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31 May, 2006

Health reform: Three states, two basic approaches

Now Vermont has entered the statewide healthcare reform arena, with a perspective remarkably similar to that of its neighboring state, Massachusetts. The announcement of the Green Mountain State’s efforts to curb Medicare costs, while promoting “full insurance” for its citizens, comes on the heels of the Bay State program recently approved (with some reservations) by the House, Senate and Governor in the Commonwealth below Vermont geographically. Alongside these two attempts is the program currently being considered in Tennessee, which has a lot farther to go in recovering from its disastrous TennCare mistake. This column seeks to compare and contrast the three approaches, in hopes of defining what is and is not likely to work in each of them.

What they all have in common is a focus on insuring everyone, rather than on providing low-cost medical care per se. They also seek to convince everyone to sign up, as employer and as individual, choosing among whatever options they and the insurance companies devise for allegedly baseline healthcare coverage, and in some way or another, they seek to penalize members at least one of those categories if they do not obey. However, there are two aspects of Tennessee’s CoverTN plan that set it aside from the other two: the emphasis on portability, and the shared cost of the coverage by the working person.

Vermont, following the lead of its neighbor to the immediate south, is focused on REQUIRING everyone to get insured. Somehow the state that prides itself on having self-defined socialist Bernie Sanders as its Independent Congressman would seem likely to take that route of forcing compliance rather than offering incentives for it, as Taxyourwhatsis has already blazed the pathway for. Although Mass. Governor Mitt Romney complained about the fines for small companies who did not comply (though not about similar requirements for individuals to sign up for the insurance), he did end up signing the bill as it was written, and it will go into effect very soon.

In all three states, the primary goal is to bring at least most of those residents who are not currently covered by health insurance, and who are working for a living (and thus are ineligible for the handout programs), so that they don’t become a greater burden on the taxpayers when some emergency arises. The Vermont and Massachusetts plans, as a Boston Sunday Globe editorial editorial notes, share many other aspects, including expansion of Medicaid, subsidies for people with low incomes and a fine (called a “fee”) for employers who don’t buy into some insurance system for their workers. (However, at $365 in Vt. and $295 in Mass., these annual penalties are a pittance compared to what the companies would be paying to insure someone even at the lowest level, so they are unlikely to deter much non-compliance.)

However, unlike the Bay State plan (which requires any individual resident to become insured by July 1, 2007, or pay a hefty fine), Vermont will not mandate that everyone buy into the program, at least not as individuals; instead the state is setting up Catamount insurance policies through private insurers, designed to attract individual subscribers with subsidized low rates and bare-bones coverage. It is hoped that this will encourage both preventive care and early detection, before problems become serious and require more extensive care.

They also plan to bankroll their program with a boost in cigarette taxes, to as much as 80 cents more per pack over the next couple of years. (Massachusetts legislators think they can make their plan go with cutbacks on existing programs and revenue growth, as well as cost savings overall by containing excessive use of emergency facilities. In a state which has seen property taxes capped via Proposition 2-1/2, and nearly saw its income tax repealed via another referendum a few years ago, finding ways to trim costs and find hidden money is becoming much more familiar to those legislators.)

Meanwhile, down [here] in Tennessee, the first challenge has been to rollback and replace most of the elements of the atrocious and overblown TennCare debacle. Started in 1994, and initially intended to provide blanket coverage for those who needed the care the most (the disabled, the elderly, chronic-pain and disease sufferers, the uninsurable and the indigent), it rapidly expanded and overflowed all of its boundaries. It was abused by out-of-staters establishing false residency, by able-bodied workers who chose the dole over productive endeavor, and finally even by medium and large companies, who saw a way out of paying for their employees health (or paying them more so they could do so themselves?), and became a large part of the problem instead of an aid to solution.

So the first step was the dismantling of the worst parts of TennCare; only then could its replacement, with subsidiary and targeted programs to attack specific aspects of health and wellness, be addressed. And now, after a somewhat ruthless slashing of that behemoth (many aspects of which seemed more politically driven than they were based on common sense!), Governor Bredesen has produced a three-part strategy for fixing the roof and the foundation of the structure. His Cover Tennessee program has been previously commented on in this space, but comparison with the efforts in the two New England states are still in order.

Generally speaking, Cover TN, the portion focusing on the working poor and middle class, is the most innovative here, since it actually encourages a working person to sign up, at relatively low cost, for a policy that is then attached, not to an employer, but to that individual person. The policy, a relatively low-level coverage with significant co-payments required for both doctor visits and prescriptions, is intended to cost about $150 a month, one-third of which would be absorbed by the taxpayers (and be paid for at least in the short term by TennCare budget savings or tobacco-settlement funds). The remaining $100 a month would be paid by some combination of the employer and the employee, or entirely by the individual. Under the plan as it is written, that would be literally a $50/$50 split, though one might expect a smart employer to offer a better deal as an incentive to keep a good worker.

The advantage of this is, the policy could be transferred from job to job, with the next employer assuming some portion of the policy-cost. Or it could exist entirely independent of an employer, allowing a self-employed consultant to afford decent healthcare coverage, instead of having to either budget for a high-cost individual policy, or go with insurance, as many do at present. (It would also phase out the archaic concept of COBRA insurance, whereby an employee leaving a job may continue coverage under a prior plan, for a limited time, but often at five or ten times the cost of the previous policy.)

Right now, while the Massachusetts plan has already been signed into law, and the Vermont one is likely to pass very shortly, the Tennessee one is still being held up, over some subsidiary issues, according to some proponents. While there is very little opposition to the plan as it is presented, there are some battles being waged on its periphery: a recent attempt to tie medical malpractice suit limits to the bill had to be defeated last week, and now the push is on to address the issue of an estimated 67,000 uninsurable Tennesseans (with pre-existing medical conditions), who were dropped from TennCare and are still now without assistance.

One does feel for their plight, and the issue should be addressed (perhaps with the first piece from those extra TennCare funds, which should continue to grow as this CoverTN program takes hold); however, it is to be fervently hoped that this experimental new paradigm in health coverage does not get derailed by this side-issue. The possible ramifications of freeing workers from their somewhat willingly accepted chains, moving away from “healthcare benefits too good to lose,” and chasing their own individual dreams … are just too wondrous to imagine!

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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30 May, 2006

Dumb but Leftist: Your future doctor

Medical schools are giving students coveted university training places based on "personality assessments" that include asking for their views on the Iraq war and gay marriage. Less academically gifted students are leapfrogging those with better marks by signing up for coaching programs that school them in handling the interview questions - fuelling critics' claims that the personality tests are skewing the selection process for the nation's future doctors away from the best and brightest.

Some interviewees have been asked to debate the rights and wrongs of providing in-vitro fertilisation services to gay people. Other questions include what applicants' parents do for a living and whether they went to a private school.

Some senior doctors are now accusing universities of attempting to "socially engineer" medical school intakes by giving preference to candidates who reflect the interviewers' views, allegedly often left-wing. The interviews - usually conducted by a panel comprising members of the public as well as doctors - often ask applicants to talk about their earliest memories, or discuss their biggest disappointment in life and how they coped with it. The process is supposed to identify "well-rounded personalities" that some claim will make better doctors.

Greg Deacon, president of the Australian Society of Anesthetists, described the situation as "absolutely appalling" and said he had been "speaking to a number of people who have been upset" at the way the interview process at a number of universities - including the University of NSW and Newcastle University - has been conducted. "Questions that are being asked, and that should never be asked, are questions such as 'What does your father do?', 'What does your mother do?', 'Where do you live?' and 'What school did you go to?'," Dr Deacon said. "If you went to a private school, or your father is a doctor, you are simply not going to be selected. The justification is the personal biases of those doing the interviews - they are trying to engineer the selection of medical undergraduates to further their own desires." He said he knew of one student whose HSC results put her in the state's top 40. "She was asked these questions," he said. "Because her father was a specialist doctor and went to private school, she didn't get in. It's hard to comprehend."

Dr Deacon said students' views on Iraq or gay marriage had "nothing to do with ability to be a doctor", and the risk was that interviewers would frown on candidates whose views clashed with their own. But these latest claims are rejected by the heads of Australia's 17 medical schools, which are already under pressure over assertions that the teaching of sciences, including anatomy and pathology, has been cut back to dangerous levels. The medical schools say interviewers are trained to judge an applicant's ability to reason and argue intelligently, not the position they take. But at least one university is scrapping the interview process after finding no evidence that the students selected by panels performed any better during the course.

And experts who assess personalities have cast doubts on the validity of the interviews. A NSW forensic psychiatrist, Julian Parmegiani, does personality assessments in situations such as parole applications and court-ordered psychiatric evaluations. He writes in the latest issue of NSW Doctor, the magazine of the NSW Australian Medical Association, that the interviews "will not identify altruistic, kind and empathetic doctors" but merely the students best able to divine what interviewers wanted to hear. "Successful students might be just a tad more psychopathic, manipulative and intent on recouping their investments," Dr Parmegiani writes.

Source

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

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

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29 May, 2006

Your regulators will protect you: Yet another botch from Queensland Health

A cosmetic surgeon who quit Victoria after botching seven operations has been disciplined in Queensland over another surgery bungle. Gold Coast-based Graydon Ronald Van Houten was found guilty of unsatisfactory professional conduct over an operation to remove a cyst from the ear of Browns Plains retiree Bob Martin in August 2001. The wound failed to heal and specialists had to remove part of Mr Martin's ear after a routine check-up three months later showed the cyst was a carcinoma.

The incident has raised concerns about how Dr Van Houten was allowed to practise in Queensland despite the adverse findings against him in Victoria. Mr Martin, 64, reached an out-of-court settlement with Dr Van Houten which prevented him from naming the surgeon. But searches of public documents, which name Dr Van Houten, reveal The Medical Board of Queensland in January ruled the 60-year-old not be allowed to perform various skin procedures until he completed courses on skin cancer practice.

Mr Martin said the ordeal had devastated him. "When I walk into shopping centres now people point at me say, 'Look at that man, he has only half an ear.' People are always saying, 'What happened to you?' " Mr Martin said. He said the compensation amounted to "chicken feed" after his legal and hospital bills were paid.

In its findings, the panel noted the Medical Practitioners Board of Victoria in October 2002 had found Dr Van Houten had engaged in unprofessional conduct of a serious nature in the treatment of four patients and unprofessional conduct not of a serious nature in the treatment of three other patients. He escaped suspension because he had moved to Queensland and his Victorian registration had lapsed.

Mr Martin's lawyer Bruce Simmonds said the Queensland panel, despite being aware of the Victorian cases, had imposed little punishment on the doctor apart from requiring him to undergo some training. "I understand he is offering the same types of services here which led to the complaints in Victoria," Mr Simmonds said.

Marilyn Van Houten, a practice manager at her husband's surgery, defended him. "He has no problems that he isn't working through. He's addressed the issues at hand," she said. "Why aren't the newspapers supporting doctors . . . we're not talking about Dr Patel here." The Medical Board of Queensland said recent changes in legislation had led to improved checks on interstate doctors and a public register being established where patients could check doctors' records.

Source



Federal Health Minister Abbott blasts Queensland hospital ban on Bible

Queensland Health are much better at political correctness than they are at medical correctness

Federal Health Minister Tony Abbott has accused Queensland hospital bosses of "losing the plot" after they banned the Bible from bedsides. An outraged Mr Abbott launched his scathing attack, following a Sunday Mail report which revealed the religious books had been removed amid fears of offending non-Christians. Mr Abbott said the Federal Government was giving $9 billion to Queensland to run public hospitals efficiently - not to ban the Bible.

The Royal Brisbane and Princess Alexandra hospitals are among those in the firing line. Staff said the Bibles had been removed because they were no longer in keeping with the "multicultural approach to chaplaincy", while some claimed the books were a source of infection. Mr Abbott told Federal Parliament: "This is not an infection control measure, it is a thought control measure - it is political correctness gone crazy. "I say to public hospital administrators: Stop worrying about offending people and start running public hospitals properly, and give people Bibles at a time when they probably most want to see them."

Gideons International, which distributes the Bibles, has offered to supply hospitals with hardcover copies which could be wiped to reduce infection fears, but health bosses have rejected the offer. This week they denied that Bibles had been banned from bedsides. "Bibles are available in all hospitals, either at the bedside or on request," Queensland Health Director-General Uschi Schreiber said.

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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28 May, 2006

Bright idea in New Jersey: Make hospital care even more expensive!

As New Jersey's July 1 deadline to adopt a state budget looms, hospital groups and some legislators are fighting to stop a new tax that Gov. Jon Corzine (D) has proposed in an effort to reduce the state's $4 billion deficit. In his budget proposal this year, Corzine suggested imposing a bed tax on all 74 hospitals operating in public-private partnership with the state. The measure is expected to raise approximately $430 million by forcing hospitals to pay an average of $1,424 a month per bed and might bring in some matching Medicaid funds from the federal government.

Corzine wants to split the $430 million in half, giving $215 million back to hospitals at rates dependent on their Medicaid utilization and putting the other half into the state's general fund in order to seek the federal matching funds. The plan has the health care industry crying foul because it hurts large hospitals with low rates of Medicaid usage and unfairly benefits small ones with large numbers of Medicaid patients.

Not only is it a bad idea that could cause division in the hospital industry, said New Jersey Hospital Association spokesman Ron Czajkowski, it's an example of horrible timing because the industry is on "spongy, if not fragile, financial turf." The average nonprofit hospital in the state has an operating margin of 1 percent. "We have a high charity-care caseload," Czajkowski said. "Medicare and Medicaid don't pay dollar for dollar, and we're dealing with the impact of the illegal immigrant population that costs $250 million a year. In addition, we have the same problems the rest of the country has with managed [care], where they are still slow or no-pay contributors to hospitals. "Forty-two percent of the state's hospitals operated in the red last year, and if a tax like this goes through, there will be cutbacks on services and layoffs," Czajkowski continued. "Some of those that are already in bad shape might close down."

Under current New Jersey law, hospitals are required to care for all patients seeking medical attention, regardless of whether they have insurance. In 2005, the state budgeted $583.4 million to reimburse hospitals for those charity-care cases, said Department of Health and Senior Services spokeswoman Gretchen Michael--an amount Corzine proposes keeping the same in the FY 2007 budget. But Suzanne Ianni, executive director of the Hospital Alliance of New Jersey, pointed out in her April 3 testimony before the state Senate Budget and Appropriations Committee that the amount is inadequate because it's based on 2002 data. Over the past four years, the state's charity-care costs have risen from $778 million to more than $1 billion, she said. Medicaid doesn't reimburse dollar for dollar, so the 2002 estimates were low to begin with.

"People receive care whether or not they have health insurance because of hospitals' public-private partnership with the state," Ianni said. "We know that Gov. Corzine wants a responsible budget this year but ignoring the substantial increases in charity-care delivery is irresponsible of this budget. Our government must meet its responsibility to ensure health care for its citizens."

The Trenton Times pointed out in an April 9 editorial that if the tax is approved, it will most likely result in even higher health care costs for consumers as hospitals pass the cost along to their patients, ultimately through higher insurance premiums. State Sen. Paul A. Sarlo (D-Wood-Ridge) opposed the tax. "We can't solve our charity-care problem on the backs of hospitals who serve our working residents who have health insurance," he told NorthJersey.com on April 8.

At press time, the state legislature was still in discussions with Corzine. The governor's press office referred calls for comment to Ms. Michael at the Department of Health and Senior Services.

Source



Nowhere for her to give birth

What happens when you rely on the great god "Gubmint" and their wonderful "planning": An interstate trip to give birth!

A critical bed shortage has led to a pregnant mother expecting twins having to travel to Canberra Hospital yesterday because of a gridlock in infant intensive care wards. A rush of multiple births - including triplets at Nepean Hospital - put pressure on an over-burdened system. The woman was flown by air ambulance to Canberra early yesterday morning. High occupancy rates in maternity and neo-natal wards across Sydney caused a serious shortage across the state.

A spokesman for ACT Health confirmed they received a NSW patient early yesterday, and said interstate transfers were "routine". "A pregnant woman was transported to the Canberra Hospital from Sydney because there were no neo-natal beds available elsewhere in Sydney," he said.

A NSW Health spokeswoman said there was a shortage in both maternity and intensive care cots across the state. "From time to time we do need to transfer patients and their babies to specialist services outside of Sydney," she said. "When the patient and her children are stable, they will be offered transfer back to Sydney."

A lack of specialist nurses is aggravating the situation, prompting one Sydney hospital on Thursday night to call in off-duty nurses. "This is a recurrent problem, it happens all the time," one specialist told The Saturday Daily Telegraph. There are currently more than 140 positions vacant in NSW in this specialist nursing field, causing major problems in all hospitals with neonatal intensive care units. "This is a highly specialised area and these babies need one on one care 24-7," an expert said. "There is not enough nurses to match the beds."

The fact women are having children later in life means there are more premature babies than ever before and technology can keep a premature infant alive at 23 weeks. About 2 per cent of all babies born in NSW are treated in one of the state's nine specialist units. There are 125 intensive care cots across NSW and the ACT. Survival rates for babies admitted to neonatal intensive care units have risen from 87 per cent in 1997 to 92 per cent in 2005.

Opposition health spokeswoman Jillian Skinner said it was an outrage a woman was made to travel during a stressful and vulnerable time.

Source

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

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

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27 May, 2006

NHS HEADS CANNOT STOMACH THE POLITICAL DECEITS AND BUNGLES

The management crisis in the health service has worsened with the resignation of a senior director who accused ministers of “deceit over reform”. Professor Aidan Halligan, director of clinical governance, stood down this week, leaving another vacancy at the top of the NHS, The Times has learnt. Nine senior positions are filled at present by temporary replacements or new appointees for staff who have resigned. The news came as the problems over jobs in the NHS increased, with another health trust announcing yesterday that it was losing 600 posts.

Professor Halligan shocked ministers last month when he condemned their failure to overhaul the NHS as they poured in billions of pounds of extra cash. His remarks were used in the Commons by David Cameron, the Conservative leader, to embarrass Tony Blair. The resignation of Professor Halligan comes two months after the sudden departure of Sir Nigel Crisp, the chief executive of the NHS and Permanent Secretary at the Department of Health. Andrew Foster, another senior department figure, also recently announced that he was leaving.

Andrew Lansley, the Shadow Health Secretary, said: “The Department of Health is a department without leadership, without direction and without any effective financial control. It is not surprising in the context of Mr Blair’s failing Government. “The ministers must take responsibility. There is a crisis of confidence between NHS staff on the one hand and the ministers and Department of Health on the other, because of the latter’s failure to articulate a clear and effective policy.”

It remains unclear why Sir Nigel resigned at a time of increasing pressure on the NHS caused by worsening deficits. But within weeks of the announcement it emerged that Mr Foster, the head of workforce planning at the department and another figure central to its reform programme, was stepping down. The department said that Mr Foster had chosen to leave to pursue other health service interests.

Professor Halligan, who was until last year the country’s second-most senior doctor when he served as deputy Chief Medical Officer, has decided to leave public service altogether. In a letter on Monday to Sir Liam Donaldson, the Chief Medical Officer, Professor Halligan thanked him for all his “support, encouragement and many kindnesses over the years”. Professor Halligan, a former lecturer in obstetrics, used an interview in a health service journal last month to criticise what he said was a failure to reform the NHS. “We have learnt that throwing money at the problem only allows us to do more of what we have always done,” he said. “Any suggestion of real reform has been a deceit. Working patterns, practice and custom are at the heart of many capacity issues [in the NHS] and have never been challenged.”

Oxford Radcliffe Hospitals confirmed plans yesterday to cut 600 jobs in an attempt to save 33 million pounds. The trust said that it could not rule out compulsory redundancies, although it has 600 vacancies

The Times



U.K. Regulators slam drug trial firm

Drug regulators have heavily criticised the firm which carried out the drug trial which left six men seriously ill. Parexel - who deny any wrongdoing - failed to follow proper procedures the Medicines and Healthcare products Regulatory Agency have reported. But the agency said the adverse reaction, which left the men with multiple organ failure, was the result of an "unexpected biological effect".

