Public hospital waiting times force British boy to go all the way to India for surgery

Pity he cannot get the treatment his parents have already paid for through their taxes

A British mother is flying her fourteen-year-old son to India for treatment after discovering he would have to wait months for an operation in the NHS. Elliot Knott was told he would have to wait more than four months for an appointment after being left housebound from an ice-skating injury, then face a further wait of at least nine months for an operation. Elliott is suffering from spondylolisthesis, a debilitating condition caused when a vertebrae slips out of line in the spinal column and presses on a nerve. Surgery may be needed if slippage continues or if the back pain does not respond to routine treatment. A spinal fusion is performed and sometimes an internal brace of screws and rods is used to hold together the vertebra as the fusion heals.

The Dorchester schoolboy was referred to Southampton general hospital in May by his local hospital, which does not carry out the procedure. But his mother decided to get her son treated in Delhi after discovering that private treatment in the UK would cost 25,000 pounds, according to a report in the Times. The same operation in India costs just 4,700 pounds. Southampton University Hospitals NHS trust today urged the family to get in touch with the hospital to discuss quicker treatment. A statement issued today by the trust said maximum waiting times being quoted by the family were reducing "all the time".

"Staff with the highly specialised knowledge and skills to treat Elliot and other patients with similarly complex needs are in short supply, and much of their time is taken up with emergency cases. We obviously have to give highest priority to those patients with the greatest clinical need. The consultant can always be contacted by Elliot's GP if he or she believes Elliot needs more urgent treatment for clinical reasons."

The statement continued: "We understand how frustrating this situation is for patients and their families, and are certainly not inflexible or unsympathetic. "We are simply trying to balance scarce skills against high demand for this complex operation."

Elliot's plight coincides with a report published today by health thinktank the King's Fund, which warned that government waiting time targets were under threat from the constraints of financial pressures, unexpected increases in demand, and staff shortages in clinical areas. Its report argues that the government has reasons to feel optimistic that no patient will wait more than 18 weeks from GP appointment to hospital treatment by 2008. [How reassuring!] But the government will need to monitor carefully the impact of potentially destabilising policies, such as payment by results and the extension of patient choice, it warned.

Even if the 18-week target is met, it will not be the "end of waiting times" that ministers have claimed. The government should look carefully at the potential costs and benefits of reducing waits even further by developing policies to remove variations in access to services and unacceptable differences in the quality of clinical practices, the report urged. The report's author, Anthony Harrison, said: "Waiting time targets are based on assumptions that are rarely made explicit: namely that the right people are being identified and referred for the right treatment at the right time."

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HOW BUREAUCRATIC MEDICINE WORKS IN THE USA

Great stuff! More is obviously needed!

As far back as 1999, federal and state regulators began to receive complaints that the heart surgery unit at Palm Beach Gardens Medical Center in Florida was a breeding ground for germs. Dust and dirt covered some surgical equipment. Trash cans and soiled linens were stored in hallways. IV pumps were spattered with dried blood. One patient's wife said she saw a medical assistant tear surgical tape with his teeth. State inspectors in 2002 found "massive post operative infections" in the heart unit, requiring patients to undergo more surgery and lengthy hospital stays. In a four-year period, 106 heart patients at Palm Beach Gardens developed infections after surgery, according to lawsuits and government records. More than two dozen were readmitted with fevers, pneumonia and serious blood infections. The lawsuits included 16 patients who died.

How did Medicare, the federal health insurance program for the elderly, respond? It paid Palm Beach Gardens more. Under Medicare's rules, each time a patient comes back for another treatment, a hospital qualifies for an additional payment. In effect, Palm Beach Gardens was paid a bonus for its mistakes.

Medicare's handling of Palm Beach Gardens is an extreme example of a pervasive problem that costs the federal insurance program billions of dollars a year while rewarding doctors, hospitals and health plans for bad medicine. In Medicare's upside-down reimbursement system, hospitals and doctors who order unnecessary tests, provide poor care or even injure patients often receive higher payments than those who provide efficient, high-quality medicine. "It's the exact opposite of what you would expect," said Mary Brainerd, chief executive officer of HealthPartners, a nonprofit health plan based in Bloomington, Minn. Her Medicare HMO ranked among the top 10 in the nation last year for quality but was paid thousands of dollars less per patient by Medicare than lower-performing plans. "The way Medicare is set up," Brainerd said, "it actually punishes you for being good."

As Medicare approaches its 40th anniversary on Saturday, much of the debate about the nation's largest health insurance program revolves around whether it will remain solvent for aging baby boomers. Yet another critical question is often overlooked: whether taxpayers and patients get their money's worth from the $300 billion Medicare spends each year -- now about 15 percent of federal spending and projected to grow to nearly a quarter of the budget in a decade.

More -- much more -- here

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

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

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