer from Sweden's Capio group to work at one its 21 clinics in Britain, he jumped at the chance. Now he's steering his Audi through the northern English countryside, headed towards the village of Renacres where he conducts operations once a week. More and more colleagues from Germany are ringing him up to ask him about jobs in Britain because they are sick of mounting bureaucracy and the growing power of hospital managers.

Most of the German doctors who emigrate go to the United States, which has taken about 2,700. Britain comes second, according to figures from the National Association of Statutory Health Insurance Physicians. Sweden, which has taken 700, and Norway, with 650, are becoming more popular. Special agencies lure doctors by placing advertisements in professional publications and doctors who want to supplement their income spend weekends working in Britain. After finishing their week's work in German practices they can earn up to 2,000 Euros for a weekend shift in a British hospital.

Doctors' salaries have fallen steadily in the last three years. Many a young clinic doctor gets paid less than a long-serving nurse even if he puts in 70 hours a week. Because ever fewer people are applying for such jobs there's a growing shortage of doctors in parts of the country. Many rural doctors are complaining that they can't find successors to hand their surgeries to.

The situation is disastrous for public health and a debacle for the economy. If the trend of recent years continues -- with only 7,000 of 12,000 medical students completing their training -- over 1 billion Euros of university costs will have been wasted. The deficit will continue to rise the more qualified doctors decide to earn their money abroad.

Froehling leans back in the chair of his office at Euxton Hall Hospital. His salary here is three times higher than it was in Germany. But his work has disadvantages too. His office is dark and tiny and his medical equipment isn't exactly modern. During operations he doesn't have two assistant doctors on hand to help him. He has to make do with a "leg holder," a semi-skilled helper. Unqualified assistants hand him the tools of his trade -- drills and hammers. Because of these limitations, he has had to change his surgical techniques to make sure he gets hips installed properly.

German doctors who come to Britain must accept that the British health system is by no means exemplary compared with the German system, says Froehling. The National Health Service provides basic care but passes on orders to the growing number of private clinics. That is making health provision more efficient and patients are benefiting, he thinks.

Medicine men made in Germany remain in demand in Britain because of their solid training. But they aren't universally popular. Many local NHS doctors who treat private patients on the side have suffered big income losses as a result of the German competition. Some of the guest workers are already encountering the same envy and disapproval they were trying to escape in Germany. "Soon not every colleague will be giving us a friendly welcome," says Froehling.

Source

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

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

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9 February, 2006

Five Myths to Socialized Medicine

In the United States there are about 14 million people - more than a third of the uninsured - who are, in principle, eligible to get free medical care by joining either the Medicaid program or the State Children's Health Insurance Program. And yet they don't bother to enroll.

To understand why they don't, you might go to the emergency room of Parkland Hospital in my hometown of Dallas. The uninsured and Medicaid patients come there to get their medical care. They all see the same doctors. They get the same treatment. If they're admitted to the hospital, they stay in the same beds. From the patient's point of view, there is no real reason to join Medicaid, because they get the same care whether or not they are formally insured. The doctors and nurses get paid the same regardless of who is enrolled in what plan. The only people who really care whether or not someone is enrolled in Medicaid are the hospital administrators, because that determines how they get their money. So they actually have paid employees who go through the emergency room and try to get people to sign up for Medicaid. Over half the time they fail. Then they literally go hospital room by hospital room, trying to get admitted patients to enroll in Medicaid. And even then they don't always succeed. Now, it's not that unusual for people to go to hospital emergency rooms for their care. It's a common feature of health systems around the world. It may not be an efficient way to deliver health care, but the same thing happens in Toronto and London. Canadians take pride in the fact that patients who get free care in Toronto emergency rooms are "insured." But in Dallas, we're ashamed to say that our patients are "uninsured", even though the care they receive in Dallas is probably better than the care they get in Toronto.

MYTH: "A RIGHT TO HEALTH CARE"

People who believe in socialized medicine have come to believe many myths. One is that socialized medicine gives you a right to health care. If you ask the head of Parkland Hospital and his counterpart in Toronto or London what the difference is in these systems, I think all three would say that in Toronto and London people have a "right" to health care, whereas in Dallas they do not. That is just not true. If you're a citizen of Canada, you don't really have a right to any particular health care service. You don't have a right to heart surgery. You don't even have a right to a place in the waiting line. If you're the hundredth person waiting for heart surgery, you're not entitled to the hundredth surgery. Other people can and do get in ahead of you. From time to time, even Americans go to Canada and jump the queue, because Americans can do something that Canadians cannot - Americans can pay for care. Canadian hospitals love to admit American patients, because that means cash into their budgets. The British government says that, at any one time, there are about a million people waiting to get into hospitals. According to the Fraser Institute, almost 900,000 Canadian patients are on the waiting list at any point in time. And, according to the New Zealand government, 90,000 people are on the waiting lists there. Those people constitute only about 1 to 2 percent of the population in those countries, but keep in mind that only about 15 percent of the population actually enters a hospital each year. Many of the people waiting are waiting in pain. Many are risking their lives by waiting. And there is no market mechanism in these countries to get care first to people who need it first.

