HARDER AND HARDER TO COLLECT ON BRITISH HEALTH INSURANCE

Smokers may be refused some treatments

Patients with illnesses deemed to be 'self-inflicted' could be denied treatment under guidance introduced by the drugs rationing watchdog. Heavy drinkers or smokers and those who are overweight could all be refused help.

Patients' groups last night demanded to know how far the definition of 'self-inflicted' illness might go. They are concerned it could also cover conditions such as sports injuries.

Details of the guidelines emerged days after health trusts in Suffolk announced that obese patients would be banned from having knee and hip replacements. It appears in a document produced by the National Institute for Health and Clinical Excellence to help decide how new drugs and treatments could best be employed. In the section on self-induced illnesses, the document, entitled Social Value Judgments, says treatment could be withheld if the selfinflicted cause of the illness affects the 'clinical or cost effectiveness' of a drug or treatment. But it adds that NICE should try not to deny treatment to those whose condition is partly or wholly self-inflicted.

Speaking to a Sunday newspaper, NICE chairman Sir Michael Rawlins defended the approach. "Alcoholism rots the liver and if the patient is going to continue drinking, giving them a liver when there is already a shortage of organs is not a sensible use of resources," he said. "We are not punishing alcoholics. It is just that it is pointless spending all that money and using a liver that could be used for someone else."

Patients' groups last night asked who would decide what a 'self-inflicted' illness was. Michael Summers, chairman of the Patients Association, said many people were worried by the events in Suffolk. The NICE guidance would merely add to that concern. "It's a question of where you draw the line. If someone falls down a mountain or hurts himself playing sport, is that self-inflicted?" he said. "And you have to say that some people are not overweight because of their lifestyle. "In some cases, it's something they may have inherited - is that self-inflicted? "I find this whole debate quite disturbing. Is it moral for someone to decide whether or not you are eligible for treatment in this way?"

A poll by the website Doctors.net.uk found one in five doctors said they had withheld treatment from a patient because of their 'unhealthy' lifestyle. A NICE spokesman said last night the guidance was for its own staff. It would not be issued to hospitals or doctors. "NICE will use this to inform the development of future guidance for the NHS on specific clinical conditions," she added.

Five health trusts in East Suffolk, including Ipswich Hospital NHS Trust, are to deny hip and knee replacements to patients who are overweight, it emerged last week. The plans come as the trusts attempt to reduce a 47.9 million pound deficit. The policy was defended by Dr Brian Keeble, who is the director of public health care for Ipswich Primary Care Trust. He said there was 'good science' behind the decision to target obese patients. He added: "Patients who are overweight do worse after operations, particularly bigger and longer operations."

Source

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

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

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POSSIBLE HIATUS

I go into hospital for a rather large surgical procedure today. It is however day surgery so I hope to be back home by the evening and blogging away as usual. If that proves too optimistic, however, this blog may not be updated for a day or so.




Vaccine shortage: British government tries to pass the buck for its own inevitable incompetence

Family doctors were blamed yesterday for the shortage of flu vaccine. Patricia Hewitt, the Health Secretary, said that GPs had ordered too little vaccine, or had given jabs to the "worried well", patients who were not over 65 or in the high-risk group, creating a shortage.

Doctors responded angrily. Dr Richard Vautrey, a Leeds GP who is a member of the British Medical Association GPs Committee, said that the claims were ridiculous. "I don't think it is fair to blame GPs" he said. "We have to order vaccine at least eight months in advance and couldn't have predicted the much higher response rate. We don't give vaccine willy-nilly to anybody who asks for it. "What is apparent is the Government's failure to plan. Ministers have responsibility for wider public health, and part of that is contingency planning. That's not the GPs' job."

In the Commons, Ms Hewitt urged doctors to prioritise the remaining stocks on those who will really benefit - those aged over 65 and younger people classed as being at clinical risk. This year more vaccine was produced than ever before, but anecdotal evidence in late October had suggested there may be a shortage, she said. She added: "The current problems may be due to a combination of factors, such as under-ordering of vaccine and vaccination of the `worried well'. Awareness may also be higher this year due in part to the level of media interest in the threat of avian flu."

Angry exchanges followed Ms Hewitt's statement, during which she was accused of blaming doctors instead of taking responsibility herself, and the department was charged with gross complacency. Andrew Lansley, Shadow Health Secretary, said: "The simple fact is that people have been going to their GPs to get their flu jabs and told that supplies have run out." Pointing at Ms Hewitt, he said: "You don't accept responsibility for this. You should have. The delivery of the programme is the Government's responsibility. It is not good enough that you blame the GPs." He added: "You have not even remotely begun to explain what has gone wrong. We have a crisis. What are you going to do about it?"

Ms Hewitt said that in previous years the GP-led arrangement for buying flu vaccine had worked well, but added: "In view of what has happened this year, I am reviewing the arrangements and will consider this matter urgently."

Doctors across the country are reporting that they have run out of vaccine, after more patients than expected turned up for immunisation. Dr Kailash Chand, Greater Manchester's BMA representative, estimated that a fifth of practices in the North West had run out of the jabs. He said: "Just weeks ago, the Government said there would be no shortage. Now they have run out." Doctors also denied that they were treating the worried well, saying that the demand came from patients who were fully entitled to vaccination on the NHS. Dr John Havard, a GP in Saxmundham, Suffolk, said: "Those who are coming in are largely the people we are always trying to persuade. This year they are a bit scared, and demand is up."

Most GPs do not have the option of sending back unused vaccine, so over-ordering costs them money. They are not paid for patients outside the at-risk groups, so have no financial incentive to vaccinate the worried well. Dr Vautrey added that in many ways it was a good thing uptake had been so high. "It means a higher level of protection against seasonal flu than ever before," he said. "That can only be helpful."


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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YOU CAN RELY ON YOUR PUBLIC HOSPITALS TO VET THEIR STAFF

A former cancer researcher at a Veterans Affairs hospital was sentenced Monday to nearly six years in prison for criminally negligent homicide in the death of an Air Force veteran enrolled in a drug experiment. Paul Kornak admitted forging medical records at the Stratton Veterans Affairs Medical Center in 1999-2002 to make dozens of patients eligible to participate in drug studies. He also pleaded guilty to fraud and making a false statement. In handing down the sentence, U.S. District Judge Frederick J. Scullin Jr. called Kornak "callous and insensitive."

Kornak, 54, said he was "a broken man" and apologized, but added that everything he did was ordered by the VA hospital's cancer program director. The judge ordered him to pay almost $639,000 in restitution to two drug companies and the VA.

The homicide charge stemmed from the death of 71-year-old James DiGeorgio in 2001. He died a few weeks after participating in a drug-research program for stomach cancer. The judge said that while it was not clear whether the experimental chemotherapy treatments caused or hastened the deaths of any patients, it was clear that they did not qualify for the experimental program and that Kornak doctored their records.