Experts slammed the conclusion, saying the outcome could have been predicted. At the time of the trial, Professor Herman Scholtz, from Parexel, said the clinical research organisation had followed regulatory, medical and clinical research guidelines during the study.

All six previously healthy men who took part suffered multiple organ failure after being given TGN1412, which is designed to treat rheumatoid arthritis, leukaemia and multiple sclerosis. One is still in Northwick Park hospital, and is said to be making steady progress. The solicitor representing two of the men has called the MHRA report "totally inadequate" and said it was "a whitewash".

The MHRA found the drug was given in correct doses and there was no sign of contamination or manufacturing errors. But it lists a catalogue of administrative errors. Parexel failed to complete the full medical background of a trial subject and the medical history of one of the volunteers was not updated. There was also no contract in place between TeGenero, the makers of the drug, and Parexel at the beginning of the trial. In addition, the MHRA reported one of the doctors involved did not have adequate training or experience. And two of the volunteers were allowed to leave before it was confirmed they had received the placebo

The German manufacturers of the drug TeGenero have maintained that the men's reactions were "completely unexpected" and did not reflect the results obtained from the earlier laboratory studies.

Dr David Glover, an independent consultant and industry expert on the development of antibody and other biological drugs said: "Today's report is inadequate and completely misses the point. "The report concluded the problem was due to an unexpected biological effect, but this is absolute nonsense. "The trial volunteers' response was predictable from preceding literature and data supplied by the company and should not have come as a surprise."

But Professor Kent Woods, MHRA Chief Executive told the BBC other monoclonal antibodies, like TGN1412, had been tested safely before, and there had been substantial safety measures built in to the study's development." However he admitted: "The number of volunteers is something that has to be reconsidered. "But even if one volunteer had been affected, it would have been a disastrous outcome." He added: "We are satisfied that the adverse incidents which occurred were not as a result of any errors made in the manufacture of TGN1412, its formulation, dilution or administration to trial participants."

It its interim report last month, the MHRA said it would take a "precautionary approach" to future trials of drugs like TGN1412. But Ann Alexander, the lawyer representing the two most seriously affected victims of the drug trial, condemned the report as "totally inadequate". "Today's report is a whitewash and leaves many questions unanswered. It gives no detailed information about the pre-clinical trials, about which there has been conflicting information." Ms Alexander, of Irwin Mitchell solicitors, questioned the finding that the reaction produced by the drug was unpredictable and called for an independent enquiry.

She added that a Health Select Committee report published last year had found a lack of transparency in the MHRA. "The concerns of the select committee seem to have been confirmed by the MHRA's investigations. "I now have little faith in the MHRA's ability to seek, obtain or make public detailed and relevant information about the clinical history of this trial or the manner in which it was conducted," she added.

The Department of Health has said the expert group will produce an interim report within three months of starting work. It will provide advice on how future trials of monoclonal antibodies should be designed.

Source

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

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

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26 May, 2006

BRITS GET HERCEPTIN AT LAST

Only after enormous pressure

Herceptin, the breast cancer drug so promising that patients have gone to court to demand treatment with it, is likely to be approved for widespread use on the NHS within the next few weeks. The drug received its UK licence for treatment of early-stage breast cancer yesterday. Many health trusts that had denied patients the drug argued that its safety remained unproven. The move means that Herceptin will probably be approved by the National Institute for Health and Clinical Excellence (NICE), which recommends on best treatments for the NHS, within the next month. It is bringing forward an announcement, originally planned for July, as a result of the record speed with which the licence has been granted.

News of the licence, which is valid across the European Union and was granted by the European Commission on the advice of its regulator, was welcomed yesterday by patients. Health trusts have said that the funding implications of the treatment, which costs about 20,000 pounds a year a patient, will be significant and not easily resolved. [sack a few bureaucrats!]

The drug is effective for the HER2-positive type of the disease, which affects about 20 to 25 per cent of women in whom breast cancer is newly diagnosed — a total of 10,000 patients annually. Research published in The New England Journal of Medicine last October showed that Herceptin reduced the risk of disease returning in women with early-stage HER2-positive cancer by 46 per cent. Breast cancer is diagnosed in more than 41,000 women every year, and more than 13,000 die each year.

Andrew Dillon, the chief executive of NICE, said that its appraisal of the clinical and cost-effectiveness of Herceptin was under way. “We are working hard to ensure our review is completed as soon as possible,” he said. “We are keen to ensure that guidance is available in a matter of weeks.” Barbara Clark, 50, who won a High Court battle for Herceptin in October, described yesterday’s announcement as great news. “I feel this is the end of a tremendous fight,” she said.

Ms Clark, from Bridgwater, Somerset, faced having to sell her home to pay privately for the drug. She is now in remission. She said that once the drug was approved by NICE, health trusts will be forced to act. “Health trusts will then have three months to put their policies in place to give the drug and if they don’t, women will have a real fight on their hands,” she said. “(The trusts) won’t be able to refuse.” Elisabeth Cooke, 60, from Southmead, Bristol, was absolutely delighted by the news. A High Court ruling in March put her case on hold but allowed her to continue receiving the drug pending her legal outcome. “Perhaps now all the scapegoating for all these women who need Herceptin will end,” she said.

Joanne Rule, the chief executive of the Cancerbackup charity, described yesterday’s decision as offering women a clear path to access a vital treatment. “Breast cancer patients across England and Wales are currently experiencing a dreadful postcode lottery — denied Herceptin because of where they live or how ‘exceptional’ their lives are deemed to be,” she said. “This can stop now.” She added that the Department of Health should assist primary care trusts by announcing an innovation fund to help local areas to absorb the costs. Professor Ian Smith, head of the breast unit at the Royal Marsden Hospital, southwest London, said that, for women with HER2-positive breast cancer, Herceptin was “one of the most important developments we have ever seen”.

The Times

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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 May, 2006

U.K.: Hepatitis C care 'fails patients'

The NHS approach to hepatitis C needs overhauling, MPs and doctors have said. A report by the All-Party Parliamentary Hepatology Group said care was a "postcode lottery" with many trusts not following official guidelines. And a second report by top doctors said the UK was lagging behind its European neighbours which had set up specialist diagnosis and treatment centres. Campaigners said the failures were costing lives, but the government said services were improving.

The hepatitis C virus, if untreated, can cause cirrhosis, liver failure or liver cancer. Most people who contract the infection can be successfully treated, but - as the virus often does not produce early symptoms- it can go undetected, often for years. The virus is spread through contact with infected blood. Most people contract it through sharing needles to inject drugs.

The All-Party Parliamentary Hepatology Group found that 92% of 191 primary care trusts had failed to fully implement a 2004 Department of Health action plan to tackle the disease. And nearly half of the 107 hospitals quizzed said there were significant delays of up to a year for patients waiting for treatment. Brian Iddon, a Labour member of the cross party group, said the infection was a "hidden timebomb". Campaigners believe about 400,000 people are infected but unaware of it - although the government says its half this number. By the end of 2005, 54,000 people had been diagnosed.

Doctors

The report by leading doctors, which was published to coincide with the MPs' study, said the UK had not responded as well as its European neighbours and management of the virus in the UK was "both unstructured and under-funded". The report details seven recommendations for the government, including developing a detailed strategy for managing the virus; appointing somebody to oversee it; raising awareness and improving testing. It also called for specialist centres to be set up as they have been in France, Germany and Italy to provide diagnosis and treatment.

Report author Professor William Rosenberg, professor of hepatology at the University of Southampton, said: "We are lagging behind many countries and that in not acceptable." Charles Core, chief executive of the Hepatitis C Trust, which commissioned the report by doctors, said lives were being lost because of the failings. "If we do not seize this opportunity we will look back and know that by our inaction we let it happen."

A Department of Health spokeswoman said: "We recognise the importance of hepatitis C as a public health issue." And she said early indications were that awareness campaigns and the national framework were having an impact as more people were being diagnosed. But she added: "The results of the survey may serve as a useful focus for discussion by local NHS organisations."

Source



ANOTHER NHS FAILURE

The parents of Victoria Climbie called on the Government today not to let her death be in "vain" after a survey discovered many NHS trusts had not implemented all the key recommendations proposed after her killing. Francis and Berthe Climbie urged Health Minister Patricia Hewitt to take "responsibility" for the situation following the poll which highlighted concerns in the child protection system. Lord Laming, who headed the public inquiry into the eight-year-old's death, said it was "unacceptable" to find the system working well in some areas and not in others.

The survey of NHS acute hospital trusts was conducted by Five News correspondent Catherine Jacob, who also interviewed the Climbies. Mr Climbie, speaking from Abidjan on the Ivory Coast, told the programme: "The Government can give all the money it likes, but if the services do not communicate with each other, then it's logical - the child protection system will always fail. "Yes, I have a message for the Health Minister. You are a representative of the Government. You can really change things. If the people who work in your health system are unhappy, then the child protection system will not work. You must take responsibility for it. Protecting children is everyone's responsibility. "When Victoria died, the then Health Secretary Alan Milburn promised us her death would not be in vain. Do not let Victoria's death be in vain."

Victoria, who died in February 2000, had 128 injuries to her body. She had endured months of torture and abuse by her great aunt Marie Therese Kouao and her boyfriend Carl Manning despite being in the care of social services and police. The couple were jailed for life in January 2001 for her murder.

Lord Laming's public inquiry found child protection services had missed at least 12 chances to save her life. The Government later accepted all but one of his 108 recommendations Five News polled 175 NHS acute hospital trusts across England and received responses from 62 of them. In each case the designated and named child protection doctors and nurses were asked whether Lord Laming's nine key recommendations had been put in place. More than two thirds of respondents (71 per cent) said they had not introduced all of them. Nearly half (48 per cent) said recommendation 78, which crucially states health professionals should work from a single set of records for each child, was still not in place.

Asked the question: "Post Laming, do you feel enough is being done to modernise child protection services within the NHS," a third (33 per cent) of respondents said no. Amongst anonymous comments made by NHS staff during the survey, one said: "As far as I'm concerned child protection in this country takes a back seat... until another tragedy occurs."

Commenting on the survey's finding, Lord Laming told Five News: "It vividly illustrates just how far we've got to go before the recommendations of the report have become a reality and there are better outcomes for children across the country. "It is, in my view, unacceptable that in this day and age we are in a situation where in some places the system is working well and therefore within the available resources it is possible to do it, but in other parts of the country, the system is not working well."

Victoria's mother Berthe said: "Six years on, I still find it incredible in such a great country that something like that could happen. "Today, here in the Ivory Coast, when you see a child who you suspect is being badly treated, you do all you can to help them. "But with Victoria, in Great Britain, nobody noticed. Nobody helped her. They didn't see her. She was alone. "You have to put children first. They are still innocent. They do not deserve to be harmed. Remember Victoria."

Source

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

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

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24 May, 2006

NHS WASTES MONEY ON DUBIOUS TREATMENTS WHILE DENYING PATIENTS PROVEN TREATMENTS

A group of Britain's leading doctors has urged every NHS trust to stop paying for alternative medicine and to use the money for conventional treatments. Their appeal is a direct challenge to the Prince of Wales's outspoken campaign to widen access to complementary therapies. Public funding of "unproven or disproved treatments" such as homoeopathy and reflexology, which are promoted by the Prince, is unacceptable while huge NHS deficits are forcing trusts to sack nurses and limit access to life-saving drugs, the doctors say.

The 13 scientists, who include some of the most eminent names in British medicine, have written to the chief executives of all 476 acute and primary care trusts to demand that only evidence-based therapies are provided free to patients. Their letter, seen by The Times, has been sent as the Prince today steps up his crusade for increased provision of alternative treatments with a controversial speech to the World Health Organisation assembly in Geneva. The Prince, who was yesterday given a lesson in crystal therapy while touring a complementary health unit in Merthyr Tydfil, will ask the WHO to embrace alternative therapies in the fight against serious disease. His views have outraged clinicians and researchers, who claim that many of the therapies that he advocates have been shown to be ineffective in trials or have never been properly tested.

The letter criticises two of his flagship initiatives on complementary medicine: a government-funded patient guide prepared by his Foundation for Integrated Medicine, and the Smallwood report last year, which he commissioned to make a financial case for increasing NHS provision. Both documents, it is claimed, give misleading information about scientific support for therapies such as homoeopathy, described as "an implausible treatment for which over a dozen systematic reviews have failed to produce convincing evidence of effectiveness". The letter's signatories include Sir James Black, who won the Nobel Prize for Medicine in 1988, and Sir Keith Peters, president of the Academy of Medical Science, which represents Britain's leading clinical researchers.

It was organised by Michael Baum, Emeritus Professor of Surgery at University College London, and other supporters include six Fellows of the Royal Society, Britain's national academy of science, and Professor Edzard Ernst, of the Peninsula Medical School in Exeter, who holds the UK's first chair in complementary medicine. The doctors ask trust chief executives to review their policies so that patients are given accurate information, and not to waste scarce resources on therapies that have not been shown to work by rigorous clinical trials. They conclude: "At a time when the NHS is under intense pressure, patients, the public and the NHS are best served by using the available funds for treatments that are based on solid evidence."

Professor Baum, a cancer specialist, said that he had organised the letter because of his "utter despair" at growing NHS acceptance of alternative treatments while drugs of proven effectiveness are being withheld. "At a time when we are struggling to gain access for our patients to Herceptin, which is absolutely proven to extend survival in breast cancer, I find it appalling that the NHS should be funding a therapy like homoeopathy that is utterly bogus," he said. He said that he was happy for the NHS to offer the treatments once research has proven them effective, such as acupuncture for pain relief, but that very few had reached the required standards "If people want to spend their own money on it, fine, but it shouldn't be NHS money."

The Department of Health does not keep figures on the total NHS spending on alternative medicine, but Britain's total market is estimated at 1.6 billion pounds.

Source



CARELESS NHS SURGICAL TRAGEDY

What a culture of quotas and minimal accountability produces. In private medicine, doctors are much more likely to listen to patients

A surgeon "in a hurry" removed the wrong kidney from a patient and left her dependent on dialysis because he did not bother to read her medical notes, a disciplinary hearing was told yesterday. The General Medical Council was told how Jerome Blanchard took out his patient's transplant kidney, which was still functioning, instead of her diseased natural kidney.

Although both kidneys were on the patient's right side, she had told the surgeon that it was the painful polycystic organ that was to be removed. The fitness to practise panel was also told that Dr Blanchard did not bother to discuss the operation properly with the woman when obtaining her consent for surgery at the Middlesex Hospital, Central London, in March 2004.

Lydia Barnfather, for the council, said that if Dr Blanchard had discussed the operation sufficiently with the patient it would have become clear what operation needed to be performed. "The impression he gave her was that he was in a hurry," she said. "Dr Blanchard examined her and while he was doing so Patient A told him it was her enlarged polycystic kidney that was to be removed and she demonstrated the region of that."

But it was only when the patient's daughter noticed after surgery that there was no catheter to support the transplant kidney that Dr Blanchard realised that he had taken out the wrong organ, the GMC panel, sitting in London, was told. Although the transplanted kidney, which the patient received in 1994, was going to have to be removed eventually, the patient still had plenty of time before it needed to be taken out.

There were other factors, including confusion on the theatre list, that contributed to the wrong organ being removed, the panel was told. "The mistake would never have been made if Dr Blanchard had been carrying out his own duties with regard to getting an informed consent," Ms Barnfather added.

The patient, a mother of three who is now on dialysis for four hours three times a week, said that her diseased kidney needed to be removed because she was in constant pain and had a swollen stomach. She told the panel that she had been expecting to see Dr Blanchard the evening she went into hospital but did not see him until shortly before the operation the next day, after she attended an outpatient appointment for a thyroid condition.

"He examined my stomach and he kept asking me where is my transplant kidney and I said, `It's here'. I said to him, `You know it's the big polycystic kidney that is coming out'," she said, and added that he did not seem to respond. "My whole stomach was out there. You couldn't miss it," she said.

The GMC was told that an abbreviation for transplant was marked on the consent form that the surgeon gave Patient A to sign. The patient said that she had not noticed the abbreviation, and would not have let the operation go ahead if she had seen it. "I just signed it because I trusted him," she said. "He didn't say anything about what operation he was going to perform." She was now back on the transplant list, but did not know how long it would be before another kidney became available.

Dr Blanchard has admitted to removing the wrong kidney but denies misconduct relating to a failure properly to discuss the procedure with the patient or ensuring that he was performing the appropriate surgery. The hearing continues.

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 May, 2006

AN ALTERNATIVE FOR THE DENTALLY DEPRIVED BRITISH?

Colin Lamont is all smiles after saving $45,000 -- a 75 per cent discount -- by having major dental work overseas. The former state MP, whose teeth were damaged by a terrorist's bomb 30 years ago, is so impressed he's now booking Australian patients into a Philippines dental clinic. Mr Lamont, 64, from the Gold Coast, was quoted $60,i?00 by his local dentist for extensive work that included several implants, 29 crowns, three bridges and seven root canals.

"The cost was astronomical. By going to the Philippines I could save $45,000 -- that's what I call a saving," he said. "I wanted a Western-trained English-speaking dentist, with a guaranteed standard of hygiene. Once I had a name, I booked."

He decided to explore the overseas option after reading a report in The Sunday Mail about cheaper dental surgery in Asia. Fish shop worker Harry Sharpe, from Currumbin on the Gold Coast, had been quoted $15,000 by a local dentist for two bridges, a crown and four fillings, only to pay $1200 for the same work at a private clinic in the Philippines.

In the report, the Australian Dental Association warned people to do their research, because while they might initially save money there could be the need for corrective surgery on their return. The report sparked numerous calls to The Sunday Mail from Queenslanders seeking the cheaper surgery but not sure who to book with. And it made Mr Lamont take extreme care in choosing an overseas dentist.

"They are dead right. That's why we have set up a service to offer reassuring testimonials for Australians who really want to go," he said. "Manila is a great place. It's clean, inexpensive, the dentists are English-speaking and Western trained. You can save 75 per cent of dental costs, have a holiday with the savings and still have money left over. My wife is delighted. She thinks she's married to a piano."

Mr Lamont, the Liberal MP for South Brisbane from 1974 to 1978 and the former Queensland chairman of the Australian Council for Education Standards, has set up a company dealing in dental tours. He said several people had booked and he had at least a dozen messages here from people waiting for bookings. "It's not for people who have one crown or a couple of root canals, but once the price gets over $5000 the savings are worthwhile."

Mr Lamont's extensive dental work was due to long-term problems caused from a terrorist attack in Hong Kong in 1976. The then young detective inspector of police was attempting to dismantle a home-made bomb when it exploded a metre away. "I had 11 teeth knocked out and both my ear drums were blasted," he said.

The above article appeared in the Brisbane "Sunday Mail" on May 21, 2006

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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 May, 2006

Can "Left and Right" meet over 'health and wellness'?

Can free-market healthcare really happen, given the essential Balkanization of political views in America? On so many issues, hardline positions on some aspect of the question have been preventing even civility from prevailing, let alone allowing the synergy of issue-based coalitions to form.

However, health concerns might finally be one of those areas where agreement across conventional barriers might actually become possible. The fact that we are all human, and all mortal, is starting to unite people who would normally cross the street to avoid confronting one another (or at the other extreme, be prepared to draw down at the slightest provocation?), around the concepts of wellness, self-responsibility and community-based and voluntarily funded healthcare.

Examples abound. In fact just in today's (Tuesday) stories, right here in the Medical Freedom Channel, there are encouraging signs. The five commentaries are about vaccinations and mercury poisoning; the misuse of power in the AIDS battle (comparing it to the War on Iraq); the dangers of ADHD medications; the Massachusetts healthcare reform proposal; and . an advice column on healthy exercise in "pollen season." Four out of five are current-event topics in the news today. The irony is the sources of those four pieces .

The vaccination story comes, not from the expected "right-wing" sources, but from the progressive site, Common Dreams. Similarly, the AIDS story is from Lew Rockwell.com, normally seen as conservative or right-libertarian in nature, but taking a rather "progressive" view on this subject. And the other two are also unexpected: ADHD meds is attacked by a Sierra Times poster, while MassCare is under scrutiny from a columnist who normally splits time among the Boston Globe and more progressive sources like The American Prospect.