MYTH: "HIGHER QUALITY"

Another myth has to do with the quality of care that patients receive. British ministers of health have told British citizens for years that their health system is the envy of the world. Canadian ministers of health say much the same thing. In fact, Canadian and British doctors see 50 percent more patients than American doctors do, and, as a consequence, they have less time to spend with each patient. In Britain, the typical general practitioner barely has time to take your temperature and write a prescription. And even if they discover something wrong with you, they may not have the technology to solve your problem. Among people with chronic renal failure, only half as many Canadians as Americans get dialysis, and only a third as many Britons on a per capita basis. The American rate of coronary bypass surgeries is three or four times what it is in Canada, and five times what it is in Britain. Britain is the country that invented the CAT scanner, back in the 1970s. For awhile it exported more than half the CAT scanners used in the world. Yet they bought very few for their own citizens. Today, Britain has half the number of CAT scanners per capita as we do in the United States. A similar problem exists in Canada.

MYTH: "MORE BANG FOR THE BUCK"

Yet another myth is that although the United States spends more on health care, we don't get more. That argument is often supported by pointing to life expectancy, which is not that much different among developed countries, and infant mortality, which is actually higher in the United States than it is in most other developed countries. What do we get for our money? The first thing we need to do is separate those phenomena that have little to do with health care from those that do. In the United States, life expectancy at birth for African American men is 68 years, while for Asian American men it's 81 years. We find wide differences in life expectancy among women, too. Nobody thinks that those differences are due to the health care system. What, then, would we want to look at if we really wanted to compare the efficacy of health care systems? We would look at those conditions for which we know medical services can make a real difference. Among women who are diagnosed with breast cancer, only one fifth die in the United States, compared to one third in France and Germany, and almost half in the United Kingdom and New Zealand. Among men who are diagnosed with prostate cancer, fewer than one fifth die in the United States, compared to one fourth in Canada, almost half in France, and more than half in the United Kingdom.

MYTH: "EQUAL ACCESS"

Perhaps no notion is more closely tied to national health insurance than the idea of equal access to health care. Every prime minister of health in Britain, from the day the National Health Service started, has said that is the primary goal of the NHS. Similar things are said in Canada and in other countries. The British government - unlike most other governments - studies the problem from time to time to see what kind of progress they're making. In 1980, they had a major report that said, essentially: "We really haven't made very much progress in achieving equality of access to health care in our country. In fact, it looks like things are worse today, in 1980, than they were 30 years ago when the British National Health Service was started." Everybody deplored the results of that report, and they all promised to do better. There were a lot of articles written, a lot of conferences, and a lot of discussions. Another 10 years passed and they pondered another report, which said that things had deteriorated further. Today we are long overdue for a third report, but no one expects the situation to have improved. It's true that racial and ethnic minorities are underserved in the United States. But we are hardly alone. In Canada, the indigenous groups are the Cree and the Inuits. In New Zealand, they are Maoris. In Australia, the Aborigines. Those populations have more health care problems, shorter life expectancies, higher infant--mortality, more health care needs, and they get less health care. When health care is rationed, racial and ethnic minorities do not usually do well in the rationing scheme. A Canadian study showed vast inequalities among the health regions of British Columbia. In some cases, there were spending differences of 10 to 1 in services provided in one area compared to another. That probably would not surprise most health policy analysts; you just don't usually get this kind of data. But if we had the data, we would probably find similar inequalities in access to health care all over the developed world. I'm especially interested in the elderly, because I find that - not only in Britain and Canada, but also in the United States - when people have to make decisions about who is going to get care and who is not, they frequently choose the younger patient. Surveys of the elderly show that senior citizens in the United States say it's much easier to get surgery, see doctors, see specialists, and enter hospitals, than say seniors in other countries.

MYTH: "LESS RED TAPE"

Then we have the myth that national health insurance is an efficient way to deliver health care. I hear this frequently repeated by advocates in the United States. Probably the most telling statistic for hospitals is average length of stay. In general, efficient hospitals get people in and out more quickly. By that standard, the U.S. hospital sector is the most efficient in the world. And I think by many other standards it would not be much in dispute that the U.S. hospital sector is far more efficient than the hospital sectors of other countries. In Britain, where at any one time there are a million people waiting to get into British hospitals, 15 percent of the beds are empty, and another 15 percent are filled with chronic patients who really don't need the services of hospital; they're simply using the hospital as an expensive nursing home. So, effectively, almost one-third of the beds are closed off to acute care patients. A study compared Kaiser in California with the NHS and concluded that, after you make all of the appropriate adjustments, Kaiser spends about the same per capita on its enrollees as Britain spends on its population. But the Kaiser enrollees were getting more care, more access to specialists, and other services. We often hear that Medicare and Medicaid are efficient. The government says Medicaid only spends about 2 percent of its budget on administration. But that ignores all the costs that are shifted to doctors and hospitals. When you incorporate all those costs, it turns out that actually Medicare is not very efficient at all.