Kornak was indicted in 2003 on charges that included manslaughter and criminally negligent homicide. His arrest led to a nationwide investigation by the General Accounting Office that found inadequate policies and training to protect volunteers at VA research centers. A month before DiGeorgio died, Kornak forged the test results of a blood sample provided by DiGeorgio so that he could qualify for the study even though he suffered from liver and kidney problems, federal prosecutor Grant Jaquith said. Stratton earned thousands of dollars for each patient enrolled in drug trials.

Kornak was hired by Stratton in 1999 to coordinate clinical trials, even though he had served three years' probation for fraud in Pennsylvania for falsifying a medical license application. He acknowledged posing as a doctor though he never completed his training at a school on the Caribbean island of Grenada. Kornak was fired in 2003 along with his boss, Dr. James Holland, a cancer specialist. Holland has not been charged. Jaquith would not comment on whether any charges would be filed.

Source


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

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

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ABUSES OF "PUBLIC HEALTH"

The proper conception of "public health" is innocuous enough. There are unquestionably some threats to our health and safety for which the remedies constitute a legitimate public good. They're limited to risks to which no rational person would submit himself – examples might include communicable diseases like tuberculosis or typhoid, calamitous events like asteroid impacts or tsunamis, or biological or chemical terrorism. Under these limited circumstances, it's understandable, even advisable, for a government limited to protecting the lives and property of its citizens to take collective measures to eradicate or minimize such risks, or minimize the damage should they come to pass.

But "public health" as it's advocated today goes well beyond public goods. Over the last century, "public health" has come to mean state pressure coercing us to avoid risks, even risks we knowingly and willingly undertake. The most obvious and conspicuous example was alcohol prohibition. And though Prohibition took an untold number of lives, bred corruption, and legitimized criminal behavior, it is distinguishable from more recent expansions of public health in that lawmakers at least recognized it as a failure, and repealed it (Unfortunately, we don't seem to have learned. The last twenty years have seen increasingly aggressive restrictions on the production, sale, and consumption of alcohol by local, state, and federal government).

But the Harrison Act – which fired the first shots of the drug war – was passed even earlier, in 1914. Drug prohibition has marched onward since. Its episodic ratchetings-up and coolings-down have commenced to a particularly aggressive and militaristic incarnation over the last twenty-five years.

Once we've accepted a definition of "public health" expansive enough for government to dictate what we can and can't put into our bodies, it's a short leap to seat belt laws, motorcycle helmet laws, assisted suicide bans, and prohibitions and restrictions on all sorts of other risky behavior. More recently, we've been given "public" smoking bans that extend to private businesses such as bars and restaurants. The Supreme Court recently upheld an Alabama ban on sex toys and marital aides. And parents are all too aware of the myriad regulations on the risks to which they can legally subject their children. Over just the last several years, governments at some level have prohibited motor scooters, "pocket bikes," all-terrain vehicles, snowmobiles, alcohol vaporizers, and fireworks, to name just a few -- all designed to keep people from hurting themselves.

So it shouldn't be the least bit surprising that "public health" might now come to include the size of our pants and the content of our refrigerators.

The justification for expansions of the government's power to promote the "public health" is typically couched in "the number of lives this will save." Sometimes, we're told that a law will add x number of years to the average life. The most-used and easiest tactic is to simply state that the law's necessary to protect "the children."

The ad naseum recitation of the 400,000 figure is a good example. As is a report released in January of 2004 stating that being overweight at forty would cut several years off the typical life. The public health activists at the Center for Science in the Public Interest have long been fighting for marketing restrictions on junk food, particularly on programs directed "at our children."

Longevity seems to be an obsession among the public health crowd. There seems to be no limit to the costs they're willing to endure if some policy promises to lengthen lives. It seems improbable to them that there may be people who'd sacrifice a month or two of their senior years for the lifetime of pleasure some get from a daily cigarette, a night of hard-drinking, or a slice of cherry pie after dinner. It's as if adding more days to the end of our lives were the only reason for living.

Even then, as British doctor and author Michael Fitzpatrick explains in his book The Tyranny of Health, death can't be prevented. It can only be postponed. And "death can generally be postponed only for a relatively short time by relatively intensive preventative measures," Fitzpatrick writes. That is, high-cost measures that would typically add just a few days or months to the average life.

There's certainly nothing wrong with studies or public awareness campaigns designed to discover and inform us about how we can make healthier choices. It's that the "advice" rarely stops there. Inevitably, such studies and campaigns lead to calls for government policies aimed at increasing longevity, and in so doing, take options and choices away from people who may value pleasure, convenience, or indulgence more than perfect health or a prolonged geriatry.

In the eloquent polemic Cigarettes Are Sublime, Richard Klein writes, "Healthism in America has sought to make longevity the principle measure of a good life. To be a survivor is to acquire moral distinction. But another view, a dandy's perhaps, would say that living, as distinct from surviving, acquires its value from risks and sacrifices that tend to shorten life and hasten dying."

Classical liberals should argue against the ever-expanding "public health" initiatives not only because they're supported by junk science or manipulated data (though that's often the case), but because the freedom to risk, indulge, and "sin" are essential to preserving individual liberty and a free society. Governments of free people aren't authorized to ensure good health, they're charged with securing liberty, which most certainly includes the liberty to hold bad habits.

Excerpt from 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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FDA INSANITY

The photograph on your Tuesday front page headlined "Hillary health care" shows Sen. Hillary Rodham Clinton, New York Democrat, in Jerusalem holding a CardioPump—a device used to assist in cardiopulmonary resuscitation. This device was developed in the United States, and data supporting its effectiveness were published in the pre-eminent American medical journal, the New England Journal of Medicine. Nonetheless, the CardioPump is illegal here because the Food and Drug Administration has refused to approve it. In the mid-1990s, in fact, the FDA halted tests of the device because unconscious heart attack victims had not "consented" to its use.

The CardioPump is essentially a sophisticated suction cup, enabling emergency medical personnel to administer CPR more effectively. It poses no risk, but there is some dispute over how definitive the supporting data are. If the device were approved here, hospitals, physicians and ambulance systems could make their own decisions on whether to use it. Because of the FDA, none of them has that option. Unless, that is, they're in Jerusalem or in any of the other major foreign cities where the CardioPump is in use and where an American senator can travel to pose for a photo-op with the device.

Source

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

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

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BRITISH FATTIES SHAFTED

They pay for their health insurance but getting what they paid for is a problem when the government is the insurer

A patient's group has criticised the NHS in East Suffolk for ruling that obese people will not be entitled to hip and knee replacement surgery. A spokeswoman for the Patients Association said: "People are obese for all sorts of reasons. Unless there is a clinical reason for not carrying out surgery they should be entitled to have an operation as anyone else would be."

The spokeswoman's comments come after it emerged that obese people will not be entitled to hip and knee replacement surgery on the NHS in East Suffolk under new cost-saving measures taken by the three primary care trusts in the area. The advice is based upon a person's body mass index (BMI) which calculates a person's body fat percentage using a height versus weight calculation. A person of average weight would have a BMI between 18.5 and 24.9, while an obese person would be classed as 30 or above.

