Sunday, October 31, 2004
Tenncare failing
"A federal judge ruled that the state has tried but failed to provide required medical screening tests for a half-million children covered by TennCare and must adopt changes quickly. U.S. District Judge John Nixon has ordered the state to follow a court-developed plan to meet federal law and terms of a previous deal regarding the tests, known as Early and Periodic Screening, Diagnosis and Treatment. ... 'If this plan becomes effective, it will be a critical blow to our efforts to reform TennCare,' he said. 'The court's proposal would significantly increase cost, impose delays and inject the court deeply into the day-to-day operation of TennCare.'"
More here
MORE BACKGROUND TO THE VACCINE SHORTAGE
Here are the facts behind this public health crisis. In the 1960s and 1970s the United States had 26 vaccine manufacturers. Now we are down to just four. There is now only one vaccine manufacturer for each of the aforementioned diseases. The explanation is politicians and trial lawyers. Drug companies can't make profits from producing vaccines any longer because of the issue of product liability lawsuits.
In 2002 the entire global vaccine manufacturing industry had roughly $6 billion in sales. But in that same year trial lawyers sought $30 billion in damages against the industry in just one lawsuit. The damages sought by the lawyers were five times larger than the entire industry's net income. And there are now over 350 similar lawsuits pending. So the trial bar has destroyed a critical medical industry.
Congress has the power to fix this crisis. Why haven't they? The answer lies with the massive political clout of the trial lawyers. Last year President Bush and Congress tried to shield American manufacturers from frivolous lawsuits and cap damages, but the legislation was squashed by the trial lawyers. The trial lawyers are the number one special interest contributor to the Democratic Party and to many Republican candidates, too. This year lawyers have donated some $100 million to federal candidates.
Senators John Kerry and John Edwards have both tried to pin the blame for the vaccine shortage on George Bush's lapel. Recently, Kerry charged: "How can we trust George Bush to protect us from bio-terrorist attacks when he can't even get us a flu vaccine?" But wait a minute. Senators Kerry and Edwards sided with the trial lawyers and opposed the very legislation that could have averted the influenza vaccine shortage. And guess who two of the largest recipients of trial lawyer largesse in the entire Congress are? This year Kerry has received $21.7 million from lawyers and Edwards received $11.5 million. These Senators and more than 200 others in Congress voted with deep-pocketed lawyers over the health needs of children and the elderly, who need the flu vaccine most.
Members of Congress will return to Washington a few weeks after the election for a "lame duck" session to complete unfinished legislative business this year. We'd say--and we would venture to guess that most Americans would heartily agree with us--that the most important "unfinished business" is to protect our public health and our access to life saving vaccines. The first action should be to vote on a Vaccine Liability Protection Act to ensure that the current shortage of a vital vaccine never happens again.
More here
And a good comment from FEE: "We now know that when the government tries to suppress the production of a drug, say, heroin, supplies nevertheless remain plentiful. Yet when the government tries to guarantee production of a drug, say, flu vaccine, supplies can run short, endangering the people most vulnerable to disease. That's government for you."
***************************
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.
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.
***************************
"A federal judge ruled that the state has tried but failed to provide required medical screening tests for a half-million children covered by TennCare and must adopt changes quickly. U.S. District Judge John Nixon has ordered the state to follow a court-developed plan to meet federal law and terms of a previous deal regarding the tests, known as Early and Periodic Screening, Diagnosis and Treatment. ... 'If this plan becomes effective, it will be a critical blow to our efforts to reform TennCare,' he said. 'The court's proposal would significantly increase cost, impose delays and inject the court deeply into the day-to-day operation of TennCare.'"
More here
MORE BACKGROUND TO THE VACCINE SHORTAGE
Here are the facts behind this public health crisis. In the 1960s and 1970s the United States had 26 vaccine manufacturers. Now we are down to just four. There is now only one vaccine manufacturer for each of the aforementioned diseases. The explanation is politicians and trial lawyers. Drug companies can't make profits from producing vaccines any longer because of the issue of product liability lawsuits.
In 2002 the entire global vaccine manufacturing industry had roughly $6 billion in sales. But in that same year trial lawyers sought $30 billion in damages against the industry in just one lawsuit. The damages sought by the lawyers were five times larger than the entire industry's net income. And there are now over 350 similar lawsuits pending. So the trial bar has destroyed a critical medical industry.
Congress has the power to fix this crisis. Why haven't they? The answer lies with the massive political clout of the trial lawyers. Last year President Bush and Congress tried to shield American manufacturers from frivolous lawsuits and cap damages, but the legislation was squashed by the trial lawyers. The trial lawyers are the number one special interest contributor to the Democratic Party and to many Republican candidates, too. This year lawyers have donated some $100 million to federal candidates.
Senators John Kerry and John Edwards have both tried to pin the blame for the vaccine shortage on George Bush's lapel. Recently, Kerry charged: "How can we trust George Bush to protect us from bio-terrorist attacks when he can't even get us a flu vaccine?" But wait a minute. Senators Kerry and Edwards sided with the trial lawyers and opposed the very legislation that could have averted the influenza vaccine shortage. And guess who two of the largest recipients of trial lawyer largesse in the entire Congress are? This year Kerry has received $21.7 million from lawyers and Edwards received $11.5 million. These Senators and more than 200 others in Congress voted with deep-pocketed lawyers over the health needs of children and the elderly, who need the flu vaccine most.
Members of Congress will return to Washington a few weeks after the election for a "lame duck" session to complete unfinished legislative business this year. We'd say--and we would venture to guess that most Americans would heartily agree with us--that the most important "unfinished business" is to protect our public health and our access to life saving vaccines. The first action should be to vote on a Vaccine Liability Protection Act to ensure that the current shortage of a vital vaccine never happens again.
More here
And a good comment from FEE: "We now know that when the government tries to suppress the production of a drug, say, heroin, supplies nevertheless remain plentiful. Yet when the government tries to guarantee production of a drug, say, flu vaccine, supplies can run short, endangering the people most vulnerable to disease. That's government for you."
***************************
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.
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.
***************************
Saturday, October 30, 2004
HOW TO USE HEALTH CARE TO CREATE UNEMPLOYMENT
Why should Californians care if they throw more people out of work or force prices up? They all think it is the other guy that will suffer and they will get a freebie.
California restaurants, retailers and labor unions are throwing millions of dollars into the campaign for and against Proposition 72, which would require large companies to provide health insurance. Each side sees the measure as critical to its future. Proposition 72 asks voters to give their blessing to a California law that will require a "pay or play" system of health care for most medium and large businesses. "We cannot afford to not fight 72," said Jot Condie, president of the California Restaurant Association. "We estimate that over 20 percent of our membership goes out of business the first day this takes effect." The association is the single largest contributor to the "no" side, putting $2.5 million into the effort earlier this month.
That contribution was countered by the Service Employees International Union, which put $2.75 million into the "yes" side last week. By the end of the campaign, both sides may top more than $10 million, in part to try to get their message out amidst the clutter of the presidential campaign and 15 other ballot measures.
The health care bill was passed last year on a party-line vote of the Legislature and signed by Gov. Gray Davis days before he was recalled. Businesses were so upset about the new law that they spent millions to put it on the ballot, and now voters will have the final say on Proposition 72. Under the law, employers with more than 200 employees must provide health care coverage for the workers and their families by Jan. 1, 2006. Companies with 50 to 199 employees would be required to offer coverage to their employees a year later. Proposition 72 requires all employers to offer coverage to their employees or pay a fee into a state health fund purchasing pool. Employers with 20 to 50 workers are exempt from the law until 2007, when it would kick in only if a new tax credit is created to help offset their costs. Businesses with fewer than 20 employees will not be affected by the law.
Gov. Arnold Schwarzenegger is opposed to the measure and campaigned against it Wednesday at a Chili's Grill and Bar in Los Angeles, saying it would creates a state-run health care program that he predicted would be "a big mess.'' ...
In even worse shape than restaurants are industries such as agriculture, which compete in a global marketplace, said Allan Zaremberg, president of the California Chamber of Commerce. "This puts the state at a horrible competitive disadvantage with every other state in the continental United States," he said. Hawaii is the only other state to require businesses to provide health insurance.
More here
DON'T GET CANCER IN ENGLAND
Cancer care across England is poorly coordinated, funding varies widely from one area to another and doctors are not referring patients for treatment quickly enough, a parliamentary report said Wednesday. The government has put Primary Care Trusts in charge of spending most of England's cancer budget but many of the local health bodies lack the experience and expertise to allocate those funds, the All Party Parliamentary Group on Cancer said. "The inquiry has exposed a serious problem. The government rightly says that cancer care is a national priority yet the system that's expected to deliver it is too fragmented," said the group's chair, Ian Gibson.
The report recommended that the budget for cancer treatment and prevention should go directly to cancer networks -- the groups of hospitals through which care is organized -- so they can make long-term plans on how best to fight the disease. It also said family doctors should have special training to recognize cancer symptoms sooner.
Charity CancerBACUP, which co-authored the report, says one in three people develop cancer during their lifetime and the government has pledged to improve cancer prevention.
Health Secretary John Reid said the government did want better training for doctors but he was not convinced the current system of funding from local boards was inadequate. "The proof of the pudding is in the eating in this because we have now got almost 1,200 more consultants, we have got hundreds, thousands of pieces of modern equipment," he told the BBC, adding Cancer deaths had fallen by 12.2 percent since 1997.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Why should Californians care if they throw more people out of work or force prices up? They all think it is the other guy that will suffer and they will get a freebie.
California restaurants, retailers and labor unions are throwing millions of dollars into the campaign for and against Proposition 72, which would require large companies to provide health insurance. Each side sees the measure as critical to its future. Proposition 72 asks voters to give their blessing to a California law that will require a "pay or play" system of health care for most medium and large businesses. "We cannot afford to not fight 72," said Jot Condie, president of the California Restaurant Association. "We estimate that over 20 percent of our membership goes out of business the first day this takes effect." The association is the single largest contributor to the "no" side, putting $2.5 million into the effort earlier this month.
That contribution was countered by the Service Employees International Union, which put $2.75 million into the "yes" side last week. By the end of the campaign, both sides may top more than $10 million, in part to try to get their message out amidst the clutter of the presidential campaign and 15 other ballot measures.
The health care bill was passed last year on a party-line vote of the Legislature and signed by Gov. Gray Davis days before he was recalled. Businesses were so upset about the new law that they spent millions to put it on the ballot, and now voters will have the final say on Proposition 72. Under the law, employers with more than 200 employees must provide health care coverage for the workers and their families by Jan. 1, 2006. Companies with 50 to 199 employees would be required to offer coverage to their employees a year later. Proposition 72 requires all employers to offer coverage to their employees or pay a fee into a state health fund purchasing pool. Employers with 20 to 50 workers are exempt from the law until 2007, when it would kick in only if a new tax credit is created to help offset their costs. Businesses with fewer than 20 employees will not be affected by the law.
Gov. Arnold Schwarzenegger is opposed to the measure and campaigned against it Wednesday at a Chili's Grill and Bar in Los Angeles, saying it would creates a state-run health care program that he predicted would be "a big mess.'' ...
In even worse shape than restaurants are industries such as agriculture, which compete in a global marketplace, said Allan Zaremberg, president of the California Chamber of Commerce. "This puts the state at a horrible competitive disadvantage with every other state in the continental United States," he said. Hawaii is the only other state to require businesses to provide health insurance.
More here
DON'T GET CANCER IN ENGLAND
Cancer care across England is poorly coordinated, funding varies widely from one area to another and doctors are not referring patients for treatment quickly enough, a parliamentary report said Wednesday. The government has put Primary Care Trusts in charge of spending most of England's cancer budget but many of the local health bodies lack the experience and expertise to allocate those funds, the All Party Parliamentary Group on Cancer said. "The inquiry has exposed a serious problem. The government rightly says that cancer care is a national priority yet the system that's expected to deliver it is too fragmented," said the group's chair, Ian Gibson.
The report recommended that the budget for cancer treatment and prevention should go directly to cancer networks -- the groups of hospitals through which care is organized -- so they can make long-term plans on how best to fight the disease. It also said family doctors should have special training to recognize cancer symptoms sooner.
Charity CancerBACUP, which co-authored the report, says one in three people develop cancer during their lifetime and the government has pledged to improve cancer prevention.
Health Secretary John Reid said the government did want better training for doctors but he was not convinced the current system of funding from local boards was inadequate. "The proof of the pudding is in the eating in this because we have now got almost 1,200 more consultants, we have got hundreds, thousands of pieces of modern equipment," he told the BBC, adding Cancer deaths had fallen by 12.2 percent since 1997.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Friday, October 29, 2004
THE HUGE COSTS OF THE MEDICAL BUREAUCRACY
Even if partisans disagree about what government should do to expand health coverage, we should at least be able to agree that government should stop doing things that make health care unnecessarily expensive. One prime example is the many outmoded and questionable federal regulations that riddle our health care system. On Oct. 4, the Cato Institute released a study by Duke University professor Chris Conover that demonstrates that the costs of health care regulation outweigh the benefits by 2-1.
After studying 47 different types of health care regulations, Conover estimates those regulations cost Americans $169.1 billion on net in 2002 alone. The total costs are actually $339.1 billion, but the regulations provide about $170.1 billion in benefits. For the typical American, this translates into a hidden tax of more than $1,500 per household per year. And because that cost is built into medical prices, it makes health coverage unaffordable for about 7.5 million people.
So how do the candidates address this issue? Bush has made a gesture toward deregulation, but neither has a serious plan for reducing this enormous barrier to medical care. Conover estimates the single greatest regulatory cost is the medical liability system, which imposes a net cost of $80.6 billion annually. (That's after subtracting the benefits of compensating injured patients and preventing medical errors.) A reasonable way to curb those unnecessary costs would be to let patients and doctors negotiate a mutually acceptable level of negligence protection prior to treatment.
Instead of adopting that sensible reform, Bush would have Congress impose damage caps and other substantive rules of tort law on the states, despite its having no constitutional authority to do so. It is doubtful that Kerry or his running mate -- former personal injury lawyer Sen. John Edwards -- would support anything that allows patients to reveal how much they value the services of the trial bar.
The next greatest regulatory cost, according to Conover, is imposed by the Food and Drug Administration, which regulates medicines and medical devices. The FDA has long been criticized for delays in approving new medicines and for preventing patients from trying new therapies. Conover estimates those delays impose a net annual cost of $41.8 billion. A sensible way to cut down on unnecessary delays would be to let independent private agencies certify the effectiveness of new medicines, just as they now certify effectiveness for new uses of existing medicines. Yet neither Bush nor Kerry has issued a proposal that would reduce the lives lost to the FDA's delays or reduce the costs the FDA builds into the prices of prescription drugs.
Nor has either candidate proposed serious efforts to deregulate hospitals and other health facilities (net cost: $25.1 billion) or doctors and other health professionals (net cost: $7.1 billion).
To his credit, Bush has proposed allowing consumers to avoid expensive health insurance regulations by purchasing coverage from out-of-state insurers. In essence, this means your average Minnesotan would not have to purchase coverage for hairpieces (yes, hairpieces) or the 59 other types of coverage required by Minnesota law. Instead, he could purchase coverage from whatever state imposes regulatory costs that are more to his liking. If applied to all types of health insurance regulation, Bush's proposal could go a long way toward eliminating the net cost of such health insurance regulation ($14.4 billion).
There's more than just affordable coverage on the line here. Conover notes the more money people have, the better able they are to purchase greater health and safety. He estimates that by depriving Americans of $169 billion annually, health care regulations lead to 22,205 unnecessary deaths each year. The Institutes of Medicine estimate 18,000 Americans die each year from a lack of health insurance, making over-regulation a bigger problem than the uninsured. It would be nice if our politicians saw it that way.
More here
SURGICAL TRAINING RATIONALIZED IN BRITAIN
I suppose some people will criticize this but it sounds like a breaking down of bureaucratic barriers to me. I cannot conceive of ANYTHING that would take more than seven years of training
The amount of time that it takes for a medical student to qualify as a surgeon is to be cut by almost half in an effort to boost numbers and encourage more women to take up the specialty. Under the current medical curriculum, junior doctors must complete at least 12 years of postgraduate training to become a consultant surgeon. Major reforms of the tuition process, outlined yesterday by the Royal College of Surgeons, will allow trainees to be fast-tracked to consultants in as little as seven years.
The new system, which could see fully qualified surgeons as young as 30, is designed to speed the rise of junior doctors set on surgical specialties, most of whom currently spend years in general medical training. It is also hoped that the timetable - which will let doctors opt out and then rejoin the training programme - will also encourage more women into surgery who had feared sacrificing the chance to have children.
Hugh Phillips, president of the Royal College of Surgeons, said that it was vital that an outdated curriculum was overhauled to guarantee the highest quality of surgeons for future generations. Instead of leaving doctors drifting for years in junior roles, the new system would target those with an aptitude for surgery and fast-track them into their desired specialty, he said. "The arrangement for training is not efficient," he said. "How can we possibly accept a situation where young people spend up to five years at the level of a senior house officer without any sign of progress?" At present there are more than 3,500 senior house officers waiting to become specialist registrars - when a junior doctor develops surgical specialties - but less than half will eventually progress to this stage. Under the new system, they will be able to progress in just two years. "There are too many talented surgeons-in-training stuck at this grade," Mr Phillips said. "Not only is this wasteful of human resources, it makes for an insecure and difficult time at a crucial stage in the surgeon's career."
The new curriculum will be introduced in 2007, with pilot schemes due to start in England and Wales from next year. Mr Phillips, an orthopaedic surgeon, said there was also an urgent need to address the work pressures created by government targets that were preventing consultants from spending time passing on their expertise to junior doctors. "There is now an incentive which gives surgeons œ100 for treating an additional patient (to help to meet government targets)," he said. "I would rather surgeons were incentivised to train instead of taking the extra case. It may not appeal to ministers, but it has got be the way forward."
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Even if partisans disagree about what government should do to expand health coverage, we should at least be able to agree that government should stop doing things that make health care unnecessarily expensive. One prime example is the many outmoded and questionable federal regulations that riddle our health care system. On Oct. 4, the Cato Institute released a study by Duke University professor Chris Conover that demonstrates that the costs of health care regulation outweigh the benefits by 2-1.
After studying 47 different types of health care regulations, Conover estimates those regulations cost Americans $169.1 billion on net in 2002 alone. The total costs are actually $339.1 billion, but the regulations provide about $170.1 billion in benefits. For the typical American, this translates into a hidden tax of more than $1,500 per household per year. And because that cost is built into medical prices, it makes health coverage unaffordable for about 7.5 million people.
So how do the candidates address this issue? Bush has made a gesture toward deregulation, but neither has a serious plan for reducing this enormous barrier to medical care. Conover estimates the single greatest regulatory cost is the medical liability system, which imposes a net cost of $80.6 billion annually. (That's after subtracting the benefits of compensating injured patients and preventing medical errors.) A reasonable way to curb those unnecessary costs would be to let patients and doctors negotiate a mutually acceptable level of negligence protection prior to treatment.
Instead of adopting that sensible reform, Bush would have Congress impose damage caps and other substantive rules of tort law on the states, despite its having no constitutional authority to do so. It is doubtful that Kerry or his running mate -- former personal injury lawyer Sen. John Edwards -- would support anything that allows patients to reveal how much they value the services of the trial bar.
The next greatest regulatory cost, according to Conover, is imposed by the Food and Drug Administration, which regulates medicines and medical devices. The FDA has long been criticized for delays in approving new medicines and for preventing patients from trying new therapies. Conover estimates those delays impose a net annual cost of $41.8 billion. A sensible way to cut down on unnecessary delays would be to let independent private agencies certify the effectiveness of new medicines, just as they now certify effectiveness for new uses of existing medicines. Yet neither Bush nor Kerry has issued a proposal that would reduce the lives lost to the FDA's delays or reduce the costs the FDA builds into the prices of prescription drugs.
Nor has either candidate proposed serious efforts to deregulate hospitals and other health facilities (net cost: $25.1 billion) or doctors and other health professionals (net cost: $7.1 billion).
To his credit, Bush has proposed allowing consumers to avoid expensive health insurance regulations by purchasing coverage from out-of-state insurers. In essence, this means your average Minnesotan would not have to purchase coverage for hairpieces (yes, hairpieces) or the 59 other types of coverage required by Minnesota law. Instead, he could purchase coverage from whatever state imposes regulatory costs that are more to his liking. If applied to all types of health insurance regulation, Bush's proposal could go a long way toward eliminating the net cost of such health insurance regulation ($14.4 billion).
There's more than just affordable coverage on the line here. Conover notes the more money people have, the better able they are to purchase greater health and safety. He estimates that by depriving Americans of $169 billion annually, health care regulations lead to 22,205 unnecessary deaths each year. The Institutes of Medicine estimate 18,000 Americans die each year from a lack of health insurance, making over-regulation a bigger problem than the uninsured. It would be nice if our politicians saw it that way.
More here
SURGICAL TRAINING RATIONALIZED IN BRITAIN
I suppose some people will criticize this but it sounds like a breaking down of bureaucratic barriers to me. I cannot conceive of ANYTHING that would take more than seven years of training
The amount of time that it takes for a medical student to qualify as a surgeon is to be cut by almost half in an effort to boost numbers and encourage more women to take up the specialty. Under the current medical curriculum, junior doctors must complete at least 12 years of postgraduate training to become a consultant surgeon. Major reforms of the tuition process, outlined yesterday by the Royal College of Surgeons, will allow trainees to be fast-tracked to consultants in as little as seven years.
The new system, which could see fully qualified surgeons as young as 30, is designed to speed the rise of junior doctors set on surgical specialties, most of whom currently spend years in general medical training. It is also hoped that the timetable - which will let doctors opt out and then rejoin the training programme - will also encourage more women into surgery who had feared sacrificing the chance to have children.
Hugh Phillips, president of the Royal College of Surgeons, said that it was vital that an outdated curriculum was overhauled to guarantee the highest quality of surgeons for future generations. Instead of leaving doctors drifting for years in junior roles, the new system would target those with an aptitude for surgery and fast-track them into their desired specialty, he said. "The arrangement for training is not efficient," he said. "How can we possibly accept a situation where young people spend up to five years at the level of a senior house officer without any sign of progress?" At present there are more than 3,500 senior house officers waiting to become specialist registrars - when a junior doctor develops surgical specialties - but less than half will eventually progress to this stage. Under the new system, they will be able to progress in just two years. "There are too many talented surgeons-in-training stuck at this grade," Mr Phillips said. "Not only is this wasteful of human resources, it makes for an insecure and difficult time at a crucial stage in the surgeon's career."
The new curriculum will be introduced in 2007, with pilot schemes due to start in England and Wales from next year. Mr Phillips, an orthopaedic surgeon, said there was also an urgent need to address the work pressures created by government targets that were preventing consultants from spending time passing on their expertise to junior doctors. "There is now an incentive which gives surgeons œ100 for treating an additional patient (to help to meet government targets)," he said. "I would rather surgeons were incentivised to train instead of taking the extra case. It may not appeal to ministers, but it has got be the way forward."
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Thursday, October 28, 2004
STEYN ON CANADIAN HEALTH CARE
A pithy comment from Mark Steyn:
Speaking of which, if there's four words I never want to hear again, it's "prescription drugs from Canada." I'm Canadian, so I know a thing or two about prescription drugs from Canada. Specifically speaking, I know they're American; the only thing Canadian about them is the label in French and English. How can politicians from both parties think that Americans can get cheaper drugs simply by outsourcing (as John Kerry would say) their distribution through a Canadian mailing address? U.S. pharmaceutical companies put up with Ottawa's price controls because it's a peripheral market. But, if you attempt to extend the price controls from the peripheral market of 30 million people to the primary market of 300 million people, all that's going to happen is that after approximately a week and a half there aren't going to be any drugs in Canada, cheap or otherwise -- just as the Clinton administration's intervention into the flu-shot market resulted in American companies getting out of the vaccine business entirely....
The Continental health and welfare systems John Kerry so admires are, in fact, part of the reason those societies are dying. As for Canada, yes, under socialized health care, prescription drugs are cheaper, medical treatment's cheaper, life is cheaper. After much stonewalling, the Province of Quebec's Health Department announced this week that in the last year some 600 Quebecers had died from C. difficile, a bacterium acquired in hospital. In other words, if, say, Bill Clinton had gone for his heart bypass to the Royal Victoria Hospital in Montreal, he would have had the surgery, woken up the next day swimming in diarrhea and then died. It's a bacterium caused by inattention to hygiene -- by unionized, unsackable cleaners who don't clean properly; by harassed overstretched hospital staff who don't bother washing their hands as often as they should. So 600 people have been killed by the filthy squalor of disease-ridden government hospitals. That's the official number. Unofficially, if you're over 65, the hospitals will save face and attribute your death at their hands to "old age" or some such and then "lose" the relevant medical records. Quebec's health system is a lot less healthy than, for example, Iraq's.
THE SUREST WAY TO SAVE PRIVATE HEALTH-CARE
You can have universal coverage without the government running ANY hospitals
In an ABC News/Washington Post poll last fall, 62 percent of the respondents favored a universal, government-run medical insurance program. Such surveys reflect a widespread frustration with a health care system that is too expensive, too uncertain, and too complicated. The answer proposed by John Kerry and John Edwards is to continue the creeping socialization of medicine that Americans have been experiencing since the 1960s. That course would mean the end of private health care in the U.S., and with it the unparalleled medical progress that has benefited patients in this country and throughout the world. It would have a disastrous impact on medical innovation and the quality of care....
When it comes to health care policy, Republicans are Democrats Lite. "The Republicans always say, `We're going to give you the same program, only less than that proposed by the Democrats,'" says Tom Miller, former director of health policy studies at the Cato Institute. "Republicans just offer cheaper, more apologetic programs." Witness the new Medicare drug benefit, which John Kerry immediately denounced as "a raw deal for America's seniors and a big windfall for the big drug companies." No matter how much they give away, Republicans can never give away enough to satisfy the demands of the nationalized health care advocates.
Since it's unlikely that Americans will allow their improvident neighbors to expire without medical care in the streets, is there a politically palatable alternative that can preserve and expand private medicine in the United States? Yes: mandatory private health insurance. The New America Foundation, a liberal policy shop in Washington, D.C., has outlined some elements of how such a system would work. The slogan for its proposal is, "Universal coverage in exchange for universal responsibility." The devil is in the details, of course, but the plan offers some interesting possibilities. For example, mandatory health insurance coverage might be combined with medical savings accounts that would encourage people to save and invest for future medical emergencies.