WHAT'S MISSING IS CAPITALISM

While our health care system is more market-oriented than in most industrialized nations, we don't really have a free market in health care in the United States. Half the spending is done by government. Most of the rest is done by bureaucratic institutions. The cosmetic surgery market is about the only market where patients are really spending their own money. And guess what? It works like a real market. People get package prices. They can compare prices. And over the decade of the 1990s, the average price of cosmetic surgery actually went down in real terms, even as there were all kinds of technological innovations that we are told drive up costs else where. Most of what I'm telling you here today I learned, not from right-wing critics of national health insurance, but from people who believe in it. If you look at my book, there are probably a thousand different references, and 95 percent of them are references to government reports, academic studies, and newspaper investigations. And in almost every case, the author of those reports is someone who believes in national health insurance. No matter how many problems they document, no matter how many failures they write about, they don't give up their faith in the system.

They all believe that all the failures that they write about can be reformed away. They all believe that we just haven't tried hard enough to reform the system and make it work. Sadly, they are wrong. Virtually all of these problems are inevitable consequences of the politicization of medicine. Why do these systems over provide to the healthy and under provide to the sick? Well, in the United States, about 4 percent of the patients spend half the money. If you're a politician allocating health care dollars, you cannot afford to spend half your money on 4 percent of the voters - 4 percent who may be too sick to go to the polls and vote for you anyway. Why is the hospital sector so inefficient? Because it's in the self-interest of hospital managers to be inefficient. The chronic care patients and the empty beds are the cheap beds. It's the acute care patients that cost money. Why can the rich and powerful jump to the head of the waiting lines? Because those are the people who control the system. They can change the system. If members of parliament, the wealthy, and the powerful had to wait for care along with everyone else, these systems would not last for a minute

Source

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

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

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8 February, 2006

AN AUSTRALIAN PUBLIC MEDICINE DEBACLE CONTINUES

Hospital waiting lists blow-out hits 544 per cent

You see why about a third of Australians go private

Queenslanders are being forced to wait longer for urgent surgery in the state's troubled public hospital system, which is performing fewer operations than it did a year ago, according to elective surgery waiting-list figures released yesterday. In spite of more than $170 million promised by the Beattie Government in the past three years to reduce waiting times for elective surgery, yesterday's waiting list report indicates the Government has failed to make any inroads into waiting times.

The number of people waiting more than 30 days for urgent category one operations increased by a massive 544 per cent during the last three months of last year compared with the same period 12 months before. Category one operations include most cancer and heart procedures which can lead to death if not performed. In the same period the number of people waiting more than 90 days for semi-urgent category two operations increased by 281 per cent. Patients in category two are likely to have severe pain, severe fractures, blocked arteries, some tumours, and some types of bowel surgery.

More here



Baby dies 'waiting for ambulance'

Queensland health authorities have launched an investigation after a 14-month-old girl died while waiting for an ambulance. The girl's grandmother, who did not want to be named, said today the baby died yesterday afternoon after waiting to be transferred by ambulance from Gympie Hospital in south-east Queensland to Nambour Hospital in the Sunshine Coast hinterland. "She had to wait over three hours for an ambulance," the grandmother said. "As she was getting into the ambulance, my granddaughter started frothing at the mouth and my daughter asked a registered nurse what's wrong." The mother was told to get into the ambulance with her daughter. "Within two to three minutes, my granddaughter was dead in my daughter's arms," the grandmother said.

Emergency Services Minister Pat Purcell said the death of the girl was a tragedy but the ambulance had not taken three hours to arrive. "The Gympie Hospital requested an ambulance transfer within two hours to another hospital and the ambulance crew arrived in one hour and 25 minutes," Mr Purcell said. He could not comment further until the matter had been fully investigated. A spokesman for Queensland Health Minister Stephen Robertson said the matter had been referred to the coroner.

Opposition emergency services spokesman Ted Malone called for an open inquiry into the response time of the ambulance. "Sadly, we are hearing of long delays for ambulances every day," Mr Malone said. "In this case, the minister may be saying that the ambulance got there within a reasonable time, but long delays for ambulances are occurring all too often."

Last week, a pregnant 15-year-old Mareeba girl with life-threatening complications was left waiting two-and-half hours for an ambulance to take her from Mareeba Hospital in north Queensland to Cairns, about 60km away. The baby died at Cairns Hospital the following morning. A preliminary report by the Queensland Ambulance Service into that incident blamed "human error" but recognised that while mistakes had been made, it appeared to be a one-off occurrence and not a systemic issue.

Source



THE SUPERBUG DEBACLE IN BRITISH PUBLIC HOSPITALS CONTINUES

Half of all hospitals in England are failing to control the MRSA superbug in line with government targets in spite of a drive to improve awareness and ward hygiene, it has emerged. The latest figures for methicillin-resistant staphylococcus aureus (MRSA) released yesterday, reveal that the NHS is highly unlikely to achieve the goal of cutting rates by 50 per cent within the next two years. Specialist “hit squads” are being sent into 20 trusts facing the biggest challenges in reducing rates of the infection, which is thought to kill thousands of patients each year.