Under the new guidelines, the surgery will not be performed unless: "The patient has a BMI below 30 and conservative means have failed to alleviate the patient's pain and disability. "Pain and disability should be sufficiently significant to interfere with the patient's daily life and/or ability to sleep."

Hospital consultants and GPs in East Suffolk came up with a list of 10 conditions for which there must be a threshold in order for surgery to be performed. Dr Brian Keeble, director of public health for Ipswich PCT, said: "Our work on clinical thresholds has been a key part of this process. "We started from the idea that operating on some conditions, either at an early stage or before other treatments have been tried, could actually be detrimental to the patient because of the risk of side effects from the procedure. "We cannot pretend that this work wasn't stimulated by the pressing financial problems of the NHS in East Suffolk. But I believe that these thresholds will produce some clear benefits in that both patients and their GPs will know when these procedures will be performed."

Source

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

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

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Canadians more open to private health: Faith in system eroding

Funny that! Dictatorship becoming unpopular even in submissive Canada!

Canadians are losing faith in the health care system and are open to the possibility of private initiatives if their access to quick and effective treatment does not improve, according to a new survey. "If Canadians are not reassured that timely access is eventually going to happen, their support for this private option is likely to increase," said Marie Larose, vice-president of POLLARA Research, which conducted the 2005 Health Care in Canada Survey. "If politicians are not able to demonstrate that there are solutions, people are more and more going to turn to other answers." Fifty per cent of respondents to the POLLARA survey indicated their confidence in the public health care system is falling, the number rising even higher -- to 54% -- among women....

Ms. Larose said the eroding levels of faith in public treatment coincide with growing awareness of private options, heightened by the recent Supreme Court decision that opened up a potential new role for private service providers. "We've been conducting the study since 1998, and gradually we've seen that more and more Canadians are looking for new ways of meeting the challenges facing the health care system," she said. But what that means for the future support of private health care is not clear, she said, as Canadians remain conflicted about the role alternative service providers should play and what impact they would have.

Forty-five percent of the public, 49% of nurses and 74% of physicians support the idea that Canadians should be allowed to pay out of pocket to purchase quicker access to health services funded under the public system. But most respondents believe private health care would have both good and bad effects. A majority of Canadians believe it would create a two-tier system (68%), lead to a shortage of physicians in the public system (61%) and increase costs (58%), but more Canadians also believe it would result in shorter wait times (68%) and improve the quality of their treatment (60%). "It's going to be difficult to have a debate about private health care because Canadians are very divided," Ms. Larose said. "They see the positives and they see negatives. They're willing to support it, but the basic principle that everyone has to have access is still there."

Mike Villene, a senior nurse consultant with the Canadian Nurses Association, which partnered in the survey, said the results demonstrate a "paradox of concern" about the current health care model. People are generally happy with their treatment when they have experienced a medical emergency, he said, but are worried about the impact of wait times on their access to care in general.

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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COMMUNIST MEDICAL CARE

A Chinese peasant woman who suffered a brain haemorrhage was left at the undertakers alive for cremation because her family could no longer afford hospital treatment, state media said on Friday. She was only saved by the tears in her eyes. The case is the latest in a series of tragedies illustrating China's stretched health care system and the inability of rural workers to meet spiralling medical costs.

You Guoying, a 47-year-old migrant worker from southwestern Sichuan province, was taken for cremation by her husband and children in Taizhou, eastern Zhejiang province, where she worked, the China Youth Daily said. Fortunately for You, the undertaker realised she was still alive when he saw her move and tears in her eyes, the newspaper said. "This is not only a tragedy for the family, but also for society," it quoted Xu Yinghe, a Taizhou official, as saying. "The fundamental reason is the absence of a social welfare system."

You was taken back to hospital for further treatment with money donated by sympathetic citizens of prosperous Zhejiang, the newspaper said. "Three days of treatment cost us more than 10,000 yuan ($1,200)," it quoted her daughter as saying, adding that was the sum of the family's life savings. "If there had been another option, who would have the heart to send a member of their own family for cremation while there was still a hope of survival?"

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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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Australia: Public hospital deaths, mistakes spark surgery audit

All surgical deaths in hospitals will be audited under a plan designed to detect system failures and medical errors that kill or harm thousands of patients a year. The national plan will be based on a West Australian audit of all surgery-related patient deaths which since 2001 has identified systemic problems and resulted in nationwide changes in surgical practice. Ninety-six per cent of West Australian surgeons took part in the audit, which achieved a progressive fall in the number of surgical deaths caused by poor clinical care, the project director, James Semmens, writes in the The Medical Journal of Australia today.

Of 876 surgery-related deaths, the audit found 45 (or 5 per cent) were caused by adverse events and 15 of those were considered preventable. There are 150,000 operations in Western Australia each year, he writes. The audit found most people who died were elderly and had other serious problems such as cardiovascular, respiratory, kidney or psychiatric diseases, the medical journal reports.

Three-quarters of the West Australian surgeons said they had changed their practices as a result of the audit and were more likely to advise patients and relatives against further surgical intervention if they believed it would not improve the condition. The audit has already forced a national change in medication given to patients before surgery, after it was discovered that too few had been given a drug to prevent deep-vein thrombosis, a common surgical complication. The audit also found that emergency patients had been given too much fluid, which often made them sicker. System-wide changes were put in place to avoid over-hydrating.

The Royal Australasian College of Surgeons aims to have every surgeon in the country voluntarily participate in the national audit, and there are hopes that New Zealand doctors will join the program next year. Along with changing surgical practice, the results would also be used to pressure politicians to legislate reform, the college's chairman of research and audit, Guy Maddern, told the Herald. "To have got to this stage is extraordinarily heartening but the real value will be in 12 months' time, when we get data and influence change," he said. "The results in WA have already improved the safety and quality of care by providing feedback to surgeons, hospitals and government that highlight system failures, which have prevented a recurrence of adverse events."

Previous studies had shown an error rate resulting in patient death or harm in Australian hospitals of between 10 per cent and 16 per cent. The West Australian program identified an overall error rate resulting in death of about 5 per cent. It found elective surgery patients were almost twice as likely to die as a result of technical errors. Emergency patients often died as a result of delays in getting treatment.

The chief executive officer of the NSW Clinical Excellence Commission, Cliff Hughes, said this state would be rolling out its audit area by area, starting with the Sydney South Western Area Health Service early next year. Professor Hughes is enthusiastic about the potential for the national audit to save lives. "You can identify areas of concern and use it as an educative experience for surgeons," he said. "I am delighted we are one step further toward complete, transparent reporting."

Source

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

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

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LEGAL PARASITES TO BE SPIKED IN FLORIDA

A study by Aon Risk Consultants has predicted the frequency of medical malpractice claims in Florida next year will decrease four times faster than the reduction in the national claims rate. By examining trends in claims at hospitals and doctors from 1995 through 2004, Aon forecast Florida's decrease at 4 percent. With 10 percent of the U.S. market examined, Aon predicted a national 1 percent reduction in 2006. That's good news for health care providers in South Florida, where medical malpractice insurance rates are among the highest in the country.