Where am I going with this? Essentially I am noticing more and more often that the traditional left-right schisms are blessedly beginning to fade, at least among those who truly do believe they are fighting a battle intended to increase liberty and allow freer exercise of our lives. It may well be that, even while the imperialist neo-cons (and the liberal-socialists who purport to "oppose" them) continue to have "slap fights" over how to divide their power - as the Leviathan state just keeps on growing and denying our liberties - a coalition of erstwhile enemies is forming around them, perhaps creating bridges that might end up leading us to a freer and healthier world in spite of the power-brokers. And it may also be that the healthcare issue might be the catalyst for creating this unity.

If progressives can be concerned about "purity of essence" and cry out against additives in vaccinations . If conservatives can be concerned about the impurities in our foods and embrace "natural healing" options . If there is common ground between the absolutist positions on birth control and emergency contraception methods, or on hospital clinics and health insurance .

What if healthcare issues turned out to be the thing that wakes up Americans, and others around the world who truly care about freedom and the right to make choices, and begins leading us to that brighter future we all say we want to create? What if the simple act of putting power battles aside, and focusing our attention on promoting self-responsibility, compassion for others and a sense of prosperity that knows that "there is enough" to go around . leads us to the free(r) society so many of us claim we really want?

Source



Medicare Beneficiaries Rush To Enroll

After procrastinating for weeks, Medicare beneficiaries flocked to senior centers across the country and made frantic telephone calls to insurers Monday to beat the deadline for getting prescription drug coverage as the initial enrollment period ended. "There seems to be a panic out there right now," said Brian D. Caswell, who runs a pharmacy in rural Baxter Springs, Kan. "Many of the people who waited this long spend only $30 a month on drugs, and they're being asked to spend about $30 a month on premiums for a prescription drug plan."

Carol H. Carter, an insurance counselor at LIFE Senior Services in Tulsa, Okla., said Monday: "It's pretty crazy around here. We are overwhelmed. We can't help everyone who has called. At the end of the day, there will be some people who do not receive individual help because they waited to the last minute."

First lady Laura Bush and Michael O. Leavitt, the secretary of health and human services, went to a church here to broadcast a final message. "Even if you are not taking any medications, it's really important to go ahead and sign up now," Bush said. "As you age, it's likely that you will add medications to your health care." Leavitt said the administration opposed extension of the deadline, and he defended the financial penalty that will be imposed on most people who are eligible now but defer enrollment to 2007 or later.

Others in the administration and members of Congress from both parties said they supported the idea of waiving the late enrollment penalty for 2006. The penalty will increase future premiums 7 percent or more, for an expected surcharge of $2.50 a month next year.

For months, the Bush administration has been urging insurers to hire additional telephone operators to cope with the expected last-minute surge in enrollment. But stark differences were evident at the two biggest Medicare insurers, UnitedHealth Group and Humana, which together have 45 percent of the market. Calls to United's toll-free number on Monday were generally answered within two minutes. People calling Humana's line often had to wait more than 30 minutes. The wait on Medicare's toll-free line often exceeded 15 minutes.

Source

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

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

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21 May, 2006

U.K.: WHAT'S A FEW BILLION BETWEEN FRIENDS?

A new generation of hospitals will overshoot its original budget by at least 3.5 billion pounds because of unrealistic planning and expensive delays, The Times has learnt. Most hospital projects are running at more than double their projected cost. The spiralling overspending is being blamed on a lack of financial scrutiny by the Government and local health trusts.

The average bill for the 18 largest schemes under development has risen by 117 per cent. All of them started with budgets of at least 75 million pounds. The Department of Health said initially that all budgets predicted to overrun by more than 10 per cent would be appraised immediately. But action was taken only recently. The National Audit Office (NAO) will publish a damning critique today of a 1 billion pound project to build a health "campus" in Paddington, West London. After six years of planning, arguing and miscalculation, the project was cancelled last May, at a cost of 15 million, leaving the area with the same three rundown hospitals with which it started.

The report says that the failure was a lesson for everyone involved in the NHS's capital investment programme and illustrated the need for far more rigorous Government monitoring. Britain is building more large hospitals than all the other G7 nations put together. Economists are concerned that many will come into use just as annual NHS spending increases slow in 2008. The 300 million Paddington scheme, which involved the redevelopment of St Mary's, Harefield and the Royal Brompton, fell apart after its budget tripled and a proposed completion date slipped by seven years to 2013. The partners in the project could not acquire enough land, could not agree whether the scheme was affordable and planning eventually forecast a reduced demand for beds in the area.

Projects of a similar size are under way at the Royal London Hospital, Barts and in Birmingham and Leicester. Another 14, all worth more than 75 million, are running at more than double their initial budgets. About 5 billion worth of Private Finance Initiative (PFI) hospitals have been built or are under construction. The cost, which is "off-budget", is paid back by trusts over several decades. Another 6 billion of projects are out to tender and have had their strategic outline cases approved.

In January, after a government "reappraisal" of PFI costs, Patricia Hewitt, the Health Secretary, said that the future plans would be cut back by between 25 and 40 per cent. It is not yet known how such savings will be made. In the NAO report on the Paddington fiasco, the Auditor General, Sir John Bourn, highlighted fatal flaws missed by officials at local and national levels.

More here



Another attempted coverup in Queensland that is not going to work

It will all come out in court

A former whistleblower who was suspended after complaining about the treatment of people with disabilities at Brisbane's Basil Stafford Centre has been sacked. In February, The Courier-Mail reported that Kerry Crossingham, a residential care officer who worked with residents at the notorious facility, had been suspended on full pay since last July after alleging people with intellectual disabilities were being isolated and locked up for long periods. The treatment contravenes Disability Services Queensland's statutory requirements and policies.

Yesterday Mr Crossingham said he had received a letter of dismissal, the grounds for which included him harassing DSQ executive director Evan Klatt by sending emails relating to his complaints to Mr Klatt's home computer, and failing to follow a direction to supply his current home address to the department.

Mr Crossingham, who was nominated for an award for his work in 2004, said the Basil Stafford resident about whose treatment he had complained was still being "detained illegally". "They have no legal authorisation to lock him up and he is one of a number of intellectually disabled people whose liberty is currently being deprived illegally by DSQ," he said. "There is no statutory authority stating that residential care officers are authorised to lock these people up virtually, in some cases, in solitary confinement."

Mr Crossingham said he would take his case to the Queensland Industrial Relations Commission.

Source. More on the Basil Stafford Centre for the intellectually disabled 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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20 May, 2006

Medicaid reforms in Oklahoma -- offering choice

The state Legislature here is working to finalize an agreement for Medicaid reform legislation creating personal health accounts (PHAs) for Medicaid enrollees. This comes hard on the heels of similar innovations in South Carolina and Florida. Reform is in the air--much the way it was when Wisconsin revolutionized its welfare system in the early 1990s, forerunning a stunning national success. Are we on the verge of consumer revolution in health care?

It is of course too soon to tell, but the Oklahoma case study is auspicious. The state's antiquated Medicaid bureaucracy has fostered, by turns, a lack of patient choice, provider dissatisfaction, a 9.5% payment error rate, and an escalating price tag of some $3.5 billion. Against these discouraging trends, state leaders spent six months last year formulating stopgap measures with state agencies, policy innovators, providers and beneficiaries.

Instead of assuming the indigent are incapable of decision-making, Oklahoma legislators proposed that Medicaid beneficiaries be given a risk-adjusted allowance to purchase private health insurance. A PHA would be established for annual out-of-pocket expenses without a "use it or lose it" penalty--that is, the unspent balance could be used for future health-care needs. They state would not mandate a homogenous set of benefits; instead, it would provide financial assistance and patient counseling.

The reform passed the Oklahoma State House in March and recently won Oklahoma State Senate approval. The bill's sponsors, Republican Rep. Kris Steele, and Democratic Sen. Tom Adelson, are working to craft a durable bill to send to the governor by the end of this year.

Oklahoma is simply coming to grips with reality--Medicaid needs fundamental change. Although the program subsidizes care for 52 million low-income people, Medicaid's price tag threatens the financial stability of many states. South Carolina's expenses, for instance, have virtually doubled in the past decade, and may consume nearly one-fourth of the state's budget in 2010. Nationwide, Medicaid spending grew 9.1% in 2004 alone, and is projected to be at nearly half a trillion dollars in less than a decade. Fiscally conscious governors and state legislatures have traditionally controlled Medicaid expenses through reductions in enrollment, benefits and provider reimbursement. Tennessee governor Phil Bredesen, for instance, culled 190,000 from the Medicaid rolls.

But Oklahoma, South Carolina and Florida have embarked on a path that is at once less draconian and yet more radical. All three states have taken the step of permitting Medicaid enrollees to choose health services and providers for themselves. South Carolina, for example, puts a set amount every year into each enrollee's PHA, to be spent as he or she sees fit. The benefits of this simple but revolutionary system will be enormous: Health costs remain low, government outlays stable and state finances healthy. Private accounts will introduce market incentives into the Medicaid system, lightening obligations all around.

Medicaid enrollees can shop for care and increase their chances of receiving the care they need. (Not surprisingly, current Medicaid enrollees have more unmet needs than similar adults with private health insurance.) Health-care providers, compelled to compete for Medicaid customers will likely offer more consumer-oriented services at competitive costs.

Critics of Medicaid choice argue that such plans have several intrinsic flaws. Some view the plan as wasteful, citing Medicaid's already low per-patient cost. But these "low costs" come at the participants' expense. Physicians, scared off by the drastically low level of state reimbursement for Medicaid providers, refuse to take them on as clients. In South Carolina, 30% of physicians refuse to accept any new Medicaid enrollees. With the new regime, physicians will have increased freedom to price competitively.

What about the common charges that Medicaid choice works only in states with numerous managed care providers? One need only look at Georgia and Ohio to refute this claim. Both states drew enthusiastic crowds of providers after they enacted Medicaid choice plans, including Goliaths of the business like Aetna, United Health and Anthem.

But these are side issues for the real opponents of Medicaid choice. They inevitably trot out a familiar, patronizing argument. Medicaid enrollees, they claim, are either not educated enough to be trusted with their own health, or lack access to necessary sources of information. Yet patients make intelligent decisions--when we let them do it. For instance, disabled people in government-run "cash and counseling" programs--monthly, need-based health allowances, spent at the discretion of the participants--consistently receive better care than those who lack discretion.

Even in the private sector, evidence favors consumer-driven plans. Definity Health and Cigna, both providers of consumer-driven insurance policies, have actually documented a reduction in flare-ups among their diabetic and asthmatic enrollees due to increased testing and drug compliance. McKinsey & Co. found that members of consumer-driven health plans were more likely to follow the complicated treatment routines necessary to hold chronic diseases at bay.

Conventional wisdom is usually posed against reform; and it seems even less trustworthy regarding Medicaid. We now stand at a crossroads, similar to the one 15 years ago regarding welfare. Strong-arming enrollees and providers with rationing tactics is not the only way, and surely not the best way, to control Medicaid costs.

We can move beyond the "Scrooge" option. Letting consumers drive the system is better both for the health of patients and the solvency of their home states. Oklahoma is the latest example of an encouraging trend.

Source



In the Australian State of Victoria, the sick suffer while the wait grows and grows

An average of 83 seriously ill or injured people each day are stranded on emergency department trolleys for more than 12 hours. Secret figures obtained by the Sunday Herald Sun show 30,332 Victorians in 2005 waited on trolleys for more than 12 hours before being admitted to wards. That is nearly three times the 1999 total of 12,603. The damning statistics were obtained through a Freedom of Information request. The State Government ditched trolley figures from its public statement on hospitals' performance in 2004.

Health experts say the system is at breaking point, with hospitals running at 96-99 per cent occupancy, when they should be at 85 per cent. Opposition health spokeswoman Helen Shardey said emergency departments were in meltdown because of Labor Government neglect. "The Government spends millions of dollars on health advertising and goes to extraordinary lengths to hide the truth about what's happening in our hospitals. It it time they were held to account," she said.

The Sunday Herald Sun found:

* AN 82-year-old woman with a broken arm waited six hours without painkillers before medics even bandaged her in one emergency department.

* SEVERAL patients walked out of an emergency waiting room after an elderly woman was left lying in faeces on a trolley for more than an hour.

* AN AVERAGE of nine people a day were last year stranded on trolleys for more than 12 hours at Northern Hospital, which produced the state's worst figures.

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 May, 2006

NHS EYE DRUG DISGRACE

Who cares if you lose your sight? Not the bloated NHS bureaucracy!

Thousands of patients whose sight could be saved by a new drug are being denied treatment on the NHS on the ground of cost. Macugen, a new treatment for age-related macular degeneration, is launched today but primary care trusts (PCTs) are already telling patients that they will not pay for it. A quarter of a million people in Britain suffer from "wet" AMD, the form of the disease that Macugen can treat. Every year, 21,000 more people, mostly over 60, have this form of the disease diagnosed. But Macugen has not yet been cleared by NICE, the National Institute for Health and Clinical Excellence, and will not be for at least another year.

Specialists fear that many patients will go blind while they wait. The delay has been condemned by the Royal National Institute of the Blind (RNIB)which has given warning that many patients will lose their sight before a decision is made on approving the drug. "We already have evidence that this drug is not getting to patients because PCTs are hiding behind NICE, saying that they can't approve a treatment until NICE makes a ruling on its effectiveness, said Steve Winyard, head of research for the RNIB. "If this happens across the country then we are going to see many people lose their sight and their independence to do things like drive and go shopping, so we are urging health trusts to think long and hard before they say no to patients getting Macugen."

Ophthalmologists are excited by Macugen, the first of a new class of treatments that can attack the underlying cause of the disease. A second medicine, Lucentis, which some specialists believe will prove even more effective, is awaiting licensing in the US and Europe. But both are relatively expensive - Macugen costs 4,000 pounds per patient a year - and a NICE ruling on their cost-effectiveness is not expected until August next year. Kevin Gregory-Evans, a consultant at the Western Eye Hospital in London, said of Macugen: "This really is a major step forward in fighting AMD. "Previously we had very little to offer patients once the disease started to become active, and so severe loss of vision was an inevitable consequence of developing AMD. So to have an effective drug is absolutely marvellous."

Both drugs are monoclonal antibodies that target VEGF (vascular endothelial growth factor), a protein that helps the formation of new blood vessels. In the eye, high levels of VEGF can cause proliferation of blood vessels and fluid leakage, the characteristics of "wet" AMD. Sufferers begin to lose central vision, making it impossible for them to read or drive. Although they may retain sufficient vision for independent life, their quality of life is very seriously damaged. "Unlike glaucoma or cataracts, very few people have heard of wet AMD - yet it has a major impact on patients' daily lives, depriving them of their central vision, independence and ability to complete every day activities, such as driving, shopping and cooking," said Philip Hykin, Consultant Ophthalmologist at Moorfields Eye Hospital, London.

Macugen, made by Pfizer, is given by injections into the eye every six weeks.

More here



FDA to be bypassed to save lives?: "On May 2, a three judge panel of the D.C. Circuit recognized that 'a terminally ill, mentally competent adult patient's informed access to potentially life-saving ... new drugs ... warrants protection under the Due Process Clause.' The decision stemmed from a case challenging FDA regulations, which require experimental drugs to go through a lengthy series of FDA managed clinical trials before they are available to patients. That red tape can be a death sentence for patients in dire need, whose lives may well depend on access to the new medicine. Following some of the language of the D.C. Circuit's opinion, law professor-bloggers Jonathan Adler and Orin Kerr then described the case as a decision that recognizes a new 'right to experimental drugs.' A Washington Post editorial went further, charging that the D.C. Circuit pulled this right to experimental drugs 'out of thin air,' 'call[ing] into question the whole fabric of drug regulation.'

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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 May, 2006

Massachusetts's health plan affects privacy and liberty

People across the nation are applauding the Massachusetts effort to increase access to health care, improve its quality, and reduce costs by forcing every resident to purchase medical insurance. It's going to be an interesting and important task to measure objectively how the Massachusetts experiment actually works-or doesn't-to achieve those goals during the coming years.

But some results we don't need to wait for. It's crystal clear (upon reading the actual bill text) that the plan invades everyone's privacy by requiring insurers and health-care providers to submit patient data to a centralized clearinghouse (a new council). And it's clear that forcing Americans to buy a product from a limited number of government-approved insurers limits their freedom of choice. There is a huge difference between freedom and choice: freedom means one is free to choose from an array of options not artificially limited by the government, while choice may include only an artificially limited number of options.

Also, it's obvious that the Massachusetts plan will interfere with every citizen's right to maintain private contracts with health-care providers. If providers are forced to submit patients' data to a centralized clearinghouse, there is no way for patients and their providers to maintain truly confidential relationships.

Perhaps New Hampshire and other surrounding states should make sure their laws uphold the precious ethics of privacy and consent. Then at least some Massachusetts residents (those with means to do so) would be free to go out of state to maintain confidential doctor-patient relationships. And after all, New Hampshire's state motto is "Live Free or Die." Better yet, all states' policies should encourage citizens to live free and thrive! Laws that uphold the ethics of privacy and consent can ensure that.

Source



Massachusetts Health-Insurance Bill Mandates New Taxes and Privacy Invasions

On Tuesday, April 4, the Massachusetts House and Senate Conference Committee reached a compromise on a first-of-its-kind legislation that requires everyone in the state to have health insurance or pay a fine... The plan includes new taxes on businesses that don't provide insurance, a requirement that everyone purchase health insurance or be penalized and chilling new invasions into personal privacy.

The legislation includes new Medicaid expansions and the "Connector," modeled after the Federal Employees Health Benefits Program, a per-person business "assessment" (read: tax) on firms not offering insurance. Most problematic, the bill provides new government authority to extensively track each person's private health insurance and medical data. "This program is being sold by the governor as a 'free market' proposal," stated JP Wieske, State Affairs Director for the Council for Affordable Health Insurance (CAHI). "But this plan is a roadmap for a single-payer system that will be a disaster for Massachusetts taxpayers and patients."

The legislation gives the government broad new invasion-of-privacy rights:

* Individuals must provide "Health Insurance Responsibility Disclosure" forms-signed under oath-that can be investigated by the insurance commissioner. The bill also includes other extensive data-reporting requirements. Business owners must also sign the disclosure.

* The "Connector"-a non-state entity-and other information-gathering agencies can request any information on the business and its employees they deem necessary. Employers not providing insurance not only pay a $295 tax [per employee], but once their employees' and dependents' state-paid health care costs exceed $50,000, employers are responsible for between 10 and 100% of the bill....

"After years of debate over health-care reform, is this the best Massachusetts can do!?" asked Dr. Merrill Matthews, Director of CAHI...."It's not a model for reform, but a costly, invasive boondoggle..."

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 May, 2006

BRAINLESS BRITISH AMBULANCE SERVICE

Put your brain out of gear (and forget how to read a map, and don't listen to anybody) when you go to work for the government

An ambulance took almost two hours to take an injured girl to hospital after it was misdirected to the scene of the accident by its satellite navigation system. Chloe Banks, 10, was left lying in the road in the village of Greenside, near Gateshead, for almost an hour waiting for an ambulance after she was injured in a car smash. The crew then took such a circuitous route to the accident and emergency department of the Queen Elizabeth Hospital that the child’s older brother, Colin, 20, questioned the driver. He was told that they were following the directions of the satellite navigation system.

Maggie Banks, 39, the injured child’s mother, has complained that Chloe was knocked down three weeks ago outside a new skate park in the village at 1.30pm, but did not arrive at the hospital until 3.20pm. She was treated at the scene by a rapid-response paramedic within six minutes and is now on holiday with her family in Spain and making a full recovery. Mrs Banks said: “Fortunately, her injuries were not more serious. I would not even like to think about how it could have been.”