The New America Foundation proposal preserves private insurance and allows consumers to choose among competing insurance plans and coverage options. Most intriguingly, the plan offers a way out of the dysfunctional employer-financed third-party-payer model that is so grievously distorting our health care system. Employers eventually would devolve responsibility for health insurance to their employees by giving them the money the companies currently pay to insurance companies. Employees would then have a strong incentive to shop around for the best health care deals, putting pressure on insurers to keep costs low.
Even some Republicans are suggesting that mandatory health insurance be required for at least some Americans. Senate Majority Leader Bill Frist (R-Tenn.) recently argued that it is unfair to expect taxpayers to pick up the health care tab for the third of Americans without health insurance who make incomes over $50,000. "I believe higher-income Americans today do have a societal and personal responsibility to cover in some way themselves and their children," the senator said in a speech at the National Press Club in July.
Uninsured Americans currently receive health care for which they don't have to pay. Their bills are paid by tax dollars spent on Medicaid or the state Children's Health Insurance Programs, or through higher insurance premiums and medical charges to make up for the losses doctors and hospitals incur when they treat the uninsured. Why shouldn't we require people who now get health care at the expense of the rest of us to pay for their coverage themselves?
There's a big bonus. "Mandated coverage would replace Medicaid and state Children's Health Insurance Programs because lower-income and unemployed people would receive a voucher to purchase private health insurance," says Wharton's Mark Pauly. "This would mean full privatization for people under age 65." He holds out an even brighter prospect: "Actually, in principle, mandated coverage could replace Medicare too." The entire medical system could be privatized. The slowly expanding Medicare, Medicaid, and S-CHIP behemoths that are inexorably absorbing more and more of the U.S. health care system could be eliminated.
Mandatory health insurance would be not unlike the laws that require drivers to purchase auto insurance or pay into state-run risk pools. They also resemble the libertarian Cato Institute's proposals for reforming Social Security, which do not eliminate mandatory payments; they privatize them. Similarly, school voucher plans generally mandate that children receive an education. As the Rose and Milton Friedman Foundation notes, universal school vouchers would allow "all parents to direct funds set aside for education by the government to send their children to a school of choice, whether that school is public, private or religious." This system separates "the government financing of education from the government operation of schools."
Once government and health insurers have defined a standard basic package of health care benefits, the current dynamic of constant government meddling in health insurance and health care markets that leads to higher and higher costs should change. Consumers, transformed from passive recipients into direct purchasers, can be expected to be vigilant about government interference that would increase their rates or reduce their services.
As Rep. Bill Thomas (R-Calif.) noted at a recent National Center for Policy Analysis conference, if everyone had to buy his or her own coverage the way people buy car or homeowner's insurance, and if the size of the tax breaks didn't hinge on employment status, you would have the beginnings of a real market. Thomas said he wanted to make basic, low-cost catastrophic health care coverage widely accessible through tax subsidies and credits. More-extensive coverage would be available to individuals who wanted it, but they would have to pay for it with after-tax dollars.
Under a mandatory insurance scheme, all Americans would be required to purchase a basic high-deductible catastrophic health insurance policy from a private insurance company. "Let's say you cap the deductible at $4,000 and set a limit that out-of-pocket health care costs can't exceed 10 percent of an individual's or family's income," suggests Pauly. "That would mean that a family earning $30,000 per year would receive $1,000 in a health voucher." In other words, the family would pay the first $3,000 of medical expenses out of pocket and receive a $1,000 voucher to cover expenses up to the $4,000 deductible.
A high deductible would encourage people to be more careful about the services they purchase. They would shop around for good deals on drugs and scrutinize the costs of various treatment options more closely. Of course, some people inevitably would try to save a penny or two by delaying a visit to the doctor for their stomachache, only to find out later that it's cancer, but no system can make people perfectly prudent.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
A pithy comment from Mark Steyn:
Speaking of which, if there's four words I never want to hear again, it's "prescription drugs from Canada." I'm Canadian, so I know a thing or two about prescription drugs from Canada. Specifically speaking, I know they're American; the only thing Canadian about them is the label in French and English. How can politicians from both parties think that Americans can get cheaper drugs simply by outsourcing (as John Kerry would say) their distribution through a Canadian mailing address? U.S. pharmaceutical companies put up with Ottawa's price controls because it's a peripheral market. But, if you attempt to extend the price controls from the peripheral market of 30 million people to the primary market of 300 million people, all that's going to happen is that after approximately a week and a half there aren't going to be any drugs in Canada, cheap or otherwise -- just as the Clinton administration's intervention into the flu-shot market resulted in American companies getting out of the vaccine business entirely....
The Continental health and welfare systems John Kerry so admires are, in fact, part of the reason those societies are dying. As for Canada, yes, under socialized health care, prescription drugs are cheaper, medical treatment's cheaper, life is cheaper. After much stonewalling, the Province of Quebec's Health Department announced this week that in the last year some 600 Quebecers had died from C. difficile, a bacterium acquired in hospital. In other words, if, say, Bill Clinton had gone for his heart bypass to the Royal Victoria Hospital in Montreal, he would have had the surgery, woken up the next day swimming in diarrhea and then died. It's a bacterium caused by inattention to hygiene -- by unionized, unsackable cleaners who don't clean properly; by harassed overstretched hospital staff who don't bother washing their hands as often as they should. So 600 people have been killed by the filthy squalor of disease-ridden government hospitals. That's the official number. Unofficially, if you're over 65, the hospitals will save face and attribute your death at their hands to "old age" or some such and then "lose" the relevant medical records. Quebec's health system is a lot less healthy than, for example, Iraq's.
THE SUREST WAY TO SAVE PRIVATE HEALTH-CARE
You can have universal coverage without the government running ANY hospitals
In an ABC News/Washington Post poll last fall, 62 percent of the respondents favored a universal, government-run medical insurance program. Such surveys reflect a widespread frustration with a health care system that is too expensive, too uncertain, and too complicated. The answer proposed by John Kerry and John Edwards is to continue the creeping socialization of medicine that Americans have been experiencing since the 1960s. That course would mean the end of private health care in the U.S., and with it the unparalleled medical progress that has benefited patients in this country and throughout the world. It would have a disastrous impact on medical innovation and the quality of care....
When it comes to health care policy, Republicans are Democrats Lite. "The Republicans always say, `We're going to give you the same program, only less than that proposed by the Democrats,'" says Tom Miller, former director of health policy studies at the Cato Institute. "Republicans just offer cheaper, more apologetic programs." Witness the new Medicare drug benefit, which John Kerry immediately denounced as "a raw deal for America's seniors and a big windfall for the big drug companies." No matter how much they give away, Republicans can never give away enough to satisfy the demands of the nationalized health care advocates.
Since it's unlikely that Americans will allow their improvident neighbors to expire without medical care in the streets, is there a politically palatable alternative that can preserve and expand private medicine in the United States? Yes: mandatory private health insurance. The New America Foundation, a liberal policy shop in Washington, D.C., has outlined some elements of how such a system would work. The slogan for its proposal is, "Universal coverage in exchange for universal responsibility." The devil is in the details, of course, but the plan offers some interesting possibilities. For example, mandatory health insurance coverage might be combined with medical savings accounts that would encourage people to save and invest for future medical emergencies.
The New America Foundation proposal preserves private insurance and allows consumers to choose among competing insurance plans and coverage options. Most intriguingly, the plan offers a way out of the dysfunctional employer-financed third-party-payer model that is so grievously distorting our health care system. Employers eventually would devolve responsibility for health insurance to their employees by giving them the money the companies currently pay to insurance companies. Employees would then have a strong incentive to shop around for the best health care deals, putting pressure on insurers to keep costs low.
Even some Republicans are suggesting that mandatory health insurance be required for at least some Americans. Senate Majority Leader Bill Frist (R-Tenn.) recently argued that it is unfair to expect taxpayers to pick up the health care tab for the third of Americans without health insurance who make incomes over $50,000. "I believe higher-income Americans today do have a societal and personal responsibility to cover in some way themselves and their children," the senator said in a speech at the National Press Club in July.
Uninsured Americans currently receive health care for which they don't have to pay. Their bills are paid by tax dollars spent on Medicaid or the state Children's Health Insurance Programs, or through higher insurance premiums and medical charges to make up for the losses doctors and hospitals incur when they treat the uninsured. Why shouldn't we require people who now get health care at the expense of the rest of us to pay for their coverage themselves?
There's a big bonus. "Mandated coverage would replace Medicaid and state Children's Health Insurance Programs because lower-income and unemployed people would receive a voucher to purchase private health insurance," says Wharton's Mark Pauly. "This would mean full privatization for people under age 65." He holds out an even brighter prospect: "Actually, in principle, mandated coverage could replace Medicare too." The entire medical system could be privatized. The slowly expanding Medicare, Medicaid, and S-CHIP behemoths that are inexorably absorbing more and more of the U.S. health care system could be eliminated.
Mandatory health insurance would be not unlike the laws that require drivers to purchase auto insurance or pay into state-run risk pools. They also resemble the libertarian Cato Institute's proposals for reforming Social Security, which do not eliminate mandatory payments; they privatize them. Similarly, school voucher plans generally mandate that children receive an education. As the Rose and Milton Friedman Foundation notes, universal school vouchers would allow "all parents to direct funds set aside for education by the government to send their children to a school of choice, whether that school is public, private or religious." This system separates "the government financing of education from the government operation of schools."
Once government and health insurers have defined a standard basic package of health care benefits, the current dynamic of constant government meddling in health insurance and health care markets that leads to higher and higher costs should change. Consumers, transformed from passive recipients into direct purchasers, can be expected to be vigilant about government interference that would increase their rates or reduce their services.
As Rep. Bill Thomas (R-Calif.) noted at a recent National Center for Policy Analysis conference, if everyone had to buy his or her own coverage the way people buy car or homeowner's insurance, and if the size of the tax breaks didn't hinge on employment status, you would have the beginnings of a real market. Thomas said he wanted to make basic, low-cost catastrophic health care coverage widely accessible through tax subsidies and credits. More-extensive coverage would be available to individuals who wanted it, but they would have to pay for it with after-tax dollars.
Under a mandatory insurance scheme, all Americans would be required to purchase a basic high-deductible catastrophic health insurance policy from a private insurance company. "Let's say you cap the deductible at $4,000 and set a limit that out-of-pocket health care costs can't exceed 10 percent of an individual's or family's income," suggests Pauly. "That would mean that a family earning $30,000 per year would receive $1,000 in a health voucher." In other words, the family would pay the first $3,000 of medical expenses out of pocket and receive a $1,000 voucher to cover expenses up to the $4,000 deductible.
A high deductible would encourage people to be more careful about the services they purchase. They would shop around for good deals on drugs and scrutinize the costs of various treatment options more closely. Of course, some people inevitably would try to save a penny or two by delaying a visit to the doctor for their stomachache, only to find out later that it's cancer, but no system can make people perfectly prudent.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Wednesday, October 27, 2004
WOW! NOW THIS IS SOCIALIZED MEDICINE AT ITS FINEST!
"Poland -- Prosecutors have charged two doctors and two ambulance workers with murder for letting patients die or killing them outright in order to collect kickbacks from funeral homes, officials said Wednesday.
The four defendands were charged in a total of 19 deaths. Under the alleged scheme, funeral homes in the central city of Lodz paid the emergency workers bribes to give them early tip-offs about deaths so the homes could snap up clients. Prosecutors say the defendants went a step further and killed patients.....
A 35-year-old ambulance crew member is accused of killing four patients with injections of a muscle relaxant and informing funeral homes of the deaths in exchange for a total of least $6,200, prosecutors said....
In 2002, police launched an investigation into ambulance staff suspected of taking bribes from funeral parlors. The investigation grabbed national attention after Polish media aired allegations that some crews may have delayed ambulance arrivals or administered drugs that resulted in the death of severely ill patients. State officials have acknowledged the system is prone to corruption. They blame low pay for government-employed medical workers and a lack of laws regulating intense competition among funeral homes".
More here
Australian check-up finds sick and sorry hospitals
"High levels of anger, starved of funds, staff not sure if anyone is in control: two major Sydney hospitals have been diagnosed with severe internal problems. At Royal North Shore Hospital, where morale has been battered by 10 years of funding cuts, rivalries have sprung up between doctors and anaesthetists and medical staff no longer trust management, an independent report has found. The report also found Ryde Hospital no longer had the resources to sustain emergency surgery, which should be abolished or limited to simple daytime procedures. Staff were "uncertain that anyone is actually in control at the level of middle management".
Last night the Health Minister, Morris Iemma, said he was shocked by the report, and said he had no idea about the state of the operating and surgical services at the two hospitals. "[The health system] is a big and complex system. My job is to get involved and do something to correct these issues when they are raised," he said. Mr Iemma denied funding had been run down at North Shore and said management denied some of the report's allegations, but he would accept its recommendation to convene immediately a restructuring committee to be chaired by North Shore's general manager, Deborah Latta.....
The report said North Shore medical staff believed management emphasised revenue raising over treatment and was dishonest in its explanation of cuts to services. Growth of adjoining private hospitals, carrying out procedures North Shore would once have charged for, had starved it of revenue. Senior management had no strategic vision, while surgical clinical committees overseeing the allocation of resources were so disaffected they had simply ceased making decisions. Some doctors believed the hospital's anaesthetics section "was managed by anaesthetists for anaesthetists". Doctors' lack of control over or input into decision-making had led to a "high level of anger and frustration at the situation" exacerbated by the simultaneous growth of the private hospitals.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
"Poland -- Prosecutors have charged two doctors and two ambulance workers with murder for letting patients die or killing them outright in order to collect kickbacks from funeral homes, officials said Wednesday.
The four defendands were charged in a total of 19 deaths. Under the alleged scheme, funeral homes in the central city of Lodz paid the emergency workers bribes to give them early tip-offs about deaths so the homes could snap up clients. Prosecutors say the defendants went a step further and killed patients.....
A 35-year-old ambulance crew member is accused of killing four patients with injections of a muscle relaxant and informing funeral homes of the deaths in exchange for a total of least $6,200, prosecutors said....
In 2002, police launched an investigation into ambulance staff suspected of taking bribes from funeral parlors. The investigation grabbed national attention after Polish media aired allegations that some crews may have delayed ambulance arrivals or administered drugs that resulted in the death of severely ill patients. State officials have acknowledged the system is prone to corruption. They blame low pay for government-employed medical workers and a lack of laws regulating intense competition among funeral homes".
More here
Australian check-up finds sick and sorry hospitals
"High levels of anger, starved of funds, staff not sure if anyone is in control: two major Sydney hospitals have been diagnosed with severe internal problems. At Royal North Shore Hospital, where morale has been battered by 10 years of funding cuts, rivalries have sprung up between doctors and anaesthetists and medical staff no longer trust management, an independent report has found. The report also found Ryde Hospital no longer had the resources to sustain emergency surgery, which should be abolished or limited to simple daytime procedures. Staff were "uncertain that anyone is actually in control at the level of middle management".
Last night the Health Minister, Morris Iemma, said he was shocked by the report, and said he had no idea about the state of the operating and surgical services at the two hospitals. "[The health system] is a big and complex system. My job is to get involved and do something to correct these issues when they are raised," he said. Mr Iemma denied funding had been run down at North Shore and said management denied some of the report's allegations, but he would accept its recommendation to convene immediately a restructuring committee to be chaired by North Shore's general manager, Deborah Latta.....
The report said North Shore medical staff believed management emphasised revenue raising over treatment and was dishonest in its explanation of cuts to services. Growth of adjoining private hospitals, carrying out procedures North Shore would once have charged for, had starved it of revenue. Senior management had no strategic vision, while surgical clinical committees overseeing the allocation of resources were so disaffected they had simply ceased making decisions. Some doctors believed the hospital's anaesthetics section "was managed by anaesthetists for anaesthetists". Doctors' lack of control over or input into decision-making had led to a "high level of anger and frustration at the situation" exacerbated by the simultaneous growth of the private hospitals.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Tuesday, October 26, 2004
A SLIGHT DEREGULATION OF MEDICINE IN BRITAIN
"Pharmacists in England and Wales could offer some health services currently provided by GPs, under a new deal agreed with the government. These would include supplying repeat prescriptions, offering basic health advice and blood pressure checks. Chemists would be paid by the NHS according to the range and quality of services they provided. Pharmacists now have to vote on whether to accept the new contract, which would come into force next April.
The document has been drawn up after two years of talks between the Department of Health and pharmacists' representatives. Speaking ahead of a meeting of the all-party parliamentary pharmacy group, health minister Rosie Winterton, said: "This new contract represents the beginning of a new era for pharmacy in the community, in which everyone will benefit... "Until now, pharmacists have been an untapped resource. I want to see them more integrated with the NHS family."
Under the new contract, patients will be able get up to a year's worth of prescriptions from their GP at a time. This will be dispensed at intervals agreed between the doctor and pharmacist. According to Ms Winterton, this will reduce GP workloads and relieve patients with chronic conditions from having to repeatedly visit their surgery.
The chairman of the Pharmaceutical Services Negotiating Committee, Barry Andrews, said: "I am pleased that we have been able to reach agreement with the government on proposals for a new pharmacy contract that will provide better services for patients, better use of the skills of pharmacists, and a more secure future for community pharmacy contractors."
Source
One of my medical readers comments:
This is just common sense. No one with chronic hypertension should have to go to a doctor just to get a prescription refill. And Wal Mart has BP machines - why not pharmacists?
Unfortunately, this is one more area where such a policy would probably be squeezed out in the USA by litigation - pharmacists may not want to be liable if a patient doesn't take his medicine reliably, takes cocaine (which could lead to a stroke, and then blame the pharmacist for not giving him the correct meds, etc..).
Also, a lot of other "baggage" goes along with hypertension - coronary artery disease, peripheral vascular disease, heart attacks, heart failute, obesity, diabetes, etc.. The pharmacist may be liable for not diagnosing such things etc.
In a rational society, patients would have the option to visit the pharmacist instead of the GP to have his BP checked etc.. But then the pharmacist would have to be immune from liability for not diagnosing diabetes etc. So add this to the list of reasons why American medicine is so expensive: Threat of litigation REDUCES COMPETITION.
AND IN AUSTRALIA THE DOCTORS STRIKE BACK
Doctors will seek authority to dispense prescription medicines to their patients after pharmacists asked the Federal Government to allow them to perform some of the basic functions of GPs.
The Pharmacy Guild of Australia yesterday revealed it was entering negotiations with the Government to extend the role of pharmacists so they could administer vaccines and help monitor conditions such as diabetes and high blood pressure. Pharmacy Guild president John Bronger said any proposal to take pressure off GPs at a time of doctor shortages should be seriously examined. Giving pharmacists the extra powers would amount to evolutionary rather than revolutionary change, he said. The Pharmacy Guild would not be asking for drug-prescribing powers.
However Australian Medical Association president Bill Glasson labelled the plan "mischievous and irresponsible", adding that it was an insult to general practitioners and an unnecessary threat to the nation's high standard of primary care.
More here
THE WYOMING CONSTITUTIONAL AMENDMENT
Payout caps are a poor substitute for reponsible judges but when judges think that they are Father Christmas (with other people's money) what choice is there?
Amendment D would give the Legislature the power to limit the amount of noneconomic damages in medical malpractice lawsuits. Noneconomic damages generally involve such things as pain and suffering or mental anguish. Economic damages, including loss of past and future pay, past and future medical costs, repair and replacement costs, would not be affected by the amendment. If voters approve the amendment, the Legislature would be charged with deciding a cap on the dollar amount that could be awarded for noneconomic damages.
A companion amendment, Amendment C, would allow lawmakers to establish a panel to review a medical malpractice case before it reaches the courts. The two amendments are among four that voters will decide on Nov. 2. For a constitutional amendment to pass in Wyoming it needs only a simple majority of votes cast in the general election.
Opponents of the amendments C and D, led by trial lawyers, argue Wyoming residents are being asked to surrender the right to collect all possible damages for injury or loss caused by medical negligence. They say Wyoming has not had any large malpractice damage awards to warrant such a drastic move.
Supporters, led by doctors, contend that unchecked malpractice awards are driving up insurance costs for doctors and driving them from the state, particularly its rural areas. They contend caps will help slow the rapid rise in premiums. A medical review panel would cut down on costly frivolous lawsuits, they say. Alarmed by news of doctors pulling up practices or retiring early, leaving some communities without medical care, the Legislature held a special session last summer where legislators overwhelmingly approved putting the constitutional amendments on the ballot. Gov. Dave Freudenthal, a lawyer, supported the amendments, saying it should be up to voters which direction the state should take.
Shauna Roberts, spokeswoman for Citizens for Real Insurance Reform, which opposes the amendments, contends capping damage awards is not going to help doctors. She noted that nine states that passed damage caps in 2003 all had subsequent premium increases. "The evidence is not at all conclusive that putting caps on noneconomic damages does anything for rates," Roberts said. She also contends that the argument doctors are leaving Wyoming is incorrect.
Citing numbers supplied by the state Legislative Service Office, Roberts said Wyoming had a total net increase of 238 direct patient care doctors since 1994. But Wendy Curran, executive director of the Wyoming Medical Society, which represents the state's physicians, contends the numbers don't mean much to a community with no obstetricians or surgeons. "What we do know is that if you live in Gillette, where there is only one surgeon and where they are having difficulty recruiting new surgeons, you might not think there's enough doctors in the state," Curran said.
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
"Pharmacists in England and Wales could offer some health services currently provided by GPs, under a new deal agreed with the government. These would include supplying repeat prescriptions, offering basic health advice and blood pressure checks. Chemists would be paid by the NHS according to the range and quality of services they provided. Pharmacists now have to vote on whether to accept the new contract, which would come into force next April.
The document has been drawn up after two years of talks between the Department of Health and pharmacists' representatives. Speaking ahead of a meeting of the all-party parliamentary pharmacy group, health minister Rosie Winterton, said: "This new contract represents the beginning of a new era for pharmacy in the community, in which everyone will benefit... "Until now, pharmacists have been an untapped resource. I want to see them more integrated with the NHS family."
Under the new contract, patients will be able get up to a year's worth of prescriptions from their GP at a time. This will be dispensed at intervals agreed between the doctor and pharmacist. According to Ms Winterton, this will reduce GP workloads and relieve patients with chronic conditions from having to repeatedly visit their surgery.
The chairman of the Pharmaceutical Services Negotiating Committee, Barry Andrews, said: "I am pleased that we have been able to reach agreement with the government on proposals for a new pharmacy contract that will provide better services for patients, better use of the skills of pharmacists, and a more secure future for community pharmacy contractors."
Source
One of my medical readers comments:
This is just common sense. No one with chronic hypertension should have to go to a doctor just to get a prescription refill. And Wal Mart has BP machines - why not pharmacists?
Unfortunately, this is one more area where such a policy would probably be squeezed out in the USA by litigation - pharmacists may not want to be liable if a patient doesn't take his medicine reliably, takes cocaine (which could lead to a stroke, and then blame the pharmacist for not giving him the correct meds, etc..).
Also, a lot of other "baggage" goes along with hypertension - coronary artery disease, peripheral vascular disease, heart attacks, heart failute, obesity, diabetes, etc.. The pharmacist may be liable for not diagnosing such things etc.
In a rational society, patients would have the option to visit the pharmacist instead of the GP to have his BP checked etc.. But then the pharmacist would have to be immune from liability for not diagnosing diabetes etc. So add this to the list of reasons why American medicine is so expensive: Threat of litigation REDUCES COMPETITION.
AND IN AUSTRALIA THE DOCTORS STRIKE BACK
Doctors will seek authority to dispense prescription medicines to their patients after pharmacists asked the Federal Government to allow them to perform some of the basic functions of GPs.
The Pharmacy Guild of Australia yesterday revealed it was entering negotiations with the Government to extend the role of pharmacists so they could administer vaccines and help monitor conditions such as diabetes and high blood pressure. Pharmacy Guild president John Bronger said any proposal to take pressure off GPs at a time of doctor shortages should be seriously examined. Giving pharmacists the extra powers would amount to evolutionary rather than revolutionary change, he said. The Pharmacy Guild would not be asking for drug-prescribing powers.
However Australian Medical Association president Bill Glasson labelled the plan "mischievous and irresponsible", adding that it was an insult to general practitioners and an unnecessary threat to the nation's high standard of primary care.
More here
THE WYOMING CONSTITUTIONAL AMENDMENT
Payout caps are a poor substitute for reponsible judges but when judges think that they are Father Christmas (with other people's money) what choice is there?
Amendment D would give the Legislature the power to limit the amount of noneconomic damages in medical malpractice lawsuits. Noneconomic damages generally involve such things as pain and suffering or mental anguish. Economic damages, including loss of past and future pay, past and future medical costs, repair and replacement costs, would not be affected by the amendment. If voters approve the amendment, the Legislature would be charged with deciding a cap on the dollar amount that could be awarded for noneconomic damages.
A companion amendment, Amendment C, would allow lawmakers to establish a panel to review a medical malpractice case before it reaches the courts. The two amendments are among four that voters will decide on Nov. 2. For a constitutional amendment to pass in Wyoming it needs only a simple majority of votes cast in the general election.
Opponents of the amendments C and D, led by trial lawyers, argue Wyoming residents are being asked to surrender the right to collect all possible damages for injury or loss caused by medical negligence. They say Wyoming has not had any large malpractice damage awards to warrant such a drastic move.
Supporters, led by doctors, contend that unchecked malpractice awards are driving up insurance costs for doctors and driving them from the state, particularly its rural areas. They contend caps will help slow the rapid rise in premiums. A medical review panel would cut down on costly frivolous lawsuits, they say. Alarmed by news of doctors pulling up practices or retiring early, leaving some communities without medical care, the Legislature held a special session last summer where legislators overwhelmingly approved putting the constitutional amendments on the ballot. Gov. Dave Freudenthal, a lawyer, supported the amendments, saying it should be up to voters which direction the state should take.
Shauna Roberts, spokeswoman for Citizens for Real Insurance Reform, which opposes the amendments, contends capping damage awards is not going to help doctors. She noted that nine states that passed damage caps in 2003 all had subsequent premium increases. "The evidence is not at all conclusive that putting caps on noneconomic damages does anything for rates," Roberts said. She also contends that the argument doctors are leaving Wyoming is incorrect.