However, Aon said the economic severity of medical malpractice claims will increase 7.5 percent nationally. After years of rapid increases in both the frequency and severity of medical malpractice claims, safety reforms at hospitals are turning that trend around, said Greg Larcher, assistant director and actuary of Aon Risk Consultants. With many hospitals choosing to self-insure because of the high price of medical malpractice insurance, they're taking greater care to prevent medical mistakes, he said.

In Florida, the predicted reduction in the number of claims is greater because of the legislative caps on medical malpractice damages awards instituted in 2003, Larcher said. The effect of the November 2004 constitutional amendments, which included a contingency fee cap for medical malpractice plaintiff attorneys and a "three strikes" law for doctors, weren't included in the Aon study. The participating hospitals made up 20,000 beds, or about 10 percent of the national total, Larcher said. The study is marketed to hospital risk adjusters to set 2006 budgets.

Source

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

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

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"ETHICS" CHAOS

So nice to have governments protecting us so well -- with guesswork

Institutional review boards (IRBs) may be wildly off base in their judgments of safety or risks for children proposed for participation in clinical trials of drugs. Because of a lack of specificity in the criteria that IRBs use to assess risk, decisions are made that both overstate and understate the risk to children of therapeutic trials, according to David Wendler, Ph.D., a bioethicist at NIH, and colleagues there and at Harvard.

Current estimates are that about 75% of drugs routinely prescribed to children have only been tested in adults, which has led to an increased demand for pediatric testing, Dr. Wendler and colleagues noted in a special communication in the Aug. 17 issue of the Journal of the American Medical Association. The investigators cited as a problem of particular concern the pediatric trials that "generate vital scientific knowledge" but offer no direct benefit. Toxicity studies of vaccines such as the Dryvax smallpox vaccine are an example.

In order to protect children, federal regulations direct IRBs to approve such studies only when the risks are considered minimal or a "minor increase over minimal." The IRBs are mandated to use risks of every day life as a yardstick. "In the absence of empirical data, IRB members may assume they are familiar with the risks of daily life and with the risks of routine examinations and tests and rely on their own intuitive judgment to make these assessments," the authors wrote. "Yet intuitive judgment of risk is subject to systematic errors, highlighting the need for empirical data to guide IRB review and approval of pediatric research."

The authors said that every day life actually presents some considerable risks. For instance car trips pose the highest mortality risk encountered by healthy kids. Car trips pose an approximately 0.06 per million chance of death for children ages 14 years and younger and approximately 0.4 per million chance of death for children ages 15 though 19 years. Likewise, every day sports pose injury risks. For every million games of basketball played, 1,900 individuals are injured, including 180 broken bones and 58 permanent disabilities.

The researchers wrote that these data suggest that IRBs may be categorizing as "greater than minimal risk" procedures that don't pose a greater risk than riding in a car or playing basketball. "For example, 70% of IRB chairpersons categorize allergy skin testing as having a greater than minimal risk," they wrote, citing a previously published survey. "Yet the present analysis indicates that the risks of allergy skin testing do not exceed the risks healthy children ordinarily encounter in daily life."

The flip side is that other IRBs have ruled that procedures presented a minimal risk when the true risk of injury was one in 250. The researchers concluded that more research is needed to determine more accurate ways of assessing the real risk of research protocols.

Source

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

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

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Public hospital gets police instead of medical staff

Only an oblique mention ("particularly in emergency wards") of WHY people get aggressive towards hospital staff. It's mainly because the relatives of very sick people who are left unseen-to for many hours get angry and afraid about their relatives being ignored

The first police facility at a hospital in the southern hemisphere would help curb violence against medical staff, the Queensland Government said today. Brisbane's Princess Alexandra (PA) Hospital today showed off its new Police Beat which will be staffed by five officers, on duty between 8am and 10pm. They would be on hand to investigate the all too frequent assaults on medical staff, particularly in emergency wards, Health Minister Stephen Robertson said. "It is just disgusting to think that our doctors, our nurses and our allied health workers, in going about their business - saving lives - might be subject to assaults or violent acts by either the patients or acquaintances or friends of those patients," Mr Robertson said.

The Princess Alexandra also will deal with coronial matters, inquiries about patients with a mental illness and incidents involving people admitted to the hospital, Mr Robertson said. The police beat is like a small police station complete with interview rooms and if it proves successful in trials, it may be expanded to other main hospitals throughout Queensland.

Other similar police facilities had been put into hospitals in the United States, Britain and Ireland but the PA was believed to be the first of its kind in the southern hemisphere, Mr Robertson said.

Police Minister Judy Spence said PA had a population the size of a small country town and it made sense to have police on hand. "We've been locating police in shopping centres, schools and neighbourhoods around the state, so it makes sense to locate them in a very large facility such as this where they have a lot of work," she said. They will also service the hospital's surrounding area in the inner southside suburb of Woolloongabba

Source

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

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

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REGULATOR MELTDOWN: DOCTORS INNOCENT BUT STILL HEAVILY PENALIZED

Another triumph of regulation in California: The regulators could not even find enough evidence to put before a court, let alone get any convictions. Persecuting law-abiding people is SO much easier than catching crooks. And note how lucrative it was to be a "whistleblower" (false accuser). Whistleblowers should certainly be protected but rewarding them with huge sums is an open invitation to fraud

"After three years of investigation, the federal government said Tuesday it could not gather enough evidence to warrant criminal charges against any of the doctors in the Redding Medical Center heart surgery case. Instead, federal officials announced they had agreed on a series of multimillion-dollar civil penalties against four doctors accused of performing unnecessary heart procedures and surgeries at the hospital.

The deal marked an anticlimactic end to a probe that began Oct. 30, 2002, when FBI agents raided medical offices in Redding and carted off boxes of documents in an effort to prove widespread medical fraud. Civil penalties and settlements are expected to top $506.5 million, U.S. Attorney McGregor Scott said in a news conference at his office in Sacramento. In addition, two of the doctors - heart surgeon Fidel Realyvasquez Jr. and cardiologist Chae Hyun Moon - agreed never again to perform procedures or surgeries on patients covered by Medicare, Medi-Cal or TRICARE military insurance.

But Scott conceded that while FBI investigators had pressed for charges to be filed, lawyers in his office and at the Justice Department in Washington, D.C., had concluded a case could not be proven against the doctors. "The question at the end of the day becomes, 'Can you convict?' " Scott said. "We came to the conclusion that we could not in good conscience go forward."

Lawyers for the doctors accused in the case, however, said the settlement proved that there was no evidence of wrongdoing by the physicians, who before the FBI raid were highly respected in the Redding area. "The government simply got it wrong," said Malcolm Segal, an attorney for Realyvasquez....