Jane Kennedy, the Health Minister, described the lack of progress as disappointing after the introduction of a series of high-profile government initiatives to address the issue. The data shows that there were 3,580 cases of MRSA bloodstream infections reported in England from April to September 2005. This was up from 3,525 for the same period the previous year, while the 2004-05 total of 7,269 represents only a slight drop in year-on-year comparisons.

In 2004 John Reid, the Health Secretary, set a target of reducing MRSA bloodstream infections by half — from an annual rate of 7,684 cases to 3,842 by 2008. But the Department of Health said yesterday that although about half of acute trusts were on target to meet this pledge, half were behind target.

Ms Kennedy said the NHS had to do better if it was to halve rates in two years’ time. “I am disappointed that despite many trusts making significant reductions in infections the overall figures do not reflect these improvements,” she said. She said that the “hit squads” would start work in Sandwell, Northumbria and Aintree NHS trusts before moving on to another 17 organisations facing difficulties with MRSA reduction over 2006

Source

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

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

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7 February, 2006

Another public hospital system has to be bailed out by the private sector

Australia following Britain's lead

The Victorian state government has turned to private hospitals for help with reducing its surgery waiting lists. The Government will pay them to operate on 500 public patients. Up to 30 private hospitals, including Epworth and Healthscope, are believed to be interested in the six-month scheme, The Age newspaper says. The scheme would involve performing high-demand procedures in the private hospitals - including non-urgent orthopedic, vascular and plastic surgery - at a rate of $4000 per operation.

The plan has upset health unions, which believe the government should increase funding of the public system, but has been welcomed by private hospitals. Health Services Union state secretary Jeff Jackson said the government provided hospitals with "substantial sums of additional money, and that doesn't appear to have eased or resolved waiting lists in our hospitals".

Australian Medical Association Victorian vice-president Doug Travis said the money should buy more staff to open more beds. Opposition health spokeswoman Helen Shardey said the government's waiting list management had been "very poor". "This is ad hoc policy-making," Ms Shardey said. "It's not part of an overall strategy; it's grabbing at anything to try to fix the system and try to make people believe they're doing something."

Source



MORE AND MORE GOVERNMENT CONTROL AND RED TAPE FOR U.S. MEDICINE

New reimbursement reporting and compliance rules for physicians participating in Medicare went into effect on January 1 as part of the budget reconciliation bill that passed the House on December 19.... As outlined in Section 6110 of the Senate Deficit Reduction Omnibus Reconciliation Act of 2005, the new rules create a "values-based purchasing" provision in the Medicare program. That provision ties Medicare physician payments, as well as payments for other medical professionals, to new "quality" reporting and compliance requirements, reducing a doctor's payment by as much as 2 percent for certain services if the doctor or other professional fails to report "quality-related" data. Also included under the "values-based" purchasing provision are hospital inpatient services and the services of home health agencies and skilled nursing facilities.

The proposed reduction in payments to noncompliant physicians and providers (1 percent in the first year and 2 percent thereafter) will establish a funding pool to be redistributed the following year to physicians and other medical providers that do comply. The Congressional Budget Office (CBO) estimates the provision will reduce total Medicare spending by $4.5 billion over five years between 2006 and 2010.

The professional literature on values-based purchasing shows limited evidence of value in this approach. A recent article, "Early Experience with Pay for Performance from Concept to Practice," by Harvard University's Meredith B. Rosenthal and colleagues, in the October 12, 2005 Journal of the American Medical Association, attempted to fill the void of published research on this physician payment strategy. The accompanying JAMA editorial ("Pay for Performance Research: How to Learn What Clinicians and Policy Makers Need to Know," by R. Adams Dudley, M.D.) rightly noted there have been "only nine randomized controlled trials of Pay for Performance ... reported in the literature." A review by the Agency for Healthcare Research and Quality (AHRQ) cited in the Rosenthal study concluded "little unequivocal data" supported this approach.

Of particular interest in Rosenthal's study is the observation that a group of Pacific Northwest physicians who were not operating under a pay for performance bonus system scored higher than the California physicians who were. Hence, financial bonuses are likely a superfluous source of motivation when compared with other factors motivating typical physicians treating patients. These other motivators include the desire to help another human being who is suffering, pride in one's work, use of one's skills to meet the challenge of the individual medical case, and the desire to maintain a sterling reputation in one's community. And if these are not strong enough motivators, medical malpractice attorneys are looking over doctors' shoulders as they treat their patients.

In the literature relating to the Medicare "pay for performance" scheme (see, for example, "Pay for Performance or Compliance? A Second Opinion on Medicare Reimbursement," Heritage Foundation Backgrounder No. 1882, October 5, 2005), study after study suggests there are various problems with this approach. These include the lack of evidence for the usefulness of government-imposed guidelines, overemphasis on process in the payment system, the subversion of physicians' professional judgment in individual patient care, the undermining of personalized health care, inhibition of medical innovation, the threat of unproductive "gaming" in the payment system, and a weakening of the traditional doctor-patient relationship.