Citing numbers supplied by the state Legislative Service Office, Roberts said Wyoming had a total net increase of 238 direct patient care doctors since 1994. But Wendy Curran, executive director of the Wyoming Medical Society, which represents the state's physicians, contends the numbers don't mean much to a community with no obstetricians or surgeons. "What we do know is that if you live in Gillette, where there is only one surgeon and where they are having difficulty recruiting new surgeons, you might not think there's enough doctors in the state," Curran said.
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Monday, October 25, 2004
LEGAL AID BAD FOR HEALTH
Poor people in Britain are given free legal services AND are exempt from paying the other side's costs if they lose. So they sue their hospitals with gay abandon: Nothing to lose. And the hospital pays up because it is cheaper than fighting the case. And the money that should be paying doctors and nurses goes to lawyers. Great system, this socialism!
It is a popular misconception that civil legal aid means access to justice. It doesn't - many people don't qualify. Civil legal aid provides access to lawyers for the eligible minority who can bring doubtful cases without risk. This is amply borne out by the dismal success rates of cases against the health care industry. Too often lawyers and claimants simply walk away from the wreckage of failed legally aided litigation, the lawyers the only winners. We pay twice, first through legal aid and again by the damage to our health system.
All patients injured by negligent treatment are rightly entitled to compensation, not just those who qualify for legal aid; there must be access to justice for all. However, this has to be set against the health budget's purpose of treating patients. How can it be done fairly and sensibly?
There is widespread concern about the cost and conduct of clinical negligence cases. The Legal Services Commission and the Conservative Party have recently published consultation papers. They propose limiting legal aid to investigating the case. Any court action can be funded by conditional fee arrangements ("no win, no fee"). Commercial prudence provides an inbuilt incentive to pursue worthwhile claims. Moreover, the usual 'loser pays' rule applies whereby the loser pays the winner's legal costs (it does not apply in legally aided cases). This sensible rule encourages cases to resolve according to their merits: weak cases are abandoned and strong cases are settled. Successful health service defendants can recover costs, thereby protecting funds for patient care. Insurance cover is available to claimants for this potential liability.
Conditional fees and the loser pays rule together ensure that the risks of litigation are balanced between the parties, and promote fairness of the legal process. There should be no more legal aid blackmail, where speculative cases are settled by defendants to avoid high irrecoverable trial costs.
This combined public and private funding recognises the expense of investigating medical cases whilst drawing on the strengths of the conditional fee system. Access to justice will be widened, weak cases will be discouraged. No system can be perfect, but the proposed reform seems best at balancing the competing considerations of compensating victims of negligence and protecting funds for patient care.
From the Adam Smith blog
HOW SURPRISING -- (NOT)
A British government attempt at half-hearted mimicry of the private sector was always a laugh
The Government's flagship policy to create foundation trusts, granting the best hospitals financial independence, was dealt a serious blow last night after it emerged that a leading trust has slid into a o5 million spending deficit in just three months. A team of American accountants has been called into Bradford Teaching Hospital NHS Trust to draw up an emergency finance plan just six months after it became one of the first hospitals to be awarded foundation status.
When Bradford was vetted by the Government and an independent regulator before its appointment in April, hospital chiefs forecast a 1 million pound budget surplus by the end of the financial year. By July this had been revised to a 4 million pound deficit, The Times has learnt.
Politicians and health leaders last night gave warning that many more hospitals would face similar problems because the Government had not foreseen the consequences of imposing numerous new finance schemes on the NHS. They expressed concerns that the debts would impact heavily on patient care as trusts fought to recoup their funds. Of the 20 hospitals that have been granted foundation status to date, four have already dropped from three to two stars in the performance ratings. The government-appointed regulator originally said that any hospital that lost a star would lose its foundation status, but it has yet to act on the pledge.
Monitor, the independent regulator of foundation trusts, announced yesterday that Alvarez and Marsal, a firm of financial recovery experts, was being called in to avoid Bradford plunging further into the red. The regulator said that the company, which helped to wind down the bankrupt accountancy giant Arthur Andersen, would work with the trust's board of directors to assess the current financial position and develop future plans. Alvarez and Marsal's fee will also be paid by the trust, the regulator said.
Frank Dobson, the Labour MP and former Health Secretary, described the move as a very worrying development and an ill omen of the financial problems to come. He said that it revealed serious shortcomings in the way that hospitals were being vetted to become foundation trusts. "Even I never imagined things would get in a mess this quickly. If we lived in a rational world, it might make the Prime Minister pause for thought," he said. "It may be necessary to spend money on financial consultants now to rescue the situation at Bradford, but perhaps there should be experts looking at the regulator who gave them a clean bill of health just six months ago."
Andrew Lansley, the Conservative health spokesman, said: "What this illustrates is that the whole sector is going to face real turbulence. The Government is trying to impose very large changes all at once, and all of them have significant financial consequences which will combine in ways that are very difficult for hospitals to manage."
The move by Monitor is the first time that the regulator has used powers under Section 23 of the Health and Social Care (Community Health and Standards) Act 2003 to intervene in foundation trust finances. Bradford was made a foundation trust in April in the first wave of the Government's controversial scheme for high-flying hospitals. Foundation trusts remain part of the NHS but are given more control over how they spend their money, are able to borrow capital to fund projects and give local people a say on their governing bodies.
But critics of the scheme claim it creates a "two-tier" NHS with greater divisions between the best and worst hospitals. Bradford's board of directors has agreed to work with the regulator and the external advisers to identify the causes of its underperformance and implement actions to tackle them. Paul Earp, its finance director, resigned two weeks ago. It is understood that, after seven successful years at the trust, he became exasperated at the financial problems it now faced.
From "The Times" (London, U.K.).
***************************
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.
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.
***************************
Poor people in Britain are given free legal services AND are exempt from paying the other side's costs if they lose. So they sue their hospitals with gay abandon: Nothing to lose. And the hospital pays up because it is cheaper than fighting the case. And the money that should be paying doctors and nurses goes to lawyers. Great system, this socialism!
It is a popular misconception that civil legal aid means access to justice. It doesn't - many people don't qualify. Civil legal aid provides access to lawyers for the eligible minority who can bring doubtful cases without risk. This is amply borne out by the dismal success rates of cases against the health care industry. Too often lawyers and claimants simply walk away from the wreckage of failed legally aided litigation, the lawyers the only winners. We pay twice, first through legal aid and again by the damage to our health system.
All patients injured by negligent treatment are rightly entitled to compensation, not just those who qualify for legal aid; there must be access to justice for all. However, this has to be set against the health budget's purpose of treating patients. How can it be done fairly and sensibly?
There is widespread concern about the cost and conduct of clinical negligence cases. The Legal Services Commission and the Conservative Party have recently published consultation papers. They propose limiting legal aid to investigating the case. Any court action can be funded by conditional fee arrangements ("no win, no fee"). Commercial prudence provides an inbuilt incentive to pursue worthwhile claims. Moreover, the usual 'loser pays' rule applies whereby the loser pays the winner's legal costs (it does not apply in legally aided cases). This sensible rule encourages cases to resolve according to their merits: weak cases are abandoned and strong cases are settled. Successful health service defendants can recover costs, thereby protecting funds for patient care. Insurance cover is available to claimants for this potential liability.
Conditional fees and the loser pays rule together ensure that the risks of litigation are balanced between the parties, and promote fairness of the legal process. There should be no more legal aid blackmail, where speculative cases are settled by defendants to avoid high irrecoverable trial costs.
This combined public and private funding recognises the expense of investigating medical cases whilst drawing on the strengths of the conditional fee system. Access to justice will be widened, weak cases will be discouraged. No system can be perfect, but the proposed reform seems best at balancing the competing considerations of compensating victims of negligence and protecting funds for patient care.
From the Adam Smith blog
HOW SURPRISING -- (NOT)
A British government attempt at half-hearted mimicry of the private sector was always a laugh
The Government's flagship policy to create foundation trusts, granting the best hospitals financial independence, was dealt a serious blow last night after it emerged that a leading trust has slid into a o5 million spending deficit in just three months. A team of American accountants has been called into Bradford Teaching Hospital NHS Trust to draw up an emergency finance plan just six months after it became one of the first hospitals to be awarded foundation status.
When Bradford was vetted by the Government and an independent regulator before its appointment in April, hospital chiefs forecast a 1 million pound budget surplus by the end of the financial year. By July this had been revised to a 4 million pound deficit, The Times has learnt.
Politicians and health leaders last night gave warning that many more hospitals would face similar problems because the Government had not foreseen the consequences of imposing numerous new finance schemes on the NHS. They expressed concerns that the debts would impact heavily on patient care as trusts fought to recoup their funds. Of the 20 hospitals that have been granted foundation status to date, four have already dropped from three to two stars in the performance ratings. The government-appointed regulator originally said that any hospital that lost a star would lose its foundation status, but it has yet to act on the pledge.
Monitor, the independent regulator of foundation trusts, announced yesterday that Alvarez and Marsal, a firm of financial recovery experts, was being called in to avoid Bradford plunging further into the red. The regulator said that the company, which helped to wind down the bankrupt accountancy giant Arthur Andersen, would work with the trust's board of directors to assess the current financial position and develop future plans. Alvarez and Marsal's fee will also be paid by the trust, the regulator said.
Frank Dobson, the Labour MP and former Health Secretary, described the move as a very worrying development and an ill omen of the financial problems to come. He said that it revealed serious shortcomings in the way that hospitals were being vetted to become foundation trusts. "Even I never imagined things would get in a mess this quickly. If we lived in a rational world, it might make the Prime Minister pause for thought," he said. "It may be necessary to spend money on financial consultants now to rescue the situation at Bradford, but perhaps there should be experts looking at the regulator who gave them a clean bill of health just six months ago."
Andrew Lansley, the Conservative health spokesman, said: "What this illustrates is that the whole sector is going to face real turbulence. The Government is trying to impose very large changes all at once, and all of them have significant financial consequences which will combine in ways that are very difficult for hospitals to manage."
The move by Monitor is the first time that the regulator has used powers under Section 23 of the Health and Social Care (Community Health and Standards) Act 2003 to intervene in foundation trust finances. Bradford was made a foundation trust in April in the first wave of the Government's controversial scheme for high-flying hospitals. Foundation trusts remain part of the NHS but are given more control over how they spend their money, are able to borrow capital to fund projects and give local people a say on their governing bodies.
But critics of the scheme claim it creates a "two-tier" NHS with greater divisions between the best and worst hospitals. Bradford's board of directors has agreed to work with the regulator and the external advisers to identify the causes of its underperformance and implement actions to tackle them. Paul Earp, its finance director, resigned two weeks ago. It is understood that, after seven successful years at the trust, he became exasperated at the financial problems it now faced.
From "The Times" (London, U.K.).
***************************
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.
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.
***************************
Sunday, October 24, 2004
KERRYCARE AND TENNCARE
Post lifted from Medpundit
"We don't have to imagine what would happen under Kerry's Medicaid expansion plan. All we have to do is look south, to Tennessee to see the Kerry plan in live action. Since 1994, Tennessee has provided state-funded healthcare with the same eligibility requirements as the Kerry plan. Nine years later the state's governor was calling it the dragon that eats everything, and financial management consultants were warning that by 2008 the program would consume $9 out of every $10 in new revenue taken in by the state. That's a lot of money, money that won't be available for other essential state-provided services.
And yet, despite spending all of that money, Tenncare patients still end up getting the shaft. In the grand American tradition, the program shunned rationing, covering everything from lava lamps to MRI's. The programs generosity, however, did not include doctors and hospitals, whose reimbursement rates are so low that seeing Tenncare patients is a losing proposition. As a result, access to care is a very real problem for Tenncare patients, some of whom have to drive 40 miles just to see a doctor. (And keep in mind, those are mountain miles.)
And what about the children? Only 19% of pediatricians in Tennessee accept Tenncare, the lowest participation rate of any state in the union. As a result, over one-third of children enrolled in Tenncare have trouble finding a doctor. That's a very real problem. And one that's much more serious and damaging to a child's health than lack of insurance.
But under Kerry's Tenncare National, access to care would be even worse. The median family income in the U.S. is $53,991. Three hundred percent of the poverty level for the average family of four is $56,500. Under Kerry, over half of America's families would qualify for the expanded Medicaid coverage. Which would mean that doctors would see their reimbursement drop drastically - to the point that they would have trouble staying in business. You can't squeeze blood from a rock, and the fact of the matter is that the safety margin of the average physician's practice is already razor thin, thanks to the medical liability crisis. And there's no reason to think that a Kerry/Edwards administration is going to enact any meaningful medical liability reform, not with donors like these. With most of the country struggling with rising malpractice insurance premiums, there's just no room for physicians and hospitals to provide mandated charity care for the middle class. The heart may be willing, but the purse won't allow it.
The pincer movement of Kerry's healthcare plan and trial lawyer friends would squeeze doctors right out of the picture. Those physicians who can would retire early, as many already are. Others would probably leave medicine all together. Hospitals that can't make up the difference by soaking the rich would close, as many small community hospitals did under the onslaught of managed care in the 1990's. But in this case, it wouldn't just be rural and inner city hospitals, it would also be suburban and small city hospitals. Only the large tertiary care centers, like Mass General and The Cleveland Clinic, who attract the wealthy the world over would stand a chance. And the future would be even bleaker. Who wants to invest the time and money to go to medical school if it's financially impossible to pay back student loans? The healthcare industry is leading employers in the U.S. Fewer hospitals and doctors not only means less access to care - it means higher unemployment rates. A vote for Kerry is anything but a vote for nurses. And it certainly isn't a vote for children. More people may have healthcare insurance under Kerry's plan, but they'll have a much harder time finding somewhere to use it.
In the last debate Kerry called our current healthcare insurance system high-priced but low-benefit. The implication was that his plan would be low-priced and high-benefit. But everything has a price, and Kerry's is higher than we can afford.
IF IT'S FREE IT GETS USED BY PEOPLE WHO DON'T REALLY NEED IT
A new study on emergency rooms disputes the common wisdom that the poor and uninsured are filling them up. In fact, more than 80 percent of patients seen in emergency rooms have health insurance and a usual source of health care such as a primary care physician, doctors reported on Tuesday. "Contrary to popular perception, individuals who do not have a usual source of care are actually less likely to have visited an emergency department than those who have such care," said Dr. Ellen Weber, an professor in the division of emergency medicine at the University of California San Francisco, who led the study.
For the study, Weber and colleagues looked at interviews of nearly 50,000 adults visiting emergency departments in 2000 and 2001. People without health insurance were no more likely to have had an emergency visit than those with private health insurance, they told a meeting of the American College of Emergency Physicians. People without a regular doctor or clinic were 25 percent less likely to have had an emergency visit than those with a private doctor, the researchers found. Their study, also published in the Annals of Emergency medicine, found that 83 percent of emergency department visits were made by people who had a doctor, clinic or were members of a health maintenance organization. Eighty-five percent had medical insurance and 79 percent had incomes above the poverty level. "The mistaken belief that emergency departments are overcrowded by a small, disenfranchised portion of the U.S. population can lead to misguided policy decisions and a perception by hospital administrators that emergency patients are not as valuable to the institution as patients having elective surgery," Weber said in a statement. "But our findings indicate that emergency departments serve as a safety net, not just for the poor and uninsured, but for mainstream Americans, and in particular those with serious and chronic illness."
A spokesman for the American Hospital Association said he was studying the report but added, "That is not surprising because a majority of people have insurance." An estimated 45 million Americans lack health insurance, but that leaves 85 percent of the population with coverage, either public or private.
Hospitals have long complained that their emergency rooms are overcrowded. Between 1992 and 2002, emergency department use climbed 23 percent, from 89.8 million visits to 110 million visits. The 1986 Emergency Medical Treatment and Labor Act requires any hospital taking part in Medicare -- the state-federal health care insurance program for the elderly and disabled -- to provide "appropriate medical screening" to anyone showing up at an emergency room and asking for it. Hospitals say the rules have burdened their emergency departments with poor and uninsured patients seeking care for everyday conditions. Many have closed emergency facilities in recent years. "Many insurance programs, and particularly public and private HMOs, require beneficiaries to have a primary care physician, which may be expected to improve overall health and health care," Weber said. "But the continued rise in emergency visits implies that such programs have not had a substantial impact on overall emergency department use."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Post lifted from Medpundit
"We don't have to imagine what would happen under Kerry's Medicaid expansion plan. All we have to do is look south, to Tennessee to see the Kerry plan in live action. Since 1994, Tennessee has provided state-funded healthcare with the same eligibility requirements as the Kerry plan. Nine years later the state's governor was calling it the dragon that eats everything, and financial management consultants were warning that by 2008 the program would consume $9 out of every $10 in new revenue taken in by the state. That's a lot of money, money that won't be available for other essential state-provided services.
And yet, despite spending all of that money, Tenncare patients still end up getting the shaft. In the grand American tradition, the program shunned rationing, covering everything from lava lamps to MRI's. The programs generosity, however, did not include doctors and hospitals, whose reimbursement rates are so low that seeing Tenncare patients is a losing proposition. As a result, access to care is a very real problem for Tenncare patients, some of whom have to drive 40 miles just to see a doctor. (And keep in mind, those are mountain miles.)
And what about the children? Only 19% of pediatricians in Tennessee accept Tenncare, the lowest participation rate of any state in the union. As a result, over one-third of children enrolled in Tenncare have trouble finding a doctor. That's a very real problem. And one that's much more serious and damaging to a child's health than lack of insurance.
But under Kerry's Tenncare National, access to care would be even worse. The median family income in the U.S. is $53,991. Three hundred percent of the poverty level for the average family of four is $56,500. Under Kerry, over half of America's families would qualify for the expanded Medicaid coverage. Which would mean that doctors would see their reimbursement drop drastically - to the point that they would have trouble staying in business. You can't squeeze blood from a rock, and the fact of the matter is that the safety margin of the average physician's practice is already razor thin, thanks to the medical liability crisis. And there's no reason to think that a Kerry/Edwards administration is going to enact any meaningful medical liability reform, not with donors like these. With most of the country struggling with rising malpractice insurance premiums, there's just no room for physicians and hospitals to provide mandated charity care for the middle class. The heart may be willing, but the purse won't allow it.
The pincer movement of Kerry's healthcare plan and trial lawyer friends would squeeze doctors right out of the picture. Those physicians who can would retire early, as many already are. Others would probably leave medicine all together. Hospitals that can't make up the difference by soaking the rich would close, as many small community hospitals did under the onslaught of managed care in the 1990's. But in this case, it wouldn't just be rural and inner city hospitals, it would also be suburban and small city hospitals. Only the large tertiary care centers, like Mass General and The Cleveland Clinic, who attract the wealthy the world over would stand a chance. And the future would be even bleaker. Who wants to invest the time and money to go to medical school if it's financially impossible to pay back student loans? The healthcare industry is leading employers in the U.S. Fewer hospitals and doctors not only means less access to care - it means higher unemployment rates. A vote for Kerry is anything but a vote for nurses. And it certainly isn't a vote for children. More people may have healthcare insurance under Kerry's plan, but they'll have a much harder time finding somewhere to use it.
In the last debate Kerry called our current healthcare insurance system high-priced but low-benefit. The implication was that his plan would be low-priced and high-benefit. But everything has a price, and Kerry's is higher than we can afford.
IF IT'S FREE IT GETS USED BY PEOPLE WHO DON'T REALLY NEED IT
A new study on emergency rooms disputes the common wisdom that the poor and uninsured are filling them up. In fact, more than 80 percent of patients seen in emergency rooms have health insurance and a usual source of health care such as a primary care physician, doctors reported on Tuesday. "Contrary to popular perception, individuals who do not have a usual source of care are actually less likely to have visited an emergency department than those who have such care," said Dr. Ellen Weber, an professor in the division of emergency medicine at the University of California San Francisco, who led the study.
For the study, Weber and colleagues looked at interviews of nearly 50,000 adults visiting emergency departments in 2000 and 2001. People without health insurance were no more likely to have had an emergency visit than those with private health insurance, they told a meeting of the American College of Emergency Physicians. People without a regular doctor or clinic were 25 percent less likely to have had an emergency visit than those with a private doctor, the researchers found. Their study, also published in the Annals of Emergency medicine, found that 83 percent of emergency department visits were made by people who had a doctor, clinic or were members of a health maintenance organization. Eighty-five percent had medical insurance and 79 percent had incomes above the poverty level. "The mistaken belief that emergency departments are overcrowded by a small, disenfranchised portion of the U.S. population can lead to misguided policy decisions and a perception by hospital administrators that emergency patients are not as valuable to the institution as patients having elective surgery," Weber said in a statement. "But our findings indicate that emergency departments serve as a safety net, not just for the poor and uninsured, but for mainstream Americans, and in particular those with serious and chronic illness."
A spokesman for the American Hospital Association said he was studying the report but added, "That is not surprising because a majority of people have insurance." An estimated 45 million Americans lack health insurance, but that leaves 85 percent of the population with coverage, either public or private.
Hospitals have long complained that their emergency rooms are overcrowded. Between 1992 and 2002, emergency department use climbed 23 percent, from 89.8 million visits to 110 million visits. The 1986 Emergency Medical Treatment and Labor Act requires any hospital taking part in Medicare -- the state-federal health care insurance program for the elderly and disabled -- to provide "appropriate medical screening" to anyone showing up at an emergency room and asking for it. Hospitals say the rules have burdened their emergency departments with poor and uninsured patients seeking care for everyday conditions. Many have closed emergency facilities in recent years. "Many insurance programs, and particularly public and private HMOs, require beneficiaries to have a primary care physician, which may be expected to improve overall health and health care," Weber said. "But the continued rise in emergency visits implies that such programs have not had a substantial impact on overall emergency department use."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Saturday, October 23, 2004
GREAT NEWS FOR LIBERTARIANS
If you don't have a right to decide what you do with your own body, what right do you have?
A Colorado man underwent a kidney transplant Wednesday in what is believed to be the first such operation involving an organ obtained through a for-profit Web site -- a transaction that has raised legal and ethical questions.
Presbyterian/St. Luke's Hospital spokeswoman Stephanie Lewis said the surgery was going well and the vital signs of both the donor and recipient were good. The operation, which began at about noon, was scheduled to last about four hours.
Before the operation, Bob Hickey, 58, met with Dr. Igal Kam, the surgeon whose objections initially postponed the transplant. The meeting was described as a time for "healing the scars of the last several days." Kam suddenly cancelled Monday's transplant operation after learning that Hickey had met his donor, Robert Smitty, 32, of Chattanooga, Tenn., through a Web site called MatchingDonors.com. Smitty agreed to give Hickey one of his kidneys before the two men ever met. The hospital later said the operation was only "postponed."
MatchingDonors.com, based in Canton, Mass., charges varying fees -- sometimes $290 a month -- to post profiles of people looking for live organ donors.
Hickey, of Edwards, Colo., has needed a transplant since 1999 because of a kidney disease. He said he was tired of waiting on the national donation list. Within three months of posting his profile on the Web site, he received 500 offers for donations.
The hospital's Clinical Ethics Committee met on Tuesday to evaluate concerns about the transplant, including whether either Hickey or Smitty stood to profit from the arrangement. The panel later advised the hospital to make a compassionate exception, once both men had signed statements indicating that neither would benefit financially. "We're pleased we were able to resolve this quickly with a compassionate exception. But it's also important to note that organ donations continue to be the topic of a broader national debate and more answers are needed," Mimi Roberson, chief executive of P/SL in Denver, said in a statement.
More here.
TEMPORARY SALVATION FOR BRITAIN'S DANGEROUS HOSPITALS?
Britain's public hospitals are full of MRSA -- largely because of lax hygeine
A small British firm says it is testing a compound that could help destroy the hospital superbug MRSA, a bacterium that is impervious to conventional antibiotics. Pharmaceutica, an 18-month-old firm in Worcestershire, western England, is testing a glycine compound on mice infected with methicillin-resistant Staphylococcus aureus (MRSA), the British weekly New Scientist says in next Saturday's issue. The substance, which Pharmaceutica calls BTA19976A, has been tested on MRSA in lab dishes. It is thought to work by altering the composition of the cell wall, preventing a key enzyme, PBP2a, from reinforcing that structure. With its cell wall weak, the bug can be killed by normal doses of methicillin, the antibiotic to which it is usually resistant.
MRSA is a serious problem for hospitals, where it is now responsible for up to 60 percent of all infections by the S. aureus microbe, usually entering through wounds, catheters and tubing. S. aureus infections cause abscesses and boils and can lead to pneumonia or fatal blood poisoning. People who become infected with MRSA are often treated with vancomycin, one of the small number of last-resort antibiotics whose use is carefully controlled in order to prevent the emergence of new resistant strains.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
If you don't have a right to decide what you do with your own body, what right do you have?
A Colorado man underwent a kidney transplant Wednesday in what is believed to be the first such operation involving an organ obtained through a for-profit Web site -- a transaction that has raised legal and ethical questions.
Presbyterian/St. Luke's Hospital spokeswoman Stephanie Lewis said the surgery was going well and the vital signs of both the donor and recipient were good. The operation, which began at about noon, was scheduled to last about four hours.
Before the operation, Bob Hickey, 58, met with Dr. Igal Kam, the surgeon whose objections initially postponed the transplant. The meeting was described as a time for "healing the scars of the last several days." Kam suddenly cancelled Monday's transplant operation after learning that Hickey had met his donor, Robert Smitty, 32, of Chattanooga, Tenn., through a Web site called MatchingDonors.com. Smitty agreed to give Hickey one of his kidneys before the two men ever met. The hospital later said the operation was only "postponed."
MatchingDonors.com, based in Canton, Mass., charges varying fees -- sometimes $290 a month -- to post profiles of people looking for live organ donors.
Hickey, of Edwards, Colo., has needed a transplant since 1999 because of a kidney disease. He said he was tired of waiting on the national donation list. Within three months of posting his profile on the Web site, he received 500 offers for donations.
The hospital's Clinical Ethics Committee met on Tuesday to evaluate concerns about the transplant, including whether either Hickey or Smitty stood to profit from the arrangement. The panel later advised the hospital to make a compassionate exception, once both men had signed statements indicating that neither would benefit financially. "We're pleased we were able to resolve this quickly with a compassionate exception. But it's also important to note that organ donations continue to be the topic of a broader national debate and more answers are needed," Mimi Roberson, chief executive of P/SL in Denver, said in a statement.
More here.
TEMPORARY SALVATION FOR BRITAIN'S DANGEROUS HOSPITALS?