Federal officials characterized the settlement as the best resolution possible after an investigation that included years of federal grand jury probing and a U.S. Senate investigation.... The 57-year-old Realyvasquez was accused along with three others of performing unnecessary procedures and then billing government health care insurance programs. Under the settlement, he will pay $1.4 million in penalties and his insurance company will pay its full limit for victims. The total insurance payout will total $24 million for Realyvasquez; cardiologist Moon, 58; heart surgeon Kent Brusett, 46; and Dr. Ricardo Javier Moreno-Cabral...

Moon attorney James Brosnahan said the settlement was a "reasonable" outcome because the case would have been too costly to defend against. Matthew Jacobs, another attorney for Moon, described the matter as "a tragedy for Dr. Moon. He was a highly skilled, very able and caring physician." ...

To date, more than $400 million in settlements have been approved in cases filed against the doctors and Tenet Healthcare Corp., the firm that owned Redding Medical Center at the time. An agreement with prosecutors in 2003 allowed Tenet to escape criminal charges in exchange for a $54 million payment and a later agreement to sell the hospital. As part of Tuesday's deal, Tenet agreed to pay an additional $5.5 million to the federal government and to pay $1 million to the California Department of Insurance and two whistle-blowers involved in tipping off authorities to the case.

The settlement concludes a dispute over how to pay off three whistle-blowers who had tipped authorities to the procedures at the hospital. Two men - former Redding resident Rev. John Corapi and a friend, Las Vegas accountant Joseph Zerga - were the first to tip authorities and will each receive $2.7 million. A third man, Redding internist Dr. Patrick Campbell, filed his claim as a whistle-blower three days after Zerga and Corapi and will be paid $4.4 million."

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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BRITS SPEND A BILLION MORE ON HEALTH BUREAUCRATS SO HOSPITALS MAY HAVE TO BE CLOSED

Do you get the logic of that policy? I don't

More than 90 community hospitals are under threat as the NHS in England heads towards nearly £1 billion of debt, according to new research. A survey by the Conservative Party claims 92 local hospitals in England face closure or being substantially scaled back. Further research by the party has shown strategic health authorities in England are forecasting a debt of £997 million by the end of this financial year.

The research by the Tories also warns that the NHS spends £1.3 billion a year more in real terms on administrators than it did in 2000. Shadow health secretary Andrew Lansley claimed the Government had supplied more money to the NHS but had lost control of costs. He said: "There is a huge demand for community hospitals and the services they provide. "While choice and vital services are taken away from those in need, the Government wallows in denial. "They have supplied more money to the NHS but lost control of costs. The increase in resources has not been matched with reform, and frontline services are suffering the consequences of this mismanagement."

A Department of Health spokesman denied community hospitals were under threat and dismissed the research on debt as "misleading". He said: "Far from being under threat, NHS community hospital services have a bright future. We are committed to building, rebuilding and refurbishing at least 50 community hospitals as part of a £100 million investment."

Source

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

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

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Insurers turning to 'consumer-driven' care to curb health costs

The view from California

The future of health coverage may look more like the Home Shopping Network than "E.R." A fast-growing trend known as consumer-driven health care aims to curb the soaring cost of health insurance by offering tailor-made coverage and increasing deductibles to make patients choosier about doctors, drugs and hospitals. Among other things, patients who don't intend to get pregnant can eliminate maternity coverage. Families can cut premiums by taking on a $2,000 annual deductible then shopping around for the most affordable care. "All the big insurers are now offering consumer-directed products," said Caroline Steinberg, vice president of trends analysis for the American Hospital Association in Washington, D.C. "It's a bit of an experiment," she said. "At this point, I don't think we know whether it's going to work or not."

Critics insist the high deductibles are merely a way for insurers to shift more costs to workers. They also point out that the plans don't require insurers to cut either their profits or prices. California Insurance Commissioner John Garamendi, a supporter of government-mandated coverage, has called the trend a "death spiral" for health care. He argued that it will cherry-pick the youngest, healthiest and richest people while forcing traditional managed care plans to charge more to cover the sickest patients. The result will be more uninsured people, he said. "It's not consumer-driven at all," Garamendi said. "What it is is market-driven by insurance companies ... segmenting the population into high-cost, high-risk segments and low-cost, low-risk segments."

Of the 186 million Americans who have health insurance, only about 3 million people are enrolled in consumer-driven plans. However, that number is expected to increase as politicians, insurers and employers struggle to hold down health care costs that have outpaced inflation for years. With the annual cost of insuring a family now about $10,000, many employers no longer offer health coverage. Only 66 percent of full-time workers at private firms have employer-sponsored plans, compared to 80 percent in 1989, according to the U.S. Bureau of Labor Statistics.

Garamendi specifically targeted a plan unveiled last year by Blue Cross. Marketed as Tonik, it's geared to people under 30 who are just starting out in their careers. By design, it does not include maternity benefits but does offer catastrophic coverage along with limited dental and vision care. Blue Cross said its research showed the target market didn't want maternity coverage. Eliminating it made the plan more affordable, said Robert Alaniz, a spokesman for Wellpoint Inc., parent company of Blue Cross. "It's not what government thinks you need, it's not what we, the plan, think you need, but it's what you, the consumer, told us," he said.....

Consumer-driven plans are based on the theory that people who must pay more upfront in deductibles will shop around for the most affordable health care. For some patients that could mean using generic rather than brand-name drugs or taking an aspirin before rushing to an emergency room after a sports injury. Tax-exempt health savings accounts recently permitted by Congress allow people to bank their own money toward the deductibles.

Giant health care provider UnitedHealth Group Inc. is betting the consumer-driven approach will help remedy the ailing system. The Minnetonka, Minn.-based firm has applied the philosophy to its own products and paid more than $800 million to buy two companies with pioneering experience in consumer-driven plans, UnitedHealth spokesman Mark Lindsay said. "The single best agent to control health care costs is the individual," he said. "Unfortunately, today they are disconnected from that reality."

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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Shake-up envisioned in Massachusetts health insurance: Higher deductibles seen possible for many

Governor Mitt Romney and other political leaders propose covering many of the 500,000 state residents who lack insurance with high-deductible plans that require them to pay the first $250 to $1,000 of their annual healthcare bills. In return, such plans would have lower monthly premiums than traditional coverage. If any one of the healthcare overhaul plans under consideration on Beacon Hill passes intact, state officials say, a ripple effect is likely. High-deductible plans would also be attractive to employers who have endured five consecutive years of double-digit premium hikes for standard health insurance; the state's HMOs could aggressively promote them; and employees would be allowed to take their health plans from job to job -- effectively seeding the marketplace. ''This is a paradigm shift. It wouldn't be surprising to me that you will see a lot more people actively taking these things up," said Timothy R. Murphy, Romney's secretary of health and human services. ''Large employers that we speak to are exploring a number of different options."

About 60,000 people have such insurance in Massachusetts, fewer than 1 percent. Nationwide, 1 million to 2 million are enrolled in high-deductible plans, according to industry estimates. Those numbers may soon increase. According to results of a survey of 86 large national employers released last week, 45 percent plan to offer such plans. The survey, conducted by Fidelity Investments, said the average projected savings on premiums would be 6 percent.