A subsequent inquiry by the North-East Ambulance Service established that there were no ambulance crews in Gateshead to ferry the child to hospital. A crew from Sunderland were called at 1.54pm after they dropped off a patient in Newcastle. The crew, who were unfamiliar with the area, were further delayed when the satellite navigation system guided them down a road in nearby Ryton that was too narrow for the ambulance. Although within sight of the scene, the crew were forced to back up and find another way, finally arriving at 2.26pm.

Mrs Banks, who travelled in the ambulance, was shocked when the ten-mile journey to the hospital took another 40 minutes. The navigational aide directed the crew along a B-road, rather than the more direct route along the dual-carriageway A695. Mrs Banks, a cleaner, said: “Chloe was lying on the ground vomiting and bleeding and she kept saying to me, ‘Mum, am I going to die?’. We had to wait almost an hour for the ambulance to come and take her. “I thought then we would go straight to the QE but they went around Rowlands Gill and Swalwell. My son told the crew it would have been quicker going to Ryton on the bypass, but the lady who was driving said she was going off the navigational system.” Mrs Banks, married to Colin, 43, a driver, has raised concerns about the system with the ambulance trust.

A North-East Ambulance Service spokesman said that they understood Mrs Bank’s concerns. However, he emphasised that paramedics arrived within six minutes and the child was treated at the scene. It was the transportation rather than emergency treatment that was subject to a delay. The journey from Newcastle to Greenside is 10.3 miles and should take no more than 20 to 25 minutes. A reporter drove from the crash site to the hospital yesterday, using local knowledge, in 22 minutes.

Source



BRITAIN: RED TAPE FOR CHOCOLATES NOW!

Nurses may be more used to monitoring heart rates, breathing patterns and blood pressure, but a new and rather more surreal target has now been added to their duties. Clearly dissatisfied with the findings of countless annual surveys, targets and inspections, audit-hungry hospital managers in the West Country have hit upon what they believe is a more accurate indicator: chocolate. Bemused staff have been instructed to complete a “chocolate audit” of gifts that they have received from grateful patients — from boxes of Milk Tray and bottles of wine to cards and flowers.

Every time a nurse receives a present — a “gesture of gratitude” — they are now required to fill out a form stating what it is, who it is from, and how much it is worth. While managers at Royal Cornwall Hospital NHS Trust claim that the audit provides a good picture of patient satisfaction, the move has been criticised by staff representatives and health watchdogs for increasing the burden on overworked staff.

Managers said that the “gestures of gratitude” count is already helping to refine hospital care. Records in 2004-05 for the trust’s three acute hospitals — in Treliske, Penzance and Hayle — reveal that there were 8,000 gestures of gratitude, including gifts and letters. There were, however, 316 complaints. “Keeping records of how many boxes of chocolates and thank you cards we get might seem trivial and a waste of time,” a spokesperson said. “But such gestures are a good way of measuring patient satisfaction and receiving feedback. We also carry out patient surveys. “It’s important staff know their efforts are appreciated by the public, and it doesn’t take very long to carry out.”

But the scheme, which is also up and running at Derriford Hospital, a part of Plymouth Hospitals NHS Trust, has not been universally welcomed. Jono Broad, of North Devon Patient and Public Involvement Forum, described the measure, at a trust that is £8 million in debt and facing 300 redundancies, as “management madness in the extreme”. ”If the staff don’t fill out the forms recording the gifts they get into trouble with management,” he said. “They have to record how much the gift is worth, who it came from and then it’s all shoved in a cupboard.”

Nursing leaders also dismissed the idea. Howard Catton, head of policy at the Royal College of Nursing, said that keeping a log of gifts was “about as useful as a chocolate teapot”. “The process of auditing performance in a hospital is crucial but trying to do so by counting biscuits is completely useless,” he said. A spokesman for Unison, the public sector trade union, described registering gifts as an unfathomable waste of time. She said: “Nurses need to spend all their available time with patients, carrying out their duties. Visit any hospital and you will see nurses rushing around with enough to do. “They work exceptionally hard and that is the true measure of performance, not who decides to give them a box of Maltesers.”

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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16 May, 2006

Competition is the way

"When businesses compete, you win," is true for consumers in every industry in America. From cell phones to computers, quality is improving and costs are shrinking as companies fight to offer the public the best product at the best price. But this philosophy is sadly missing from our health-care insurance system.

Health care comprises nearly 20 percent of our national economy, but outdated bureaucracy and red tape have stifled competition and raised costs. As a result, today more than 45 million are without any health coverage.

As President Bush and many others have noted, our third-party payer health-care system was built for the world of yesterday, not the opportunities of tomorrow. The current patchwork of state regulationhascreated50 mini-monopolies that are driving up costs for everyone, and no one bears this burden more than the ill, the elderly, and the working poor. New regulations cannot solve the problem, because excessive and unnecessary regulations are the problem.

In the past 30 years, state governments have instituted more than 1,500 mandated benefits. According to the Council for Affordable Health Insurance, these mandates have increased the cost of individual health insurance by as much as 45 percent in some markets. Some people may not want or need health insurance coverage for drug abuse treatment, hair pieces, or acupuncture -- but if the state they live in mandates it, they can only buy policies with that coverage. You can be sure the policies are more expensive as a result. Speaker Dennis Hastert likened the situation to requiring everyone to purchase a Cadillac when all they want or need is a Chevy.

To address this problem, we have introduced the Health Care Choice Act, which would break down these state-imposed barriers to affordable insurance. Under the Health Care Choice Act, individuals would continue to shop for health insurance as they do now -- in consultation with an insurance agent in their hometown, online, by mail or over the phone. But consumers would no longer be limited only to policies that meet their state's regulations and mandated benefits. Instead, they would be able to select from a wide array of insurance policies that are qualified in one state and offered for sale in multiple states, thus allowing them to choose the policy that best suits their needs -- and their budget.

For example, families could choose between similar policies with a $500 deductible that cost $3,780 in New Jersey, $1,471 in Maine, $466 in Wisconsin, or $355 in Arizona. With this huge variation in price, it's clear that consumers who already have health insurance -- especially those in excessively regulated states like New Jersey -- would see substantial savings. Plus small-business owners, young people and low-income working families who are currently priced out of the market could afford health insurance.

Additionally, this bill would allow insurance companies to consolidate administrative functions by making them comply with only a single state's review of coverage and qualifications, as opposed to 50. The savings would invariably find their way back to consumers as insurance companies lowered premiums to compete for business.

Not surprisingly, this bill faces opposition from lobbyists who have a vested interest in protecting the current monopoly system. Naysayers have already started claiming the sick will be left with skyrocketing premiums and unwitting consumers will be preyed upon by unprincipled insurers in under-regulated states. Scare tactics are always a predictable last resort of monopolies.

The good news is, Americans know firsthand the benefits of a free market -- more choices, lower prices, higher quality -- and there is no reason why we cannot help them see these same benefits in health care. This includes high-risk consumers, who would even have the option to decline coverage they don't truly need, thus increasing their savings even more. And states, currently charged with protecting their residents, will still have the capability and responsibility to go after insurance carriers that victimize consumers. Under this bill, states will simply be held accountable to reconcile their regulatory policies with the realities of a competitive market -- something they already successfully do in nearly every other sector of our economy.

The choice for the future of American health care is clear. Either we continue to allow bureaucrats and regulators to call all the shots and watch costs and the number of uninsured surge or we take steps to create a bold new patient-centered health-care system that puts Americans back in charge.

With the nation's health on the line, Congress must rise to the challenge and empower consumers,offerthem choices, and restore affordability. In doing so, we can insure that America's health care slogan for the 21st century will be "When insurance providers compete, patients win."

Source



Another abuse from the nasty Queensland government health system

David Gray's experience would be many people's worst nightmare. He went to a hospital for help with depression - and was locked up in a mental health ward without explanation under an Involuntary Treatment Order. During his 11 days in the ward, neither he nor his wife, Yvonne, was given any reason for his detention - or for the ITO. Under Queensland's mental health laws, Mr Gray could have been detained for two months until an independent Mental Health Review Tribunal was required to review the ITO. However, more than 80 per cent of ITOs are revoked before a patient is put before the tribunal, preventing many ITOs from being independently reviewed.

Until he went to Brisbane's Princess Alexandra Hospital three weeks ago, Mr Gray said he had no history of mental health, no history of violence, and no history of trying to harm himself. The 50-year-old builder admits he has been suffering from depression and has been on a variety of medication over the past five years to try to control it. Recently he said he was tired of the side-effects of the medication and wanted to see if counselling could help him to manage his illness without medication. He and his wife agreed he should go to the Community Mental Health service at Annerley to discuss what was available.

"My depression hit me after I stopped taking medication. I knew I was going to go down with my depression. I had been off them (depression medication) just over two weeks. It started to level off and I was coming out of my depression two days before my interview at Annerley," Mr Gray said. "I went to the interview in excellent spirits as I was looking forward to being able to speak to a psychiatrist to help me." Mr Gray said he talked to a nurse, who recommended that he go to PA Hospital where he could voluntarily admit himself into its mental health unit if he felt he needed to.

Soon after arriving at PA Hospital, Mr Gray found himself being escorted to its mental health unit by an orderly and two security guards. "I was starting to smell a rat. I thought: 'I am still in a hospital - they have professional staff here that will take care of me.' "At that stage I did not know they had made an assessment and put an ITO (Involuntary Treatment Order) on me." "It was not until the next day I knew this was not a hospital, it was a prison. And these are not nurses, these are jailers." After 11 days of incarceration, Mr Gray managed to escape from the mental health unit.

He says the entire saga has done more to damage his health than the original depression he wanted treated. A Queensland Health spokeswoman said the Health Services Act 1991 provided for the protection of patient confidentiality, and the department could not comment on individual patient matters. "A patient can be admitted voluntarily but changed to involuntary if they are assessed by the treating doctors as meeting the criteria for involuntary treatment under the Mental Health Act 2000," the spokeswoman said.

Source

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

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

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15 May, 2006

Medical charity illegal, insane U.S. government agency says

"Thou shall not commit charity." So decrees the federal government, under the 1996 HIPAA and other laws and regulations. In Western Civilization, ethical requirement for personal fulfillment once included charity and charitable action. How did this ethic get turned on its head?

Once again, incompletely-considered intentions have gone awry. And this particular awryness goes back at least 40 years, when the federal government got into the business of paying for medical care big time, with the Medicare and Medicaid programs. In addition to politicians garnering political points, votes and political campaign contributions, another intention was to help older Americans get medical and hospital coverage. These government officials have been worried that doctors might inflate charges for patients covered by Medicare. So, the bureaucrats and Congress made rules limiting what doctors could charge for services rendered to Medicare recipients. Government bureaucrats allowed the small fries (such as doctors and hospitals) to collect only their lowest price for goods and services.

From the beginning, doctors had trouble keeping up with government regulations and filling out the claim forms. This paperwork is like having to fill out an individual income tax return to the IRS for every patient. The doctor is responsible for coming up with politically-correct patient information, code numbers, modifiers and other minutiae lest he be convicted of insurance fraud and sent to jail for five years. Oh, I almost forgot to mention, the degree of fraud has to be significant, defined as at least $100, under the 1996 HIPAA Law.

In the late 1960s, Dr. James Baker of Aberdeen WA charged $8.00 for a standard office consultation. But when a patient on blood pressure medicine came in to have blood pressure checked, Dr. Baker couldn't justify charging the full $8.00 so he charged a more charitable $4.00 instead. Because the government had to get the best price, the Medicare bureaucrats informed the doctor that as far as the Medicare program was concerned his fee for his standard office consultation was actually $4.00, not $8. So, the government would pay him or reimburse patients the usual 80 percent, or $3.20.

Oh, yes, and he better try really hard to collect that other 80 cents or the government would conclude that his usual fee was actually only $3.20, and the government would pay 80 percent of that, or $2.56; the formula spirals downward from there. So, if a doctor charitably charged less to poor patients, the government paid the doctor no more than the fee paid by these charity patients. Some doctors became charity cases themselves. Of course, there could be exceptions, if you knew your way through the Magic Code Book and kept bureaucratic-style records meeting the bureaucratic requirements du jour. If some doctor or hospital was rash enough to treat charity patients for free, the government would conclude that was the usual fee and pay nothing for services rendered to government patients.

Indeed, this seems to be the approach to several charity hospitals that had the gall to continue their charitable mission. They get into trouble when they only give charity to human beings and not to Medicare apparatchiks. This is exactly happened to the 161 bed Deborah Hospital in New Jersey. The hospital never charges patients for medical services. But the hospital did collect from Medicare when patients had Medicare coverage.

As medical lawyer Madeline P. Cosman, Ph.D., writes "the U.S. Department of Health and Human Services prosecuted Deborah over the course of four years because Deborah accepts Medicare payments without requiring patient copayments and therefore violates a slew of civil and criminal laws. "By following its own three-quarter-century-old mandate to never charge patients, Deborah Hospital was accused of granting incentives for referrals, submitting false claims to the government, unfairly competing with community and other specialty hospitals, and generally flouting White Coat Crime laws ... Medicare has no obligation to pay for hospital care that the patient gets as a free gift."

The "false claims" charge alone carries a $10,000 fine, per incident, plus triple damages. Each patient charge can be prosecuted as a separate false claim. "Deborah's refusal to violate its free care mandate that defies medical law nearly forced the generous doors and charity operating rooms to close shut. In 2003, Deborah Hospital finally got a reprieve, a waiver enabling them to continue their tradition of not charging copayments" writes Cosman.

Deborah Hospital was presumed guilty, until proven innocent or granted a waiver from the boss. So, in order to keep government prosecutors at bay, doctors and hospitals who have contracts with Medicare or private insurance companies are essentially forced to charge their highest fees so that the government can't accuse them of cheating. These fees are like the "rack rate" room charges posted in hotel rooms. In our experience, these posted hotel charges are always a lot higher than what you actually pay and are apparently posted because of some "consumer protection" regulation. Just as individuals, travel agents and businesses negotiate lower rates for hotel rooms, insurance companies and individuals negotiate lower rates for hospital rooms, at least with some hospitals.

At least this bureaucratic inversion of charity is now coming to public attention. The Robert Wood Johnson Foundation paid for a study of 6,600 physicians that found that 68 percent of doctors now say they deliver any free or discounted assistance to low-income patients. This is down from 76 percent a mere 10 years earlier according to Donald Devine, former director of the Federal Employees Health Benefits and Civil Service Retirement programs in an article published in the Washington Times two days after April Fools Day.

It took a study to find out what doctors have been experiencing for several decades. Although Devine "had managed the largest employer health insurance plan in the nation and written often on health matters" this problem had escaped his notice, he writes. "When one reads about doctors being hauled off to jail for fraud, odds are this is the cause: Guilty not of fraud but of charity."

Source



More on Queensland's crooked health bureaucrats

But the government is still lying

The State Government has released the names of three senior bureaucrats suspended in the wake of the latest Queensland Health bungle. The three are being investigated by the Crime and Misconduct Commission for their role in the appointment of a nurse with false qualifications and subsequent disciplining of a doctor who complained. The three were identified as Prince Charles Hospital acting district manager Michael Cleary, Statewide Health Services executive director Linda Dawson and Gloria Wallace, general manager of Central Health Area Services.

A spokesman for Health Minister Stephen Robertson said Ms Wallace was flying back from a private trip to Britain. The Government strenuously denied she was part of the British recruitment team headed by Premier Peter Beattie. But sources told The Sunday Mail Ms Wallace had been in Britain in an official capacity.

It has been revealed Health officials were warned more than a year ago about the threat of a Jayant Patel-like situation after the nurse's appointment. A confidential email that expressed concern about the risk to patient safety was ignored.

The State Government this week was forced to apologise to Dr Chris Davis, head of rehabilitation and aged care at Brisbane's Prince Charles Hospital, after he was ignored, then disciplined, for raising concerns about the nurse. Dr Davis sent an email to two senior health officials in April last year dealing with the performance of new nursing manager Virginia Hancl. He had spoken to Ms Hancl's former manager, who was surprised she had been appointed without any reference checks. Queensland Health had only called her boyfriend, listed as a referee. Dr Davis warned that trying to manage someone who should not have been appointed was like "trying to improve the performance of Dr Patel".

Opposition health spokesman Bruce Flegg slammed Queensland Health for the cover-up. "These revelations make a mockery of the Government's claims things are getting better," he said.

Source

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

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

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14 May, 2006

THE AUSTRALIAN PUBLIC MEDICINE MELTDOWN CONTINUES

Three more reports below on government control of medicine:

Universities producing doctors trained as social workers

University medical schools have filled their curriculums with "soft" subjects to such an extent they are now busy turning out a generation of "medical social workers and medical psychologists" instead of doctors. One of the country's top neurosurgeons warned that the decline of anatomy teaching was "a growing cause of concern, to the point of panic" among many surgeons, who felt powerless to stop the universities cutting traditional science subjects.

Leigh Atkinson, associate professor of neurosurgery at the University of Queensland, said the downgrading of science in favour of soft topics such as communication skills meant young doctors "haven't got the basics they have to build their medical thinking on". Professor Atkinson said junior doctors' understanding of anatomy was "very poor". "I think the people running the medical schools have to justify to the profession why they are changing direction, and what are the benefits of changing direction," he said. "It would seem they are trying to turn our medical students into glorified social workers... we are going to be producing medical social workers and medical psychologists."

Professor Atkinson said senior doctors "do not feel the universities are listening to the clinical colleges" about what skills medical students needed. "There's this big rush to see how much money they can get ... I think they are forgetting the basic principles."

The Weekend Australian on Saturday revealed widespread alarm among senior doctors over the decline in anatomy training to make way for "touchy-feely" subjects such as "cultural sensitivity". One group, the Australian Doctors' Fund, sent a dossier to the federal Government last week detailing its concerns.

Final-year Monash University medical student Michael Gardner said up to 25 per cent of his course was now focused on cultural sensitivity and other subjects such as ethics, law and "personal development". Sensitivity training taught students that some ethnic groups had "different expectations" of doctors, and that they should "be aware that things you say may be viewed in a different way than how you intend". A smaller module on personal development focused on "relaxation techniques" and "how to manage stress".

Education Minister Julie Bishop said she was "concerned by the issues raised" in the ADF submission, which will be considered in a current review of medical education.

Source



Medical schools in new alert on anatomy teaching

Three more doctors' colleges have raised concerns about the standard of teaching in medical schools, with one warning that doctors' skills risk being taken "back to the Middle Ages" by cutbacks to the basic sciences. Amid a continuing row over the downgrading of anatomy teaching, the Royal College of Pathologists of Australasia has opened a new front, warning that the problem extends to other basic sciences such as pharmacology and pathology, the study of the disease process. Anaesthetists, obstetricians and gynaecologists have added their voices to the concerns, saying the gaps now evident in junior doctors' knowledge raise questions over the extent to which they could practise safely if they did not do further training after university.

RCPA president Stewart Bryant said universities had slashed pathology tuition so much that many newly graduated doctors were "often quite unsure" what pathology tests they should order to confirm or exclude a diagnosis. "That's another fallout of this - it's something we are observing routinely," Dr Bryant said. "If you go back to the origins of the names of diseases, malaria means 'bad air'. Do we want to go back to believing malaria is caused by bad air, when modern medicine shows us it's caused by a parasite in the blood? "Pathology started 250 years ago and has taught us this basic information about the disease process - and we risk losing that, we risk going back to the Middle Ages."

The Weekend Australian last week revealed a coalition of senior doctors and academics had called on the federal Government to step in to sort out the "appalling" state of medical education. But the deans of the nation's 17 medical schools have strenuously denied their courses are failing to equip medical students with essential knowledge, and have accused critics of resisting necessary change. The Royal Australasian College of Surgeons is in talks to arrange remedial training courses in anatomy for junior doctors entering its own specialist training program, saying their anatomical knowledge was "unacceptably low".

The president of the Australian and New Zealand College of Anaesthetists, Michael Cousins, said the teaching of communication skills was important, but that graduates "need to have a fundamental knowledge of the major structures in the human body". "We are finding we have to do more work with students, especially those coming out of four-year programs, in bringing them up to speed," Professor Cousins said. "It raises some concern, I suppose, with us that the people who aren't coming to us for further education, but go out practising as doctors or GPs, may not necessarily have as much knowledge as they should have."