Britain's public hospitals are full of MRSA -- largely because of lax hygeine
A small British firm says it is testing a compound that could help destroy the hospital superbug MRSA, a bacterium that is impervious to conventional antibiotics. Pharmaceutica, an 18-month-old firm in Worcestershire, western England, is testing a glycine compound on mice infected with methicillin-resistant Staphylococcus aureus (MRSA), the British weekly New Scientist says in next Saturday's issue. The substance, which Pharmaceutica calls BTA19976A, has been tested on MRSA in lab dishes. It is thought to work by altering the composition of the cell wall, preventing a key enzyme, PBP2a, from reinforcing that structure. With its cell wall weak, the bug can be killed by normal doses of methicillin, the antibiotic to which it is usually resistant.
MRSA is a serious problem for hospitals, where it is now responsible for up to 60 percent of all infections by the S. aureus microbe, usually entering through wounds, catheters and tubing. S. aureus infections cause abscesses and boils and can lead to pneumonia or fatal blood poisoning. People who become infected with MRSA are often treated with vancomycin, one of the small number of last-resort antibiotics whose use is carefully controlled in order to prevent the emergence of new resistant strains.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Friday, October 22, 2004
YOUR BUREAUCRACY WILL PROTECT YOU
In reality, nobody gives a damn -- ever AFTER negligence is discovered
Campbelltown Hospital, in Sydney's southwest, was forced to apologise yesterday to a patient who became seriously ill when a gauze pack was left inside her after the birth of her first child. First-time mother Kellie Van Gool gave birth to her daughter in January, but for days afterwards experienced pain so intense she was unable to sit down. She developed an infection and after further investigation, doctors found the surgical gauze pack was left inside her.
Mrs Van Gool and her husband Wally yesterday lodged a formal complaint with the Health Care Complaints Commission. NSW Minister for Health Morris Iemma said safety procedures at Campbelltown Hospital had changed since the incident. "Dr David Saxton, head of obstetrics at Campbelltown Hospital, has today advised me that as a result of the experience of Ms Kellie Van Gool at Campbelltown Hospital on January 7 this year, the hospital has reviewed its surgical equipment counting practices and changes have been made to prevent a repeat of this incident," Mr Iemma said. "Mrs Van Gool's poor experience appears to have been made worse by difficulty in presenting a complaint to the hospital. However I am advised that hospital did meet with Mrs Van Gool on January 14. "If the complaint process has let the patient down, then I am determined to ensure that the process is improved."
Details of the incident come two years after nurses at Campbelltown and Camden hospitals first went public with allegations that mistakes and sub-standard care had caused patient deaths at the hospitals. However, the hospital said yesterday that full disclosure was made to Mrs Van Gool at the time the gauze was discovered. "It appears now that we have had a breakdown in communication and we would like to apologise again," Dr Saxton said.
Opposition Leader John Brogden said disciplinary action should be taken against the hospital's then acting general manager, who he claims failed to contact Mrs Van Gool despite her calling three times to lodge a complaint. "Joanne Fisher needs to explain why she refused to contact Kellie and she also needs to unreservedly apologise... Despite the rhetoric being peddled by the Government that things are getting better in the South Western Area Health Service, Kellie Van Gool's experience proves nothing has changed."
Source
MORE ON THE FLU VACCINE SHORTAGE
I have received the following email but have not been able to confirm its accuracy:
Almost half of the nation's flu vaccine will not be delivered this year. Chiron, a major manufacturer of flu vaccine, will not be distributing any influenza vaccine this flu season. Chiron was to make 46-48 million doses vaccine for the United States. Chiron is a British company. Recently British health officials stopped Chiron from distributing and making the vaccine when inspectors found unsanitary conditions in the labs. Some lots of the vaccine were recalled and destroyed.
The major pharmaceutical companies in the US provided almost 90% of the nations flu vaccine at one time. They did this despite a very low profit margin for the product. Basically, they were doing us a favor.
In the late 80's a man from North Carolina who had received the vaccine got the flu. The strain he caught was one of the strains in that years vaccine made by a US company. What did he do? He sued and he won. He was awarded almost $5 million! After that case was appealed and lost, most US pharmaceutical companies stopped making the vaccine. The liability out weighed the profit margin. Since UK and Canadian laws prohibit such frivolous law suits UK and Canadian companies began selling the vaccine in the US.
By the way...the lawyer that represented the man in the flu shot law suit was a young ambulance chaser by the name of John Edwards.
***************************
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.
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.
***************************
In reality, nobody gives a damn -- ever AFTER negligence is discovered
Campbelltown Hospital, in Sydney's southwest, was forced to apologise yesterday to a patient who became seriously ill when a gauze pack was left inside her after the birth of her first child. First-time mother Kellie Van Gool gave birth to her daughter in January, but for days afterwards experienced pain so intense she was unable to sit down. She developed an infection and after further investigation, doctors found the surgical gauze pack was left inside her.
Mrs Van Gool and her husband Wally yesterday lodged a formal complaint with the Health Care Complaints Commission. NSW Minister for Health Morris Iemma said safety procedures at Campbelltown Hospital had changed since the incident. "Dr David Saxton, head of obstetrics at Campbelltown Hospital, has today advised me that as a result of the experience of Ms Kellie Van Gool at Campbelltown Hospital on January 7 this year, the hospital has reviewed its surgical equipment counting practices and changes have been made to prevent a repeat of this incident," Mr Iemma said. "Mrs Van Gool's poor experience appears to have been made worse by difficulty in presenting a complaint to the hospital. However I am advised that hospital did meet with Mrs Van Gool on January 14. "If the complaint process has let the patient down, then I am determined to ensure that the process is improved."
Details of the incident come two years after nurses at Campbelltown and Camden hospitals first went public with allegations that mistakes and sub-standard care had caused patient deaths at the hospitals. However, the hospital said yesterday that full disclosure was made to Mrs Van Gool at the time the gauze was discovered. "It appears now that we have had a breakdown in communication and we would like to apologise again," Dr Saxton said.
Opposition Leader John Brogden said disciplinary action should be taken against the hospital's then acting general manager, who he claims failed to contact Mrs Van Gool despite her calling three times to lodge a complaint. "Joanne Fisher needs to explain why she refused to contact Kellie and she also needs to unreservedly apologise... Despite the rhetoric being peddled by the Government that things are getting better in the South Western Area Health Service, Kellie Van Gool's experience proves nothing has changed."
Source
MORE ON THE FLU VACCINE SHORTAGE
I have received the following email but have not been able to confirm its accuracy:
Almost half of the nation's flu vaccine will not be delivered this year. Chiron, a major manufacturer of flu vaccine, will not be distributing any influenza vaccine this flu season. Chiron was to make 46-48 million doses vaccine for the United States. Chiron is a British company. Recently British health officials stopped Chiron from distributing and making the vaccine when inspectors found unsanitary conditions in the labs. Some lots of the vaccine were recalled and destroyed.
The major pharmaceutical companies in the US provided almost 90% of the nations flu vaccine at one time. They did this despite a very low profit margin for the product. Basically, they were doing us a favor.
In the late 80's a man from North Carolina who had received the vaccine got the flu. The strain he caught was one of the strains in that years vaccine made by a US company. What did he do? He sued and he won. He was awarded almost $5 million! After that case was appealed and lost, most US pharmaceutical companies stopped making the vaccine. The liability out weighed the profit margin. Since UK and Canadian laws prohibit such frivolous law suits UK and Canadian companies began selling the vaccine in the US.
By the way...the lawyer that represented the man in the flu shot law suit was a young ambulance chaser by the name of John Edwards.
***************************
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.
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.
***************************
Thursday, October 21, 2004
FDA REGULATIONS ARE A MAJOR CAUSE OF THE FLU VACCINE SHORTAGE
Even a Leftist commentator can see that. Excerpt from Kevin Drum:
The FDA has a famously tight regulatory regime, made even tighter in the late 90s, and as a result the United States has only two approved manufacturers of flu vaccine while Britain has half a dozen. (Although, ironically, it's worth noting that abreakdown of the regulatory regime seems to be a more likely explanation for Chiron's immediate problem.) The bottom line is that there are other flu vaccine manufacturers besides Chiron and Aventis, but they don't sell into the U.S. market because the cost of complying with FDA regulations is higher than the narrow profits they could expect to make from selling flu vaccine.
And Drum's follow-up post is good too. I reproduce it in full below -- and the comments on the post really drive home how indefensible the FDA is in the matter
FLU VACCINE UPDATE....Two companies say they may jump into the U.S. flu vaccine market next year:
So: demand is high and growing; prices have quadrupled recently, which means government price caps aren't an issue; and it's an "attractive business," which mean liability lawsuits must not be scaring anyone too badly.
However, FDA approval could be a problem. This leads me to think that my tentative conclusion yesterday was probably correct: out of all the reasons on offer to explain why the United States relies on only two main suppliers for its flu vaccine supply (small market, low price, risky business, lawsuit worries), it's probably FDA regulatory hurdles that explain the most.
Are those hurdles reasonable? I don't know. But it does seem as if they're the most likely reason that the United States, with a huge market, has only two approved suppliers, while Britain, with a market 10% the size, has half a dozen.
Needless to say, there is no shortage of flu vaccine in Australia either. I recollect that there was a shortage of some vaccine in Australia a while back but we just bought in a whole lot of extra shots from Britain to fix the problem in comparatively short order. Australians did not think that their regulators were the sole source of wisdom in the matter
AND IT IS NOT ONLY THE FDA THAT IS THE PROBLEM
It's government meddling generally according to Rich Lowry:
Americans have been shocked to learn a flu-vaccine shortage will keep many of them from getting their flu shots this year. They shouldn't be. What they are experiencing is the effect of the most basic law of economics. Guess what? When it ceases to be profitable to make a vaccine (or a prescription drug, or anything else), companies stop making it.
Litigation, regulation and government pricing have hammered vaccine makers during the past two decades, chasing them out of business. Democrats "have a plan" -- as John Kerry would put it -- in response to the flu-vaccine debacle, which is to bring the same model of failure to the prescription-drug market and make it just as unprofitable. Then there will no longer be any of those "greedy" pharmaceutical companies. Problem solved!
In the 1980s, many vaccine makers were driven out of business by litigation costs. Congress eventually passed legislation protecting vaccine makers from out-of-control lawsuits. But the damage had been done. Once a company gets out of the business, it is difficult to get back in because it loses its manufacturing capacity and its expertise.
Another blow came from Hillary Clinton. She championed getting the government into the pediatric vaccine business in a big way in the 1990s. It now buys 60 percent of pediatric vaccines, dictating cut-rate prices that have dried up vaccine-manufacturing capacity. More regulation inevitably accompanied the government purchases. "It's a snowball effect of more and more regulation over the past decade, driving more and more vaccine makers out of business," says Grace-Marie Turner, president of the free-market-oriented Galen Institute.
On top of these regulations, the flu-vaccine business has its unique hurdles. As Scott Gottlieb of the American Enterprise Institute points out, the vaccine for each flu season needs to be set a year in advance because the vaccine is developed in chicken eggs in a cumbersome, dated and very expensive process. Just as with pediatric vaccines, there's a lot of government purchasing, which keeps prices low.
Companies have to sell tens of millions of doses to make a profit. Since the entire U.S. market at its maximum is about 150 million doses, it means there is room for only two or three suppliers, and therefore no margin for error. Worse, vaccine makers have to take back any unused vaccines (usage can vary widely year to year), eating the production costs and exposing themselves to millions of dollars in annual losses. The setup is based on the idea that manufacturers are doing a public service by providing the flu vaccine, considerations of profit be damned. "It's a market that hasn't been allowed to make a profit and not allowed to innovate," says Gottlieb. Without innovation, vaccine makers can't engage in premium pricing based on changes that make their product better than the competition. Everyone is stuck with the same old method.
Flu-vaccine makers could move to a more efficient process involving monkey or human cell lines instead of chicken eggs, but the Food and Drug Administration -- which imposed new regulations in 1999 that drove several flu-vaccine makers out of the business --has been nervous about approving the new techniques. Rather than more government intervention, what vaccine manufacturers need is the government's permission to innovate so they can move beyond the inefficiencies of the current system.
The vaccine market is a harbinger of what could happen to the prescription-drug industry if Democrats get their way. They are agitating for the government to be able to negotiate -- read: mandate -- low drug prices as part of the new Medicare prescription-drug benefit. And the push for re-importation of drugs from Canada is really a way of importing Canada's price controls into this country.
But when the government vanquishes profits, it vanquishes the incentive to create new drugs, vaccines and technologies in the first place. This year's flu season might be a brutal, unfortunate reminder of that fact.
***************************
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.
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.
***************************
Even a Leftist commentator can see that. Excerpt from Kevin Drum:
The FDA has a famously tight regulatory regime, made even tighter in the late 90s, and as a result the United States has only two approved manufacturers of flu vaccine while Britain has half a dozen. (Although, ironically, it's worth noting that a
And Drum's follow-up post is good too. I reproduce it in full below -- and the comments on the post really drive home how indefensible the FDA is in the matter
FLU VACCINE UPDATE....Two companies say they may jump into the U.S. flu vaccine market next year:
GlaxoSmithKline, the largest vaccine maker in the world, and ID Biomedical, a small Canadian company, have announced plans to sell flu shots in the U.S. ID Biomedical could enter the market as soon as next year.
....The competitive interest in making flu vaccines could dispel the notion that there is no money to be made in the business. In fact, over the last five to six years, the wholesale price of a flu shot has jumped to more than $8 from less than $2, far outpacing increases in production costs. What's more, the market is growing...."It is a very attractive business," said Anthony Holler, ID Biomedical's chief executive.
....U.S. public health officials have said they are unsure the FDA could move swiftly enough to approve the shots. The FDA will clear a drug only if the manufacturer can demonstrate that the product is safe and effective, a process that typically takes years.
So: demand is high and growing; prices have quadrupled recently, which means government price caps aren't an issue; and it's an "attractive business," which mean liability lawsuits must not be scaring anyone too badly.
However, FDA approval could be a problem. This leads me to think that my tentative conclusion yesterday was probably correct: out of all the reasons on offer to explain why the United States relies on only two main suppliers for its flu vaccine supply (small market, low price, risky business, lawsuit worries), it's probably FDA regulatory hurdles that explain the most.
Are those hurdles reasonable? I don't know. But it does seem as if they're the most likely reason that the United States, with a huge market, has only two approved suppliers, while Britain, with a market 10% the size, has half a dozen.
Needless to say, there is no shortage of flu vaccine in Australia either. I recollect that there was a shortage of some vaccine in Australia a while back but we just bought in a whole lot of extra shots from Britain to fix the problem in comparatively short order. Australians did not think that their regulators were the sole source of wisdom in the matter
AND IT IS NOT ONLY THE FDA THAT IS THE PROBLEM
It's government meddling generally according to Rich Lowry:
Americans have been shocked to learn a flu-vaccine shortage will keep many of them from getting their flu shots this year. They shouldn't be. What they are experiencing is the effect of the most basic law of economics. Guess what? When it ceases to be profitable to make a vaccine (or a prescription drug, or anything else), companies stop making it.
Litigation, regulation and government pricing have hammered vaccine makers during the past two decades, chasing them out of business. Democrats "have a plan" -- as John Kerry would put it -- in response to the flu-vaccine debacle, which is to bring the same model of failure to the prescription-drug market and make it just as unprofitable. Then there will no longer be any of those "greedy" pharmaceutical companies. Problem solved!
In the 1980s, many vaccine makers were driven out of business by litigation costs. Congress eventually passed legislation protecting vaccine makers from out-of-control lawsuits. But the damage had been done. Once a company gets out of the business, it is difficult to get back in because it loses its manufacturing capacity and its expertise.
Another blow came from Hillary Clinton. She championed getting the government into the pediatric vaccine business in a big way in the 1990s. It now buys 60 percent of pediatric vaccines, dictating cut-rate prices that have dried up vaccine-manufacturing capacity. More regulation inevitably accompanied the government purchases. "It's a snowball effect of more and more regulation over the past decade, driving more and more vaccine makers out of business," says Grace-Marie Turner, president of the free-market-oriented Galen Institute.
On top of these regulations, the flu-vaccine business has its unique hurdles. As Scott Gottlieb of the American Enterprise Institute points out, the vaccine for each flu season needs to be set a year in advance because the vaccine is developed in chicken eggs in a cumbersome, dated and very expensive process. Just as with pediatric vaccines, there's a lot of government purchasing, which keeps prices low.
Companies have to sell tens of millions of doses to make a profit. Since the entire U.S. market at its maximum is about 150 million doses, it means there is room for only two or three suppliers, and therefore no margin for error. Worse, vaccine makers have to take back any unused vaccines (usage can vary widely year to year), eating the production costs and exposing themselves to millions of dollars in annual losses. The setup is based on the idea that manufacturers are doing a public service by providing the flu vaccine, considerations of profit be damned. "It's a market that hasn't been allowed to make a profit and not allowed to innovate," says Gottlieb. Without innovation, vaccine makers can't engage in premium pricing based on changes that make their product better than the competition. Everyone is stuck with the same old method.
Flu-vaccine makers could move to a more efficient process involving monkey or human cell lines instead of chicken eggs, but the Food and Drug Administration -- which imposed new regulations in 1999 that drove several flu-vaccine makers out of the business --has been nervous about approving the new techniques. Rather than more government intervention, what vaccine manufacturers need is the government's permission to innovate so they can move beyond the inefficiencies of the current system.
The vaccine market is a harbinger of what could happen to the prescription-drug industry if Democrats get their way. They are agitating for the government to be able to negotiate -- read: mandate -- low drug prices as part of the new Medicare prescription-drug benefit. And the push for re-importation of drugs from Canada is really a way of importing Canada's price controls into this country.
But when the government vanquishes profits, it vanquishes the incentive to create new drugs, vaccines and technologies in the first place. This year's flu season might be a brutal, unfortunate reminder of that fact.
***************************
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.
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.
***************************
Wednesday, October 20, 2004
RISKY BLOOD
Precautions being deliberately ignored in Australian public hospitals generate "mistakes"!
Blood transfusion protocols are being shunned in some hospitals, posing a potentially fatal threat to patient health, a conference has heard. Errors include people being given the wrong blood, mislabelling of blood samples and unrecognised bacterial infection from transfused blood.
To combat the problem, Australia needs to follow England's example and establish a national blood protocol-monitoring body, said Dr Lorna Williamson, a transfusion consultant from Britain who addressed a hematology conference in Melbourne. "Hospitals are very busy places and there's a lot going on and less than perfect habits creep in," she said.
Dr Williamson co-founded the Serious Hazards of Transfusion scheme (SHOT) in Britain, which monitors the number and types of mistakes made along the transfusion supply chain in hospitals.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Precautions being deliberately ignored in Australian public hospitals generate "mistakes"!
Blood transfusion protocols are being shunned in some hospitals, posing a potentially fatal threat to patient health, a conference has heard. Errors include people being given the wrong blood, mislabelling of blood samples and unrecognised bacterial infection from transfused blood.
To combat the problem, Australia needs to follow England's example and establish a national blood protocol-monitoring body, said Dr Lorna Williamson, a transfusion consultant from Britain who addressed a hematology conference in Melbourne. "Hospitals are very busy places and there's a lot going on and less than perfect habits creep in," she said.
Dr Williamson co-founded the Serious Hazards of Transfusion scheme (SHOT) in Britain, which monitors the number and types of mistakes made along the transfusion supply chain in hospitals.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Tuesday, October 19, 2004
CALIFORNIA PRISON DOCTORS ARE THE DREGS
The state has stripped a Soledad prison doctor's medical license after he failed to diagnose and treat an inmate's spinal injury, resulting in the prisoner's permanent paralysis. An administrative law judge for the state health system found this week that Dr. Isaac Grillo, 72, was a danger to his patients. Grillo, who been practicing at Salinas Valley State Prison, would not comment when reached at his Soledad home Thursday. "I'm not going to talk to anyone," he said.
Grillo was one of three doctors who said they believed inmate Kenneth Holcomb was faking a spinal injury following a June 2000 prison brawl, according to a lawsuit Holcomb filed against the state Department of Corrections. Later, after non-medical officials sent Holcomb to Salinas Valley Memorial Hospital for evaluation, the complaint says, private physicians correctly diagnosed the inmate's injuries and sent him into surgery.
The other two prison doctors involved in the incident also have disciplinary records with the medical board. Dr. David Stuart Clark surrendered his medical license in 2003 to settle a disciplinary action and Dr. David Thor was placed on probation, according to the State Medical Board's Web site.
Grillo's suspension comes as medical care in the state prison system is facing increased scrutiny. In July, a nonprofit prisoner advocacy group issued a report challenging the competence of prison physicians. In September, a judge ordered a complete review of all 261 doctors in the prison system. "The Department of Corrections has been a refuge for doctors who have been unable to provide care in other places," said Alison Hardy, staff attorney at the Prison Law Office, the San Quentin group investigating prison health care. "As a result, there are a lot of prisoners who have been harmed."
Hardy said the Grillo case follows a pattern in the Corrections Department of using doctors practicing outside their specialties. Grillo, a surgeon, was performing internal medicine. Grillo's conduct in the Holcomb case triggered an October 2001 state Medical Board inquiry that resulted in accusations of gross negligence and incompetence. After a two-day examination of Grillo's clinical skills, UC-San Diego professor of medicine Dr. William Norcross concluded that Grillo lacked the knowledge, training and judgment to avoid making potentially serious errors. "The deficiencies documented... if applied to the real-world practice of medicine, would almost certainly have resulted in patient harm, and perhaps even death," Norcross reported.
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
The state has stripped a Soledad prison doctor's medical license after he failed to diagnose and treat an inmate's spinal injury, resulting in the prisoner's permanent paralysis. An administrative law judge for the state health system found this week that Dr. Isaac Grillo, 72, was a danger to his patients. Grillo, who been practicing at Salinas Valley State Prison, would not comment when reached at his Soledad home Thursday. "I'm not going to talk to anyone," he said.
Grillo was one of three doctors who said they believed inmate Kenneth Holcomb was faking a spinal injury following a June 2000 prison brawl, according to a lawsuit Holcomb filed against the state Department of Corrections. Later, after non-medical officials sent Holcomb to Salinas Valley Memorial Hospital for evaluation, the complaint says, private physicians correctly diagnosed the inmate's injuries and sent him into surgery.
The other two prison doctors involved in the incident also have disciplinary records with the medical board. Dr. David Stuart Clark surrendered his medical license in 2003 to settle a disciplinary action and Dr. David Thor was placed on probation, according to the State Medical Board's Web site.
Grillo's suspension comes as medical care in the state prison system is facing increased scrutiny. In July, a nonprofit prisoner advocacy group issued a report challenging the competence of prison physicians. In September, a judge ordered a complete review of all 261 doctors in the prison system. "The Department of Corrections has been a refuge for doctors who have been unable to provide care in other places," said Alison Hardy, staff attorney at the Prison Law Office, the San Quentin group investigating prison health care. "As a result, there are a lot of prisoners who have been harmed."
Hardy said the Grillo case follows a pattern in the Corrections Department of using doctors practicing outside their specialties. Grillo, a surgeon, was performing internal medicine. Grillo's conduct in the Holcomb case triggered an October 2001 state Medical Board inquiry that resulted in accusations of gross negligence and incompetence. After a two-day examination of Grillo's clinical skills, UC-San Diego professor of medicine Dr. William Norcross concluded that Grillo lacked the knowledge, training and judgment to avoid making potentially serious errors. "The deficiencies documented... if applied to the real-world practice of medicine, would almost certainly have resulted in patient harm, and perhaps even death," Norcross reported.
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Monday, October 18, 2004
NO BEDS FOR THE SICK AT AN AUSTRALIAN PUBLIC HOSPITAL
Which in turn ties up ambulances
A confidential document from the Ambulance Service of NSW has revealed that patients are being put at risk at Bankstown Hospital in Sydney due to extensive delays. A memo obtained by The Sunday Telegraph shows two patients had to wait for more than 12 hours, while a further two patients experienced a significant wait after-hours last Wednesday. Patients were unable to be offloaded from ambulance trolleys as no hospital beds were available and ambulance crews were told to stay with patients.
Opposition health spokesman Barry O'Farrell said that the memo highlighted a system in crisis. "The hospital system is placing stress upon patients and ambulance crews," he said. "There is a risk to patients ... placed on ambulance trolleys. In July, there were 14 ambulance crews per shift unavailable and it's because of this sort of thing."
A spokesperson from Bankstown Hospital said staffing shortages and an influx of emergency cases were to blame for the delays. "The important thing is that these patients were with ambulance crews that were within the emergency ward and were receiving constant medical and nursing care," she said.
Source.
AN ALTERNATIVE TO REGULATION AND RELIANCE ON CREDENTIALS
"Leaving aside medical insurance, for the medical field as a whole I believe that reputation systems would work better than our current system of credential-based regulation. A friend who is an optometrist puts a lot of time into lobbying the state legislature. That is because the boundaries between what he can do relative to an optician or an ophthalmologist are determined by state laws. One group is constantly trying to use the legislative process to take territory away from the others.
These sorts of regulatory boundaries impose tremendous costs on consumers, without our realizing it. Like fish unaware that they are swimming in water, most of us go through life without ever thinking about the pervasive, murky regulatory swamp through which we swim when we seek medical care.
In most industries, government does not get involved in defining work rules. If a company decides to have a financial analyst do computer programming or a computer programmer do financial analysis, that is none of the government's business. In the medical industry, however, the government does dictate such work rules. This creates all sorts of supply bottlenecks. For example, if there is an increase in the number of patients needing help with starting exercise programs to recover from orthopedic injuries, the result is a shortage of "physical therapists." Any other market would adapt by coming up with a close substitute. In medicine, that is not allowed.
Another example is the rule that only a physician may write prescriptions. This protects the income of physicians, but by the same token it prevents lower-cost alternative health delivery systems from emerging. Medical work rules mean that the benefits of what I call The Elastic Economy (chapter 12 in Learning Economics) are not felt in the medical sector. In medical care, supply is rigid, inelastic, and slow to adapt, rather than dynamic and rapidly improving as are other sectors of the economy. Although medical work rules serve primarily to carve out economic rents for health care providers, they are not sold that way to the public. Instead, these regulations ride in under the banner of "consumer protection."
The free market principle is that as consumers we should protect ourselves. The key to protecting ourselves in a deregulated environment for medical care would be reputation systems. As Howard Rheingold discusses in his book Smart Mobs, the concept of reputation systems receives increasing attention in our information-rich, networked society. There are reputation systems all around us. Consumer Reports ratings are a reputation system. eBay uses a reputation system to keep buyers and sellers honest. Mortgage lenders and other suppliers of consumer credit rely on a reputation system known as credit scoring.