The new rules establish, in effect, government guidelines for the practice of medicine and tie Medicare payments to physician compliance with those guidelines. That constitutes a radical break from the original Medicare policy that prohibited federal officials from interfering in the practice of medicine.

The new system is pregnant with perverse incentives. Physicians will have every incentive to enroll in "obedience school" and carefully tend to the bureaucracy's paperwork and government guidelines to secure higher reimbursement in a tight fiscal environment, which will soon get tighter as the baby boom generation starts to retire. By diverting the focus of doctors and other medical professionals from appropriate, patient-centered medical care, the Medicare "values-based purchasing" provision will likely create new incentives for physicians and other medical professionals to game the system in unproductive ways. While doctors are fulfilling their reporting requirements, giving the government the data the government wants, real quality could decline even though the measured indicators look good.

More here

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

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

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6 February, 2006

GLOBALIZED DENTISTRY NOW TAKING OFF



For fish-shop worker Harry Sharpe, the lure of a dental holiday in Asia proved impossible to resist. The Australian Dental Association may not be smiling about the growing trend, but Mr Sharpe is among hundreds of Aussies taking the bait of discount deals at overseas clinics. Mr Sharpe, from Currumbin on the Gold Coast, was quoted $15,000 by a local dentist for two bridges, a crown and four fillings. After some research, and consulting friends who had booked dental trips to Asia, Mr Sharpe, 52, visited a private clinic at Sebang in Puerto Galera in the Philippines, where he paid $1200 for the same work.

"All up it cost me $3000 for 2½ weeks there. You get a good holiday, a good feed and your teeth done at one-fifth of the price," Mr Sharpe said. "They were very good. I didn't feel one ounce of pain. And the diving and snorkeling there – it's like the Barrier Reef. "I bumped into about 50 Aussies, and 30 of them were there for their teeth. "It's a big thing, and it's getting bigger."

The dental association is worried by the trend, warning Australians to do some research before embarking on an overseas dental visit. Chief executive Robert Boyd-Boland said there were risks involved. "We've heard some good reports about some of the treatment overseas, then we've heard some not-so-good reports," Mr Boyd-Boland said. He added that a patient might initially save money, but then find corrective work was needed back in Australia. "It's a false economy. And infection control requirements are a bit unknown from country to country. "We have very strict infection controls here. Some of the practitioners there are obviously well qualified, but some of them wouldn't necessarily be registered here."

But overseas bookings look set to spiral, with Brisbane travel agents advertising dental holidays to Manila and patients such as Mr Sharpe encouraging his friends to book a trip. Advised of the dental association warnings, Mr Sharpe said: "It's the same in Australia. I've heard of shoddy stories. You do your checks. "I know of seven people who have gone overseas and haven't had one bad report."

Source

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

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

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5 February, 2006

YOU EVEN WAIT TO GET ON A WAITING LIST IN AUSTRALIAN PUBLIC MEDICINE SYSTEMS

Covered up by government deception, of course. Imagine how bad it would be if so many Australians did not go to private hospitals instead

The Victorian Government has been accused by the opposition of manipulating hospital statistics and spending money on advertising to mislead voters on the parlous condition of the state's health system. Elective surgery waiting lists put out by the Victoria Government were vastly underestimated, opposition health spokeswoman Helen Shardey said today. Mrs Shardey said there were 20,000 people at least still waiting to visit specialists before they could be placed on surgery waiting lists. "This is what I call the waiting waiting list," she said. The numbers included about 700 children who were waiting to get an appointment in the Royal Children's Hospital.

"I appreciate not all people waiting to attend an appointment are going to be lining up for elective surgery but it's likely a high proportion will," she said. "The figures the Government is presenting are not a true indication of the parlous state of health in Victoria. "(They) should take action to reduce the waiting lists instead of wasting money on advertising, trying to con Victorians into thinking that the health system is running well."

The Victorian Government has recently launched an advertising campaign highlighting a reduction in the time that people wait for surgery. The Government has provided $30 million funding for 16,260 additional outpatient beds at 18 clinics across the state as part of a blitz on waiting lists planned over the next six months. "This is all part of a major push to reduce times for Victorians waiting for outpatient consultation," Victorian Health Minister Bronwyn Pike said today.

But, Mrs Shardye said the $30 million announced in last year's budget. She said the Victorian Government was deliberately hiding the problem by modifying the information that was released. "They changed the quarterly hospital reporting it is now only six monthly with less information (and) they changed the method by which ambulance bypass is being recorded... to cover up (the fact) there were probably about 4000 bypasses of hospitals occurring last year," she said. Mrs Shardey said the Liberal Party was yet to release its health policy and could not guarantee it would direct more funds to the health budget

Source

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

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

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4 February, 2006

An American Doctor in the Canadian Health Care System

As an Emergency Room doctor, I have been able to practice in several countries including Canada. And while the fish may be bigger in Canada, the grass is not greener and the health system is not better than in the U.S. First of all, primary care is easily available in Canada. Thereafter, specialty care is a real challenge. I will never forget having to call every day to a cardiologist's office to try to get a patient of mine bumped up the list to get an angiogram because he was having chest pain just getting to the bathroom. Somewhere about the time I learned the names of the receptionist's goldfish, I finally got him an appointment. He could easily have died waiting in line - something bureaucrats don't mind in big systems. I saw that both in Canada and in Saudi Arabia (for the non-VIPs) - the line meant health care was available ... eventually, if you survived.