John Svigos, chairman of the training and accreditation committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said almost all the colleges shared the concerns and would discuss them when college presidents meet later this month. John Carmody, who taught physiology and pharmacology at the University of NSW for more than 40 years, said many medical courses had now changed the sequence of education in a way that made it harder for students to apply the knowledge.

Source



Health bureaucrats at last get some blame

The Queensland Government has suspended three senior health bureaucrats, pending the outcome of an investigation by the Crime and Misconduct Commission (CMC). The Director-General of Queensland Health Uschi Schreiber referred the matters to the CMC last week after receiving new information from a doctor that raised concerns about possible misconduct. The Queensland Government was forced yesterday to apologise to Dr Chris Davis after he was disciplined for raising concerns about a nurse hired on fake qualifications and recommendations of her boyfriend. Health Minister Stephen Robertson said he had personally apologised to Dr Davis, who heads the rehabilitation and geriatric unit at Brisbane's Prince Charles Hospital. Mr Robertson said based on new information, Dr Davis had been given whistleblower status and his disciplinary record cleared.

A decision today by a delegate of the Public Service Commissioner found that Queensland Health had denied natural justice to the senior doctor as he was not given an opportunity to respond to a charge against him. Dr Davis was disciplined last September after raising concerns about the abilities of a nurse employed in a senior role in his unit. The nurse's competence also was questioned in a written document by 18 other staff members in the unit. The Opposition revealed yesterday the nurse had been hired despite presenting fake qualifications of a masters degree from a university in Tasmania where she had nursed in an old age home. It also said Queensland Health had failed to question the nurse's previous employer, interviewing only one referee who turned out to be her boyfriend.

Opposition health spokesman Dr Bruce Flegg said Dr Davis was "very distressed". "All his hard work to build the rehabilitation unit has been blown out of the water," Dr Flegg said. "Three-quarters of the staff has left and the unit is in disarray." The future of the nurse in question, who has been on leave without pay since last August, will be determined following the CMC report.

The case raises fresh concerns of bullying in Queensland Health, following the case of Bundaberg nurse Toni Hoffman whose complaints about rogue surgeon Jayant Patel were initially ignored....

More here

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

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

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13 May, 2006

Study: Four out of 10 Medical Malpractice Cases Are Groundless

About 40 percent of the medical malpractice cases filed in the United States are groundless, according to a Harvard analysis of the hotly debated issue that pits trial lawyers against doctors, with lawmakers in the middle. Many of the lawsuits analyzed contained no evidence that a medical error was committed or that the patient suffered any injury, the researchers reported. The vast majority of those dubious cases were dismissed with no payout to the patient. However, groundless lawsuits still accounted for 15 percent of the money paid out in settlements or verdicts.

The study's lead researcher, David Studdert of the Harvard School of Public Health, said the findings challenge the view among tort reform supporters that the legal system is riddled with frivolous claims that lead to exorbitant payouts. "We found the system did reasonably well in sorting the good claims from the bad ones, but there were problems," he said.

However, the American Medical Association, which favors caps on malpractice awards, called the study proof that a substantial number of meritless claims continue to slip through the cracks, "clogging the courts" and forcing doctors to waste time defending them, association board member Dr. Cecil Wilson said in a statement.

The findings were published in Thursday's New England Journal of Medicine. The study found 3 percent of claims analyzed were filed by patients who had no injury. Of the claims that involved injuries, two-thirds were caused by medical error. But the remaining injury claims, or 37 percent, lacked evidence of a medical mistake, and most of those -- 72 percent -- were thrown out or otherwise resolved without a payout to the patient. Altogether, the Harvard researchers reviewed 1,452 malpractice claims randomly selected from five insurance companies. The cases were resolved -- meaning they ended in a verdict, a settlement or a dismissal -- between 1984 and 2004. The claims resulted in a combined $449 million in verdicts and settlements. The researchers examined medical records, depositions and court transcripts to determine if the patients were injured and whether the injury was due to a medical error.

In one instance, a young woman with no family history of breast cancer underwent routine breast exams for four years and came back with a clean bill of health. But doctors later found she had breast cancer that had spread to other parts of the body. The researchers determined the case did not involve medical error because proper procedures were followed. The woman filed a malpractice claim and received an undisclosed settlement.

The study also confirmed that defending a claim is expensive and long, taking an average of five years to resolve. It also found that for every dollar awarded to patients, about half went to cover lawyer fees and other expenses. Chris Mather, a spokeswoman for the Association of Trial Lawyers for America, said the study was biased because data was taken from insurers, which sometimes are the defendants in malpractice suits.

The debate over malpractice litigation simmered in Congress this week when Senate Democrats defeated a pair of Republican-backed bills aimed at limiting how much pain-and-suffering damages juries can award in malpractice cases. Similar legislation already passed the House.

George Annas, a Boston University bioethicist who had no role in the study, said he was not surprised by the findings. Many personal injury attorneys receive a contingency fee -- meaning they get paid only if they win -- and will not go to court with a baseless lawsuit, Annas said. "There's really no motivation to bring a frivolous lawsuit," he said. "It's not worth their time and effort." Among the findings:

* An overwhelming number of malpractice claims (97 percent) involved a severe disability or death. Seventy-three percent of all of the injury claims that were due to medical error were settled with a payment.

* In about a quarter of cases where a groundless claim was settled, the average payout was lower than that given to a legitimate claim ($313,000 versus $521,000).

Source



THE STEADY DECLINE OF AUSTRALIAN PUBLIC MEDICINE CONTINUES

Three stories from one day below:

Queensland Health: Nurse-hiring as incompetent as its doctor-hiring

Queensland Health appointed a senior nurse with false qualifications and called her boyfriend as her principal referee, State Parliament was told yesterday. The three-year-old blunder is now under investigation by the Crime and Misconduct Commission after it was revealed that a senior doctor who raised concerns about the appointment was disciplined and ignored by the department.

The Opposition yesterday issued a list of allegations against Prince Charles Hospital nursing manager Virginia Hancl, suggesting she was removed from clinical duties in her previous job because of concerns about her nursing skills. It was also alleged she falsified her master's degree in public administration from the University of Tasmania and the doctor discovered her past employer had not been contacted about a reference. The Opposition said the fiasco bore striking similarities to the Jayant Patel scandal, where nurse Toni Hoffman was ignored after complaining about the surgeon's ability, and accused the Government of attempting to cover up the matter.

After uncovering the concerns last year, doctor Chris Davis sought a review of Ms Hancl's appointment and applied for whistleblower protection, but instead was disciplined for breaching her privacy. Yesterday, Health Minister Stephen Robertson admitted the reference check had not been thorough and involved someone close to the nurse. "In terms of the referee that was contacted, that referee did not disclose the personal relationship he had with Hancl at that point in time," he said.

Defending yet another Queensland Health bungle, Premier Peter Beattie said the matter was a product of "the old" Queensland Health. "What you've got . . . is the legacy of the bad old days of Health - the new days are on the way," he said. Mr Beattie said any staff found to have erred would have "the book thrown at them". The department where the woman worked at Prince Charles will be reviewed to decide whether her appointment and the ensuing staff concerns resulted in reduced services.

The admissions are in stark contrast to comments last November when Mr Robertson said two internal reviews had found no problem with her appointment, her reference checks were "appropriate" and she was fully qualified. Yesterday, Mr Robertson said he had acted "decisively and transparently" when the real facts of the matter came to light in May, when the department prepared documents before an industrial relations hearing into Dr Davis's appeal for whistleblower protection. Since then, Mr Robertson has apologised to the doctor, offered to pay his legal fees, strike the disciplinary action from his record and give him whistleblower protection.

Ms Hancl is still employed by Queensland Health but has been on unpaid leave for several months. Mr Robertson said there was no evidence that any patients had experienced adverse outcomes as a result of her appointment.

Source



Resigning surgeons 'had no choice': "One of four urological surgeons, who have resigned from Sir Charles Gardiner Hospital, says they had no choice but to quit in protest over delays in treating patients and ever-increasing waiting lists. Robert Davies and three other specialists will leave the hospital within six weeks. He says surgeons, nurses and other medical workers at the coal face feel disenfranchised with the health system. "We don't feel as though we have control or any real input into the way the system is organised and run," Dr Davies said. "What we see at the end of the line is a diminishing resources in the face of increased demands."



Superbug link to 103 deaths in Victoria's public hospitals: "A deadly superbug has been linked to 103 Victorian deaths in public hospitals. The MRSA superbug, a multi-antibiotic-resistant golden staph, has infected 1447 Victorians who were admitted to Melbourne hospitals last year. Department of Human Services figures show Bayside Health, which oversees the Alfred hospital, had the highest number of MRSA cases of all Melbourne health networks. More than 530 patients admitted to Bayside hospitals had MRSA -- 29 of them died. At Southern Health, which includes the Monash Medical Centre and Casey and Dandenong hospitals, 17 patients with MRSA died. And 11 patients died at Northern Health, which runs the Northern Hospital in Epping. MRSA, or methicillin-resistant staphylococcus aureus, is spread by doctors and nurses who have not washed their hands properly, and by dirty hospital equipment. The bug can be found in harmless levels on the skin, but once it enters the bloodstream it can become lethal... Department of Human Services acting director of quality and safety Alison McMillan said 75 per cent of Victoria's MRSA cases caught the superbug in hospitals. Ms McMillan said MRSA rates had improved since the introduction of a hand hygiene program in all Victorian hospitals last year, but there was still a lot of work to be done. "It's not an easy area to tackle, it's an enormous challenge," she said. "We've got this rolling program of educating hospitals, setting up systems to encourage people to use the hand gel, but that's going to take some time because there are a lot of hospitals in Victoria."

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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 May, 2006

Australia: Public medicine demands coverups

There is so much failure to conceal

Specialist doctors say governments are gagging them from speaking out about serious flaws in the public hospital system that are costing lives and harming their patients. Members of the Royal Australasian College of Physicians (RACP) have complained they are being forced to sign public hospital contracts preventing them from telling the public about major problems affecting health care Australia-wide.

They said a 30 per cent drop in the number of hospital paediatric wards since 1992 had resulted in children being placed alongside adults who were sometimes psychiatrically disturbed or dying. "I know of children having adult emergency patients in the adjacent bed," Melbourne-based physician Peter Lazzari said in Cairns, where he was attending the RACP's annual scientific conference. "That adult emergency may be a death or a cardiac arrest or a massive haemorrhage, and you can imagine the trauma to the child as a result of that deliberate exposure by the government of children to adult illness," Dr Lazzari said.

Rural Victoria-based paediatrician Peter Goss said he risked the sack for speaking out, but could no longer continue to remain silent when children's welfare was at stake. "It's the first time in a year that I've said anything because speaking out in public prior to that caused me such significant emotional stress from the harassment," Dr Goss said. "These sorts of scandals would not be propagated if the medical staff were allowed to openly ... tell the general population what's going on. "Children will get better more quickly in an environment which is child-friendly and will be cared for more safely if we retain nurses with paediatric experience. "Over the last three years across Victoria, there are multiple examples of hospitals who have downsized children's wards and co-located adults in those wards. "An entire children's ward in Ballarat was closed last year."

Dr Lazzari said governments, both state and federal, had forced medical practitioners to become unwilling jailers and executioners, having to tell patients they might have to wait years in pain for necessary surgery and might even die waiting. "Instead of a diagnosis and an operation, we're actually ... giving those patients who can't get through the waiting list system a sentence," he said. "We say 'yes, you need that hip operated on otherwise your health is going to continue to deteriorate. "'You're going to have continuing pain, continuing suffering, your weight's going to become more of a problem, your exercise program is going to become more of a problem, and you may well die because it's going to be five or six years before you get your operation. "'We're giving you a term of imprisonment with your illness and ultimately you may well die'. "It's a disgrace," he said.

Dr Lazzari said he had decided to speak out because he believed doctors had a major democratic responsibility to raise issues of concern with public health. "We need to be able to speak up freely, but accurately and fairly," he said.

Source



One Australian coverup comes unglued

Queensland Health has been forced into another embarrassing backdown after admitting it wrongly disciplined a whistleblower doctor. The doctor had exposed serious concerns about a senior manager at the Prince Charles Hospital. The man was disciplined last year after checking into the background of a woman appointed to a senior nursing position at the hospital when he had concerns about her ability and referees.

However, the department has now been forced into an about-face, admitting it was wrong, and the matter has been referred to the Crime and Misconduct Commission for investigation. Health Minister Stephen Robertson yesterday told State Parliament that at a May 5 meeting, he personally apologised to the doctor and offered to pay his legal fees and strike the disciplinary action from his record. "We also accorded the doctor with whistleblower status, and the director-general of Queensland Health has taken steps to ensure that he will not be disadvantaged because of the disclosures he has made," Mr Robertson told Parliament.

The doctor first raised concerns about the woman's ability to manage her position and the process of her appointment with hospital management in April last year. He asked for a review of the appointment process, saying her former supervisor had not been contacted as a referee by the hospital before the woman was hired in 2003. Despite the doctor seeking whistleblower protection in May last year, Queensland Health took disciplinary action against the doctor in September for breaching the woman's privacy. He appealed against the action.

Mr Robertson said the incident demonstrated the importance of the soon-to-be-established independent Health Quality and Complaints Commission, which would ensure the concerns of staff and the public were properly managed. The issue was first raised in State Parliament last November by Liberal Party health spokesman Bruce Flegg, who accused the department of ignoring complaints from 18 staff about the woman's appointment and shredding documents relating to the issue.

At the time, the hospital said the appointment had been endorsed by two external reviews. Yesterday, Dr Flegg said the incident had all the hallmarks of poor Queensland Health management including staff bullying and decisions by bureaucrats not clinicians. "This was an appalling episode in the management of a critically important clinical unit," he said.

Source

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

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

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11 May, 2006

IN SOCIALIZED MEDICINE, TREATMENT IS A PRIVILEGE THAT CAN BE WITHDRAWN, NOT A RIGHT

A pro-life campaigner who sent hospital staff pictures of mutilated and aborted foetuses has been denied hip treatment. Edward Atkinson, 74, was jailed for 28 days and given a five-year antisocial behaviour order for sending offensive photographs to the Queen Elizabeth Hospital in King's Lynn, Norfolk. The pensioner has been taken off a waiting list for an assessment for a hip operation and banned from treatment for anything other than life-threatening conditions.

The move was criticised yesterday by an anti-abortion group backing Atkinson. James Dowson, the national co-ordinator of the UK Life League, said: "It is ridiculous. I think it is completely unfair. They are refusing to treat him. Would they refuse a murderer or a paedophile? "He has paid his taxes, he is entitled to that treatment, who are they to withhold it from him?"

Atkinson, of Hilgay, Norfolk, was jailed at Swaffham Magistrates' Court on Thursday last week after he was convicted of three counts of sending offensive literature or material to staff at the hospital between January and April this year. A hospital spokesman said that the pensioner had been on a waiting list for an assessment for a hip operation when he started sending in pictures of aborted foetuses. The NHS trust wrote to him asking him not to send such material to the hospital as it was distressing staff. When he continued, the trust said he had broken its "Zero Tolerance" policy with regards to staff. Ruth May, chief executive of the Queen Elizabeth Hospital, said: "The trust's view is that we have a duty of care to our staff." [But no duty to people who have paid for care?]

Source



U.K.: 340 MILLION POUNDS FOR NOTHING

A new contract for hospital consultants cost at least 340 million pounds in its first two years but offered patients few improvements in care, a report has found. The King's Fund, an influential health think-tank, says that rushed implementation, a failure to cost the contract properly and a preoccupation with other problems mean that hospitals, the NHS and patients have failed to get much benefit. The result is that consultants are being paid more money for doing the same work as previously, while hospitals are running deficits caused, in part, by the cost of paying them.

Despite promises by Alan Milburn, then Health Secretary, that the new contract would reduce moonlighting by consultants, private work may actually have increased. Mr Milburn claimed that the contract, the first change in consultants' terms and conditions since 1948, was a "something for something" deal. But the King's Fund concludes that it was closer to something for nothing. Niall Dickson, the chief executive of the charity, said: "Consultants are at the core of the NHS and deserve to be paid well for the work they do. However, the Government promised that this contract would also bring benefits to patients and so far that does not appear to have materialised. This is a limited study and these are early days, but it raises profound questions about the effectiveness of the deal and what now needs to be done to ensure that it delivers greater productivity."

Paul Miller, chairman of the BMA consultants' committee, said that the report was limited, inaccurate and based on a small sample of senior managers in five London trusts. "Blaming the consultant contract for the financial crisis facing the NHS is an easy option," he said. "Many NHS trusts are in debt because they are struggling to shake off years of under-investment. They also face rising drug costs and an ever-increasing number of patients. The blame for the NHS funding crisis lies with an incoherent and inconsistent health policy, riddled with errors and misjudgments."

The consultants' contract, which was finally agreed in 2003, aimed to give management greater control over doctors' activities in return for better pay. The report says that, under the old contract, hospitals and consultants had colluded in a deal that meant consultants worked very long hours. In return for this, managements allowed them to "do their own thing". The consultants worked hard, but wrote their own rules. The new contract aimed to define their work much more precisely, and was based on ten four-hour sessions, called programmed activities, a week. Consultants could do private work only if they offered their NHS hospitals an extra weekly session. In practice this lever proved worthless. There is so much work that the average consultant does more than eleven sessions a week, not the ten envisaged.

The contract cost the NHS 90 million pounds more than expected, in part because nobody in the Department of Health believed what the consultants told them about the hours they worked. Pay increased substantially, with starting salaries rising by 36 per cent since 2001 to 69,298 pounds in 2005. But corresponding improvements in productivity have been lacking, largely because managers have seen the contract as "a box to be ticked" rather than an opportunity for change. "There needs to be more emphasis at both national and local levels on how the contract can be used as a tool to benefit patients," Professor James Buchan, co- author of the report, said.

A spokeswoman for the Department of Health said: "NHS pay reform, including the consultant contract, has been part of a significant success story in the NHS. "There is still some way to go before we realise the full benefits of its implementation, but increasing pay rates is only one small part of the new contract." Alastair Henderson, deputy director of NHS Employers, said: "The focus is now turning to realising the benefits that can be provided for patients."

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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10 May, 2006

THE BRITISH DENTAL DISASTER

It takes socialism to send people back to the Dark Ages



"I snapped it out myself," said William Kelly, 43, describing his most recent dental procedure, the autoextraction of one of his upper teeth. Now it is a jagged black stump, and the pain gnawing at Mr. Kelly's mouth has transferred itself to a different tooth, mottled and rickety, on the other side of his mouth. "I'm in the middle of pulling that one out, too," he said.

It is easy to be mean about British teeth. Mike Myers's mouth is a joke in itself in the "Austin Powers" movies. In a "Simpsons" episode, dentalphobic children are shown "The Big Book of British Smiles," cautionary photographs of hideously snaggletoothed Britons. In Mexico, protruding, discolored and generally unfortunate teeth are known as "dientes de ingles."

But the problem is serious. Mr. Kelly's predicament is not just a result of cigarettes and possibly indifferent oral hygiene; he is careful to brush once a day, he said. Instead, it is due in large part to the deficiencies in Britain's state-financed dental service, which, stretched beyond its limit, no longer serves everyone and no longer even pretends to try. Mr. Kelly, interviewed in a health clinic here as he waited for his son to see a doctor, last visited a dentist six years ago, in Sussex. Since moving to Rochdale, a working-class suburb of Manchester, he has been unable to find a National Health Service dentist willing to take him on. Every time he has tried to sign up, lining up with hundreds of others from the ranks of the desperate and the hurting - "I've seen people with bleeding gums where they've ripped their teeth out," he said grimly - he has arrived too late and missed the cutoff.

"You could argue that Britain has not seen lines like this since World War II," said Mark Pritchard, a member of Parliament who represents part of Shropshire, where the situation is just as grim. "Churchill once said that the British are great queuers, but I don't think he meant that in connection to dental care." Britain has too few public dentists for too many people. At the beginning of the year, just 49 percent of the adults and 63 percent of the children in England and Wales were registered with public dentists.