In medicine, we already use reputation systems. The diploma on the doctor's wall is one. The referral that is made by friends or other doctors is another. All sorts of private systems are springing up to evaluate data on hospitals, doctors, and so on. Reputation systems could provide us with an alternative to the strict, credential-driven structure that we have today. Someone could earn a reputation as capable of training you to do certain exercises without earning a license as a physical therapist. Someone could earn a reputation as a reliable prescriber for certain types of medications in certain types of situations without getting a full-fledged MD. In fact, the drug industry could be deregulated, with reputation systems for medicines replacing "FDA approval."
If you took away the centrally-planned regulatory system for medical care, my conjecture is that reputation systems would emerge as a more efficient Hayekian market response. In some cases, such as medicines, I would want to see a gradual deregulatory process, rather than lose consumer protection completely and suddenly. Some of the expense of operating reputations systems could be offset by lower costs elsewhere. If bad doctors (and incompetent technicians as well) were dealt with by reputation systems, malpractice lawsuits would be needed much less, if at all.
If we took away the regulatory swamp, the changes would be dramatic. You could have your gall bladder surgery done by a dental assistant. That would not be a good idea, but it would be your responsibility as a consumer to make that decision. Your protection against making bad decisions would be common sense, information, and effective reputation systems. My guess is that a lot of business process re-engineering would take place spontaneously if the regulatory swamp were replaced by consumer choice and reputation systems. I think that this is the best hope for allowing medical care to become as efficient as possible by taking advantage of the best technologies and practices our economy has to offer".
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Which in turn ties up ambulances
A confidential document from the Ambulance Service of NSW has revealed that patients are being put at risk at Bankstown Hospital in Sydney due to extensive delays. A memo obtained by The Sunday Telegraph shows two patients had to wait for more than 12 hours, while a further two patients experienced a significant wait after-hours last Wednesday. Patients were unable to be offloaded from ambulance trolleys as no hospital beds were available and ambulance crews were told to stay with patients.
Opposition health spokesman Barry O'Farrell said that the memo highlighted a system in crisis. "The hospital system is placing stress upon patients and ambulance crews," he said. "There is a risk to patients ... placed on ambulance trolleys. In July, there were 14 ambulance crews per shift unavailable and it's because of this sort of thing."
A spokesperson from Bankstown Hospital said staffing shortages and an influx of emergency cases were to blame for the delays. "The important thing is that these patients were with ambulance crews that were within the emergency ward and were receiving constant medical and nursing care," she said.
Source.
AN ALTERNATIVE TO REGULATION AND RELIANCE ON CREDENTIALS
"Leaving aside medical insurance, for the medical field as a whole I believe that reputation systems would work better than our current system of credential-based regulation. A friend who is an optometrist puts a lot of time into lobbying the state legislature. That is because the boundaries between what he can do relative to an optician or an ophthalmologist are determined by state laws. One group is constantly trying to use the legislative process to take territory away from the others.
These sorts of regulatory boundaries impose tremendous costs on consumers, without our realizing it. Like fish unaware that they are swimming in water, most of us go through life without ever thinking about the pervasive, murky regulatory swamp through which we swim when we seek medical care.
In most industries, government does not get involved in defining work rules. If a company decides to have a financial analyst do computer programming or a computer programmer do financial analysis, that is none of the government's business. In the medical industry, however, the government does dictate such work rules. This creates all sorts of supply bottlenecks. For example, if there is an increase in the number of patients needing help with starting exercise programs to recover from orthopedic injuries, the result is a shortage of "physical therapists." Any other market would adapt by coming up with a close substitute. In medicine, that is not allowed.
Another example is the rule that only a physician may write prescriptions. This protects the income of physicians, but by the same token it prevents lower-cost alternative health delivery systems from emerging. Medical work rules mean that the benefits of what I call The Elastic Economy (chapter 12 in Learning Economics) are not felt in the medical sector. In medical care, supply is rigid, inelastic, and slow to adapt, rather than dynamic and rapidly improving as are other sectors of the economy. Although medical work rules serve primarily to carve out economic rents for health care providers, they are not sold that way to the public. Instead, these regulations ride in under the banner of "consumer protection."
The free market principle is that as consumers we should protect ourselves. The key to protecting ourselves in a deregulated environment for medical care would be reputation systems. As Howard Rheingold discusses in his book Smart Mobs, the concept of reputation systems receives increasing attention in our information-rich, networked society. There are reputation systems all around us. Consumer Reports ratings are a reputation system. eBay uses a reputation system to keep buyers and sellers honest. Mortgage lenders and other suppliers of consumer credit rely on a reputation system known as credit scoring.
In medicine, we already use reputation systems. The diploma on the doctor's wall is one. The referral that is made by friends or other doctors is another. All sorts of private systems are springing up to evaluate data on hospitals, doctors, and so on. Reputation systems could provide us with an alternative to the strict, credential-driven structure that we have today. Someone could earn a reputation as capable of training you to do certain exercises without earning a license as a physical therapist. Someone could earn a reputation as a reliable prescriber for certain types of medications in certain types of situations without getting a full-fledged MD. In fact, the drug industry could be deregulated, with reputation systems for medicines replacing "FDA approval."
If you took away the centrally-planned regulatory system for medical care, my conjecture is that reputation systems would emerge as a more efficient Hayekian market response. In some cases, such as medicines, I would want to see a gradual deregulatory process, rather than lose consumer protection completely and suddenly. Some of the expense of operating reputations systems could be offset by lower costs elsewhere. If bad doctors (and incompetent technicians as well) were dealt with by reputation systems, malpractice lawsuits would be needed much less, if at all.
If we took away the regulatory swamp, the changes would be dramatic. You could have your gall bladder surgery done by a dental assistant. That would not be a good idea, but it would be your responsibility as a consumer to make that decision. Your protection against making bad decisions would be common sense, information, and effective reputation systems. My guess is that a lot of business process re-engineering would take place spontaneously if the regulatory swamp were replaced by consumer choice and reputation systems. I think that this is the best hope for allowing medical care to become as efficient as possible by taking advantage of the best technologies and practices our economy has to offer".
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Sunday, October 17, 2004
MEDICAL WAL-MART NEEDED
Post lifted from the Piper Report.
In an excellent new piece for HealthLeaders, E. Preston Gee asks an fascinating question with wide ranging implications for health care: "What if the mass merchandising giants like Wal-Mart or Target got into the healthcare delivery business in a big way?"
Highly efficient, consumer friendly, and tech-savvy companies like Wal-Mart and Target stand in sharp contrast to health care delivery. Many health strategists, including myself, have noodled on what it would take for hospitals and clinics to adopt consumer-focused, competitor-savvy practices of high performing industries like these "big box" retailers.
As Mr. Gee notes, the big retailers may never enter health care but that is beside the point. Health care providers must adapt to the new market realities. Employers and other demand-side players expect an end to the inefficiency, poor quality, and high error rates that plague much of health care delivery. After providing thoughtful advice on how they can adapt, Mr. Gee calls on health care executives to "lead their organizations into and through this new era of heightened expectations and emerging market-driven dynamics."
HIGHER STANDARDS ACHIEVED THROUGH LESS BUREAUCRACY
Specialty surgical hospitals in the United States trace their roots to ambulatory surgical centers (ASCs), which started to appear approximately 30 years ago. An ASC is a facility whose patients are admitted, treated, and discharged within a single day. No overnight hospitalization is included. Typically they are free-standing facilities not attached to or affiliated with a traditional general hospital. According to the American Surgical Hospital Association (ASHA), ASCs developed for several reasons, including:
** physician dissatisfaction with the work environment, efficiency, and quality of care provided in traditional general hospitals;
** advances in medicine that allow many procedures that once required an overnight stay in the hospital for recovery to be done on an out-patient basis;
** patient dissatisfaction with the hospital environment and lack of customer service; and
** increasing costs of medical care at traditional general hospitals.
A February 2002 report by the U.S. Department of Health and Human Services Office of Inspector General attributes the growth of ASCs to "advances in medical technology, increased focus on patient convenience, and economic incentives created by changes in reimbursement systems." According to ASHA, the ASCs developed slowly until 1982, when Medicare first approved them for reimbursement. From that point, growth has been rapid. There are currently more than 3,500 ASCs in the U.S.
The results of this industry growth have been impressive. By freeing themselves of the bureaucracy of a traditional general hospital, ASCs have been able to provide high-quality care at a lower cost. The key is specialization: A surgeon or facility devotes all of its energies to a few specific areas of care, resulting in increased efficiency and effectiveness.
From the ASCs developed modern specialty surgical hospitals. By focusing on a few surgical specialties, additional gains in efficiency and quality can be realized, this time in procedures that require an overnight stay or longer while the patient recovers.
Approximately 100 specialty surgical hospitals exist in the U.S. today. Some, such as Stanislaus Surgical Hospital in Modesto, California, offer a broad range of surgical procedures, including knee and hip replacement, hysterectomy, corneal transplant, and kidney surgery. By contrast, MedCath, a chain of 13 hospitals in nine states, focuses on cardiovascular surgery.
Specialty surgical hospitals are much smaller than traditional general hospitals. Medcath's 13 hospitals have between 32 and 112 inpatient beds each, and Stanislaus Surgical Hospital has 23 inpatient beds, while the average hospital in the U.S. has more than 160 beds. Hospitals in large urban area typically have several hundred beds, and some have more than one thousand beds.
Nurse-to-patient ratios are typically lower at specialty surgical hospitals. In a recent interview with Surgicenter Online, Stanislaus Surgical Hospital CEO Michael Lipomi said, "The nurses who prepare patients for surgery also recover patients, so patients see the same reassuring faces." At larger traditional general hospitals, a patient may see many different nurses during the course of his or her treatment, which can interfere with the continuity of care.
Many specialty surgical hospitals appear to provide better care than their traditional counterparts, as measured by patient outcomes......
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Post lifted from the Piper Report.
In an excellent new piece for HealthLeaders, E. Preston Gee asks an fascinating question with wide ranging implications for health care: "What if the mass merchandising giants like Wal-Mart or Target got into the healthcare delivery business in a big way?"
Highly efficient, consumer friendly, and tech-savvy companies like Wal-Mart and Target stand in sharp contrast to health care delivery. Many health strategists, including myself, have noodled on what it would take for hospitals and clinics to adopt consumer-focused, competitor-savvy practices of high performing industries like these "big box" retailers.
As Mr. Gee notes, the big retailers may never enter health care but that is beside the point. Health care providers must adapt to the new market realities. Employers and other demand-side players expect an end to the inefficiency, poor quality, and high error rates that plague much of health care delivery. After providing thoughtful advice on how they can adapt, Mr. Gee calls on health care executives to "lead their organizations into and through this new era of heightened expectations and emerging market-driven dynamics."
HIGHER STANDARDS ACHIEVED THROUGH LESS BUREAUCRACY
Specialty surgical hospitals in the United States trace their roots to ambulatory surgical centers (ASCs), which started to appear approximately 30 years ago. An ASC is a facility whose patients are admitted, treated, and discharged within a single day. No overnight hospitalization is included. Typically they are free-standing facilities not attached to or affiliated with a traditional general hospital. According to the American Surgical Hospital Association (ASHA), ASCs developed for several reasons, including:
** physician dissatisfaction with the work environment, efficiency, and quality of care provided in traditional general hospitals;
** advances in medicine that allow many procedures that once required an overnight stay in the hospital for recovery to be done on an out-patient basis;
** patient dissatisfaction with the hospital environment and lack of customer service; and
** increasing costs of medical care at traditional general hospitals.
A February 2002 report by the U.S. Department of Health and Human Services Office of Inspector General attributes the growth of ASCs to "advances in medical technology, increased focus on patient convenience, and economic incentives created by changes in reimbursement systems." According to ASHA, the ASCs developed slowly until 1982, when Medicare first approved them for reimbursement. From that point, growth has been rapid. There are currently more than 3,500 ASCs in the U.S.
The results of this industry growth have been impressive. By freeing themselves of the bureaucracy of a traditional general hospital, ASCs have been able to provide high-quality care at a lower cost. The key is specialization: A surgeon or facility devotes all of its energies to a few specific areas of care, resulting in increased efficiency and effectiveness.
From the ASCs developed modern specialty surgical hospitals. By focusing on a few surgical specialties, additional gains in efficiency and quality can be realized, this time in procedures that require an overnight stay or longer while the patient recovers.
Approximately 100 specialty surgical hospitals exist in the U.S. today. Some, such as Stanislaus Surgical Hospital in Modesto, California, offer a broad range of surgical procedures, including knee and hip replacement, hysterectomy, corneal transplant, and kidney surgery. By contrast, MedCath, a chain of 13 hospitals in nine states, focuses on cardiovascular surgery.
Specialty surgical hospitals are much smaller than traditional general hospitals. Medcath's 13 hospitals have between 32 and 112 inpatient beds each, and Stanislaus Surgical Hospital has 23 inpatient beds, while the average hospital in the U.S. has more than 160 beds. Hospitals in large urban area typically have several hundred beds, and some have more than one thousand beds.
Nurse-to-patient ratios are typically lower at specialty surgical hospitals. In a recent interview with Surgicenter Online, Stanislaus Surgical Hospital CEO Michael Lipomi said, "The nurses who prepare patients for surgery also recover patients, so patients see the same reassuring faces." At larger traditional general hospitals, a patient may see many different nurses during the course of his or her treatment, which can interfere with the continuity of care.
Many specialty surgical hospitals appear to provide better care than their traditional counterparts, as measured by patient outcomes......
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Saturday, October 16, 2004
SOME PROGRESS ON EXCESSIVE MALPRACTICE LITIGATION
Reforms to Oklahoma's civil justice system passed last year have contributed to a drop in medical malpractice cases, officials say. "Our claims have gone down as dramatically, if not more dramatically, than Texas' have,'' said State Finance Director Scott Meacham.
Tony Laizure, president of the Oklahoma Trial Lawyers Association, said that from July 2003 to this July, medical negligence cases dropped more than 60 percent in the eight counties whose cases are reported on the Oklahoma Supreme Court Network. Laizure credits tort reform improvements passed by the Legislature in 2003. The new law requires that each case be reviewed by an expert who determines if there was medical negligence.
While the number of cases has dropped, malpractice insurance rates have not and may not for awhile. The Dallas Morning News reported recently that the Texas reform law has not pushed physicians' premiums down, although malpractice cases have declined at least 80 percent in most major Texas counties.
Laizure said the state needs time to see whether two years of reform will produce positive changes. "These rates don't go up overnight and they don't go down overnight,'' he said. "You have to give these things some time to take effect.''
More here
ANOTHER UNHEALTHY PUBLIC HOSPITAL
In Australia, this time
WA health authorities said today an outbreak of highly contagious Noro virus at Royal Perth Hospital (RPH) was under control, but they were continuing efforts to contain another potentially fatal superbug.
Dr Shirley Bowen, the WA Health Department's director of communicable diseases, today said four patients at RPH had contracted the Noro virus, with three fully recovered and one person still in isolation.
But an RPH spokeswoman said 16 other patients were in isolation after being identified as carriers of the potentially fatal "superbug" vancomycin-resistant enterococci (VRE). RPH has been battling to contain an outbreak of the antibiotic-resistant VRE for the past two weeks. A total of 27 RPH patients have been identified as carriers of VRE, with six people testing positive in the last 24 hours, according to the spokeswoman.
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Reforms to Oklahoma's civil justice system passed last year have contributed to a drop in medical malpractice cases, officials say. "Our claims have gone down as dramatically, if not more dramatically, than Texas' have,'' said State Finance Director Scott Meacham.
Tony Laizure, president of the Oklahoma Trial Lawyers Association, said that from July 2003 to this July, medical negligence cases dropped more than 60 percent in the eight counties whose cases are reported on the Oklahoma Supreme Court Network. Laizure credits tort reform improvements passed by the Legislature in 2003. The new law requires that each case be reviewed by an expert who determines if there was medical negligence.
While the number of cases has dropped, malpractice insurance rates have not and may not for awhile. The Dallas Morning News reported recently that the Texas reform law has not pushed physicians' premiums down, although malpractice cases have declined at least 80 percent in most major Texas counties.
Laizure said the state needs time to see whether two years of reform will produce positive changes. "These rates don't go up overnight and they don't go down overnight,'' he said. "You have to give these things some time to take effect.''
More here
ANOTHER UNHEALTHY PUBLIC HOSPITAL
In Australia, this time
WA health authorities said today an outbreak of highly contagious Noro virus at Royal Perth Hospital (RPH) was under control, but they were continuing efforts to contain another potentially fatal superbug.
Dr Shirley Bowen, the WA Health Department's director of communicable diseases, today said four patients at RPH had contracted the Noro virus, with three fully recovered and one person still in isolation.
But an RPH spokeswoman said 16 other patients were in isolation after being identified as carriers of the potentially fatal "superbug" vancomycin-resistant enterococci (VRE). RPH has been battling to contain an outbreak of the antibiotic-resistant VRE for the past two weeks. A total of 27 RPH patients have been identified as carriers of VRE, with six people testing positive in the last 24 hours, according to the spokeswoman.
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Friday, October 15, 2004
GOVERNMENT CAN'T FIX IT
USA Today can see the problems but has no solution other than a huge raid on the taxpayer -- which has already been rejected in the Clinton years. Complete privatization is the only real solution. Medicine is too important an industry to be a government puppet
Bush and Kerry fail to grasp health crisis' magnitude. As every voter knows, health care in the U.S. is in crisis. The average monthly premium for a family is up 64% just since 2000. Annual medical spending now consumes 15 cents of every dollar spent. One in six Americans lack insurance, and their ranks continue to climb.
But neither President Bush nor Sen. John Kerry has a plan to match the scale of the problem. They've shown little passion about reforming a system that appears out of control. Instead, they seem most animated when arguing over secondary health issues: Bush rails against trial lawyers who drive up malpractice insurance rates, and Kerry assails drug companies that block the reimportation of cheaper drugs from Canada. Yes, both candidates have health care proposals they are sure to tout in tonight's debate. But viewers looking for a comprehensive plan that extends coverage to the 45 million uninsured and tackles the underlying causes of skyrocketing costs will be disappointed.
The sad truth is that neither candidate has a bold vision that can spark an overdue debate on how to overhaul a system that no longer works for most Americans. By failing to think big now, the next president will only have a worse problem to face later in his term. Bush and Kerry each offer help for some people, but they don't go nearly far enough:
Bush: He would let small businesses band together to buy cheaper insurance coverage, provide $89 billion in tax credits over 10 years to help low-income families buy private insurance, and expand tax breaks for others to pay out-of-pocket medical expenses. Independent groups say his proposals would extend coverage to less than 20% of the uninsured and would not do anything to control costs.
Kerry: He has a more ambitious plan to extend coverage to 27 million people - more than half of the uninsured - by letting them buy coverage similar to what federal employees get. He would also have the government pay for most medical bills over $50,000 and greatly expand existing programs for children and the poor. But he provides few cost controls for a plan estimated to cost $653 billion to $1.5 trillion over 10 years.
Costs are going up for many reasons. One is that expensive new drugs, procedures and tests are coming onto the market. Yet consumers have little incentive to shop for bargains as long as their insurance covers the expense. And many doctors feel compelled to order unnecessary tests to protect themselves from potential malpractice suits. Another factor is that people with insurance pay ever-larger costs to subsidize those without coverage. Many providers offer discounts to the uninsured, and make up the difference from those with health plans. Meanwhile, Medicare costs keep soaring as Washington adds new benefits for seniors, the latest being prescription drug coverage.
More efficient use of medical services and more competition can help slow costs. Extending coverage to all benefits the insured as well as the uninsured. And restraining Medicare costs is essential as baby boomers begin retiring before the end of the decade.
***************************
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.
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.
***************************
USA Today can see the problems but has no solution other than a huge raid on the taxpayer -- which has already been rejected in the Clinton years. Complete privatization is the only real solution. Medicine is too important an industry to be a government puppet
Bush and Kerry fail to grasp health crisis' magnitude. As every voter knows, health care in the U.S. is in crisis. The average monthly premium for a family is up 64% just since 2000. Annual medical spending now consumes 15 cents of every dollar spent. One in six Americans lack insurance, and their ranks continue to climb.
But neither President Bush nor Sen. John Kerry has a plan to match the scale of the problem. They've shown little passion about reforming a system that appears out of control. Instead, they seem most animated when arguing over secondary health issues: Bush rails against trial lawyers who drive up malpractice insurance rates, and Kerry assails drug companies that block the reimportation of cheaper drugs from Canada. Yes, both candidates have health care proposals they are sure to tout in tonight's debate. But viewers looking for a comprehensive plan that extends coverage to the 45 million uninsured and tackles the underlying causes of skyrocketing costs will be disappointed.
The sad truth is that neither candidate has a bold vision that can spark an overdue debate on how to overhaul a system that no longer works for most Americans. By failing to think big now, the next president will only have a worse problem to face later in his term. Bush and Kerry each offer help for some people, but they don't go nearly far enough:
Bush: He would let small businesses band together to buy cheaper insurance coverage, provide $89 billion in tax credits over 10 years to help low-income families buy private insurance, and expand tax breaks for others to pay out-of-pocket medical expenses. Independent groups say his proposals would extend coverage to less than 20% of the uninsured and would not do anything to control costs.
Kerry: He has a more ambitious plan to extend coverage to 27 million people - more than half of the uninsured - by letting them buy coverage similar to what federal employees get. He would also have the government pay for most medical bills over $50,000 and greatly expand existing programs for children and the poor. But he provides few cost controls for a plan estimated to cost $653 billion to $1.5 trillion over 10 years.
Costs are going up for many reasons. One is that expensive new drugs, procedures and tests are coming onto the market. Yet consumers have little incentive to shop for bargains as long as their insurance covers the expense. And many doctors feel compelled to order unnecessary tests to protect themselves from potential malpractice suits. Another factor is that people with insurance pay ever-larger costs to subsidize those without coverage. Many providers offer discounts to the uninsured, and make up the difference from those with health plans. Meanwhile, Medicare costs keep soaring as Washington adds new benefits for seniors, the latest being prescription drug coverage.
More efficient use of medical services and more competition can help slow costs. Extending coverage to all benefits the insured as well as the uninsured. And restraining Medicare costs is essential as baby boomers begin retiring before the end of the decade.
***************************
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.
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.
***************************
Thursday, October 14, 2004
ISRAELI HOSPITAL TOLERATES MURDEROUS DOCTOR
The bureaucrats just turned a blind eye
In the worst-ever case of medical malpractice in Israel, Yakirevich, who was the head of Ichilov's cardiac surgery department from 1990 to 1996, was found guilty of the manslaughter of two 80-year-old patients he treated. In the first case, Yakirevich hastened his patient's death by stopping the balloon pump in her heart. In the second case he was found guilty of killing through malpractice a patient who was recovering from an operation. After being informed that the patient, semi-conscious and who was suffering from severe respiratory and blood pressure problems, was in a critical state, Yakirevich ordered the medical staff not to use a life-support system.
Following his orders, the medical staff didn't try to resuscitate the patient, who died several hours later from asphyxiation. The judge ruled that the doctor knew his orders would lead to the death or the hastening of the patient's death. The judge said that the doctor "Acted out of insensitivity as though he possessed unlimited power. He decided who could live or die."
The Tel-Aviv District Court also slammed Ichilov hospital's management and conduct of the case. The hospital showed, according to the verdict, "a lenient and ingratiating attitude" towards Yakirevich "despite being aware of part of his acts." The hospital, he continues, "decided to leave the doctor in his position because it needed his expertise and experience, which no one could doubt."
This criticism follows one raised in Judge Kara's verdict from January, according to which the hospital's management, under Professor Gabi Barbesh did not pay heed to serious complaints put forward by patients and staff against Dr. Yakirevich, and did not report them to the Health Ministry.
In addition to manslaughter charges, Yakirevich was also found guilty of a number of financial offenses, such as "accepting illegal and immoral payments," to the tune of thousands of dollars, from patients and their families, fraudulent deception, and, in one case, extorting money from the daughter of a patient he had operated on at another Tel Aviv hospital.
More here.
CANCEROUS GROWTH IN THE COST OF GOVERNMENT-FUNDED "FREEBIES"
How unsurprising!
"Medicaid will become the No. 1 cost facing U.S. state governments in 2004, beating out elementary and secondary education for the first time ever, according to a report from state budget officers on Tuesday. The cost of providing health services under the federal-state program for the poor and disabled climbed 8 percent in fiscal 2003 and came within a hair of overtaking elementary and secondary education as the top expenditure. Medicaid accounted for 21.4 percent of all state spending while elementary and secondary education took 21.7 percent of state spending in 2003, according to the National Association of State Budget Officers' annual State Expenditure Report.
In 1987, the program accounted for only 10.2 percent of total state spending compared with the 22.8 percent of spending allocated to education, the budget officers' group said. When final results are tallied for fiscal 2004, the budget officers group expects Medicaid to top states' list of expenses, said Scott Pattison, executive director of the group. "It's amazing," Pattison said. "Based on the projections for the (fiscal year) 2004 data, we would expect that it has surpassed the (kindergarten through grade 12) figure." Fiscal 2004 ended June 30 for most states. The expenditures data lags by about a year.
Raymond Scheppach, executive director of the National Governors Association, said federal requirements mandating Medicaid coverage would force states to cut back on other services. "Since Medicaid is a federal entitlement and education is discretionary, Medicaid will trump education going forward," Scheppach said. State budget and Medicaid officials, as well as health advocates, have warned for years that growth in Medicaid costs was unsustainable. Rising prescription drug costs, increasing enrollment and costly nursing home care have been cited throughout the country as the program's main cost drivers.
The Kaiser Commission on Medicaid and the Uninsured last week said Medicaid costs would continue to squeeze state governments in fiscal 2005 despite rising revenue collections and improving economies.
***************************
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.
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.
***************************
The bureaucrats just turned a blind eye
In the worst-ever case of medical malpractice in Israel, Yakirevich, who was the head of Ichilov's cardiac surgery department from 1990 to 1996, was found guilty of the manslaughter of two 80-year-old patients he treated. In the first case, Yakirevich hastened his patient's death by stopping the balloon pump in her heart. In the second case he was found guilty of killing through malpractice a patient who was recovering from an operation. After being informed that the patient, semi-conscious and who was suffering from severe respiratory and blood pressure problems, was in a critical state, Yakirevich ordered the medical staff not to use a life-support system.