Secondly, if you compare the space and equipment in a Canadian Hospital (outside a few key cities) to a US Hospital, you will think that you were going from a high mileage Volkswagen to an almost new Chevy Tahoe. Everything is better on this side of the border, which is why all of the hospital elite cross the border for their care (money often out of pocket). The Mayo Clinic has thrived due to Canada more than Minnesota.

Third, the decision making in Canada is made to look like it is citizen based. But it is really very centralized with a group of rotating urban consultants that show up in rural garb with all the facilitator gab about patient empowerment. The one I got to work with brought some ten inches of documents with him which quickly depressed the citizen committee. He offered then to help the people by simplifying all the issues. Then he gave the committee the summer off as he reported montly meetings wherein their input was being garnered - all lies. In the end, the citizens were told that they had approved closing urgent care in the snowbound area of Emo, Ontario. I helped mobilize 600 citizens to suddenly join and take over the hospital district board of three hospitals in angry reaction. It was all bogus.

Fourth, Canada hired a US consultant to come in to Winnipeg and downsize the main hospital - the one that already had lines waiting. This was necessary because the federal government was no longer willing to match the provinces 50:50 in funding. Government knows that distant consultants can come in, downsize, and go home - never caring about outcome. Most Canadians thought the health system was one of the dimmest rather than the brightest of the crown jewels.

Fifth, the physicians were all grouped into a giant IPA for each province. If they went over budget in patient expenses, they were billed for the difference. I still ignore my Ontario bill that tries to follow me. So the docs are programmed to say "No", just as the Permanente physicians do - and for the same reasons.

Sixth, medical malpractice suits are almost unheard of even though malpractice is quite common. I witnessed one of my patients who got an ectopic pregnancy on each side of a supposed tubal cauterization. Another patient had a poorly repaired ankle fracture with life long pain. The richest surgeon in the province was near our small town because he offered to do all specialty cases - messing up ortho, then urology, etc. I helped him retire as I left by simple patient empowerment. But no one else cared - he saved the other docs money.

Seventh, the local docs tried to "get me up to speed" and also pointed out that I was like a "K-Mart" coming to town and sending my income south of the border. The unfilled position should have been left empty. I got up to my own speed and shared my opinion with the public. I am a team player - I just formulate my team with mostly patients.

So go ahead and believe that everything is great where the rivers flow north. But for those who want to dig deeper, look to the source of the comments and find out how they would individually benefit by a national health system here. Anticipate global mediocrity. Everyone would be on board, but the train would run a lot slower - some dying in the journey.

Source

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

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

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3 February, 2006

THE ABSURD EMPLOYER SPONSPORSHIP SYSTEM GRADUALLY ON THE WAY OUT IN THE USA?

There is NO sense in giving tax breaks to employer schemes only. In Australia, EACH INDIVIDUAL deals directly with the health insurer

President Bush wants to bring to healthcare the same "ownership society" approach that gained him little political traction during last year's Social Security debate but remains central to his self-help view of America. By proposing new tax breaks for the health savings accounts he won congressional approval for three years ago, analysts said, Bush hopes to nudge the nation away from the employer-sponsored health insurance on which most working Americans depend. Instead, Bush wants to use sweeping new tax incentives to encourage workers to set aside their own money to cover routine medical expenses and get individually purchased insurance plans to meet larger costs.

In his State of the Union address to a joint session of Congress and an accompanying news release from the White House, the president put forth a healthcare strategy remarkably similar to the plan he promoted last year to permit younger workers to divert a portion of their Social Security taxes into stock and bond accounts that they would own. "He is walking down the same road as he did with Social Security," said Robert D. Reischauer, a former director of the Congressional Budget Office and president of the nonpartisan Urban Institute, a Washington think tank. "He wants to shift more of the responsibility and risk now borne by insurance onto individuals."

Bush indirectly acknowledged the link between the two policy prescriptions by calling for a bipartisan commission to examine the problems of cost and coverage that loom for all of the government's major safety net programs with the coming retirement of the baby boom generation. "Congress did not act last year on my proposal to save Social Security, yet the rising cost of entitlements is a problem that is not going away," Bush told lawmakers and a national television audience.

He cast his healthcare initiatives primarily in terms of helping workers who do not have the kind of comprehensive health insurance traditionally provided by large companies — especially the self-employed and those employed by small businesses. But his strategy of greater reliance on individuals has important implications for most working Americans because even major corporations are seeking ways to reduce the burden of providing traditional insurance.