And now, discouraged by what they say is the assembly-line nature of the job and by a new contract that pays them to perform a set number of "units of dental activity" per year, even more dentists are abandoning the health service and going into private practice - some 2,000 in April alone, the British Dental Association says.

How does this affect the teeth of the nation? "People are not registered with dentists, they can't afford to go private and therefore their teeth are going rotten," said Paul Rowen, the member of Parliament for Rochdale. Rotting teeth and no one to treat them are among his constituents' biggest complaints, up there with gas prices and shrinking pensions. Just 33 percent of the Rochdale population is signed up with a state dentist, down from 58 percent in 1997.

Nor is the level of care what it might be. The system, critics say, encourages state dentists to see too many patients in too short a time and to cut corners by, for instance, extracting teeth rather than performing root canals. Claire Dacey, a nurse for a private dentist, said that when she worked in the National Health Service one dentist in the practice performed cleanings in five minutes flat. Moreover, she said, by the time patients got in to see a dentist, many were in terrible shape. "I had a lady who was in so much pain and had to wait so long that she got herself drunk and had her friend take out her tooth with a pair of pliers," Ms. Dacey said.....

In Rochdale, people who have no dentist but who are in dire straits can visit an emergency clinic that very day - provided they can get an appointment. The phones open at 8 a.m.; the books are closed by about 8:10. "We see toothaches through trauma, toothaches through neglect, dental caries, dental abscesses, gum disease," said Dr. Khalid Anis, the clinical leader for the emergency facility, the Dental Access Center. "What we see is shocking." Dr. Anis enumerated some positive dental developments in Rochdale: a second, soon-to-be-opened clinic; an aggressive community-health program; a political push, finally, to fluoridate the water. But, he said, "sometimes I feel as if I'm hitting my head against a brick wall."

The waiting room at the center was a testament to his concerns. Sitting by the window was George Glasper, 81. One of Mr. Glasper's teeth had broken off a week earlier, but when he called his dentist, he was told the practice had become a private one. Efforts to sign up with four other dentists failed, he said. Nearby sat Shahana Begum, 27, a Bangladeshi immigrant with a bad toothache and no dentist. Her stepdaughter, Sanya Karim, 16, said her family had been trying to find a health service dentist for six years, since moving to Rochdale from Birmingham. Occasionally, Miss Karim says, she feels a twinge or an ache, but she tries to ignore it. "It normally goes away in a couple of days," she said.

In extremis, Britons can always buy dental emergency supplies made by a company called Passion for Health DenTek. These include materials that allow people to replace lost fillings, treat gum pain or reattach cracked crowns "until they can actually get in and see a dentist," said Jennifer Stone, the company's sales and marketing director. Sales in Britain have increased by 40 percent in the last year, Ms. Stone said. A recent Guardian newspaper article about the company titled "D.I.Y. Dentistry" (meaning Do It Yourself) said that the previous week British drugstores had sold 6,000 jars of the filling replacement, and 6,000 of the crown-and-cap replacement.

Ms. Stone, an American, says she is struck by the profound differences in attitudes about dental care in Britain and the United States. "Prevention and having nice white shiny teeth is a huge priority for us from the moment we're born," she said. "That doesn't seem to be the culture here. You've got a lot of tea drinkers; you've got a lot of staining. In the U.S., we go through a spool of dental floss in six weeks, on average. Here it's a year and a half." Back in Rochdale clinic, Dr. Anis laughed hollowly when the word came up in connection with his patients, who come from some of the area's most deprived neighborhoods. "Floss?" he said. "That's a good one."

Source



ROMNEYCARE'S RECIPE FOR UNEMPLOYMENT

The following post is lifted from Powerline. The major conclusion to be drawn from its revelations seems to be that the Massachusetts law substantially raises the cost of employing people

Last week the Wall Street Journal published a column by Elizabeth McCaughey on the fine print in the new Massachusetts law providing for compulsory health insurance. Governor Romney exercised a line item veto over one provision that would have required employers with 10 or more employees who don't provide insurance to start offering it or pay fees of $295 per employee. The Massachusetts legislature nevertheless overrode the veto, and Governor Romney appears to have been straining at gnats while swallowing camels. In her column McCaughey observes:

Everyone should have access to health care. Massachusetts aims to achieve this goal with a double mandate: All residents must have health coverage (Section 12) and all employers with more than 10 workers must assume ultimate financial responsibility if employees or their immediate family members need expensive medical care and can't pay for it (Sections 32, 44).

What is the impact on individuals? The state will offer subsidies to help low income residents pay for coverage (Section 19), but most of the uninsured earn too much to be eligible. An individual making $29,000 or more would probably have to pay the full cost or find a job that provides health insurance. Individual coverage costs about $3,600 in Massachusetts -- a hefty bill. Moreover, under the new law, individuals purchasing their own insurance must buy HMO policies. Preferred provider plans (PPOs) -- which give you more ability to choose your own doctors and treatments -- are not allowed (Section 65).

The impact of this law on employers is substantial. The original bill required employers with more than 10 full-time workers to provide all of them (and their families) with health insurance or to opt out of that requirement by paying a $295 annual tax per worker into a state fund. This modest penalty was highly publicized by the bill's supporters as proof that the bill would not be a heavy burden on businesses. Nevertheless, Gov. Romney vetoed it, perhaps to display his Republican credentials as a tax-cutter.

The Massachusetts House of Representatives overrode the veto -- but the reality is that the $295 penalty is small potatoes compared with the other obligations in the law. Say, for example, you open a restaurant and don't provide health coverage. If the chef's spouse or child is rushed to the hospital and can't pay because they don't have insurance, you -- the employer -- are responsible for up to 100% of the cost of that medical care. There is no cap on your obligation. Once the costs reach $50,000, the state will start billing you and fine you $5,000 a week for every week you are late in filling out the paperwork on your uncovered employees (Section 44). These provisions are onerous enough to motivate the owners of small businesses to limit their full-time workforce to 10 people, or even to lay employees off.

What else is surprising about this new law? Union shops are exempt (Section 32).

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People should be allowed to buy basic, high deductible insurance without costly extras. The new Massachusetts law allows only people under age 27 to buy such policies (Section 90).

McCaughey's column is unavailable to nonsubscribers. Brendan Miniter draws what appearst to me to be the appropriate conclusion in an OpinionJournal column that is accessible: "RomneyCare will turn out to be not only expensive but also a mandate for more government spending and more government intrusion."

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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.

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



9 May, 2006

Toxic fungus found at La Jolla hospital

The headline above is taken from the "Sacramento Bee" of California. In the body of the article we read of the fungus concerned: "It is harmless to healthy people". So much for "toxic". Most things are toxic in some dose and to some people, of course. Are peanuts "toxic"? They kill a lot of people who are allergic to them. Even common salt can kill you if you eat enough of it.

So why the scare headline? Why not, (say) "problem fungus"? Easy. Because it was a private hospital concerned -- and a Leftist rag that often puts up very cautious headlines (See e.g. here or here) could not resist letting their socialist hatreds out.

Aspergillus is of course an extremely common fungus in the environment and hence both difficult to eliminate and much less important to eliminate than many less common but highly virulent hospital-borne organisms.



Australian junior doctors to catch up on anatomy

Remedial courses in anatomy are being considered for junior doctors following complaints their anatomical knowledge upon graduation from medical school is "unacceptably low". Amid a push by senior doctors to increase the amount of anatomical teaching in universities, the Royal Australasian College of Surgeons says it is negotiating directly with university anatomy departments to provide extra tuition to get junior doctors up to speed before they enter surgical training.

Julian Smith, a member of the anatomy committee of the Royal Australasian College of Surgeons, said the "basic anatomical knowledge amongst graduating medical students at many universities is unacceptably low". Professor Smith -- a heart surgeon and professor of surgery at Monash University -- said he had some final-year medical students in his operating theatre to watch a live cardiac operation. "The heart was exposed and I pointed to a part of the heart and asked them to name it. They said 'the liver'. That was in my own university. "There are some fairly ugly anecdotes. I don't think too many of them are as bad as that, but it's a big worry."

RACS executive director for surgical affairs John Quinn said the college was "concerned about the level of anatomical knowledge of those wanting to enter the (RACS) training program". "That knowledge is much less than it used to be," he said. The college had already tried persuading medical schools to increase the anatomy training they provided, but the "community is demanding more from their doctor". "As many (medical school) courses have moved from being six years to four years postgraduate, the time is less and the demands are more and something has to give," Dr Quinn said. "The rationale (for cutting anatomy teaching) is that the only doctors who need to know anatomy are surgeons. That's rubbish, but it's the justification."

The Weekend Australian reported a coalition of concerned doctors had sent a 70-page submission to the federal Department of Education, Science and Training, calling for benchmarks on medical training and mandatory minimum standards for science teaching.

Professor Smith said when students encountered patients "their anatomical knowledge is often very weak and makes it difficult for them to appreciate many of the clinical conditions they might encounter". "If they don't know the normal, how can they understand the abnormal?" he said.

The Australian Medical Council accredits Australia's 17 medical schools and approves their curricula. Chief executive officer Ian Frank said the AMC set "general requirements" about the knowledge, skills and attributes that graduating doctors were expected to have after their education. "We have stopped short of saying that means you have to have done X-hundred hours of such-and-such, because there really isn't any evidence ... that says that 500 hours (of anatomy teaching) is better than 300 hours, or 100 hours," he said. "The studies that have been done here and elsewhere show the guys coming out (of Australian medical schools) are at least the equal of those from more traditional courses, and superior in some areas, such as interpersonal skills and capacity to work in collaboration."

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 May, 2006

MEDICAL POLITICS

A letter from a reader on the unwisdom of battles against bureaucracy such as that undertaken by Dr. Szabo in California -- a case referred to here yesterday:

"While I was an anesthesiologist at a major teaching hospital, the hospital administration hired a surgical specialist. The hospital paid good money to a search firm to find this doctor. But he had been at his last job less than a year.

Things went very wrong with this man from the start. He threw bags of IV fluids at anesthesiologists. He did a number of strange things, and behaved in a bizarre manner. A colleague found out all he needed to know with a few phone calls to those who had worked with him. Others discovered that he had been the same since his training. One by one, the anesthesia staff formally refused to work with this surgeon. Only I and two others (including the Chairman) would work with him after a few months.

On the day after I wrote a letter to the Chairman saying that I would no longer work with this man, the Chairman gave me a letter saying he would not renew my contract. He backed down when I said I would work with this surgeon. If I knew what I know now, I wouldn't have done so.

A few years passed, and I was again given a letter of non-renewal. I filed an appeal with the Medical School, with hearings and an attorney, etc. But, predictably, I was turned down by the Dean. [Of course, knowing what I know now, the Dean has only 2 options - fire me or the Chairman. Firing me was much less costly to him]

Fortunately, my attorney convinced me NOT to pursue this further. The case was much too complex for a jury. On the other hand, if I had filed an appeal immediately after the letter that I received one day after refusing to work with this incompetent surgeon (who was eventually removed from the staff -- in under a year. He had 7 lawsuits against him by this time), this would have been a "smoking gun" and would have been much easier to litigate. In addition, my attorney convinced me that, if I filed a lawsuit, I would be a "marked man' and likely unable to get a good job in medical schools.

And why, I asked myself, should I make life miserable for myself and others by forcing those who didn't want me to keep me on their staff? I took his advice, and got a better job. And no one has tried to fire me for the last 14 years".



DANGEROUSLY INSANE IRISH REGULATIONS

And there's no move to change anything, either

The life of a Newbridge baby was put at risk recently because of a restrictor device that limits an army ambulance to speeds of just 55 miles per hour. The 14-month-old baby had reportedly slipped into unconsciousness following a seizure, but when the anguished parents called 999 it transpired that all the ambulances at Naas General Hospital were out on call.

The emergency protocol then kicked in and the Eastern Health Board Regional Area (EHRA) called for backup from the Defence Forces at the Curragh Camp. In February, the army had bought a new 250,000 Euro state-of-theart Emergency Rescue vehicle as a back-up resource for the county. As this new ambulance was on stand-by in the army barracks on the Curragh, it was closer to Newbridge than any other ambulance that could be dispatched from Naas.

The parents, who were relieved that the medical experts were on hand to deal with their little boy, were unaware that the paramedics were secretly panicking. On the way to the hospital, the condition of the baby worsened, but instead of racing even faster the ambulance crew made a decision that baffled everyone. They pulled over and called Naas General Hospital to dispatch a different ambulance to collect the child.

The reason was that they didn’t trust their own vehicle to save the child’s life as a restrictor had been put on the engine. This meant that the highest speed the ambulance could reach was 90kmh (around 55mph); the speed limit on the motorway to Tallaght hospital is 120kmh.

Emergency response vehicles regularly break the speed limits to save lives, but if this ambulance had tried to rush the child to hospital the journey would have taken three times as long as it should. Since the incident, Naas General Hospital has not called on the services of the Curragh ambulance as emergency back up. The restrictor remains in place on that vehicle.

Over a typical weekend, the previous Military Medical Facility, which is no longer considered reliable or roadworthy, would have responded to up to 25 calls, but now people have to rely on back-up from Athy, which is at least 20 minutes away from Newbridge.

A spokesperson for the army said that the restrictor was a manufacturing design. He said: “It is a legal requirement to do with the weight of the vehicle, and is actually set higher than the legal speed limit for army vehicles.” He was keen to point out that the ambulance was for military use only and was only a back-up service for the EHRA.

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.

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



7 May, 2006

Tort reform brings doctors back to Texas

The Senate is once again taking up the issue of medical justice reform. If senators want to expand access to health care by increasing the number of physicians and lowering costs, they need to look at Texas. In the summer of 2003 the Texas Legislature enacted important medical litigation reform. A voter-approved constitutional amendment, Proposition 12, followed later that year to solidify the changes. As a result, physicians are returning to the state, particularly in underserved specialties and counties. Insurance premiums to protect against frivolous lawsuits have declined dramatically, with the state's largest carrier reporting declines up to 22% and other carriers reducing premiums by an average of 13%. The number of lawsuits filed against doctors has been cut almost in half.

Prior to the successful reform effort, personal injury lawyers had put Texas doctors on the run. According to the Texas Department of Insurance, the frequency of claims was increasing at a rate of 4.6% annually--between 1996 and 2000 alone, one out of four doctors was sued. These surging legal and insurance bills reduced patient access to health care. Texas fell to 48th out of 50 in physician manpower. There were 152 medical doctors per 100,000 citizens, well below the U.S. average of 196. Some 158 counties had no obstetrician. Good, competent doctors were closing their doors, unable to afford the cost of insurance.

Other industry players suffered as well. Hospital premiums to protect against the onslaught of lawsuits more than doubled between 2000 and 2003. From 1999 to 2002, the annual per-bed cost of litigation-protection insurance in nursing homes increased from $250 to $5,000--a factor of 20! Texas seniors were being displaced and deprived of care, as nursing homes closed, unable to afford the cost of escalating insurance premiums.

At the core of House Bill 4, led with remarkable courage and dedication by state Rep. Joe Nixon and state Sen. Jane Nelson, was a hard $250,000 cap on noneconomic damages for all physicians, with a separate $250,000 cap on noneconomic damages payable by hospitals and other providers. The law keeps doctors, hospitals and nursing homes liable for all economic damages assessed by a jury. HB 4 was modeled on California's successful 1975 Micra law, still on the books, keeping litigation-related costs under control and allowing competent doctors and hospitals to continue providing care.

Additional provisions of HB 4 included periodic payments for all awards greater than $100,000, procedural changes to address claim frequency, and Good Samaritan protections. This new law passed by a two-thirds majority in both chambers of the legislature and was integrated into the Texas constitution by voters later that same year. Importantly, the constitutional amendment prevents activist judges from ignoring the law and imposing a subjective opinion.

So what has happened since September of 2003, when the new law went into effect? After years of losing doctors, Texas has added nearly 4,000 since passage of Proposition 12, including 127 orthopedic surgeons, almost 300 anesthesiologists, over 200 emergency room physicians, 146 new obstetricians, 58 neurologists and 24 neurosurgeons. The Texas Medical Board is anticipating some 4,000 applicants for new physician licenses this year alone--double last year's numbers, and 30% more than the greatest growth year ever.

The threat of lawsuits has been a particular barrier to attracting and retaining pediatric specialists. Since 2003, Texas has gained 20 pediatric cardiologists, 14 pediatric oncologists, almost 50 new perinatologists (obstetricians specializing in high-risk pregnancies), 10 pediatric surgeons and 8 new pediatric endocrinologists.

Medically underserved counties in Texas are benefiting as well. Jefferson, Webb and Victoria Counties, as well as the counties of Cameron and Hidalgo in the Rio Grande Valley, have all experienced an influx of physicians. Additionally, the market for insurance to protect health-care providers against the cost of lawsuits has become more robust and competitive. In 2002 there were only four companies writing policies. Today that number has more than tripled. And all of these trends are expected to continue.

Gov. Matt Blunt and the Missouri Legislature enacted similarly tough medical liability reform in 2005. The state's citizens can expect to benefit from more doctors with lower liability premiums in the coming years as well, assuming no meddling by the courts.

The legislation to be considered by the Senate would ensure more predictability in our justice system by reining in the most egregious abuses by personal injury lawyers. In deference to states' rights, it does not pre-empt the noneconomic damage caps in place in 26 states whether they are higher or lower than the proposed federal standard. Thus, Texas, California, Missouri and Mississippi with strong caps will not be affected; similarly, a state like Nevada with weak damage caps also will not be touched. The Senate bill would apply only to states that currently have no damage caps in place.

Proper medical justice reform plays a central role in ensuring the availability and affordability of health care for families everywhere, and our elected officials should not underestimate how deeply this issue resonates with the American people. A March 2006 Gallup poll showed that "availability and affordability of health care" topped a list of 12 issues of most concern to Americans. A full 68% of respondents said they worried about this a "great deal," compared to 51% who were worried a great deal about social security, the next highest issue area.

In the coming days, our senators in Washington will have a chance to stand up with America's doctors and patients against the personal injury lawyers. Expect a brawl. On one side will be the lawyers, frantically attempting to protect and pad their wallets, while driving up costs for the American people and limiting our access to health-care providers. On the other will be the positive, pro-patient, pro-health-care story from Texas, a state which has taken an important first step toward creating a 21st-century health justice system that meets the needs of doctors and patients alike.

Source



BUREAUCRATIC NASTINESS IN CALIFORNIA PUBLIC MEDICINE

An orthopedic surgeon and tenured professor at the University of California, Davis, Medical School is suing the UC Davis chancellor and the medical school's dean emeritus, claiming he was subjected to retaliation for blowing the whistle on irregularities at a university clinic in Sacramento. In a lawsuit filed Thursday in Sacramento federal court, Dr. Robert M. Szabo alleges that a long-simmering feud between him and Dr. Joseph Silva, then the dean of the medical school, boiled over two years ago when Szabo complained about another physician's billing practices and the way Medi-Cal patients were being scheduled at the university's primary care clinic on J Street in midtown Sacramento.

On May 12, 2004, the day after Szabo was notified that his complaint was unsubstantiated, Silva ordered Szabo's academic and clinical offices moved off the UC Davis Medical Center campus to a primary care clinic in Carmichael and eliminated Szabo's block of operating-room time at the medical center, the suit alleges.

In November a three-professor panel of the university's Academic Senate, after conducting a hearing, sustained Szabo's grievance and found inappropriate conduct by Silva in retaliating against Szabo for his whistle-blower complaint, the suit alleges. It alleges that, on Feb. 9, the hearing panel reaffirmed its decision in response to the university's request for reconsideration. But, on March 29, "despite overwhelming evidence of willful misconduct and retaliation by former Dean Silva, Chancellor (Larry) Vanderhoef rejected the findings" of the hearing panel, the suit alleges.