Following his orders, the medical staff didn't try to resuscitate the patient, who died several hours later from asphyxiation. The judge ruled that the doctor knew his orders would lead to the death or the hastening of the patient's death. The judge said that the doctor "Acted out of insensitivity as though he possessed unlimited power. He decided who could live or die."
The Tel-Aviv District Court also slammed Ichilov hospital's management and conduct of the case. The hospital showed, according to the verdict, "a lenient and ingratiating attitude" towards Yakirevich "despite being aware of part of his acts." The hospital, he continues, "decided to leave the doctor in his position because it needed his expertise and experience, which no one could doubt."
This criticism follows one raised in Judge Kara's verdict from January, according to which the hospital's management, under Professor Gabi Barbesh did not pay heed to serious complaints put forward by patients and staff against Dr. Yakirevich, and did not report them to the Health Ministry.
In addition to manslaughter charges, Yakirevich was also found guilty of a number of financial offenses, such as "accepting illegal and immoral payments," to the tune of thousands of dollars, from patients and their families, fraudulent deception, and, in one case, extorting money from the daughter of a patient he had operated on at another Tel Aviv hospital.
More here.
CANCEROUS GROWTH IN THE COST OF GOVERNMENT-FUNDED "FREEBIES"
How unsurprising!
"Medicaid will become the No. 1 cost facing U.S. state governments in 2004, beating out elementary and secondary education for the first time ever, according to a report from state budget officers on Tuesday. The cost of providing health services under the federal-state program for the poor and disabled climbed 8 percent in fiscal 2003 and came within a hair of overtaking elementary and secondary education as the top expenditure. Medicaid accounted for 21.4 percent of all state spending while elementary and secondary education took 21.7 percent of state spending in 2003, according to the National Association of State Budget Officers' annual State Expenditure Report.
In 1987, the program accounted for only 10.2 percent of total state spending compared with the 22.8 percent of spending allocated to education, the budget officers' group said. When final results are tallied for fiscal 2004, the budget officers group expects Medicaid to top states' list of expenses, said Scott Pattison, executive director of the group. "It's amazing," Pattison said. "Based on the projections for the (fiscal year) 2004 data, we would expect that it has surpassed the (kindergarten through grade 12) figure." Fiscal 2004 ended June 30 for most states. The expenditures data lags by about a year.
Raymond Scheppach, executive director of the National Governors Association, said federal requirements mandating Medicaid coverage would force states to cut back on other services. "Since Medicaid is a federal entitlement and education is discretionary, Medicaid will trump education going forward," Scheppach said. State budget and Medicaid officials, as well as health advocates, have warned for years that growth in Medicaid costs was unsustainable. Rising prescription drug costs, increasing enrollment and costly nursing home care have been cited throughout the country as the program's main cost drivers.
The Kaiser Commission on Medicaid and the Uninsured last week said Medicaid costs would continue to squeeze state governments in fiscal 2005 despite rising revenue collections and improving economies.
***************************
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.
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.
***************************
Wednesday, October 13, 2004
DOCTORS REPLACED BY NURSES IN BRITAIN
Doctors are to be instructed to make evening home visits following a surge in the number of patients being forced to use hospital casualty departments at night. Hospital staff say they are struggling to cope with the increasing workload created by patients who find it difficult to see their family doctor. Almost half a million extra patients were treated in accident and emergency departments this summer, compared with the same period in 2003.
Health minister John Hutton will this week give patients a guarantee that they can have a home visit from a GP if their condition requires it - although it may not be their own family doctor. A Department of Health source said: 'Ministers are adamant that, should the clinical need arise, patients should be able to see a GP around the clock. The guidance will show exactly what ministers expect the NHS to deliver for patients in the evenings and weekends.'
Under the new GP contract introduced earlier this year, doctors can take a small pay cut and opt out of providing care between 11pm and 6am, and at weekends. It is now up to primary care trusts to provide cover at night, using nurses, locum doctors and other staff to deal with calls. When the change comes into full force in December, it is expected that nine out of 10 family doctors will choose not to offer night cover.
There are growing concerns about the burden this is placing on A & E departments. They are partly a victim of their own success because the four-hour waiting time target means more people are seen more quickly, but the burden has been exacerbated by difficulties across England in accessing care from GPs. Martin Shalley, president of the British Association of Emergency Medicine and a consultant in Birmingham, said: 'We see an awful lot [of patients] who cannot get in to see their GP with non-emergency problems.'
Casualty nurses take the brunt of the extra work. Some say they have seen a 20 per cent rise in attendance in the last two years, and a 13 per cent rise this year alone. Earlier this year, Northumbria Healthcare Trust was warned by its nurses that they could be forced to quit, so great was the burden of work at night in its overstretched A & E department. Sue Burt, a sister in the casualty department at Norfolk and Norwich Hospital Trust, told the Nursing Times that her department had seen a 13 per cent rise in attendances since January alone, mostly at night. 'People tell me they are here because it is convenient and because they cannot get an appointment with their GP. We are struggling to cope with the onslaught.'
More here:
AUSTRALIA'S MOST LEFTIST STATE CANNOT TREAT THE SICK
"Three thousand people have joined elective surgery waiting lists in the past year and thousands more waited too long in emergency departments, according to a new report on Victoria's public hospitals. The latest quarterly report on the state's public hospitals yesterday painted a grim picture, with most major performance measures pointing to a system unable to cope with growing patient demand. The number of people waiting in emergency for more than 12 hours shot up by 36 per cent, up from 4784 in the first three months of this year to 6547 in April, May and June. Elective surgery waiting lists also rose sharply, increasing by 3486 on the same time last year to 42,120, according to the report. Victoria's hospitals were forced to turn ambulances away 238 times in the three months to the end of June this year, 60 times more than in the same period last year.
Opposition health spokesman David Davis said the State Government had deliberately withheld the figures to avoid embarrassment before the federal election. "These figures should have been out some time ago. Steve Bracks decided to sit on these figures because they are disastrous," he said. Mr Davis said the poor results were due to a decision to close hospital beds and not a nurses' strike earlier this year. "The Bracks Government has to open beds and manage our system better," Mr Davis said....
A decline in performance at The Alfred hospital, where more than one in three patients waited for more than 12 hours on a trolley, would be addressed. "The Alfred hospital, as a major trauma centre, has some challenges," Ms Pike said...... "
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Doctors are to be instructed to make evening home visits following a surge in the number of patients being forced to use hospital casualty departments at night. Hospital staff say they are struggling to cope with the increasing workload created by patients who find it difficult to see their family doctor. Almost half a million extra patients were treated in accident and emergency departments this summer, compared with the same period in 2003.
Health minister John Hutton will this week give patients a guarantee that they can have a home visit from a GP if their condition requires it - although it may not be their own family doctor. A Department of Health source said: 'Ministers are adamant that, should the clinical need arise, patients should be able to see a GP around the clock. The guidance will show exactly what ministers expect the NHS to deliver for patients in the evenings and weekends.'
Under the new GP contract introduced earlier this year, doctors can take a small pay cut and opt out of providing care between 11pm and 6am, and at weekends. It is now up to primary care trusts to provide cover at night, using nurses, locum doctors and other staff to deal with calls. When the change comes into full force in December, it is expected that nine out of 10 family doctors will choose not to offer night cover.
There are growing concerns about the burden this is placing on A & E departments. They are partly a victim of their own success because the four-hour waiting time target means more people are seen more quickly, but the burden has been exacerbated by difficulties across England in accessing care from GPs. Martin Shalley, president of the British Association of Emergency Medicine and a consultant in Birmingham, said: 'We see an awful lot [of patients] who cannot get in to see their GP with non-emergency problems.'
Casualty nurses take the brunt of the extra work. Some say they have seen a 20 per cent rise in attendance in the last two years, and a 13 per cent rise this year alone. Earlier this year, Northumbria Healthcare Trust was warned by its nurses that they could be forced to quit, so great was the burden of work at night in its overstretched A & E department. Sue Burt, a sister in the casualty department at Norfolk and Norwich Hospital Trust, told the Nursing Times that her department had seen a 13 per cent rise in attendances since January alone, mostly at night. 'People tell me they are here because it is convenient and because they cannot get an appointment with their GP. We are struggling to cope with the onslaught.'
More here:
AUSTRALIA'S MOST LEFTIST STATE CANNOT TREAT THE SICK
"Three thousand people have joined elective surgery waiting lists in the past year and thousands more waited too long in emergency departments, according to a new report on Victoria's public hospitals. The latest quarterly report on the state's public hospitals yesterday painted a grim picture, with most major performance measures pointing to a system unable to cope with growing patient demand. The number of people waiting in emergency for more than 12 hours shot up by 36 per cent, up from 4784 in the first three months of this year to 6547 in April, May and June. Elective surgery waiting lists also rose sharply, increasing by 3486 on the same time last year to 42,120, according to the report. Victoria's hospitals were forced to turn ambulances away 238 times in the three months to the end of June this year, 60 times more than in the same period last year.
Opposition health spokesman David Davis said the State Government had deliberately withheld the figures to avoid embarrassment before the federal election. "These figures should have been out some time ago. Steve Bracks decided to sit on these figures because they are disastrous," he said. Mr Davis said the poor results were due to a decision to close hospital beds and not a nurses' strike earlier this year. "The Bracks Government has to open beds and manage our system better," Mr Davis said....
A decline in performance at The Alfred hospital, where more than one in three patients waited for more than 12 hours on a trolley, would be addressed. "The Alfred hospital, as a major trauma centre, has some challenges," Ms Pike said...... "
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Tuesday, October 12, 2004
THE VACCINE SHORTAGE IS GOVERNMENT-CREATED
"Flu vaccine should be an attractive product for manufacturers - it is used every year, recommended for virtually everyone, and extremely safe. But like virtually all other vaccines, it isn't profitable. And that has so discouraged vaccine development that supplies of many lifesaving vaccines are in jeopardy. The fundamental problem is government policies that discourage companies from investing aggressively to develop new vaccines. Innovation has suffered, and producers have abandoned the field in droves, leaving only four major producers and a few dozen products. There are only two producers of injectable flu vaccine, for example: Chiron, unable to supply any product this year because of alleged contamination; and Aventis Pasteur, whose 54 million doses will be all that's available. (In addition, there will be another 2 million doses of FluMist, an inhalable nasal vaccine.)
This is not the first time we have had dangerous shortages of several essential vaccines. Some school systems have been forced to waive immunization requirements because there aren't enough vaccines available.
Vaccination to prevent viral and bacterial diseases is modern medicine's most cost-effective intervention. Although their social value is high, their economic value to pharmaceutical companies is low because of vaccines' low return on investment and the manufacturers' exposure to legal liability....
Federal bureaucrats, who seem not to understand the concept of carrots and sticks, can do much to encourage greater production of more and better vaccines in the long term. For example, the CDC, the largest domestic purchaser of vaccines, uses its buying clout to compel deep discounts for purchases.
Arbitrary and excessive regulation also blocks progress. Consider, for instance, the FDA position on a vaccine to prevent meningitis C, a bacterial illness that infects thousands of Americans and kills hundreds each year. No state-of-the-art vaccine against this infectious disease is approved for use in the United States, although three excellent products are available in Canada and Europe. The safety and efficacy of these vaccines have been amply demonstrated, with more than 20 million doses administered. Yet the FDA refuses to recognize the foreign approvals.
Moreover, the FDA has a history of removing safe and effective vaccines from the market based merely on perceptions of excessive side effects - a prospect terrifying to manufacturers.
We need a fundamental change in mind-set: The rewards for creating, testing and producing vaccines must become commensurate with their benefits to society, as is the case for therapeutic pharmaceuticals. First, our government should accept U.S.-European Union reciprocity of vaccine regulatory approvals. This would cut development costs significantly. Second, public agencies must stop extorting huge discounts for vaccines..... And finally, a regulatory-compliance defense should be allowed so that after a manufacturer meets the rigorous regulatory requirements for vaccine approval, any mishap from use of the product is considered to be nonculpable... "
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
"Flu vaccine should be an attractive product for manufacturers - it is used every year, recommended for virtually everyone, and extremely safe. But like virtually all other vaccines, it isn't profitable. And that has so discouraged vaccine development that supplies of many lifesaving vaccines are in jeopardy. The fundamental problem is government policies that discourage companies from investing aggressively to develop new vaccines. Innovation has suffered, and producers have abandoned the field in droves, leaving only four major producers and a few dozen products. There are only two producers of injectable flu vaccine, for example: Chiron, unable to supply any product this year because of alleged contamination; and Aventis Pasteur, whose 54 million doses will be all that's available. (In addition, there will be another 2 million doses of FluMist, an inhalable nasal vaccine.)
This is not the first time we have had dangerous shortages of several essential vaccines. Some school systems have been forced to waive immunization requirements because there aren't enough vaccines available.
Vaccination to prevent viral and bacterial diseases is modern medicine's most cost-effective intervention. Although their social value is high, their economic value to pharmaceutical companies is low because of vaccines' low return on investment and the manufacturers' exposure to legal liability....
Federal bureaucrats, who seem not to understand the concept of carrots and sticks, can do much to encourage greater production of more and better vaccines in the long term. For example, the CDC, the largest domestic purchaser of vaccines, uses its buying clout to compel deep discounts for purchases.
Arbitrary and excessive regulation also blocks progress. Consider, for instance, the FDA position on a vaccine to prevent meningitis C, a bacterial illness that infects thousands of Americans and kills hundreds each year. No state-of-the-art vaccine against this infectious disease is approved for use in the United States, although three excellent products are available in Canada and Europe. The safety and efficacy of these vaccines have been amply demonstrated, with more than 20 million doses administered. Yet the FDA refuses to recognize the foreign approvals.
Moreover, the FDA has a history of removing safe and effective vaccines from the market based merely on perceptions of excessive side effects - a prospect terrifying to manufacturers.
We need a fundamental change in mind-set: The rewards for creating, testing and producing vaccines must become commensurate with their benefits to society, as is the case for therapeutic pharmaceuticals. First, our government should accept U.S.-European Union reciprocity of vaccine regulatory approvals. This would cut development costs significantly. Second, public agencies must stop extorting huge discounts for vaccines..... And finally, a regulatory-compliance defense should be allowed so that after a manufacturer meets the rigorous regulatory requirements for vaccine approval, any mishap from use of the product is considered to be nonculpable... "
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Monday, October 11, 2004
GOVERNMENT IS THE PROBLEM
Politicians used to run for office promising to fix the health-care crisis, but lately they've given up pretending they have any answers. Since 2000, medical costs have soared, and the number of people without medical insurance has grown. Yet the issue has been almost invisible in this presidential campaign. We know more about the candidates' hobbies than we do about their health-care plans.
As it happens, President Bush and Sen. John Kerry have some proposals, which consist mainly of measures to increase the number of Americans with medical coverage. Bush wants to rely on tax credits, while Kerry hopes to reduce insurance premiums by making the government pick up some of the costs of catastrophic illness.
Unfortunately, neither addresses the maddening dilemma we face. Anything you do to expand access to health care, like making insurance more available, increases the demand for health care and, in turn, drives up the price of health care. But if you try to control the cost of health care, you make it less accessible by discouraging hospitals and doctors from providing it. Politicians can't figure out a way to ameliorate both problems at once, so they end up doing little or nothing, or else they take steps that are likely to make things worse.
But there is a way to advance both worthy goals simultaneously--one that has been almost completely overlooked. Instead of focusing on demand, we could take steps to expand supply and promote competition. Like a glut in the gasoline market, that would allow people to consume more without all of us spending more.
Medicine is one of the most tightly regulated sectors in the entire economy, and many of the regulations limit supply. We require doctors to spend at least seven years in training after college, which deters many people from going into medicine. We impose licensing requirements that prevent some trained people from offering care. At the same time, we limit the types of treatment that other medical professionals, like physician assistants and nurses, may provide.
These policies are supposed to ensure quality, but they also deprive patients of options they might happily choose. Licensing of physicians arose in the 19th Century mainly as a way of limiting the supply of doctors and thus shielding the profession from competition.
Even now, California State University economist Shirley Svorny notes, "Many economists view licensing as a significant barrier to effective, cost-efficient health care." You might think tight regulation is needed to protect patients from quacks. But Svorny notes that while this type of regulation certainly raises costs, studies indicate that "the effect of licensure on consumption quality is ambiguous."
There is plenty of evidence that government policies reduce the availability of medical care. Though chiropractic is now widely used, the medical profession waged a long battle to prevent it from gaining acceptance. Today, the value of spinal manipulation for treating lower back pain, said a 1998 article in the New England Journal of Medicine, is "no longer in dispute." Medicare, however, still declines to cover some services that chiropractors are licensed to provide.
That experience should be a lesson about the value of expanding patient options, an approach that could lower costs while increasing satisfaction. It's not the only such lesson. Twenty years ago, midwifery was treated with scorn by medical experts. But a growing body of academic reports indicates that for normal pregnancies, deliveries can be handled as safely by nurse-midwives and lay midwives as by obstetricians.
One reason many people find health care inaccessible or too expensive is that we insist on providing so much of it through highly trained physicians. The idea of finding ways to reduce the years of training doesn't seem to have occurred to anyone. Apart from that, nurse practitioners, nurses and physician assistants could do a lot of what we now rely on doctors to do--and they could do it at a lower cost. They could also expand access to medical care in poor and rural areas that physicians shun.
It's easy to say everyone should get care from doctors. But that's like saying everyone should drive a Volvo. If we limited consumer choices to one ultrasafe nameplate, many people would not be able to afford a car at all. We let individuals make most of their own choices about safety and cost when it comes to their wheels. Why not with medical care?
For the last 40 years, every solution to our health-care problems has been a variation on the same theme: more government. Maybe the real answer is more freedom.
From the Chicago Trib.
***************************
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.
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.
***************************
Politicians used to run for office promising to fix the health-care crisis, but lately they've given up pretending they have any answers. Since 2000, medical costs have soared, and the number of people without medical insurance has grown. Yet the issue has been almost invisible in this presidential campaign. We know more about the candidates' hobbies than we do about their health-care plans.
As it happens, President Bush and Sen. John Kerry have some proposals, which consist mainly of measures to increase the number of Americans with medical coverage. Bush wants to rely on tax credits, while Kerry hopes to reduce insurance premiums by making the government pick up some of the costs of catastrophic illness.
Unfortunately, neither addresses the maddening dilemma we face. Anything you do to expand access to health care, like making insurance more available, increases the demand for health care and, in turn, drives up the price of health care. But if you try to control the cost of health care, you make it less accessible by discouraging hospitals and doctors from providing it. Politicians can't figure out a way to ameliorate both problems at once, so they end up doing little or nothing, or else they take steps that are likely to make things worse.
But there is a way to advance both worthy goals simultaneously--one that has been almost completely overlooked. Instead of focusing on demand, we could take steps to expand supply and promote competition. Like a glut in the gasoline market, that would allow people to consume more without all of us spending more.
Medicine is one of the most tightly regulated sectors in the entire economy, and many of the regulations limit supply. We require doctors to spend at least seven years in training after college, which deters many people from going into medicine. We impose licensing requirements that prevent some trained people from offering care. At the same time, we limit the types of treatment that other medical professionals, like physician assistants and nurses, may provide.
These policies are supposed to ensure quality, but they also deprive patients of options they might happily choose. Licensing of physicians arose in the 19th Century mainly as a way of limiting the supply of doctors and thus shielding the profession from competition.
Even now, California State University economist Shirley Svorny notes, "Many economists view licensing as a significant barrier to effective, cost-efficient health care." You might think tight regulation is needed to protect patients from quacks. But Svorny notes that while this type of regulation certainly raises costs, studies indicate that "the effect of licensure on consumption quality is ambiguous."
There is plenty of evidence that government policies reduce the availability of medical care. Though chiropractic is now widely used, the medical profession waged a long battle to prevent it from gaining acceptance. Today, the value of spinal manipulation for treating lower back pain, said a 1998 article in the New England Journal of Medicine, is "no longer in dispute." Medicare, however, still declines to cover some services that chiropractors are licensed to provide.
That experience should be a lesson about the value of expanding patient options, an approach that could lower costs while increasing satisfaction. It's not the only such lesson. Twenty years ago, midwifery was treated with scorn by medical experts. But a growing body of academic reports indicates that for normal pregnancies, deliveries can be handled as safely by nurse-midwives and lay midwives as by obstetricians.
One reason many people find health care inaccessible or too expensive is that we insist on providing so much of it through highly trained physicians. The idea of finding ways to reduce the years of training doesn't seem to have occurred to anyone. Apart from that, nurse practitioners, nurses and physician assistants could do a lot of what we now rely on doctors to do--and they could do it at a lower cost. They could also expand access to medical care in poor and rural areas that physicians shun.
It's easy to say everyone should get care from doctors. But that's like saying everyone should drive a Volvo. If we limited consumer choices to one ultrasafe nameplate, many people would not be able to afford a car at all. We let individuals make most of their own choices about safety and cost when it comes to their wheels. Why not with medical care?
For the last 40 years, every solution to our health-care problems has been a variation on the same theme: more government. Maybe the real answer is more freedom.
From the Chicago Trib.
***************************
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.
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.
***************************
Sunday, October 10, 2004
INDIAN HOSPITALS BEAT BRITISH ONES
"BBC Radio Four (indeed any part of the B.B.C.) is not where one would expect to find support for liberty, but a few a days ago I heard, on the Radio 4 Today Program, a report on medical care.
According to the report private hospitals in India (including in Calcutta) offer British people medical care at least as good as that provided by the NHS, and in wonderful conditions (marble floors, everything clean rather than the dirt, and decay one finds in British government hospitals - thousands of people die every year in Britain from infections they pick up whilst in government hospitals) and at a small fraction of the cost of the (highly regulated) British private hospitals.
The Labour MP Frank Field (a man known for his honesty - hard to believe in a politician, but it is true in his case) came on to the program and claimed that a constituent of his was being left to go blind by the NHS, people are normally left to rot for long periods of time by the government medical service, but his sight was saved by sending him to an Indian hospital. The price of his medical care (not including the cost of flying to India, I admit) was œ50 - in Britain the medical care would have cost (according to Mr Field) œ3000.
So the choices were - go to a highly regulated British private hospital (if you happen to have œ3000), rely on government medical care (and go blind), or go overseas. Being a Labour MP Mr Field wanted the NHS to pay to send people to private hospitals in India (they put administrative barriers in the way of this ["it is too far"] - although they are willing to spend far more money sending people to European hospitals), but this was the closest I have ever come to hearing both the BBC and a Labour MP condemn statism in health care."
From Samizdata.
UNAFFORDABLE INSURANCE
"Doctors at Montgomery General Hospital are asking administrators to let them work without malpractice insurance because they cannot afford a statewide 33 percent increase in premiums. The doctors say the rates are so high now that they also are considering whether to discontinue high-risk procedures or to close or move practices out of state. "I look at these options myself," said Dr. Brian Avin, a neurologist with admitting privileges at Montgomery General. "I don't go to the emergency room anymore. I've cut back on treating the indigent. We've cut back on Medicaid. That hurts. I went into medicine to do all of those things."
Gov. Robert L. Ehrlich Jr., a Republican, yesterday described the price of medical-malpractice insurance in Maryland as a "very serious" issue. He also said that without reform, the state could lose its "very best medical providers." However, Mr. Ehrlich and state lawmakers have been unable to strike a deal to address the cost of malpractice premiums.
Meanwhile, the Maryland State Medical Society said this week that as many as 40 percent of the state's physicians will close or relocate if premiums are not reduced. Dr. Avin said he supports the Montgomery General doctors who are asking the medical staff's executive committee if they can practice without insurance, although he was not at the meeting on Tuesday night, when they voted on the plan. Montgomery General does not give admitting privileges to physicians unless they have malpractice insurance. But doctors want the hospital to drop the requirement because, they say, high malpractice-insurance rates are driving them out of business.
Doctors complained about malpractice premiums last month after insurance regulators approved a 33 percent rate increase for Medical Mutual Liability Insurance Society of Maryland, which insures about three-fourths of the state's doctors. The increase brought the cost of premiums for some doctors to more than $150,000 a year.
More here:
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
"BBC Radio Four (indeed any part of the B.B.C.) is not where one would expect to find support for liberty, but a few a days ago I heard, on the Radio 4 Today Program, a report on medical care.
According to the report private hospitals in India (including in Calcutta) offer British people medical care at least as good as that provided by the NHS, and in wonderful conditions (marble floors, everything clean rather than the dirt, and decay one finds in British government hospitals - thousands of people die every year in Britain from infections they pick up whilst in government hospitals) and at a small fraction of the cost of the (highly regulated) British private hospitals.
The Labour MP Frank Field (a man known for his honesty - hard to believe in a politician, but it is true in his case) came on to the program and claimed that a constituent of his was being left to go blind by the NHS, people are normally left to rot for long periods of time by the government medical service, but his sight was saved by sending him to an Indian hospital. The price of his medical care (not including the cost of flying to India, I admit) was œ50 - in Britain the medical care would have cost (according to Mr Field) œ3000.
So the choices were - go to a highly regulated British private hospital (if you happen to have œ3000), rely on government medical care (and go blind), or go overseas. Being a Labour MP Mr Field wanted the NHS to pay to send people to private hospitals in India (they put administrative barriers in the way of this ["it is too far"] - although they are willing to spend far more money sending people to European hospitals), but this was the closest I have ever come to hearing both the BBC and a Labour MP condemn statism in health care."
From Samizdata.
UNAFFORDABLE INSURANCE
"Doctors at Montgomery General Hospital are asking administrators to let them work without malpractice insurance because they cannot afford a statewide 33 percent increase in premiums. The doctors say the rates are so high now that they also are considering whether to discontinue high-risk procedures or to close or move practices out of state. "I look at these options myself," said Dr. Brian Avin, a neurologist with admitting privileges at Montgomery General. "I don't go to the emergency room anymore. I've cut back on treating the indigent. We've cut back on Medicaid. That hurts. I went into medicine to do all of those things."
Gov. Robert L. Ehrlich Jr., a Republican, yesterday described the price of medical-malpractice insurance in Maryland as a "very serious" issue. He also said that without reform, the state could lose its "very best medical providers." However, Mr. Ehrlich and state lawmakers have been unable to strike a deal to address the cost of malpractice premiums.