The theory behind the president's proposal is that individuals who shop for their own insurance and spend their own dollars from personal health savings accounts will drive a harder bargain with care providers than employers and the government have done. That, he argues, will help tame spiraling costs. To encourage individuals to take on the job, the government already offers health savings accounts that combine a bare-bones insurance policy with a personal account into which people deposit money and from which they withdraw funds to pay medical bills — all tax-free. In this regard, health savings accounts are unique in the federal tax code; no other type of account provides tax breaks for deposits and withdrawals.

Health savings accounts are an arrangement in which consumers deposit their own money into special accounts — sometimes with contributions from employers. That money, which is not counted in taxable income, can be used to pay for routine medical costs. At the same time, workers get less-than-comprehensive insurance for major medical problems; again, employers can contribute to the cost. The insurance policies feature lower monthly premiums than comprehensive plans because they pay for less coverage. The president proposed to sweeten the deal by permitting individuals to deduct the premium cost of the bare-bones policy from their taxable income, and by steeply increasing the tax-free amount that people can put into health savings accounts.

The exact size of the of the proposed increase was somewhat unclear Tuesday. The White House news release describing Bush's plan suggested that individuals could deduct all out-of-pocket medical expenses from their taxable income by paying for them with health savings accounts. Under current law, people can deduct medical expenses only if they exceed 7.5% of their adjusted gross income. In addition, the release said that the president wanted to give individuals who set up health savings accounts a tax credit that could be worth as much as $1,500 a year for an individual in the top tax bracket. "The president proposed allowing Americans … to cover all out-of-pocket costs under their HSA policy," the White House release said. The Bush plan "will allow patients to cover all their out-of-pocket expenses tax-free through their HSAs," it said.

However, independent analysts said they believed Bush's proposed tax breaks would not be open-ended. They said that the 2003 law establishing health savings accounts set a cap on out-of-pocket expenses at $5,250 for an individual and $10,500 for families, and these probably limit how much in medical expenses people could deduct from their taxes. Even with the limit, however, the president's proposal would nearly double the amount people could contribute to their accounts tax-free. Under current law, the maximum contribution for an individual is $2,700 and for families $5,450.

The White House clearly believes that its proposed tax incentives would give health savings accounts a huge boost. About 3 million have qualified for the accounts and some experts have estimated that number could rise to 14 million by 2010. With the new incentives, White House officials said that number could jump to more than 20 million by the end of the decade.

Analysts were unable Tuesday to estimate the cost to the government of boosting the amount people could contribute tax-free to health savings accounts, but they predicted that it would run into the tens of billions of dollars over the next decade. A previous administration proposal to make premiums for bare-bones insurance tax-deductible was estimated to cost nearly $30 billion over 10 years.

Some critics challenged the administration's assertion that health savings accounts would help solve the nation most pressing healthcare problems — rapidly rising medical costs and an increasing number of Americans with no health insurance. And they warned that any expansion of the individual accounts could undermine the existing employer-based health insurance system. In addition, critics said that Bush's reliance on tax breaks effectively limited the benefits of his proposals to those who paid substantial taxes. "HSAs are going to do nothing for medical inflation, which is pricing almost all of us out of healthcare," said California Insurance Commissioner John Garamendi. The president's new tax breaks "will be a significant benefit to the wealthy, but it won't do much for the middle class because they have no extra money to put into another savings account."

Account proponents argue that by giving individuals the kind of tax breaks that employers get for providing healthcare, the savings accounts encourage more people to get health insurance and to become more involved in managing their own health. "If we're going to solve our nation's healthcare problems, patients are going to have to be involved," said John C. Goodman, president of the conservative National Center for Policy Analysis and a longtime advocate of health savings accounts. "Research shows that people with chronic diseases like diabetes can manage their healthcare on their own," he said.

But critics say the president's approach will encourage healthy people with few medical costs to split off from the traditional employer-based insurance system. That could destabilize the employer system by leaving it to cover a larger proportion of older, less healthy and therefore higher-cost people. "The real danger is that the employers market erodes fast," said Robert Greenstein, executive director of the liberal Center on Budget and Policy Priorities in Washington.

Source

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

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

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2 February, 2006

ANOTHER UK CHANGE OF DIRECTION

"Thrashing about" might describe it better. They clearly do not know where to turn.

The community hospital, a part of the health service threatened with widespread closures, is to be recast as a centrepiece of the NHS after a government rethink. Sweeping changes to the NHS, outlined yesterday in the long-awaited community services White Paper, will mean community hospitals taking on a significant role in efforts to provide more care to patients closer to home. The initiative comes after big cuts to community hospital care, with more than 90 thought to be at threat of imminent closure. Many of these will now be redeveloped as part of the restructuring of primary care, and the Government plans to build a “new generation” of 50 community hospitals over the next ten years. The hospitals, modelled on “polyclinics” pioneered in Germany, will be state-of-the-art but without the A&E departments that generate emergency pressures on district general hospitals.