The suit says that "power was abused by defendants Silva and Vanderhoef to punish and retaliate against Dr. Szabo for exercising his right of free speech protected" by the Constitution's First Amendment and those provisions of California's Constitution and statutes that protect whistle-blowers. Szabo is seeking $2.5 million general damages and $1 million punitive damages. "Dr. Szabo has been damaged in his reputation, professional standing, and has been subjected to emotional distress and upset and humiliation as he watched and experienced the unlawful, discriminatory and willful acts of the defendants," Szabo's attorney, Donald Heller, wrote in the complaint.

UC Davis spokeswoman Lisa Lapin said Thursday that Silva and Vanderhoef have not yet seen the complaint and would have no immediate comment.

The Academic Senate's three-member hearing panel found the evidence "supports the finding that Dean Silva acted out of personal animus toward Dr. Szabo in making the relocation decision," according to the panel's report. The report, which is attached to the complaint as an exhibit, notes that Silva claimed when he made the relocation decision that he was unaware that Szabo had made a whistle-blower complaint. However, the report states, "the very public and widespread knowledge of Dr. Szabo's complaint as early as late January and early February 2004 undermines Dean Silva's credibility on this point." "We find that, based on the totality of the circumstances, Dr. Szabo demonstrated by a preponderance of the evidence that his filing of a whistle-blower complaint was a contributing factor in Dean Silva's decision to relocate Dr. Szabo, and that the relocation was retaliatory."

The panel recommended Szabo's grievance be sustained and that he be reimbursed attorney's fees incurred pursuing the grievance. The university asked the panel to reconsider its decision, but the panel stood firm in its findings and recommendations. "Let us be clear," the panel said in its response to the university, "the consequences of the dean's decision had such a negative impact on the care of patients and the training of the fellows that animus is the only explanation the panel can come up with to explain why the dean made this change."

But Vanderhoef, in a March 29 letter to Szabo, rejected the panel's findings and recommendations and refused to uphold the doctor's grievance. "Absent findings of misconduct against Dean Silva, I do not find a preponderance of the evidence supports a conclusion that your rights and privileges as a faculty member have been violated," Vanderhoef wrote. "I find no persuasive evidence to support a conclusion that Dean Silva's actions were based on personal animus. "The factors cited by the (panel) in support of its finding are not persuasive. "I find no compelling evidence to indicate that Dean Silva was aware of your (whistle-blowing) at the time the relocation decision was being considered. Instead, only argument and inference is offered to support such a conclusion. "Further, even if Dean Silva were aware of your whistle-blower report ... there is no persuasive evidence that he had any personal animus or other motivation to retaliate against you based upon such information."

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.

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



6 May, 2006

U.K.: MORE FAILED GOVERNMENT MEDDLING

Don't get sick late at night in Britain!

The Government’s reorganisation of out-of-hours medical care has failed patients and cost 70 million pounds more than was expected. The nine million patients a year who use the services were kept waiting for calls to be answered and 85 per cent of out-of-hours surgeries missed targets for urgent consultations, according to the National Audit Office. Primary care trusts (PCTs), which took on the services after GPs were allowed to opt out, were given insufficient funds by the Department of Health, increasing their financial difficulties. The findings are published as NHS hospitals and PCTs — responsible for planning and commissioning healthcare — are struggling with deficits and laying off staff. Better organisation of the out-of-hours service could have saved the NHS up to 134 million pounds in 2005-06, the audit office says.

The Department of Health had drawn up a list of 13 “quality requirements” for after-hours care, hardly any of which were met. For example, only 2 per cent of PCTs were able to answer patients’ calls within 60 seconds, and only 23 per cent began clinical assessment of patients within 20 minutes of their arrival at a medical centre. Fewer than one in ten surgeries could prove that they had assessed patients within 20 minutes of their making an urgent out-of-hours call for help, and fewer than one in six could provide emergency face-to-face consultations at a centre within an hour, or an urgent consultation within two hours. As for visiting patients’ homes, only 13 per cent of out-of-hours centres were able to arrange urgent consultations within two hours, and only 25 per cent could arrange less urgent consultations within six hours. But, despite these problems, the audit office found no evidence of serious incidents or deaths and says that, a year after they took on the service, “out-of-hours providers are beginning to deliver a satisfactory standard of service”.

The changes came about in 2004 when GPs were given the right to opt out of 24-hour care. By giving up 6,000 pounds a year they could hand over responsibility for patients from 6.30pm to 8am on weekdays, and on all weekends and public holidays. Nine out of ten did so. However, 6,000 did not represent the full cost of the service — as the Government knew. It was an amount reached in negotiation with the British Medical Association (BMA). The real figure was believed to be 9,500 a GP, or a total of 322 million in 2005-06. This was the sum provided to the PCTs— but the actual cost proved to be 22 per cent higher, or 392 million. In addition, PCTs lacked the “experience, time and reliable management data” to pick up the service. It was not even clear whether out-of-hours services should be restricted to urgent care, an issue that remained unresolved.

However, direct comparisons are difficult because nobody really knew how well or badly the old system worked. Chris Shapcott, the director of value-for-money studies at the audit office, said that PCTs were dealing with numerous other issues, such as changes to GP contracts and the payment-by-results reform. “The out-of-hours system probably did not get the attention it deserved in some areas,” he said. The audit office added that there appeared to be a discrepancy between patients’ experiences and the PCTs’ views of the care that they were offering, “suggesting that providers are currently not capturing negative feedback”.

Hamish Meldrum, the chairman of the GPs committee of the BMA, said that the old service had been unsustainable. “The finding that the costs of providing out-of-hours services were higher than the Government anticipated will not be a surprise to the thousands of family doctors who, in former years, provided it on the cheap to the NHS,” he said. Lord Warner, the Health Minister, said that the report “confirms the NHS is on the right track towards providing quality round-the-clock GP services”. [Amazing! What evidence would he need that they were on the wrong track??]

Source



Stuck in HSA Denial

Consumer-driven health care is beginning to show real signs of progress. A recent survey by America's Health Insurance Plans found that the number of people with a health savings account (HSA) tripled, from 1 million to 3 million, in barely a year's time. Companies are finding that high-deductible plans coupled with an HSA cost less. In his recent visit to Milwaukee, President Bush pointed to the hamburger giant Wendy's, which saw an increase of only 1 percent in its premiums after switching to an HSA plan.

Although I haven't had much to cheer about regarding the White House as of late, health care is an exception. President Bush has released a relatively bold agenda that would add steam to consumer-driven health care. The proposals include allowing all taxes, including payroll taxes, to be deducted from HSA contributions; putting individually-purchased health insurance on a more equal footing with employer-purchased insurance by permitting those who buy an individual HSA policy to deduct the cost of the premium from their income taxes; and also putting individual-purchased insurance on an equal footing with that of large employers by allowing individuals to purchase their insurance out of state.

Despite the progress, the political left refuses to acknowledge consumer-driven health care's promise and persists in promoting misconceptions about it. Jason Furman, of the liberal Center for Budget and Policy Priorities, in a missive against HSAs, complained that:

Our nation is suffering from two chronic health challenges: spiraling insurance premiums and 46 million Americans with no coverage at all. Just since 2000, premiums have skyrocketed by 73% and 6 million more people have become uninsured. The President's Health Savings Account "solution" would likely make these problems even worse.

Actually, consumer-driven health insurance provides relief from higher premiums. The Deloitte Center for Health Solutions released a survey showing that while premiums for more traditional plans rose between 6.6 and 7.5 percent last year, premiums for consumer driven plans rose only 2.6 percent. That's lower than the 2005 inflation rate of 3.4 percent.

Furman also overlooks improvement in the insured/uninsured numbers since HSAs came on line in 2004. While Census Bureau statistics show the number of uninsured has increased by 6 million since 2000, in 2004 the growth in the uninsured slowed. In the previous three years, the growth in the uninsured had ranged from about 3.2 percent to 5.7 percent; in 2004, it was under 2 percent. Another promising development in 2004 was that the total number of privately insured and those with employer-based insurance increased for the first time in five years. The arrival of a lower cost insurance product in the form of HSAs is likely one factor leading to these positive developments.

In reaction to Bush's agenda, many liberals like Ted Kennedy trotted out the increasingly tired "only for the healthy and the wealthy" charge against HSAs. While it is tempting to go through all the evidence showing it isn't true, it may be more instructive to consider the example of Wendy's touted by Bush. The average worker at Wendy's is likely part of the "working poor." And since the health of the poor tends to be worse than that of general population, chances are that Wendy's employees are a bit sicker on average. In other words, Wendy's is an excellent example of consumer-driven plans not being primarily for the healthy and the wealthy.

Furthermore, other parts of Bush's health care agenda make HSAs more accessible for the poor and sick. Bush's agenda permits a low-income family to take a refundable tax credit to purchase an HSA. It also allows small businesses and civic and religious groups to form associations that enable them to pool their resources to purchase insurance for their members. Finally, Bush enables employers to put additional contributions in the HSA of an employee with a chronic health condition.

Despite all the promising news, the path toward a more consumer-oriented health care system will not be without some serious obstacles. Many people are still stuck in an "entitlement" mentality regarding health care, for years accustomed to employers and insurance companies picking up the tab. A recent article in the Chicago Tribune examined the experience of Lutheran Social Services, which switched to an HSA plan last July. On balance, it has not been positive:

Larry Lutey, the agency's vice president of human resources, said many employees "don't like the HSA, to be quite frank," because it's a new way of thinking about buying medical services, and workers think it costs them more. "If my position had been an elective one," he added, "I would have been voted out of office this year."

Lutey said employees are unhappy with HSAs because "it feels like they're paying more upfront. The perception is, this is a very expensive type of plan. Even though there is money in [employee] accounts to cover these expenses, people end up feeling they're paying more out of pocket."

As the example of Whole Foods shows, companies can minimize such problems if they make a serious effort to educate employees about the switch to a consumer-driven plan. Nevertheless, there will be both some resistance and resentment as people change from health-care dependents to health-care consumers.

Despite some problems, consumer-driven health care can be expected to grow as it lowers costs and gives people more control over their health care choices. Congress can move the process along even more if it acts on Bush's health care agenda.

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.

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



5 May, 2006

Uncovering CoverTN

I’ve been waiting until Cover Tennessee was actually ready to be voted on by the State Assembly, before commenting on this latest attempt by a state to promote universal health insurance. No, I take that back: I’ve actually been waiting to see if any major improvements took place, before slamming down on yet another socialized medicine ploy, disguised as a “fair and just reform” of the existing morass. But nobody has shown the initiative as yet to begin tweaking this newest monstrosity, so I guess I declare that time is up, and begin with my own scalpel-work.

The plan actually consists of three programs, including one for children (Cover Kids) and another focused on Tennesseans who have incomes, but have been denied health insurance due to prior conditions (AccessTN). For the purpose of this editorial, however, I will focus solely on the third branch of the plan, addressing “low-income workers” and known as CoverTN. Let’s start with the good news:

Unlike the folks in Massachusetts, Gov. Phil Bredesen seems actually to be seeking a mostly voluntary involvement with his proposals. Gov. Romney’s plans for the Bay State were based largely on forcing people to take on health insurance, while his Senate and House cronies added the provision of essentially fining any employer who would not buy into the program. (The penalty is small, compared to the actual cost of providing decent annual coverage for employees, but the principle is still forcing compliance, rather than offering incentives to do so willingly.) Romney vetoed this provision (although he did not reject the compulsory insurance for individual citizens), but the legislature overrode that veto in the final analysis.

Bredesen, on the other hand, is seeking to divide the cost of a modest healthcare plan among employees, employers, state government … and the insurance companies. Under CoverTN, an employee would purchase health insurance at a reduced rate (estimated at $150 a month), and then pay one-third of that amount ($50), with the employer ($50) and the state ($50) picking up the remainder. If the person was either self-employed, had an employer who refused to play along, or even got laid off or fired, the total cost would still be only $100 a month, and the policy would be yours to continue paying for, regardless of your job-situation. (There would be some additional costs, based on age, smoking habits or obesity factors.)

One concern about the plan is that it contains no deductible provisions; the fear is that without such baseline incentives for frugality, patients may overuse minor services and lead to just another TennCare fiasco, but on a far broader scope. However, Bredesen hopes to mitigate this at least somewhat, by including small yet significant co-pay provisions, to include doctor-visits as well as prescriptions. (Similar problems arose in the state of Washington, which has had a statewide healthcare program since 1987, but finally added both deductible and co-pay provisions during the last half-decade, to provide disincentives for wasting resources.)

The insurance company, meanwhile, would have to be content with the $150 a month per person. This would place the main burden for cost-containment on the insurance industry, which also makes this program significantly different from those elsewhere. Meanwhile, with the focus shifted to defined contributions ( rather than benefits), insurance companies would mostly define what benefits would ensue from the $150 program.

If that industry makes smart choices, providing a basic set of preventative and screening services to those who choose to purchase the no-frills program, this might lead to a real cost-savings, and promote more self-responsibility among the subscribers. (If you know you’ll have a co-pay each time you use the services, and you’re limited in the number of visits and degree of treatment for the most part, wouldn’t that encourage you to make an annual physical your first priority, and then take the advice of the physicians, nutritionists and other advisors, and improve your own health habits – so you might avoid coming back six months or a year later, with something seriously wrong with you?)

There is also word that CoverTN might encourage Medical Savings Accounts, as well as similar measures, to be chosen by individual citizens or their families. Moreover, and perhaps most significant, is the portability factor: since the insurance policy would be attached to the employee, it would be transferred from job to job, rather than dissolving with a job-change, or being connected to a government program. (This compromise solution may not please libertarians much, but it is a small step toward individual self-responsibility, and might even provide a pathway to transition this program entirely out of government hands one day!) The largest concern among critics of the program is that the projected funding only extends out about three years, using one-time money to fund the estimated $15 million annual cost to the taxpayers during that time.

The claim of CoverTN supporters is that the program needs to resemble the kind of mechanism for healthcare that a small business might choose to set up for its employees, seeking both their health and productivity, and containing costs wherever possible by minimizing use of the system unless it was necessary. Of course the direction this editor favors, like the one being pioneered by companies like Whole Foods Market, is not being explored in any way; there’s no encouragement here for employees paying their high-deductible policy premiums (in exchange for their employer giving them the deductible amount as a no-strings bonus, to spend or save as they choose), or being rewarded for saving on their own, rather than buying an insurance policy they might barely use, were they to live healthful and prudent lives themselves.

However, as an attempt to answer both rising healthcare costs and the “free rider” factor in hospital and clinic use, Bredesen’s plan has much to recommend in it. If CoverTN can offer an affordable alternative to those who do not truly need public assistance in order to conduct their own lives, it would at least take some pressure (economic as well as social) off the blighted TennCare mess.

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.

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



4 May, 2006

CALIFORNIA HOSPITALS NOW TO BE REQUIRED TO PROVIDE HOMES FOR THE HOMELESS

If you are homeless, just get yourself admitted to a hospital and you will be right from then on! Yet more incentive for hospitals to take in the poor, I guess

The incident last December stuck in Tim Brown's craw. Barton Memorial Hospital in South Lake Tahoe sent a homeless woman on a 101-mile taxi ride, dropping her off outside Sacramento's Loaves & Fishes. Brown, executive director of the homeless service organization, found that decision unacceptable. He called the hospital but was dissatisfied with their response.

The ensuing publicity caught the attention of Assemblyman Dave Jones, D-Sacramento. "It almost seemed like it was a policy of some of the surrounding counties to send people to Sacramento to services, and they're doing that because they're not providing the services in their own counties and that's just not right," he said. Four months later, Jones' proposed bill to address the issue is beginning to make its way through the Legislature. The bill - AB 2745 - would require hospitals to develop discharge procedures specifically for homeless patients and to submit the plans to their county board of supervisors. The idea of the bill, Jones said, is to discourage the "dumping" of homeless people across county lines, and to encourage counties to provide services for their own homeless residents.

Another bill, proposed by state Sen. Gil Cedillo, D-Los Angeles, would slap a maximum $10,000 fine on any agency that transports a homeless person to the streets near a homeless service provider without that person's permission and without confirming that the service provider has space available. The bill is one of nine Cedillo is proposing to address homelessness in the state, especially in the Skid Row area of Los Angeles. Both Jones' and Cedillo's bills took a step forward last week: The Jones bill passed out of the Assembly Health Committee, the Cedillo bill out of the Senate Judiciary Committee.

The California Hospital Association has voiced opposition to both bills on the grounds that they single out hospitals for a responsibility that belongs to all of society. "We're really the wrong target in this conversation," said Jan Emerson, a spokeswoman for CHA. When hospitals send homeless people to other counties or drop them off on the street, they often don't have shelters or other services to help them locally, she said. "This is a symptom of a much bigger problem in terms of local governments and the state and what they do in terms of providing services to the homeless," she said.

In the case of Barton Memorial, Emerson pointed out, hospital officials thought they were doing the right thing by sending the woman to a warmer area, away from the frosty streets of South Lake Tahoe. They said at the time that El Dorado County had no shelter where they could send her.

Michael Stoops, acting executive director of the Washington, D.C.-based National Coalition for the Homeless, agreed that the issue of homeless dumping reflects a deeper problem. "It points to the fact that we don't have an adequate social service infrastructure to help people that can't help themselves," Stoops said. But he voiced support for the bills. If they pass, he said, California would be one of the first states in the nation to directly take on the issue. He, and others who support the bill, say dumping can be traumatic and dangerous for homeless individuals who find themselves in a foreign environment. It also burdens urban counties, and the service providers located within them, with serving homeless individuals who live elsewhere....

More here



Waiting times for public hospital treatment increase

One has to laugh. As in Britain, the more money this Australian government throws at its hospitals, the worse the service gets. But reality never bothers Leftists. Their simplistic theories are all they are mentally capable of handling

Almost 30 per cent of patients still wait too long for elective surgery despite millions of dollars being spent on state health reforms. Figures released yesterday showed 9600 Queenslanders endured long waits for elective surgery between January and March - 2300 more than at the same time last year. The number waiting more than 30 days for urgent category one operations increased by 400 per cent compared with last year.

But Health Minister Stephen Robertson said category one figures showed a slight improvement in more recent months. Only 13.7 per cent faced long waits in April compared with 18 per cent in December. He blamed increasing demand for emergency operations and the increasing population for the waiting lists and hoped the trend would turn by July. "We've made some gains and I would hope in three months time we will be able to demonstrate more gains, but this is tough," Mr Robertson said. The figures show an increase in numbers on the "secret" lists of those waiting to see a specialist. At March 1, more than 122,000 people were waiting for a specialist appointment, up 12 per cent from July 2004. Of these, 82,900 were waiting for a consultation which could lead to surgery and another wait.

AMA state president Steve Hambleton said the figures were not encouraging. Opposition Leader Lawrence Springborg said the figures were a "disgrace" and showed the Beattie Government's maladministration of the state health system was continuing.

Cathleen Cantwell, 69, of Kirra on the Gold Coast, is one of thousands waiting for surgery in a Queensland hospital. She suffers from spinal canal stenosis, a condition that could leave her unable to walk. She has been booked in for surgery to correct the problem since December 2004, but is yet to see the inside of an operating theatre. And her problem is getting worse the longer she has to wait. "I can't walk very far at all especially on cement or bitumen . . . I'm in such pain when I walk," she said. She was hoping to have the operation before September so she could celebrate her 70th birthday and 50th wedding anniversary and "enjoy myself".

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 May, 2006

U.K.: NHS PAY CHAOS

Town halls and National Health Service trusts face having to pay out more than 1 billion pounds as tens of thousands of women workers embark on equal pay claims. Nearly 20,000 health workers could be eligible for payments averaging 60,000 pounds each, according to specialists in employment law. And at least 8,000 council workers in England and Wales have lodged claims with tribunals which, if successful, would be worth an average of 15,000 pounds each.

The multi-million-pound bills could leave some NHS trusts, which already have deficits totalling an estimated 800 million, on the brink of insolvency, while councils will be forced to raise their council taxes or take out large loans. John Prescott's Office of the Deputy Prime Minister (ODPM) has refused to bail out councils while Patricia Hewitt's health department insists it is not setting aside contingency funds for potential bills.