Meanwhile, the Maryland State Medical Society said this week that as many as 40 percent of the state's physicians will close or relocate if premiums are not reduced. Dr. Avin said he supports the Montgomery General doctors who are asking the medical staff's executive committee if they can practice without insurance, although he was not at the meeting on Tuesday night, when they voted on the plan. Montgomery General does not give admitting privileges to physicians unless they have malpractice insurance. But doctors want the hospital to drop the requirement because, they say, high malpractice-insurance rates are driving them out of business.
Doctors complained about malpractice premiums last month after insurance regulators approved a 33 percent rate increase for Medical Mutual Liability Insurance Society of Maryland, which insures about three-fourths of the state's doctors. The increase brought the cost of premiums for some doctors to more than $150,000 a year.
More here:
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Saturday, October 09, 2004
BRITISH HYPOCRISY
"Tony Blair's had his minor heart operation and is apparently in fine fettle, so good luck to him. Remarkable, though, how our leading politicians seem to get treated so quickly while the rest of us NHS patients have to wait.
"Unlike Tony, I'm still waiting for treatment," says Mickey Clark, the Markets Correspondent in London's Evening Standard newspaper today. "The Prime Minister and I are both 51 and suffer from irregular heartbeats. There the similarities end."
Clark was diagnosed last year and given drugs to thin his blood and hopefully to kick-start his heart. A date was set for and operation later that spring and an appointment with the cardiologist in July. But then an ECG showed his heart seemed to be beating normally so the treatment was postponed, as was the cardiologist appointment. Indeed, the cardiologist date has since been cancelled twice, so Clark won't be seeing the specialist until next February (unless he cancels again). "Compare that with Tony Blair, who was given [the treatment] the same weekend his complaint was diagnosed."
Quite. When defenders of state medicine say "we don't want a two-tier system," they should reflect that that is exactly what we've got."
From the Adam Smith blog.
***************************
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.
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.
***************************
"Tony Blair's had his minor heart operation and is apparently in fine fettle, so good luck to him. Remarkable, though, how our leading politicians seem to get treated so quickly while the rest of us NHS patients have to wait.
"Unlike Tony, I'm still waiting for treatment," says Mickey Clark, the Markets Correspondent in London's Evening Standard newspaper today. "The Prime Minister and I are both 51 and suffer from irregular heartbeats. There the similarities end."
Clark was diagnosed last year and given drugs to thin his blood and hopefully to kick-start his heart. A date was set for and operation later that spring and an appointment with the cardiologist in July. But then an ECG showed his heart seemed to be beating normally so the treatment was postponed, as was the cardiologist appointment. Indeed, the cardiologist date has since been cancelled twice, so Clark won't be seeing the specialist until next February (unless he cancels again). "Compare that with Tony Blair, who was given [the treatment] the same weekend his complaint was diagnosed."
Quite. When defenders of state medicine say "we don't want a two-tier system," they should reflect that that is exactly what we've got."
From the Adam Smith blog.
***************************
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.
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.
***************************
Friday, October 08, 2004
Health Insurance Costs Rise Faster Than Wages
[There's always new rules being added by do-gooding legislators so the well-paid medical bureaucracy just keeps growing like a cancer]
"Health insurance premiums for workers are rising around three times faster than their wages, and health costs eat up a quarter of earnings for more than 14 million Americans, according to a survey on Tuesday. While benefits are being cut, health insurance premiums are rising, the report from the nonprofit Families USA found.
"Working families were squeezed by runaway health care costs over the past four years," said Families USA executive director Ron Pollack. "As a result, workers are paying much more in premiums but are receiving less health coverage, wages are being depressed; and millions of people have lost health coverage entirely."
The cost of health insurance premiums rose by nearly 36 percent on average from 2000 to 2004 in 35 states, said the group, which bills itself as a nonpartisan watchdog on health care issues. Average earnings rose just 12 percent over the same time".
More here.
[There's always new rules being added by do-gooding legislators so the well-paid medical bureaucracy just keeps growing like a cancer]
"Health insurance premiums for workers are rising around three times faster than their wages, and health costs eat up a quarter of earnings for more than 14 million Americans, according to a survey on Tuesday. While benefits are being cut, health insurance premiums are rising, the report from the nonprofit Families USA found.
"Working families were squeezed by runaway health care costs over the past four years," said Families USA executive director Ron Pollack. "As a result, workers are paying much more in premiums but are receiving less health coverage, wages are being depressed; and millions of people have lost health coverage entirely."
The cost of health insurance premiums rose by nearly 36 percent on average from 2000 to 2004 in 35 states, said the group, which bills itself as a nonpartisan watchdog on health care issues. Average earnings rose just 12 percent over the same time".
More here.
Thursday, October 07, 2004
MEDICAL MADNESS IN AUSTRALIA
Expensive surgery for the elderly is not the best use of taxpayers' money, writes Ross Gittins
Whichever side wins this election, the new government will be committed to pouring a mighty lot more money into Medicare over coming decades - far more than either side is willing to admit. But this huge injection of taxpayers' funds is likely to do more to enhance doctors' incomes than improve the quality of our health care.
The present bout of renovations to Medicare began in response to the public's concern about a sharp decline in bulk-billing by general practitioners. This decline occurred because the Howard Government had spent the past eight years sitting on the schedule fee - stopping it from rising as much as doctors' costs were rising. Watching enviously while specialists' incomes continued to grow strongly, many GPs finally broke out of the system, cutting back their bulk-billing so they could charge fees well above the schedule fee. Getting them back into the bulk-billing paddock - where the rate at which their fees rise is effectively controlled by the Government - won't be easy now they've tasted financial freedom.
Both parties give the impression they're trying to preserve bulk-billing, but only Labor is genuine. Only it is offering GPs the monetary incentives needed to possibly - possibly - lure them back into the system and get the proportion of GP consultations that are bulk-billed back up to the 80 per cent level John Howard inherited. The Liberals have limited their inducements to encourage the bulk-billing of pensioners and children. They appeared to match Labor's recent offer to pay a 100 per cent (as opposed to the present 85 per cent) rebate on the schedule fee for GP consultations, but the appearance is deceptive. Labor would pay the higher rebate only to doctors who bulk-bill, whereas the Libs would pay it also to patients who were not bulk-billed - thereby permitting GPs who so chose to increase their fees by the same amount as the increase in the rebate. So the Libs' version is designed to allow doctors to share the largesse.
Rather than seek to restore bulk-billing, the Libs' approach has been to introduce a safety net where, once a family's out-of-pocket payments (ie, doctor's fee minus Medicare rebate) exceed a threshold of $300 or $700 a year, Medicare picks up 80 per cent of all further out-of-pocket payments during the year. So the Libs are saying, we're going to let bulk-billing continue to wither for most people, but don't worry, we've got this other way of protecting you from undue expense. What's more, bulk-billing is limited mainly to GP visits, whereas our safety net comes into its own with specialists' fees, most of which are way above the schedule fee.
There's no denying the safety net is very generous (mainly because a misguided minority in the Senate forced the Government to accept much lower threshold levels than made sense). This is why the measure will cost far more than the Government originally bargained for. And indeed, the early figures for this year suggest the cost to the taxpayer will be double what was expected. Those figures showed that payments to people in Brendan Nelson's prosperous North Shore electorate exceeded those going to people in the whole of South Australia.
Actually, that isn't surprising. It's in the most prosperous suburbs that doctors don't bother bulk-billing and know they can charge way above the schedule fee, while patients can afford lots of visits to specialists even at high prices. This says the lion's share of taxpayers' money to be spent on the safety net will go to patients who don't particularly need help (including yours truly) and to those specialists in the best suburbs with the highest fees. Worse, the advent of the safety net removes the last constraint on the freedom of doctors to raise their fees: conscience. Don't worry that your patients can't afford your fee increase - as soon as they're over a quite low threshold, the taxpayer will be picking up 80 per cent of the rise. So the safety net is likely to underwrite a continuing surge in doctors' fees. Its cost will just keep exploding - but with surprisingly little of the benefit going to needy patients.
In its own way, however, Labor's rival offer, Medicare Gold, would be just as dubious and wasteful. This is the promise to end hospital waiting lists for people aged 75 and over by giving them the equivalent of free private health insurance. The proposal has two attractions from a policy perspective: it would end the duckshoving between public hospitals (state) and nursing homes (federal) over care of the frail aged, and it would make public and private hospitals part of a single, integrated system. Apart from that, Medicare Gold is bad news. Despite all Labor's fulminating over the evils of a two-tier health system, that's just what it would be: Medicare Gold for those old enough, Medicare Ordinary for the rest. This discrimination would be on the basis of age, not need. The old wouldn't face queues for elective surgery, but everyone else would. The old would get free private health insurance, everyone else would have to pay.
This is a tacit admission from Labor that by itself, Medicare is not up to snuff. For decent treatment, you must have additional, private insurance. Private insurance is now an integral part of Labor's version of Medicare. Wow. By giving the elderly unfettered access to "free" hospital treatment, their doctors would gain an open go in ordering additional procedures. A $20,000 heart bypass for someone in their 80s? Not a problem. Might keep them going a few months longer.
Because specialists would be paid a higher (private) fee for operations, a lot more of them would make themselves available. Even so, the blowout in demand would lead to a constant threat of waiting lists emerging. Every time that happened, a Labor government would be under pressure to keep its promise by pouring yet more taxpayers' money into system. It would be a never-ending struggle, with a cost that was completely open-ended.
The pollies will never admit it, but waiting lists for elective surgery aren't an unfortunate accident - they're a design feature. Pollies of both colours - federal and state - use them to keep a lid on growth in the cost of public hospitals that would otherwise be uncontrollable. If Labor gave oldies an exemption from queuing, there's nothing surer than that the queues for you and me would be longer - and this despite hugely increased spending on the oldies and their doctors.
***************************
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.
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.
***************************
Expensive surgery for the elderly is not the best use of taxpayers' money, writes Ross Gittins
Whichever side wins this election, the new government will be committed to pouring a mighty lot more money into Medicare over coming decades - far more than either side is willing to admit. But this huge injection of taxpayers' funds is likely to do more to enhance doctors' incomes than improve the quality of our health care.
The present bout of renovations to Medicare began in response to the public's concern about a sharp decline in bulk-billing by general practitioners. This decline occurred because the Howard Government had spent the past eight years sitting on the schedule fee - stopping it from rising as much as doctors' costs were rising. Watching enviously while specialists' incomes continued to grow strongly, many GPs finally broke out of the system, cutting back their bulk-billing so they could charge fees well above the schedule fee. Getting them back into the bulk-billing paddock - where the rate at which their fees rise is effectively controlled by the Government - won't be easy now they've tasted financial freedom.
Both parties give the impression they're trying to preserve bulk-billing, but only Labor is genuine. Only it is offering GPs the monetary incentives needed to possibly - possibly - lure them back into the system and get the proportion of GP consultations that are bulk-billed back up to the 80 per cent level John Howard inherited. The Liberals have limited their inducements to encourage the bulk-billing of pensioners and children. They appeared to match Labor's recent offer to pay a 100 per cent (as opposed to the present 85 per cent) rebate on the schedule fee for GP consultations, but the appearance is deceptive. Labor would pay the higher rebate only to doctors who bulk-bill, whereas the Libs would pay it also to patients who were not bulk-billed - thereby permitting GPs who so chose to increase their fees by the same amount as the increase in the rebate. So the Libs' version is designed to allow doctors to share the largesse.
Rather than seek to restore bulk-billing, the Libs' approach has been to introduce a safety net where, once a family's out-of-pocket payments (ie, doctor's fee minus Medicare rebate) exceed a threshold of $300 or $700 a year, Medicare picks up 80 per cent of all further out-of-pocket payments during the year. So the Libs are saying, we're going to let bulk-billing continue to wither for most people, but don't worry, we've got this other way of protecting you from undue expense. What's more, bulk-billing is limited mainly to GP visits, whereas our safety net comes into its own with specialists' fees, most of which are way above the schedule fee.
There's no denying the safety net is very generous (mainly because a misguided minority in the Senate forced the Government to accept much lower threshold levels than made sense). This is why the measure will cost far more than the Government originally bargained for. And indeed, the early figures for this year suggest the cost to the taxpayer will be double what was expected. Those figures showed that payments to people in Brendan Nelson's prosperous North Shore electorate exceeded those going to people in the whole of South Australia.
Actually, that isn't surprising. It's in the most prosperous suburbs that doctors don't bother bulk-billing and know they can charge way above the schedule fee, while patients can afford lots of visits to specialists even at high prices. This says the lion's share of taxpayers' money to be spent on the safety net will go to patients who don't particularly need help (including yours truly) and to those specialists in the best suburbs with the highest fees. Worse, the advent of the safety net removes the last constraint on the freedom of doctors to raise their fees: conscience. Don't worry that your patients can't afford your fee increase - as soon as they're over a quite low threshold, the taxpayer will be picking up 80 per cent of the rise. So the safety net is likely to underwrite a continuing surge in doctors' fees. Its cost will just keep exploding - but with surprisingly little of the benefit going to needy patients.
In its own way, however, Labor's rival offer, Medicare Gold, would be just as dubious and wasteful. This is the promise to end hospital waiting lists for people aged 75 and over by giving them the equivalent of free private health insurance. The proposal has two attractions from a policy perspective: it would end the duckshoving between public hospitals (state) and nursing homes (federal) over care of the frail aged, and it would make public and private hospitals part of a single, integrated system. Apart from that, Medicare Gold is bad news. Despite all Labor's fulminating over the evils of a two-tier health system, that's just what it would be: Medicare Gold for those old enough, Medicare Ordinary for the rest. This discrimination would be on the basis of age, not need. The old wouldn't face queues for elective surgery, but everyone else would. The old would get free private health insurance, everyone else would have to pay.
This is a tacit admission from Labor that by itself, Medicare is not up to snuff. For decent treatment, you must have additional, private insurance. Private insurance is now an integral part of Labor's version of Medicare. Wow. By giving the elderly unfettered access to "free" hospital treatment, their doctors would gain an open go in ordering additional procedures. A $20,000 heart bypass for someone in their 80s? Not a problem. Might keep them going a few months longer.
Because specialists would be paid a higher (private) fee for operations, a lot more of them would make themselves available. Even so, the blowout in demand would lead to a constant threat of waiting lists emerging. Every time that happened, a Labor government would be under pressure to keep its promise by pouring yet more taxpayers' money into system. It would be a never-ending struggle, with a cost that was completely open-ended.
The pollies will never admit it, but waiting lists for elective surgery aren't an unfortunate accident - they're a design feature. Pollies of both colours - federal and state - use them to keep a lid on growth in the cost of public hospitals that would otherwise be uncontrollable. If Labor gave oldies an exemption from queuing, there's nothing surer than that the queues for you and me would be longer - and this despite hugely increased spending on the oldies and their doctors.
***************************
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.
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.
***************************
Wednesday, October 06, 2004
NOT ENOUGH DOCTORS FOR AUSTRALIA
And the triumph of feminism is largely to blame
"Ailing Australians may have to wait longer to see their regular general practitioner as doctors and medical students choose to work fewer hours as part of a fundamental shift in the medical profession, a new study has found. A two-year study published today in The Medical Journal of Australia found family and lifestyle will be just as important as medicine to the next generation of Australian doctors and many will opt to work part-time to accommodate their lifestyle. The move could force patients in need of immediate care to seek out other doctors. Researchers from the University of Newcastle and the Royal Australian College of General Practitioners surveyed 130 students about how they would balance their careers as doctors with their family and private lives. Although women doctors already work fewer hours than male doctors, the reality is that many find the conflict between their roles as doctors, mothers and wives a significant source of stress," said author Helen Tolhurst, a postdoctoral research fellow in the university's discipline of General Practice. With women now making up 50 per cent of medical students, this is going to have a significant impact on the delivery of medical services in the future. But Dr Tolhurst said it was "not just the women" feeling that way. "Both sexes are concerned about the impact of vocational choice on family life and lifestyle - and this is borne out by our study," she said.
Australian Medical Association state president Dr William Heddle said the change in the make-up of medical students had led to doctors working "safer hours". "But we still need to graduate enough doctors to fill the workforce," he said. "Last year, you needed 1.7 graduates for one full-time equivalent doctor with the hours the graduates were working. This used to be about 0.7 for one full-time equivalent because everyone used to work 80 hours a week." He admitted it could be difficult for female medical students to balance specialist training careers with family life.
Australian Medical Students Association president Matthew Hutchinson said changes in the demographic of medical students "put the onus on the government to really think about workforce planning. Doctors used to work 60 or 70 hours a week but these days we are not going to get that," he said. "So we need a bigger medical workforce to plug those gaps." He said 76 per cent of first-year medical students at the University of Adelaide this year were female.
More here.
THE REALITY OF "UNIVERSAL" HEALTH COVERAGE
"A woman expecting her first child was told to drive more than 135km because the hospital in her home town had no anaesthetist on call to be at the birth. Mandy Schiller, 30, had planned to have her child in her local hospital but, with husband Geoff by her side, she was forced to stay at home before being told to drive to somewhere else.
Their experience is typical of the stress and trauma faced by country mothers. A survey released yesterday shows 45 per cent of women in rural NSW cannot give birth in their local areas because of a lack of specialist health services and staff. The survey released by the Gender, Women and Social Policy research group at Charles Sturt University, Wagga Wagga, found country women had trouble accessing GPs and health specialists, and were far behind their city cousins when it came to education, childcare, transport and mental health services.....
The couple eventually arrived at Wagga Base Hospital, with Mrs Schiller giving birth to son Nicholas, her first child, at 5.35am. She checked out at lunchtime that day to head back to Young. "I wanted to go home and check into Young Hospital so I could be near family and friends," Mrs Schiller said. "We've got a brand new hospital here and it seems totally stupid that I couldn't use it to have my baby. "The whole experience adds to the stress of giving birth for the first time, I know in my pre-natal classes the other mothers were very worried about it. Sometimes the anaesthetist is gone for a week at a time and if you're due that week what do you do?"
The couple's trauma is repeated on a daily basis across NSW, said Danette Watson from Maternity Coalition. "Perfectly healthy women are being forced to go out of town to give birth simply because of the shortage of full-time anaesthetists," she said. Southern Area Health Southern Slopes division general manager Margaret Gerkens said Young's single anaesthetist was not on duty that day and no locums were available."
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
And the triumph of feminism is largely to blame
"Ailing Australians may have to wait longer to see their regular general practitioner as doctors and medical students choose to work fewer hours as part of a fundamental shift in the medical profession, a new study has found. A two-year study published today in The Medical Journal of Australia found family and lifestyle will be just as important as medicine to the next generation of Australian doctors and many will opt to work part-time to accommodate their lifestyle. The move could force patients in need of immediate care to seek out other doctors. Researchers from the University of Newcastle and the Royal Australian College of General Practitioners surveyed 130 students about how they would balance their careers as doctors with their family and private lives. Although women doctors already work fewer hours than male doctors, the reality is that many find the conflict between their roles as doctors, mothers and wives a significant source of stress," said author Helen Tolhurst, a postdoctoral research fellow in the university's discipline of General Practice. With women now making up 50 per cent of medical students, this is going to have a significant impact on the delivery of medical services in the future. But Dr Tolhurst said it was "not just the women" feeling that way. "Both sexes are concerned about the impact of vocational choice on family life and lifestyle - and this is borne out by our study," she said.
Australian Medical Association state president Dr William Heddle said the change in the make-up of medical students had led to doctors working "safer hours". "But we still need to graduate enough doctors to fill the workforce," he said. "Last year, you needed 1.7 graduates for one full-time equivalent doctor with the hours the graduates were working. This used to be about 0.7 for one full-time equivalent because everyone used to work 80 hours a week." He admitted it could be difficult for female medical students to balance specialist training careers with family life.
Australian Medical Students Association president Matthew Hutchinson said changes in the demographic of medical students "put the onus on the government to really think about workforce planning. Doctors used to work 60 or 70 hours a week but these days we are not going to get that," he said. "So we need a bigger medical workforce to plug those gaps." He said 76 per cent of first-year medical students at the University of Adelaide this year were female.
More here.
THE REALITY OF "UNIVERSAL" HEALTH COVERAGE
"A woman expecting her first child was told to drive more than 135km because the hospital in her home town had no anaesthetist on call to be at the birth. Mandy Schiller, 30, had planned to have her child in her local hospital but, with husband Geoff by her side, she was forced to stay at home before being told to drive to somewhere else.
Their experience is typical of the stress and trauma faced by country mothers. A survey released yesterday shows 45 per cent of women in rural NSW cannot give birth in their local areas because of a lack of specialist health services and staff. The survey released by the Gender, Women and Social Policy research group at Charles Sturt University, Wagga Wagga, found country women had trouble accessing GPs and health specialists, and were far behind their city cousins when it came to education, childcare, transport and mental health services.....
The couple eventually arrived at Wagga Base Hospital, with Mrs Schiller giving birth to son Nicholas, her first child, at 5.35am. She checked out at lunchtime that day to head back to Young. "I wanted to go home and check into Young Hospital so I could be near family and friends," Mrs Schiller said. "We've got a brand new hospital here and it seems totally stupid that I couldn't use it to have my baby. "The whole experience adds to the stress of giving birth for the first time, I know in my pre-natal classes the other mothers were very worried about it. Sometimes the anaesthetist is gone for a week at a time and if you're due that week what do you do?"
The couple's trauma is repeated on a daily basis across NSW, said Danette Watson from Maternity Coalition. "Perfectly healthy women are being forced to go out of town to give birth simply because of the shortage of full-time anaesthetists," she said. Southern Area Health Southern Slopes division general manager Margaret Gerkens said Young's single anaesthetist was not on duty that day and no locums were available."
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Tuesday, October 05, 2004
BIG PROBLEMS AND TRIVIAL RESPONSES
Another email from a U.S. doctor:
"I am a physician in the U.S., and I love your socialized medicine pearls, the latest of which -- by another medical practitioner -- I want to comment on. I just wanted to tell you, we have JCAHO coming to our hospital this month. It is causing all the panic you note. What a dog and pony show! We'll do all this total b.s., and it's all about the show...nothing to do with really taking care of patients. It's all about jobs for doctors and other adminstrators who can't make it in the "real world", or so I am convinced.
Recently, there was a campaign that we all not use certain abbreviations, thought to lead to horrible mistakes in the ER; for instance, we have to write ml instead of cc for our IV infusion rates. Or write out morphine sulfate instead of MS. (Both of these we have done since day 1 that I have been in practice, which is since 1979, and I recall neither leading to a single accident. Oh well.). JCAHO, on their website, recommended an entire scheme to get us to use the good and not bad abbrevations, including making up songs and posters and well....here's a partial list pasted from their website:
It gets much, much worse. I looked at the latest "FAQS" for the Patient safety guidelines, revision 8/30/04. It took me several minutes just to scroll, with just cursory reading, through the entire list. I opened the "printer friendly" PDF version...it's 24 pages LONG. This is obscene. These folks, I can tell you, have smoked too many "joints" and thus the name.
And yes, I came up with the even more juvenile "Operation, in response to Operation BANEM above: Forgive Us Clearly Klutzy Emergency Medicos, (You can figure out the acronym!) since we do such an obviously horrible job, killing hundreds of thousands via time-tested abbreviations.
Of course, none of the problems could be from overcrowding, over-utliization, overbearing bureaucracy, overabundant lawsuits and fear of same or other REAL reasons medicine is so messed up!
Your previous correspondent did leave out other factors: Insurance. Medical insurance, both private and govt. is horribly construed here. It is dissimilar to any other insurance, and because of the low pay copays of employer-offered care, or no-pays of govt. programs such as Medicaid, care is overutilized. People run in to the ER I work in with paper cuts and knee scrapes. Heaven forfend they would put a bandage themselves or an antiseptic at home. I am not exaggerating.
No one cares or worries about the true cost of care. So the "free lunch" theory is in place, as everyone assumes the "system" can pay for everything. And they have to pay less than the price of a baseball game ticket. A family of four have to pay out something like $200 US to go to a ballgame here, on average. No big deal, but to shell out that for an ER visit...oh my, we are gouging them!
Also, I can't forget that doctors' organizations are guilty also... licensing laws have kept down the supply of doctors, and there are other mechanisms that physician groups have tried over the years to restrict the supply of "providers" to keep up licenses. I know that is heresy to my own group, but it's true.
My contention is that all groups are guilty....govt., insurers, pharmacy companies, patients, employers, physicians, lawyers and patients and their families. There is not a single group NOT guilty in the medical care "crisis". Which is why we'll end up with socialized medicine, because it is such a muddle and so many groups are involved in the muck-up, that the political will will be to turn to the govt. to fix the crisis, though they are the MOST guilty of all!
***************************
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.
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.
***************************
Another email from a U.S. doctor:
"I am a physician in the U.S., and I love your socialized medicine pearls, the latest of which -- by another medical practitioner -- I want to comment on. I just wanted to tell you, we have JCAHO coming to our hospital this month. It is causing all the panic you note. What a dog and pony show! We'll do all this total b.s., and it's all about the show...nothing to do with really taking care of patients. It's all about jobs for doctors and other adminstrators who can't make it in the "real world", or so I am convinced.
Recently, there was a campaign that we all not use certain abbreviations, thought to lead to horrible mistakes in the ER; for instance, we have to write ml instead of cc for our IV infusion rates. Or write out morphine sulfate instead of MS. (Both of these we have done since day 1 that I have been in practice, which is since 1979, and I recall neither leading to a single accident. Oh well.). JCAHO, on their website, recommended an entire scheme to get us to use the good and not bad abbrevations, including making up songs and posters and well....here's a partial list pasted from their website:
Have the list printed on pens.
Send monthly reminders of the list to staff via computer.
Educate and monitor staff who document in the medical record.
Create an educational display for use during Patient Safety Awareness Week.
Educate affiliated health care professional education programs about the list.
Place articles in employee and physician newsletters.
Provide mouse pads with the list.
Convene regional/community meeting to develop consistent list for physicians who maintain privileges at two or more facilities.
Direct pharmacy not to accept any of the prohibited abbreviations.
Orders with dangerous abbreviations or illegible handwriting must be corrected before being dispensed.
Conduct a mock survey and question staff to test their knowledge.
Work with software vendor to ensure changes are made to be consistent with the list.
At every medical staff meeting, give patient safety updates, including information about the prohibited abbreviations.
Identify and promote "Physician Champions" who support accreditation-related activities and advocate for full compliance with the NPSGs.
Ask every staff person to sign a statement that he/she has received the list and agrees not to use the abbreviations.
Create a catchy name or theme: Do the "Write" Thing; "Dirty Dozen"; "Outlaw Abbreviations"; "Join the Patient Safety Posse"; "Operation BANEM" (Banned Items); Uncle Sam-style poster saying "You can prevent a fatal error;"
Promote a "Do not use abbreviation of the month" campaign.