The shift toward more out-of-pocket expenses for consumers is controversial. Critics, including Massachusetts healthcare consumer groups, say it will encourage people to forgo routine doctor visits and vital preventive care, like pap smears and mammograms. They also worry that the plans will be most attractive to the healthiest people, leaving a high concentration of high-risk patients in traditional plans and making their coverage more expensive.

Proponents argue that people covered by traditional health plans have no incentive to shop for price or quality. Making them bear more of the cost of routine care would change that, they say.

A leading health consumer advocate in Massachusetts, John McDonough, executive director of Health Care for All, in Boston, supports State House proposals to expand coverage for the uninsured. But he opposes the broader use of high-deductible plans. ''We call it faith-based health insurance. You're supposed to pray you don't get sick, because if you get sick, you're in trouble," McDonough said.

But Stuart H. Altman, a professor of national health policy at Brandeis University, said expanding traditional forms of health coverage to those without it would be too expensive. ''I do believe that advocates for comprehensive healthcare are actually hurting the poor, even though they say they are helping the poor, because we have made it so expensive that no one can afford it," he said.

More here

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

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

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TROUBLESOME TOOTHACHES IN SCOTLAND

Their nationalized health insurance is supposed to cover Scots for dentistry but getting what you have paid for is of course a problem whenever you cannot take your business elsewhere

The crisis in Scotland’s dental services was underlined yesterday when it emerged that more than 57,000 Scots have had their registration with an NHS dentist withdrawn in the past two years. The figures was described as “shocking and unacceptable” by opposition parties and were revealed only weeks after the Scottish Executive announced that 32 dentists from Poland were to be recruited next year in an attempt to close the growing gap in provision. In 2002, 24,844 Scots were deregistered and this year already, the figure has reached 32,713....

Ms Marwick said the figures supported the anecdotal evidence that many MSPs were receiving from constituents about the problems they are facing in their search for dental treatment. “Withdrawing NHS services from patients is only deepening the crisis facing dentistry in Scotland, increasing the number of people who do not have an NHS dentist and are unable to pay for private treatment,” she said. Ms Marwick added: “There are thousands of people, both young and old, in Scotland who are entitled to free NHS dentistry who now cannot find a dentist prepared to treat them.”

As well as the influx of Polish dentists to Scotland, the Executive, which has pledged to recruit 200 dentists by 2008, disclosed that several of the country’s health boards were in talks with an independent health company to provide NHS dental treatment in those areas facing the most severe service problems.

Over the past year in parts of Scotland there have been repeated scenes of hundreds of people queueing to register with a dentist. Thousands of people throughout the country have been forced to re-register as private patients after their dental practice opted out of the health service. Scotland’s dentists have rejected a £295 million package from the Executive that would have allowed thousands of people the opportunity of treatment on the NHS. The Dental Action Plan was intended to help to lure dentists back from the private sector, but talks broke down after the British Dental Association said that the package would force its members to treat a set number of adults on the NHS before receiving the money.

The Executive sees the level of commitment to the NHS from the dentists as the main stumbling block to resolving the situation. The association maintains that it rejects the ministers’ “all-or nothing” approach and it has dismissed the Executive’s recruiting drive in Poland as “a short-term measure”. The Executive is committed to giving all Scots a free dental check-up by 2007, an initiative to be phased in over the next 18 months — putting even more pressure on dentists working within the NHS. It pointed out last night that the statistics showed only the number of people who had been deregistered and did not take into account the number of Scots who had re-registered elsewhere.

Mr Macdonald said that it was disappointing that some dentists chose to deregister NHS patients. “Patients should feel free to tell dentists what they think about that decision,” he said. “We announced a massive funding package earlier this year — an extra £295 million over three years — and no other government in history has invested so much in Scotland’s dental care. “We have always acknowledged that the current difficulties around accessing NHS dental services would not be solved over night.”

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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EXTRAORDINARY EROSION OF MEDICAL PROFESSIONALISM IN BRITAIN

They cannot provide enough doctors so you get a nurse instead!

Nurses and chemists are to be allowed to prescribe any medicine except controlled drugs such as diamorphine, the Government has announced. The British Medical Association called the changes “irresponsible and dangerous” and called for an urgent meeting with Patricia Hewitt, the Health Secretary. The plans allow for “extended formulary nurse prescribers and pharmacist independent prescribers” to be able to prescribe any licensed medicine for any medical condition from next spring.

James Johnson, chairman of the BMA, said: “We need to meet urgently with the Secretary of State to clarify the conditions under which other professions can prescribe. It is difficult to see how healthcare professionals who are not trained to diagnose disease can safely prescribe appropriate treatment. “The BMA will be seeking assurances from the Government that patient safety will not be compromised.”

The Department of Health said that the extension of prescribing powers would mean, for example, that specialist nurses running diabetes and heart-disease clinics would be able to prescribe independently.This could help patients to control high blood pressure, quit smoking and manage their diabetes, and would take pressure off GPs and allow them to focus on more complex cases.

But Dr Paul Miller, chairman of the BMA’s consultants’ committee, said: “This is an irresponsible and dangerous move. Patients will suffer. I would not have me or my family subject to anything other than the highest level of care and prescribing, which is that provided by a fully trained doctor.” Hamish Meldrum, chairman of the BMA’s GPs committee, added: “While we support the ability of suitably trained nurses and pharmacists to prescribe from a limited range of medicines for specific conditions, we believe only doctors have the necessary diagnostic and prescribing training that justifies access to the full range of medicines for all conditions. “This announcement raises patient safety issues and we are extremely concerned that the training provided is not remotely equivalent to the five or six years training every doctor has undertaken.”

Qualified nurses have had prescribing powers for a number of years which have been gradually increased to include more and more drugs. Nurses and pharmacists will be able to take on the extended prescribing powers once they have completed training courses. Once trained they will have to keep their skills up to date.

Ms Hewitt said: “By expanding traditional prescribing roles, patients can more easily access the medicines they need from an increased number of highly trained health professionals. Today’s announcement means that the young person wanting to control their asthma or the terminally-ill patient being cared for at home by a multi-disciplinary healthcare team will soon find it easier and more convenient to get the medicines they need. “This is another step towards a truly patient-led NHS, giving patients the power to choose where and by whom they are treated.”

Christine Beasley, the Chief Nursing Officer, added: “Nurses are the biggest single staff group in the NHS and they have demonstrated that they are safe, careful and professional prescribers. Pharmacists have wide knowledge of medicines and the effects they have on people. This knowledge is invaluable to their colleagues and to patients. “Today’s announcement demonstrates our confidence in nurses and pharmacists and our wish to use their skills and professionalism to the full.”

Beverly Malone, the general secretary of the Royal College of Nursing, said: “This is something we have been campaigning on for over 20 years and the Government must be applauded for taking this step. “This is good news for nurses and most importantly it is good news for patients. They will now get even better care and faster access to medicines and research shows that nurse prescribing is safe, cost-effective and popular with patients."