The move is designed to provide more care and treatment outside the costly setting of traditional acute hospitals. The White Paper also pledges to improve access to GP practices, encouraging them to stay open for longer to meet local demand. In areas that are under-served by GPs and primary care services, private providers could be brought in. The reforms are also designed to provide more support for carers and encourage people to have regular health “MoTs”. While the 200-page White Paper was broadly welcomed last night, it raised concerns as to how acute hospitals would cope with fewer patients — and the resulting reduced income.

Chris Ham, former head of strategy at the Department of Health, said that it would likely prompt the closure or severe scaling-back of larger hospitals. He added that those hospitals tied into long-term repayment contracts with the private sector could face serious problems.

The White Paper said that in its aim to deliver more specialist care locally, “a new generation of community facilities” would need to be created. It stated that over the next five years the Government will develop “a new generation of modern NHS community hospitals”, as set out in its manifesto pledge. There are about 350 community hospitals in England, mostly owned and run by primary care trusts.

Patricia Hewitt, the Health Secretary, said that over the next ten years she wanted to see 5 per cent of resources — about £2.5 billion from the NHS budget — shifted from secondary to primary care. “Nearly 90 per cent of patient contact occurs in the community and is trusted, but we still spend below the European average on primary care,” she said. She said that where community hospitals were not considered viable to serve the local population, it was right that they should close, adding: “But if there are community facilities that are needed for the long-term they shouldn’t be closed down due to short-term budgetary problems.”

Ms Hewitt denied that taking more treatment out of hospitals would destabilise finances. She said that hospitals would be more able to treat the most complex patients while more routine procedures were carried out locally. The Health Secretary added that the Government was working with the medical royal colleges to consider which specialities — such as dermatology, orthopaedics and gynaecology — could be bought out of hospitals and nearer to people.

Details of health MOTs — providing people with check-ups at key points in their life — were also outlined. The initiative will take the form of a questionnaire that patients complete online or on paper. If problems are shown up they may be invited for a face-to-face consultation with a GP. The White Paper said that it would soon be easier for patients to register with the practice they wanted but the idea of letting patients register with two GPs — one near home and one near where their work — has been ruled out after being branded difficult and costly. Reforms of social care will include a respite service, to give people a break from caring for relatives or friends, and other support such as a helpline.

Health campaigners and doctors last night insisted that more money was needed if the Government was to succeed in meeting its ambitious pledges. Many questioned how the NHS would be able to pay for the plans set out in the White Paper as it is already hundreds of millions of pounds in the red.

Ms Hewitt said that some funding for the reforms would come from the Department of Health’s central budget, while other aspects would be covered by the large increases in funding for the NHS set for the next few years.

Andrew Lansley, the Conservative health spokesman, said that the White Paper left many questions unanswered. “Many primary care trusts are cutting back precisely the community-based services on which her care plan depends,” he said. “The White Paper fails to face up to the reality of the NHS today. It fails to provide the necessary long-term reforms which will deliver the improvements in the NHS which everyone — staff and patients, so badly want.”

Source

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

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

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1 February, 2006

SOCIALIZED MEDICINE BY PHONE!

Congestion at overstretched hospital emergency departments could worsen under a plan to assess sick people via a national hotline, doctors warn. Under the plan, a 24-hour national call centre staffed by triage nurses will direct sick people to a pharmacy, doctor or hospital, depending on the seriousness of their complaints. The plan, to cost up to $40 million, aims to ease pressure on emergency departments by sending those with minor ailments elsewhere. The Council of Australian Government meeting will consider the proposal on February 10 with some states, including NSW, already behind the idea after successful local trials.

A spokeswoman for federal Health Minister Tony Abbott confirmed the plan was on the agenda for the COAG meeting. But the Australian Medical Association has warned that hospital congestion could worsen under the proposal, with studies showing most people who go to emergency departments need to be there. The phone triage plan would probably not reduce the number of people presenting at emergency departments, AMA president Dr Mukesh Haikerwal said. "The people that turn up to emergency departments by and large need to be there and such a system may well increase the demand of people needing to be seen in a general practice or in an emergency department."

But NSW Premier Morris Iemma said the system had worked in a Hunter Valley trial and a national scheme was long overdue. "This is an initiative whose time has come and is one that we have, for a long time, been pressing the Commonwealth to make as part of the after-hours service," he said. But his position was undermined by federal Labor's health spokeswoman Julia Gillard, who said the plan had failed in Britain. A shortage of doctors was the fundamental problem, Ms Gillard said. A better scheme was proposed by Labor at the last election that would put callers in contact with local services, she said. "Labor's model is a model that will actually get you a doctor if you need one after hours," she said.

Doctors Reform Society president Tim Woodruff backed the AMA, calling the proposal a gimmick that would have no real impact on emergency department pressures and waiting times. "Instead of properly addressing all the problems in our public hospitals, the Federal Government spends $2.5 billion every year on supporting the private hospital sector and offered an extra $40 million for a hotline, which will have a marginal impact at best," he said. – AAP

Source

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

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

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