Create a song incorporating the "do not use" list.
Create a slide show/presentation illustrating poor handwriting and dangerous abbreviations. Include actual examples from your organization.
Please feel free to use any of these practices that you feel may be helpful for your staff.
It gets much, much worse. I looked at the latest "FAQS" for the Patient safety guidelines, revision 8/30/04. It took me several minutes just to scroll, with just cursory reading, through the entire list. I opened the "printer friendly" PDF version...it's 24 pages LONG. This is obscene. These folks, I can tell you, have smoked too many "joints" and thus the name.
And yes, I came up with the even more juvenile "Operation, in response to Operation BANEM above: Forgive Us Clearly Klutzy Emergency Medicos, (You can figure out the acronym!) since we do such an obviously horrible job, killing hundreds of thousands via time-tested abbreviations.
Of course, none of the problems could be from overcrowding, over-utliization, overbearing bureaucracy, overabundant lawsuits and fear of same or other REAL reasons medicine is so messed up!
Your previous correspondent did leave out other factors: Insurance. Medical insurance, both private and govt. is horribly construed here. It is dissimilar to any other insurance, and because of the low pay copays of employer-offered care, or no-pays of govt. programs such as Medicaid, care is overutilized. People run in to the ER I work in with paper cuts and knee scrapes. Heaven forfend they would put a bandage themselves or an antiseptic at home. I am not exaggerating.
No one cares or worries about the true cost of care. So the "free lunch" theory is in place, as everyone assumes the "system" can pay for everything. And they have to pay less than the price of a baseball game ticket. A family of four have to pay out something like $200 US to go to a ballgame here, on average. No big deal, but to shell out that for an ER visit...oh my, we are gouging them!
Also, I can't forget that doctors' organizations are guilty also... licensing laws have kept down the supply of doctors, and there are other mechanisms that physician groups have tried over the years to restrict the supply of "providers" to keep up licenses. I know that is heresy to my own group, but it's true.
My contention is that all groups are guilty....govt., insurers, pharmacy companies, patients, employers, physicians, lawyers and patients and their families. There is not a single group NOT guilty in the medical care "crisis". Which is why we'll end up with socialized medicine, because it is such a muddle and so many groups are involved in the muck-up, that the political will will be to turn to the govt. to fix the crisis, though they are the MOST guilty of all!
***************************
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.
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.
***************************
Monday, October 04, 2004
HOSPITAL VOUCHERS?
It's the Left that is proposing something of that sort in Australia
"Private health-care providers will be big winners if Labor wins office this week... Labor's $2.9 billion Medicare Gold proposal, providing free health care for everyone over 75, would provide a massive windfall to private hospitals and the companies that operate them.
Health care analyst Marcus Wilson of Macquarie Equities said the resulting increase in admissions would reduce spare capacity in the private sector. "It's going to be a boom for them," he said. "If it was to go through in the way it's proposed, any additional use of existing beds is going to be significant for private hospitals."
Companies that operate facilities with high vacancy rates stand to benefit most. One of the biggest, Healthscope, operates hospitals on average only 68 per cent full. If Medicare Gold can push that towards maximum capacity around 90 per cent, the company would reap a huge benefit..... "
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
It's the Left that is proposing something of that sort in Australia
"Private health-care providers will be big winners if Labor wins office this week... Labor's $2.9 billion Medicare Gold proposal, providing free health care for everyone over 75, would provide a massive windfall to private hospitals and the companies that operate them.
Health care analyst Marcus Wilson of Macquarie Equities said the resulting increase in admissions would reduce spare capacity in the private sector. "It's going to be a boom for them," he said. "If it was to go through in the way it's proposed, any additional use of existing beds is going to be significant for private hospitals."
Companies that operate facilities with high vacancy rates stand to benefit most. One of the biggest, Healthscope, operates hospitals on average only 68 per cent full. If Medicare Gold can push that towards maximum capacity around 90 per cent, the company would reap a huge benefit..... "
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Sunday, October 03, 2004
THE GUILTY ARE WELL PROTECTED IN N. IRELAND
"The system for investigating deaths in Northern Ireland's hospitals has failures, according to a report by the province's Human Rights Commission. The report, written by Tony McGleenan, professor of law at the University of Ulster and a practising barrister, criticises the absence of an automatic requirement for an investigation into a death in hospital. "The system of death certification can conceal the presence of individual or systemic errors which have contributed to the death," the report says.
A total of 14 462 people died in Northern Ireland in 2003, of whom 7464 died in hospitals, 3042 in nursing homes, and 58 in psychiatric hospitals.
The Human Rights Commission, which is charged with ensuring that human rights are fully protected in law, asked Professor McGleenan to examine hospital deaths in the context of Article 2 of the European Convention on Human Rights. The chief commissioner, Professor Brice Dickson, said the commission has received a number of complaints from people concerning alleged medical negligence in hospitals in Northern Ireland and that the report was one method by which the commission was trying to address people's concerns.
According to Professor McGleenan the key question he set out to answer was "whether there is currently in place an effective system of ensuring that life is protected in hospital systems." In concluding that there is not he criticises the practice whereby a coroner retains wide discretion as to whether a postmortem examination should be carried out when a hospital death is reported to him. He is also critical of coroners combining investigative and judicial roles when holding an inquest".
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
"The system for investigating deaths in Northern Ireland's hospitals has failures, according to a report by the province's Human Rights Commission. The report, written by Tony McGleenan, professor of law at the University of Ulster and a practising barrister, criticises the absence of an automatic requirement for an investigation into a death in hospital. "The system of death certification can conceal the presence of individual or systemic errors which have contributed to the death," the report says.
A total of 14 462 people died in Northern Ireland in 2003, of whom 7464 died in hospitals, 3042 in nursing homes, and 58 in psychiatric hospitals.
The Human Rights Commission, which is charged with ensuring that human rights are fully protected in law, asked Professor McGleenan to examine hospital deaths in the context of Article 2 of the European Convention on Human Rights. The chief commissioner, Professor Brice Dickson, said the commission has received a number of complaints from people concerning alleged medical negligence in hospitals in Northern Ireland and that the report was one method by which the commission was trying to address people's concerns.
According to Professor McGleenan the key question he set out to answer was "whether there is currently in place an effective system of ensuring that life is protected in hospital systems." In concluding that there is not he criticises the practice whereby a coroner retains wide discretion as to whether a postmortem examination should be carried out when a hospital death is reported to him. He is also critical of coroners combining investigative and judicial roles when holding an inquest".
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
Saturday, October 02, 2004
SOME REASONS WHY AMERICAN MEDICINE IS SO EXPENSIVE
Below is an article written by a U.S. medical specialist who wishes to remain anonymous
JCAHO (Joint Commission on Accredition of Healthcare Organizations) is a quasi private organization that is approved by Medicare for accrediting hospitals - to assure quality care. Like most bureaucracies, JCAHO has mushroomed to become an end in itself - the "quality assurance" process has become more important than the quality itself. JCAHO produces guidelines that have become almost the law itself - violations can lead to loss of Medicare funding, and malpractice settlements.
There is great controversy over whether JCAHO does, in fact, improve the quality of care. Citations for incomplete or absent dictations for surgical procedures, when the emergency room is overwhelmed with patients, hardly improves anything; often, the doctors and everyone else may be operating on accident victims all night long and may simply forget to sign the records or do the dictation. Likewise, citations for lack of proper physician signatures, how often the ivs are changed, whether the nurse knew the fire safety rules, whether they have proper IV badges, hardly determines quality.
Prior to the JCAHO visit (every 3 years) there is great hysteria among QM (quality management) nurses and other highly-paid "consultants" to make sure the hospital is spic and span - walls are painted, floors are polished, and many drills are held to make sure everything is perfect. Much time and effort (and eventually money) is spent on this essentially circular motion. An adversary relation develops among these QM people and the entire hospital staff - they demand "quality" while the budget is cut.
The bottom line with JCAHO is that much money is spent on questionable procedures "because Medicare requires it".
--------------
The HIPAA (Health-Insurance Portability and Accountability Act) was allegedly introduced to "protect patient privacy". Not so. Much effort and many compliance seminars by highly-paid consultants, and massive expansion of the IT staff (for "compliance" with encryption technology, etc..) has created an adversary relationship between staff and hospital. Sneaking into your mother's medical records could get you fined or fired or put in jail.
While limiting public access to "sensitive medical data", Government has even more access. In truth, the only real harm could come from insurance companies denying you coverage because you have "high risk" conditions; but they have this data anyway.
Perhaps someone who has comitted sex crimes may not want their medical data public, but police records usually have this information and it is often a public record. So a massive expensive process has been introduced to solve a non-problem.
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MALPRACTICE: This is a problem that some say adds 10-20% to the cost of medical care. The problem is massive. Not only are predatory trial lawyers legally protected (mostly by Democrats) because of their massive political contributions, but many patients feel that "they owe me" if something bad happens. We call this the "lottery mentality" - many people truly believe they will retire with a medical malpractice settlement. Of course, dishonest judges make the problem worse. Aside from the money extracted from doctors and hospitals, there are additional expenses that result from the threat of malpractice, and prevention of lawsuits.
One example was the mother who brought her son to the ER (emergency room) with a bump on his head. The ER doctor ordered a neurological consult, CT scan, MRI (x-ray tests costing thousands of dollars - total visit about $3000) - reason? The ER doctor probably has marching orders (called "policy" ) to "cover all angles" -- "just in case the patient has a brain injury". This is purely medicolegal - it the child has not lost consciousness and has no "localizing signs" (like weakness of a hand or leg, dizziness, etcc. ) there is simply no reason for all these tests - simply observing the patient and a little ice to the head and a mother's hug is all that is needed. Wisely, this woman signed out "AMA" (against medical advice) - still probably got charged over $100 just for showing up).
As an Obstetrical Anesthesiologist, I face "unnecessary cesarean sections" daily. Of course, "necessary" is defined by litigation potential, not medical judgement. Several examples illustrate this problem:
1. A lady with premature twins (24 weeks) was in labor. Some would do an immediate C-section to protect the fragile premature baby - some believe that a normal delivery would be hard on the delicate premature baby's head; others disagree on this. But the only "no risk" way to do this is a C-section, so no one can sue a doctor for not doing it. My colleague did not do a C-section because the results on such a premature fetus are dismal - survival is low, and damage to survivors is common; he simply let nature take its course and the patient delivered. He took a chance on being sued, but practiced better medicine.
2. Another lady with a 25 week fetus was immediately taken to the operating room and a C-section was done. This was another doctor who just didn't want to deal with the medicolegal issues; unfortunately, the majority of doctors do this - who can blame them?
3. Another younger doctor did a C-section on a lady that was showing a "trend" on the fetal monitoring strip. There was no "danger signal" of "iminent damage", but there was a definite abnormality. The baby came out screaming. Of course, the C-section was done to avoid any criticism that one wasn't done if something did go wrong. Doing a C-section because "something might go wrong" is like ensuring that a fly is dead by killing it with a sledgehammer.
------------------------
MEDICAL WASTE: On my way in to work, I pass by this "Medical Waste" trailer. This trailer is hauled off periodically, and another is placed.
The hospital is full of these boxes with different color coded liners for needles, liquid waste (which is solidified by powder; I am not sure if simply pouring this stuff down the drain would be safer than mixing the powder with the liquid - either way, some exposure id possible), surgical drapes, etc..
There is nothing in the hospital that could be any more infectious or dangerous than what's going down the sewers already, so all the hysteria about "liquid waste" and special containers for it etc.. Is nothing but additional baggage created by regulators.
Likewise for paper drapes and the paper and plastic used to package surgical supplies - much of this stuff could be safely burned on-site (as used to be done) - all germs would be killedI am sure that California greens long ago stopped this practice for "clean air".
------------------------
HOUSKEEPING: The people from "environmental services" often wear paper shoe covers and plastic gloves and surgical masks at times when they are dusting. I am unsure whether this is because of some hysteria about germs, regulations, or because the management simply doesn't want to be bothered with lawsuits from unhappy employees who say they had an "unsafe workplace").
------------------------
NUCLEAR MEDICINE: Low level radioactive isotopes are used in many tests, and higher level isotopes for therapy for cancer.
Regulations for disposal of this mostly harmless material are just unvelievable - and the low level stuff is subject to almost the same regulations for disposal of atomic bombs.
This regulation has been so expensive to maintain that only a few companies remain to dispose of these isotopes - last count down to 2 or 3 - which has had the predictable effect - disposal costs have increased tenfold.
-------------------------
MEDICAL RECORDS: It's just difficult for people outside medicine to imagine how hysterical the medical records business has become.
Some records are simply lost - pages fall out of the binder and people forget about putting them back.
Then some clerk spends hours on a single record - going through it to find missing signatures; for a complex patient, there may be literally dozens of signatures missing (people get busy and they simply forget to sign - but to the Feds, this can be viewed as fraud - but that's another problem).
Then, each missing signature is flagged with a color coded tag, and then the fun begins - each doctor with a missing signature receives a nasty letter telling them that their privileges will be pulled it they don't sign the records. For me, I receive the letter, give it to my secertary who then sends a student worker to medical records to get the record, I sign it, and send it back; for each transaction, there is time and money that produces nothing. Then the record is recycled to the other doctors. Just insane, expensive, and contributes nothing to the care of patients.
---------------------------
COMPLIANCE: Prosecuting doctors and medical centers for "Medicare Fraud" has become big business following laws passed by the Clinton administration.
In the past, many attending doctors signed for residents when the attendings weren't present - everyone did this in a charity institution where much of the care was unfunded. Of course, the Feds see it differently - some of Medicare Part B (hospital funding) is designated for "training doctors" (residents) so the Feds didn't like the idea of an absent attending sending a separate bill. {As usual, the goals of the Feds are out of tune with reality - they want "equal care" for"the poor" but are not willing to fund it equally}.
Our institution was hit with a large fine for "Medicare Fraud" - mostly focused on one doctor. Part of the "Corporate Integrity Agreement" was "compliance training". This was the most bloated waste of time of all - MANDATORY for every worker in the entire institution - requiring a day off of work - even for part time employees {I calculated at least a cost of several million dollars just for lost time; that didn't count the full time "consultants" and "compliance attorneys" and an entire new staff or "experts".
------------------------
CONCLUSION: All these expenses add up to make American medical care the most expensive in the world. And Government cannot fix it - they are the cause. HIPAAS and JCAHO have been created by government, and malpractice has escalated because of legal protection of trial lawyers by Government. Solution? Less Government.
***************************
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.
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.
***************************
Below is an article written by a U.S. medical specialist who wishes to remain anonymous
JCAHO (Joint Commission on Accredition of Healthcare Organizations) is a quasi private organization that is approved by Medicare for accrediting hospitals - to assure quality care. Like most bureaucracies, JCAHO has mushroomed to become an end in itself - the "quality assurance" process has become more important than the quality itself. JCAHO produces guidelines that have become almost the law itself - violations can lead to loss of Medicare funding, and malpractice settlements.
There is great controversy over whether JCAHO does, in fact, improve the quality of care. Citations for incomplete or absent dictations for surgical procedures, when the emergency room is overwhelmed with patients, hardly improves anything; often, the doctors and everyone else may be operating on accident victims all night long and may simply forget to sign the records or do the dictation. Likewise, citations for lack of proper physician signatures, how often the ivs are changed, whether the nurse knew the fire safety rules, whether they have proper IV badges, hardly determines quality.
Prior to the JCAHO visit (every 3 years) there is great hysteria among QM (quality management) nurses and other highly-paid "consultants" to make sure the hospital is spic and span - walls are painted, floors are polished, and many drills are held to make sure everything is perfect. Much time and effort (and eventually money) is spent on this essentially circular motion. An adversary relation develops among these QM people and the entire hospital staff - they demand "quality" while the budget is cut.
The bottom line with JCAHO is that much money is spent on questionable procedures "because Medicare requires it".
--------------
The HIPAA (Health-Insurance Portability and Accountability Act) was allegedly introduced to "protect patient privacy". Not so. Much effort and many compliance seminars by highly-paid consultants, and massive expansion of the IT staff (for "compliance" with encryption technology, etc..) has created an adversary relationship between staff and hospital. Sneaking into your mother's medical records could get you fined or fired or put in jail.
While limiting public access to "sensitive medical data", Government has even more access. In truth, the only real harm could come from insurance companies denying you coverage because you have "high risk" conditions; but they have this data anyway.
Perhaps someone who has comitted sex crimes may not want their medical data public, but police records usually have this information and it is often a public record. So a massive expensive process has been introduced to solve a non-problem.
---------------------
MALPRACTICE: This is a problem that some say adds 10-20% to the cost of medical care. The problem is massive. Not only are predatory trial lawyers legally protected (mostly by Democrats) because of their massive political contributions, but many patients feel that "they owe me" if something bad happens. We call this the "lottery mentality" - many people truly believe they will retire with a medical malpractice settlement. Of course, dishonest judges make the problem worse. Aside from the money extracted from doctors and hospitals, there are additional expenses that result from the threat of malpractice, and prevention of lawsuits.
One example was the mother who brought her son to the ER (emergency room) with a bump on his head. The ER doctor ordered a neurological consult, CT scan, MRI (x-ray tests costing thousands of dollars - total visit about $3000) - reason? The ER doctor probably has marching orders (called "policy" ) to "cover all angles" -- "just in case the patient has a brain injury". This is purely medicolegal - it the child has not lost consciousness and has no "localizing signs" (like weakness of a hand or leg, dizziness, etcc. ) there is simply no reason for all these tests - simply observing the patient and a little ice to the head and a mother's hug is all that is needed. Wisely, this woman signed out "AMA" (against medical advice) - still probably got charged over $100 just for showing up).
As an Obstetrical Anesthesiologist, I face "unnecessary cesarean sections" daily. Of course, "necessary" is defined by litigation potential, not medical judgement. Several examples illustrate this problem:
1. A lady with premature twins (24 weeks) was in labor. Some would do an immediate C-section to protect the fragile premature baby - some believe that a normal delivery would be hard on the delicate premature baby's head; others disagree on this. But the only "no risk" way to do this is a C-section, so no one can sue a doctor for not doing it. My colleague did not do a C-section because the results on such a premature fetus are dismal - survival is low, and damage to survivors is common; he simply let nature take its course and the patient delivered. He took a chance on being sued, but practiced better medicine.
2. Another lady with a 25 week fetus was immediately taken to the operating room and a C-section was done. This was another doctor who just didn't want to deal with the medicolegal issues; unfortunately, the majority of doctors do this - who can blame them?
3. Another younger doctor did a C-section on a lady that was showing a "trend" on the fetal monitoring strip. There was no "danger signal" of "iminent damage", but there was a definite abnormality. The baby came out screaming. Of course, the C-section was done to avoid any criticism that one wasn't done if something did go wrong. Doing a C-section because "something might go wrong" is like ensuring that a fly is dead by killing it with a sledgehammer.
------------------------
MEDICAL WASTE: On my way in to work, I pass by this "Medical Waste" trailer. This trailer is hauled off periodically, and another is placed.
The hospital is full of these boxes with different color coded liners for needles, liquid waste (which is solidified by powder; I am not sure if simply pouring this stuff down the drain would be safer than mixing the powder with the liquid - either way, some exposure id possible), surgical drapes, etc..
There is nothing in the hospital that could be any more infectious or dangerous than what's going down the sewers already, so all the hysteria about "liquid waste" and special containers for it etc.. Is nothing but additional baggage created by regulators.
Likewise for paper drapes and the paper and plastic used to package surgical supplies - much of this stuff could be safely burned on-site (as used to be done) - all germs would be killedI am sure that California greens long ago stopped this practice for "clean air".
------------------------
HOUSKEEPING: The people from "environmental services" often wear paper shoe covers and plastic gloves and surgical masks at times when they are dusting. I am unsure whether this is because of some hysteria about germs, regulations, or because the management simply doesn't want to be bothered with lawsuits from unhappy employees who say they had an "unsafe workplace").
------------------------
NUCLEAR MEDICINE: Low level radioactive isotopes are used in many tests, and higher level isotopes for therapy for cancer.
Regulations for disposal of this mostly harmless material are just unvelievable - and the low level stuff is subject to almost the same regulations for disposal of atomic bombs.
This regulation has been so expensive to maintain that only a few companies remain to dispose of these isotopes - last count down to 2 or 3 - which has had the predictable effect - disposal costs have increased tenfold.
-------------------------
MEDICAL RECORDS: It's just difficult for people outside medicine to imagine how hysterical the medical records business has become.
Some records are simply lost - pages fall out of the binder and people forget about putting them back.
Then some clerk spends hours on a single record - going through it to find missing signatures; for a complex patient, there may be literally dozens of signatures missing (people get busy and they simply forget to sign - but to the Feds, this can be viewed as fraud - but that's another problem).
Then, each missing signature is flagged with a color coded tag, and then the fun begins - each doctor with a missing signature receives a nasty letter telling them that their privileges will be pulled it they don't sign the records. For me, I receive the letter, give it to my secertary who then sends a student worker to medical records to get the record, I sign it, and send it back; for each transaction, there is time and money that produces nothing. Then the record is recycled to the other doctors. Just insane, expensive, and contributes nothing to the care of patients.
---------------------------
COMPLIANCE: Prosecuting doctors and medical centers for "Medicare Fraud" has become big business following laws passed by the Clinton administration.
In the past, many attending doctors signed for residents when the attendings weren't present - everyone did this in a charity institution where much of the care was unfunded. Of course, the Feds see it differently - some of Medicare Part B (hospital funding) is designated for "training doctors" (residents) so the Feds didn't like the idea of an absent attending sending a separate bill. {As usual, the goals of the Feds are out of tune with reality - they want "equal care" for"the poor" but are not willing to fund it equally}.
Our institution was hit with a large fine for "Medicare Fraud" - mostly focused on one doctor. Part of the "Corporate Integrity Agreement" was "compliance training". This was the most bloated waste of time of all - MANDATORY for every worker in the entire institution - requiring a day off of work - even for part time employees {I calculated at least a cost of several million dollars just for lost time; that didn't count the full time "consultants" and "compliance attorneys" and an entire new staff or "experts".
------------------------
CONCLUSION: All these expenses add up to make American medical care the most expensive in the world. And Government cannot fix it - they are the cause. HIPAAS and JCAHO have been created by government, and malpractice has escalated because of legal protection of trial lawyers by Government. Solution? Less Government.
***************************
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.
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.
***************************
Friday, October 01, 2004
A HOSPITAL SO BAD IT IS NEARLY DEAD
"The Los Angeles County Board of Supervisors on Monday unexpectedly moved to shut down the trauma unit at Martin Luther King Jr./Drew Medical Center, immediately drawing the ire of physicians, politicians and community activists. The only public hospital serving a large swath of South Los Angeles, King/Drew treats more trauma patients than any other hospital in the region except County-USC Medical Center.
The proposed trauma closure, expected to take effect in about 90 days, amounts to a last-ditch scramble to save a foundering hospital that repeatedly has been cited by regulators for harming patients and in some cases contributing to their deaths. Under pressure from federal health officials, the supervisors also agreed to hire outside managers to run the hospital — replacing the team of county health leaders who have run it for nearly a year.
The reaction from community leaders was swift and mostly negative. Assemblyman Mervyn Dymally (D-Compton), who has led legislative hearings on the future of King/Drew, was outraged. "I could see if they were going to close some other department, but not the trauma center. My God, this is a crisis," he said. But Assemblyman Mark Ridley-Thomas (D-Los Angeles), applauded the board's latest actions, saying they were long overdue. "It's about time that the Board of Supervisors faced up to their responsibility, and has chosen to take appropriate action, albeit unpopular," he said. "There's no expert in the area of public healthcare worth his or her salt who would deny that Martin Luther King hospital was in need of radical intervention."
The trauma unit, dedicated to treating life-threatening injuries from such incidents as shootings and car accidents, served 2,150 patients last year... Supervisor Michael Antonovich deemed the county's efforts to fix King/Drew over the last eight months "pathetic." ... "It took so many losses of life and inferior medical treatments to bring us to the stage where we are today," he said at the supervisors' news conference....
Over the last nine months, his agency removed the hospital's administrator and medical director, hired a nursing turn-around firm, installed an internal team of crisis managers and responded to demands from a host of accrediting groups and regulatory agencies. "We didn't know how much we were going to find and how hard the process would be," Garthwaite said. But many politicians said the county supervisors' actions would inevitably lead to the closure of the entire hospital."
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
"The Los Angeles County Board of Supervisors on Monday unexpectedly moved to shut down the trauma unit at Martin Luther King Jr./Drew Medical Center, immediately drawing the ire of physicians, politicians and community activists. The only public hospital serving a large swath of South Los Angeles, King/Drew treats more trauma patients than any other hospital in the region except County-USC Medical Center.
The proposed trauma closure, expected to take effect in about 90 days, amounts to a last-ditch scramble to save a foundering hospital that repeatedly has been cited by regulators for harming patients and in some cases contributing to their deaths. Under pressure from federal health officials, the supervisors also agreed to hire outside managers to run the hospital — replacing the team of county health leaders who have run it for nearly a year.
The reaction from community leaders was swift and mostly negative. Assemblyman Mervyn Dymally (D-Compton), who has led legislative hearings on the future of King/Drew, was outraged. "I could see if they were going to close some other department, but not the trauma center. My God, this is a crisis," he said. But Assemblyman Mark Ridley-Thomas (D-Los Angeles), applauded the board's latest actions, saying they were long overdue. "It's about time that the Board of Supervisors faced up to their responsibility, and has chosen to take appropriate action, albeit unpopular," he said. "There's no expert in the area of public healthcare worth his or her salt who would deny that Martin Luther King hospital was in need of radical intervention."
The trauma unit, dedicated to treating life-threatening injuries from such incidents as shootings and car accidents, served 2,150 patients last year... Supervisor Michael Antonovich deemed the county's efforts to fix King/Drew over the last eight months "pathetic." ... "It took so many losses of life and inferior medical treatments to bring us to the stage where we are today," he said at the supervisors' news conference....
Over the last nine months, his agency removed the hospital's administrator and medical director, hired a nursing turn-around firm, installed an internal team of crisis managers and responded to demands from a host of accrediting groups and regulatory agencies. "We didn't know how much we were going to find and how hard the process would be," Garthwaite said. But many politicians said the county supervisors' actions would inevitably lead to the closure of the entire hospital."
More here.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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.
***************************