Source

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

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

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DOZENS DIE BECAUSE OF CALIFORNIA PUBLIC HOSPITAL INADEQUACIES

More than 30 people died waiting for liver transplants at the University of California, Irvine Medical Center while the hospital turned down scores of organs, according to a report in Thursday's Los Angeles Times. The hospital received 122 liver offers between August 2004 and July 2005 but transplanted just 12, according to the story, which was based on an Aug. 5 federal report that the paper obtained through the Freedom of Information Act.

The number of transplants and the patients' survival rate fell short of federal requirements between 2002 and 2004, according to the report by the U.S. Centers for Medicare and Medicaid Services. The problems were linked to a staffing shortage [The old, old story in public medicine]. The hospital medical center has not had a full-time liver transplant surgeon since July 2004, although federal standards require that a surgeon be constantly available. More than 100 UCI patients are awaiting transplants, 28 of whom joined the roster this year.

Dr. David Imagawa, who oversees UCI's liver transplant program, said a full-time transplant surgeon will join the hospital in early 2006. "We agree that there were some problems, and we're moving forward to change them," said Imagawa, who founded UCI's liver transplant program in 1994 and left in 2002 before returning last summer.

The federal review was prompted by a complaint from former UCI patient Elodie Irvine, who suffered from a disease that caused large cysts to form on her liver and kidneys. Irvine languished on the transplant list from 1998 to 2002 as UCI turned down 38 livers and 57 kidneys offered for her. Organ offers stopped in February 2002 because the hospital did not submit required information on Irvine's condition to the national group that oversees organ transplants. As a result, she dropped from the top of the transplant list to the bottom. Doctors "kept saying, 'You're on top. You're on top.' They led me to believe that there were no offers," said Irvine, 51. "They left me to die." Irvine ultimately received a transplant at Cedars-Sinai Medical Center. She settled a lawsuit against UCI Medical Center earlier this year.

Imagawa acknowledged the hospital made mistakes in Irvine's case but said the organs offered for her were "not suitable for someone without life-threatening emergency." According to the federal report, UCI performed only eight transplants a year between 2002 and 2004 — less than the federal requirement of 12 annually. Just under 69 percent of the liver transplant patients survived at least a year — below the 77 percent survival rate required for federal certification, the report said. Despite the problems, the hospital maintained its accreditation from the United Network for Organ Sharing.

UCI Medical Center was rocked by two other major scandals in recent years. In the mid-1990s, fertility doctors stole patients' eggs and implanted them in infertile women who in some instances gave birth. The university paid nearly $20 million to settle legal claims. In 1999, the facility fired the director of its donated cadaver program amid suspicion that he had improperly sold spines to an Arizona research program.

Source

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

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

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NO JOBS FOR NURSES DESPITE OVERSTRETCHED BRITISH HOSPITALS

But plenty of jobs for bureaucrats

Nurses who have just qualified are finding it difficult to get jobs in the NHS and are taking on other work to make ends meet, it has been claimed. The Nursing Standard magazine said that across Britain fresh graduates who had spent three years studying to become nurses were taking any job they could find - including in supermarkets and pubs. The Royal College of Nursing (RCN) has found hot spots across England where new nurses are having trouble getting a job in the NHS. They include Birmingham, Coventry, Sheffield, Surrey and Durham, as well as Scotland and Wales.

The Nursing Standard said that one university in Hampshire had already told nursing students not to expect any jobs in the NHS. The RCN has blamed rising financial deficits in NHS trusts for recruitment freezes and cutbacks. Gill Robertson, an RCN student adviser, said: "This is a new problem relating to trust deficits and it's very worrying. "Every year you hear of glitches, say where 20 midwives can't get jobs, but this is very, very different. There is nowhere for them to get jobs. "It's difficult to track this problem because trusts are not parting with information and they are also masking the problem by giving nurses part-time contracts.

"The other problem is that overseas nurses are stuck in bottom grades and not being promoted - and this is blocking the path for newly-qualified nurses." Ms Robertson said the problem was particularly bad for nurses who qualified in September - but said things would get worse for students who graduate in February. Iain Kightley, a member of the RCN's Association of Nursing Students, added: "Out of those who qualified recently at my university (Stirling), 20 out of 65 didn't get jobs. "Some are thinking of quitting their courses and morale is quite low. People feel despondent after training for so long."

One nurse, Helen Scott, qualified at Stirling University in September but has been forced to take a job at her local pub because she cannot find work as a nurse. The 20-year-old earns £120 a week for working 40 hours, but will find herself on the dole this week when her job runs out. "I'm prepared to do anything. I'll work on the check-out - anything that pays me," she said. "It's a hard time to be out of work, coming up to Christmas. "I have applied for lots of jobs in nursing since the spring but there just isn't anything and I'm finding it very hard and it takes a long time to get replies to applications."

A Department of Health spokeswoman said: "There are still lots of jobs in the NHS but we don't have the shortages we once had and there is more competition now. "We still need more newly-qualified staff to replace those who retire or take career breaks, but new staff may not always be able to find their first-choice job in their first-choice location and may need to be more flexible. "This is an issue that needs to be addressed locally. "Workforce planners within Strategic Health Authorities are working closely with their local organisations to make sure that staff and students understand the range of opportunities that are available. "NHS Jobs, which advertises NHS vacancies, has hundreds of jobs for all staff groups." [Translation: There are still jobs in some sink hospitals where it is dangerous to live and work]

Source

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

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

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SUPERBUG NEGLIGENCE IN BRITAIN

Even highly vulnerable babies being infected

Hospitals in England are making patchy progress towards controlling hospital superbugs, a study says. The Patients Association found that fewer than half of doctors are routinely using hand gels despite MRSA guidelines advising them to do so. And the survey of 229 NHS staff working in infection control said there were worrying gaps in patient screening and the provision of cleaning services. The government said more needed to be done, but measures were in place.

MRSA is linked to nearly 1,000 deaths a year and is consistently reported to be one of the public's major concerns about the health service. But the Patients Association found that only 47% of doctors - 31% in London - always used hand gels. Expert advice on MRSA states good hand hygiene is vital in keeping infections at bay and under the Health Bill currently before parliament hospitals can face government intervention if they fail to maintain standards.

The report also highlighted access to cleaning services. In some areas only a third of hospitals had facilities available 24 hours a day, seven days a week. It added just 44% of patients are screened for MRSA up on arrival and many hospitals were too crowded to properly control the superbug. Respondents, which included infection control nurses and trust managers, from 22 out of England's 28 strategic authorities reported the youngest patients with MRSA were under a week old.

The Patients Association's director of communications Katherine Murphy said: "Hand hygiene is essential to control infection in a hospital but again our report show that there is a low compliance among doctors." And she said she would like to see more hospitals appoint clinical staff to oversee MRSA control - nearly two-thirds employ managers.

Simon Gillespie, of the Healthcare Commission watchdog, said: "Hospitals really must do more to reassure patients that they are doing everything possible to prevent infections from occurring in the first place." And Tony Field, of MRSA Support, added: "It is reprehensible hospitals are not doing more. If we make inroads into MRSA we will also make inroads into other hospital infections." But he said wearing mask was as important as hand-washing.