The women want the same pay as male workers who are on a similar pay scale. They will capitalise on a landmark 60 million payout made by an NHS trust last year and the fact that 11 councils in northeast England have already agreed settlements worth 100 million with some 30,000 women employees, who include cleaners, clerical staff, care assistants and catering workers.

Stefan Cross, a lawyer from the northeast whose firm is handling 16,000 claims, said: "This is a national scandal. All the fine words about equal pay haven't been translated into reality. For too long the government has relied upon women workers being paid far less than men." Despite the introduction of the equal pay act in 1970, women working full time still earn on average 17% less per hour than men.

The Convention of Scottish Local Authorities has estimated that equal pay claims will cost its members 560 million, while Hampshire county council is negotiating a multi-million-pound settlement with its women staff. The ODPM, however, is refusing to help councils foot the bill, insisting "the onus is on local government to resolve the issue of equal pay in an affordable manner".

Mick Brodie, chairman of the North East Regional Employers Organisation, said: "Whitehall needs to wake up and see we've got a crisis on our hands and give councils the support and resources they need. Local authorities are having to spend large sums of money they haven't got."

More than 1,500 women health workers in North Cumbria won 60 million in an equal pay battle last year. The nurses, health care assistants, clerical staff, porters and telephonists were each given payouts of between 35,000 and 200,000 pounds, which were backdated by up to six years. The Department of Health agreed to bail out the trust due to its "exceptional circumstances", but insisted it has no plans to pay for future claims against NHS trusts.

To co-ordinate the response of NHS trusts, the health department has expanded the role of the NHS litigation authority. The possible payouts come at a difficult time for the health service. Trusts are facing an estimated deficit of 1.2 billion, with wards closed, patients denied potentially life-saving drugs and tens of thousands of staff being laid off.

Source



AUSTRALIA: DON'T GET SICK IF YOU ARE IN THE ARMY

Yet another defence coverup, by any chance?

The Defence Force has sacked a nursing manager who questioned a delay in the arrival of an ambulance called to a suspected cardiac arrest. Anne Woodward was removed from her job as a senior civilian nurse at the Defence Force's Kapooka health centre near Wagga Wagga in NSW after querying a delay in treating an army recruit who had collapsed. Ms Woodward asked her boss why an ambulance called to transfer the man urgently to Wagga Wagga Base Hospital was forced to sign in at the front gates and was then escorted at slow speeds.

After six years as nurse manager at Kapooka, she was removed from her position on March 29 following an order from the centre's commanding officer. Ms Woodward was given no explanation at the time. She says she was given an hour to clean out her desk and was told military police would be called if she did not leave by that time. Kapooka commanding officer Lieutenant Colonel Paul Langworthy declined to comment yesterday and referred The Weekend Australian to the Defence media unit, which did not reply to a series of questions.

NSW Nurses Association acting secretary Judith Kiedja said Ms Woodward had worked at Kapooka since 2000 without incident before her sacking and had the strong backing of staff. Nurses at Kapooka are so irate they have signed a statement condemning army management and voicing "angst and disillusion". "We categorically state that Anne Woodward is the most proficient and respected leader that we have had the pleasure to work with," they said.

But Ms Kiedja said Defence Force management had refused to listen, relying on a technicality that Ms Woodward could be removed at any time because she was employed by a nursing agency, RED Alliance.

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 May, 2006

Over 200 hurt or killed by botched radiation in U.K. public hospitals

And secrecy is the first response, of course

More than 200 cancer sufferers have been seriously injured or killed by overdoses of radiation from botched treatment, confidential government figures have shown. Among those harmed are a 15-year-old schoolgirl left with life-threatening injuries, a young father with testicular cancer who suffered nerve damage and a 69-year-old lung cancer victim who died within weeks of his radiotherapy. The errors over the past six years have been blamed on shortages of trained radiographers and substandard equipment combined with spiralling demand because of rising cancer rates.

Senior cancer specialists have expressed alarm at the scale of the problem, which has been exposed under freedom of information laws. Karol Sikora, one of Britain’s leading professors of cancer medicine and a former government adviser, said: “It shocks me that this has been kept quiet and that lessons which could have been learnt from these errors have not been disseminated throughout the service.” According to senior radiologists, the Department of Health (DoH) has also failed to act on an internal National Health Service inquiry that recommended improvements a year ago after a breast cancer patient received a potentially fatal overdose.

Radiotherapy is the use of precisely targeted x-rays that kill cancer cells. About 40% of cancer patients have tumours considered suitable for such treatment. Even when correctly administered, the radiation also kills some healthy cells and generally causes severe nausea. The figures show there were 211 incidents where patients suffered radiation exposure 20% or more higher than the intended dose in the six years between April 2000 and this month — equivalent to one incident every fortnight. It is not known how many of these incidents were fatal. The information has come to light as a result of the campaigning of two former cancer patients: Katharine Tylko, a piano teacher from Bath, and Mitzi Blennerhassett, a health service activist from York.

Radiation remains in the body and, if too much is given, can have a devastating effect, burning through healthy tissue and destroying the body’s efforts to recover. A victim can look outwardly healthy while internal tissue is effectively melting away. In the case of 15-year-old Lisa Norris, who was being treated for a brain tumour, a mistake was made in calculating the dose to be administered by the specialist linear accelerator machine. The error was repeated 17 times because the dose was never rechecked. Lisa’s chances of long-term survival are considered limited.

Two months ago the family had been celebrating what they believed was Lisa’s recovery when specialists called to tell them of the error. Her father, speaking from their home in Girvan, on the Ayrshire coast, said: “She is gradually getting thinner . . . Some days she eats and some days she doesn’t. She is having ups and downs. The problem is, the radiation will never leave her body.” Lisa’s case was thought to be exceptional but the new data show that overdoses are occurring on a regular basis.

Lawrence McCabe, 69, a retired civil engineer, received 70 times the radiation exposure intended to cure a lung tumour at Charing Cross hospital, London, in 2002. He had been expected to survive for five to seven years after treatment but he was dead within weeks. His family received a 35,000 pound out-of-court settlement. “We were told it was the highest accidental overdose of radiation ever recorded,” said Lorraine Buckmaster, his daughter. “He died in agony. Great chunks of his digestive system and his blood vessels just melted away.”

Lack of staff and untrained operators were blamed for the disaster in 2002, but last week the hospital said training and quality managers had been employed and only six of the 52 radiotherapists’ posts were vacant compared with 44% when the accident happened. Details of the case were never circulated among cancer centres nationally.

Last week Irwin Mitchell, a firm of solicitors in Sheffield, said it had recently been contacted by a man in his thirties who suffered damage to his leg nerves in 2003 after an overdose of radiotherapy during treatment for testicular cancer. The man, who did not want to be interviewed, runs his own business and is married with children. He fears that he could lose the use of his legs.

Doctors and technicians in the field blame the disasters on chronic undermanning, obsolete equipment and spiralling demand. There are 1,758 radiographers in 51 centres across the country who deliver 2.5m treatments a year. At least 260 more qualified specialists are needed, according to the Society of Radiographers.

Cookridge, the Leeds hospital where a breast cancer patient received a radiation overdose, has refused to say if the middle-aged mother survived or not. It confirmed, however, that recommendations in a report commissioned from Professor Brian Toft, a national expert on risk analysis, were forwarded to the DoH and to Sir Liam Donaldson, the chief medical officer.

The Royal College of Radiologists (RCR) last week held preliminary discussions with representatives of the Society of Radiographers, the technicians who deliver the treatment, and officials from the Health Protection Agency, to find ways of improving systems for reporting accidents and passing on information so lessons can be learnt. A formal meeting is to be held next month. The DoH insisted last week that new guidelines had been circulated but Robin Hunter, dean of clinical oncology at the RCR, said nobody delivering NHS radiotherapy treatment had seen them. “It is a bad situation,” he said. “Because of the secrecy surrounding these accidents, there is plenty of time before information filters out to us for the same thing to happen to someone else.”

Source

Update:

A reader writes:

"Radiation leaves the body almost instantly, particularly x-rays and gamma rays. Both of those modalities are photons -- light -- which either deposits energy in cells or passes through on its way to infinity. Once the radiation source is turned off, there's no radiation left in the body. What remains behind is the damage done to cells, which may take time to manifest."



Public hospital antibiotic ignorance in Australia



Patients are being placed at greater risk of acquiring harmful infections because doctors are giving them the wrong antibiotic before surgery, according to infectious disease experts. An analysis of almost 18,000 surgical procedures in 27 Victorian hospitals, by the body that collects information for the State Government about hospital infections, shows the proportion in which the choice of antibiotic is described as "inadequate" ranges from 2.3 per cent for cardiac surgery to 56.7 per cent for hysterectomies. The timing of antibiotic administration is also crucial. A patient should be given a shot of antibiotics ideally in the hour before the surgeon makes the first incision, and no more than two hours before. But too much antibiotic use can build resistance.

The data was collected by VICNISS for surgery between 2002 and 2005. It shows the proportion of operations where a patient was given antibiotics at the wrong time was as high as 42.5 per cent for gall bladder removals. VICNISS director Mike Richards said using antibiotics as a prophylaxis - as a means of preventing infections - was one of the most effective strategies, but not all surgery required antibiotics. He said it was not known how many patients who were inappropriately given antibiotics developed an infection. And patients given the right antibiotics might still develop an infection because of other factors.

Dr Richards said the choice of antibiotic was crucial, because surgery on different parts of the body left patients exposed to different types of bugs. "The rate of infection should be lower if people are given optimum prophylaxis," he said. "What's being observed overseas is if you get all the processes right at times you get very dramatic reductions in infection rates."

Associate Professor Paul Johnson, deputy director of the Austin Health infectious diseases department, said that whether or not antibiotics were used most patients would not get an infection after surgery. Not all doctors knew they were supposed to use prophylaxis before some operations, he said. "So one problem would be failure to be aware of the current guidelines. The second would be being aware of the guidelines, but there's a system failure," he said.

Executive member of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Roy Watson, said the higher rate of inadequate prophylaxis in hysterectomies could be because of a perception that infection in such cases was less serious. "In gynaecological surgery if you get a wound infection, yes it's bad, but it's relatively easily dealt with, whereas clearly with cardiac surgery or orthopedic surgery the consequences are much more dire."

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 May, 2006

MORE ACTUAL EXPERIENCE OF NHS DECLINE

With some history and what it shows

The prime minister was blunt. "No gain without pain" was his Easter message to the National Health Service to celebrate his third attempt to reorganise it. Two days later I felt the pain. It was a stabbing sensation from a burst cyst and it occurred in two equally alarming places. One was the right groin and the other was mid-Wales. The latter is currently the NHS's Bermuda triangle, where doctors, ambulances and entire hospitals simply disappear from the radar each time I visit.

Not long ago this part of Wales had a 24-hour GP service in the village and two hospitals, one offering surgery, within 10 miles. Now the 24-hour service is a Cardiff call centre with a response from a locum doctor 25 miles away in Dolgellau. The latter explained that under NHS rules I had to visit her in person before she could refer me for an operation a further 40 miles away, either in Bangor or in Aberystwyth. If I were you, she said, I would drive yourself to an A&E somewhere, take a good book and hope for the best. I suddenly saw what Blair meant by his new "patient-driven, choice-based" NHS. You drive, we choose.

To the public the present NHS "crisis" must be baffling. Not a day passes without a bad news story in the press. Deficits are soaring, hospitals going into virtual administration, drug treatments being decided by the High Court and 6,000 staff about to be sacked. Even in fashionable Kensington and Chelsea the health trust has recently found itself with 6 mi;;ion pounds in invoices not accounted for and the auditor not noticing. The same auditor, Price Waterhouse Coopers, is then called in to audit the loss, doubtless adding its own invoice to the pile.

Yet I can dimly see method in Blair's pain and gain. There is at last an NHS "narrative". Waiting lists are down and gleaming hospitals are rising at least in the big cities. The much-quoted 800 million pound deficit is no big deal in a service costing 72 billion. It is only getting publicity because, at last, the government is refusing to rob Peter to pay Paul. The pus of inefficiency is finally starting to ooze from the NHS patient.

The British health service had by the mid-1980s become an unsustainable racket. Doctors were running hospitals according to mind-bending restrictive practices. Theatre productivity was pitiful. Nurses and paramedics were treated by doctors as serfs. A&E patients were handed from one clinician to another in a ludicrous make-work scheme. Drug companies, computer firms, management consultants, negligence lawyers and staff unions were walking away with the till each night.

By 1987 the Tories had doubled spending and the money had vanished. Margaret Thatcher lost her temper. Wailing to Panorama about the "bottomless pit" of NHS costs, she set in train what became the 1990 NHS Act and two decades of reform. Any Briton who smugly insults public administration in France or Italy or Paraguay or Papua New Guinea should study Britain's NHS, c1990-2006. Thatcher's reform began as essentially sound. She introduced fundholding doctors and trust hospitals, forcing GPs to be more resource-minded and trying to release hospitals from the grip of a reactionary medical profession. A bureaucratised NHS would be supplanted by a market-led local one.

The 1990 Act was scuppered first by the Treasury and then by the Labour party. The Treasury refused to allow hospital trusts financial autonomy, even denying them freedom to negotiate their own wages. They lost control of their costs and simply dumped the bill on the exchequer. Yet as a recent report for auditors KPMG by Rupert Darwall - a director of the Reform think tank - has shown, Thatcher's fundholding yielded a more dramatic fall in waiting times than did Labour's extravagance.

When Blair came to office in 1997 he wrecked this structure out of sheer political vengeance. His health secretary, Frank Dobson, dismantled fundholding and the internal market and reduced the NHS to administrative chaos. There followed three structural reorganisations, roughly in 1998, 2002 and 2004 (though connoisseurs have counted seven). There are now 572 hospital and primary care trusts. Community health councils give way to patient forums. Some 40 quangos float round Whitehall as flotsam left over by some overnight headline-grabbing initiative. Last week, desperate for a good news story, Patricia Hewitt came up with "dignity nurses".

Within two years of being created, some 30 "strategic health authorities" are to be cut to 10 and 303 primary care trusts to be cut to 100. Millions of pounds have gone on these reorganisations, which are completely unrelated to health care. Some 15 billion (some say 30 billion) is being allocated to a nationwide "choose and book" computer for which nobody unconnected with the project sees any need. It would have been of no use to me last weekend, in contrast with a tiny fraction of that sum spent on a modicum of local healthcare.

After a further doubling of health spending Blair has returned to where Thatcher was in 1987, with fundholding, trust hospitals and internal markets. This time he appears to mean it, but he will need to keep his nerve. The "missing billions" that caused such anguish to trust budgets this year resulted from Brown's disastrous insistence that Whitehall, which means the Treasury, negotiates NHS pay. The resulting 2004 pre-election award to doctors sent GP pay to 100,000 pounds (and reportedly to 250,000 pounds for some). It came as a bolt from the blue to hospital treasurers. So has the new national tariff for hospital operations. Neither took any account of local costs and wrecked all long-term planning. Four top children's hospitals, including Great Ormond Street, have indicated that the tariff may bankrupt them.

Hospitals are the financially threatened species of the new Blair/Thatcherism. By allowing hospitals to borrow at will - rather than borrow from him - Brown has allowed them to build up a 6 billion liability at private rates of interest with twice as much in the pipeline. A big hospital such as Queen Elizabeth's Woolwich predicts an annual debt charge of 100 million pounds, money it certainly does not have. British hospitals will soon be fighting for their lives.

The government appears to have accepted that an NHS hospital is no longer regarded by staff or patients as a philanthropic charity but as a factory supplying an expensive service, lucrative for some. Blair says he expects 40% of operations to be performed privately. But if hospitals are to revert to their 19th-century status their independence must be real.

Hospitals must be free to collaborate, plan their specialisms, liaise with "cottage" outposts and not have the Treasury and the NHS central costs imposed on them, whether expensive staff or expensive drugs. Otherwise they will end up like Railtrack, healthcare's infrastructure authority with ministers meddling in every bedpan.

Blair is clearly relying on his new breed of highly paid and entrepreneurial GPs to hold and disburse NHS cash. It is a version of Thatcher's original (but diluted) Enthoven plan whereby "money follows the patient". Gone will be the local general hospital offering a table d'hote service within easy range of patients, which is why northwest Scotland and mid-Wales are being denuded of beloved institutions.

On the other hand local GPs, their pockets and "commissioning" budgets bursting with money, may band together with local authorities to run new health centres, perhaps even hospitals. Already Wychavon council in Worcestershire is doing just that. If there is any superfluous tier in all this it is the once-vaunted primary care trusts. They should be put out of their misery.

GPs should go back to the arrangement before the war, under the wing of elected local health committees. They were cheap and they worked. There will be "postcode lottery" rows. But democratic accountability will be clear, as in Scandinavia, Germany and other countries where healthcare contrives to be better than ours yet is not "nationalised". In Denmark just 5% of patients need treatment that cannot be supplied within the remit of their elected county health authority.

It is possible, just possible, that this is the "gain" of which Blair was talking. Of the pain there is no doubt.

Source



South Australian public hospitals hit by 'thousands' of mishaps

And health officials are spinning like a top

The number of adverse events being reported in South Australian public hospitals has soared as officials move to make the system safer. A concerted effort to make the system more open, including a 24-hour "dob-in" line for health workers to report incidents or near-misses, saw reported incidents jump from about 8000 two years ago to more than 22,000 last financial year. An "adverse event" in the health system is any incident that accidentally causes harm or has the potential to cause harm to patients or to staff, and may range from minor events, such as slippery surfaces, to major surgical errors.

The rise in reports is expected to continue, with more than 16,000 reported in the financial year to March. However, officials say the high number is due to staff being encouraged to report all incidents rather than reflecting a rise in problems. They say patient safety is being improved as a result. Incidents being reported - and investigated for future prevention - range from minor problems to major medical disasters. A 2003/04 report, the latest published in-depth data, showed these included 66 incidents causing serious harm to patients, and five "sentinel", or most serious, events. They were:

TWO suicides in hospitals.

ONE intravascular gas embolism.

ONE reaction from a transfusion of incompatible blood.

ONE maternal death or serious morbidity associated with childbirth.

Officials estimate more than 10 per cent of the 360,000 people admitted to SA public hospitals will suffer an adverse event.

To reduce this, the Health Department three years ago introduced a new approach aimed at making the health care system safer. A key point was encouraging staff to report events including near-misses so they could be investigated to ensure such events did not occur again anywhere in the public health system. A 24-hour, seven-day hotline was established where incidents could be reported, then followed up with an investigation rather than simply being recorded.

From a slow start, health workers have embraced the idea and last month reported 1200 incidents on the hotline. SA Chief Medical Officer Professor Chris Baggoley said this week the rise in reports was due to the new culture of openness rather than a rise in problems. "This is about getting people to call in to prevent problems," he said. "Fully three-quarters of the total reports relate to what we call close calls, and that is something to encourage. "No one came to harm, but could have unless someone was on the ball. "Even though people are alert and preventing problems, people still get on the phone and report it, which is really good; it is a culture coming in. "There have been significant improvements in safety in a variety of areas but there are still improvements to be made."

As part of the major overhaul of the public system, a new SA Hospitals Safety and Quality Council will be launched on July 1. Prof Baggoley said private hospitals, GPs and community health services would be invited to join as part of the concerted effort to improve patient safety across the state. The move to upgrade safety has seen the Health Department launch initiatives, including a 10 Tips for Safer Health Care brochure urging hospital patients to take a more active role in their health care. Another is a new protocol upgrading checks to ensure the correct person receives the correct operation or medication. A BloodSafe Nurses program has reduced blood transfusions given outside national guidelines from 18 per cent to less than 2 per cent. More than 1000 senior staff have been trained in root cause analysis methods to find why problems occurred and correct the system rather than simply finding someone to blame.

By June 30, all metropolitan hospitals will have a uniform medication chart which will be extended statewide by June 30 next year to cut the chance of mistakes as staff move between hospitals. "We want patients to be partners in this because they can reduce their own risk," Prof Baggoley said. "In the past, there was a tendency to say once in hospital, 'I'm in you're care' but we want people to ask questions, to help make sure they are getting the right medication and so on."

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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