The Department of Health said it would be impossible to screen all patients as some were emergency admissions. But a spokesman added the Health Bill would toughen procedures. "The NHS has made a good start with many hospitals already cutting their MRSA rates but more work needs to be done."

Source

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

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

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WOMAN DIES IN AN AUSTRALIAN PUBLIC HOSPITAL WHILE NOBODY GIVES A DAMN

(Campbelltown is a low-income area)

A woman who found another woman collapsed in the toilet of a Sydney hospital has told an inquest that nurses had no sense of urgency when she reported the discovery. Susan Bucknell was giving evidence today at the inquest into the death of mother of two Sharon Brophy. Ms Brophy, 34, died while awaiting treatment in the accident and emergency department of Campbelltown Hospital on March 26, 2004. Westmead Coroners Court has been told Ms Brophy spoke to a nurse but was not examined by a doctor at the hospital.

Ms Bucknell, who had taken her daughter to the hospital that day with a broken collarbone, said Ms Brophy ``looked very very sick'' when she returned from triage (casualty) about 1pm. ``She was bending over and she was holding her chest,'' she told the court. ''(She) was leaning over and she looked in pain. She looked quite grey.'' Ms Bucknell, a former registered nurse, said she was surprised Ms Brophy had to wait for treatment while her daughter was seen straight away. ``I would have thought that the other lady needed attention more than my daughter,'' she said. ``At the time, accident and emergency was very quiet, there would only have been two people in the waiting room.''

Ms Bucknell discovered Ms Brophy lying face down in the ladies' toilets about 2.45pm and immediately alerted nurses. ``I was singing out `hurry, hurry there's a lady in the toilet' and they were just looking at me. ``I felt that they thought I was a mad woman because they were just looking at me ... this silly lady running across. ``I felt there wasn't enough urgency in them trying to get the lady. ``There was no action, it just didn't appear to be an emergency situation.''

Ms Bucknell told the court a nurse went to Ms Brophy's aid but ``they weren't doing cardiac compressions, they were just moving her chest around''. The inquest was told Ms Brophy visited a general practitioner at a medical centre on the morning of March 26 complaining of abdominal pain. A post-mortem examination revealed she had probably suffered a heart attack three to four days earlier.

Source

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

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

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Complications send 'one in five' patients back to hospital

One in five Australians sent home from hospital are readmitted after suffering complications, prompting warnings that patients are being released too soon. A survey of 7000 patients admitted to hospital in the past two years in Australia, the US, Britain, New Zealand, Canada and Germany found Australia had the highest rate of readmission. "We are discharging too soon due to the pressure on beds in the public system," said Australian Healthcare Association executive director Prue Power. "Discharging patients too early because there is a pressure on hospital beds just causes patients to be readmitted, is not good for the patients and is not financially sound."

The Commonwealth Fund International Health Policy Survey, to be released today in the US, compared health systems in six countries. It reports that 20per cent of Australians were readmitted to hospital after discharge, compared with only 10per cent in Germany and 14per cent in the US.

Eighteen per cent of Australians said hospital staff failed to warn them about the risks of surgery before a procedure and did not mention complications that could occur after discharge. "Staff clearly need to improve communication with patients," Ms Power told The Australian.

Cathy Schoen, vice-president of the Commonwealth Fund - a private foundation that conducts research on healthcare issues - said the number of medical errors occurring in all countries and the lack of co-ordinated care was a concern. "There were many symptoms of poorly co-ordinated care in every country, regardless of the type of delivery or financing system." Almost a third of Australian patients said they were given the wrong medication or an incorrect dosage, or received the wrong test results.

However, 70 per cent were not told about the errors. "Despite studies that patients value discussion about mistakes or errors, most patients, 61-83 per cent in each country, said that the doctor or health professional involved did not tell them about the mistake," the report says.

Source


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

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

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DENTAL CRISIS IN BRITAIN

David Howarth has 11 teeth and they're all loose — but he can't find an NHS dentist to give him an examination. Nor can John Kelf, who has resorted to doing his own fillings with a DIY kit from Boots. Which is why they have both been queuing in the rain outside the Langley Dental Practice in Manchester since 5am. The practice advertised that it has a limited number of spaces for new NHS patients, and the queue now stretches over the horizon to Bury.

It hurts Richard Hyland to queue. He is over 80 and has had both knees replaced. It also hurts him because he's an ex-navy man who believed he fought the second world war for a brighter future. Now here he is with one tooth broken off in his gum and no dentist to examine him. "I paid my stamps," he says. "But why? What did I fight for? If I had my time again, I'd have turned round in 1940 and said, 'I'm not going.'"

The shortage of dentists in the NHS is getting worse. A heavily pregnant woman in Wrexham was unable to find an NHS dentist to deal with her severe toothache. So she rang NHS Direct, which told her the nearest dentist who could register her was 48 miles away. She ended up in A&E with a tooth infection which, had it been left untreated, could have harmed her and her unborn baby. Those American jokes about the state of Britain's teeth aren't so funny any more.

You wouldn't know it, but the government is in the midst of the most radical reform of dentistry since the NHS was founded. And by April 2006, that reform will be complete. It will mean a new system of dental charges and a new NHS contract for dentists. It's designed to remove dentists from what they call the drill-and-fill treadmill by paying them for the overall service they provide to a patient, rather than for each individual treatment they carry out. At least, that's the idea.

Dentists aren't convinced. They reckon the charges will mean most patients will end up paying more. And that the new contract will put them on a different sort of treadmill. "It sounds glib," says Ian Wylie, the chief executive of the British Dental Association ( BDA), "but this could be the last chance to save NHS dentistry. Unless the government restores dentists' faith in the NHS, you could see a time where they no longer want to work for the health service."

There is already a shortage of NHS dentists. When a practice opened this year in Ludlow, the local primary care trust (PCT) refused to give out its address or phone number for fear of being inundated with clients. It feared similar queues to the ones in Wooton-under-Edge and Scarborough. When the BDA saw the queues in Carmarthen, after a practice said it was taking on more NHS patients, it said the situation "evoked a Third World country, where you have to queue to access what should be part of NHS care".

Tony Blair made the mistake of pledging, in 1999, that within two years everyone would have access to an NHS dentist. It didn't happen. The shortfall of dentists is getting worse. According to the Department of Health, it will more than double in the next five years. In Sweden there is one dentist for every 800 people. In the UK there is one for every 2,300 people and over 40% of dentists are refusing to take on new NHS patients. According to a Which? survey, the worst places to live are Cornwall, Shropshire and the Grampians, where it's nearer 75%. In parts of Wales your only chance of getting on an NHS dentist's books is when someone dies.

Most shaming for Labour are the statistics that reveal a widening gap in the levels of decay in children's teeth between the poorest and richest parts of Britain. In places such as Merthyr in Wales and Argyll and Clyde in Scotland, for instance, tooth decay is getting worse. In Barnsley, decay in five-year-olds is one tooth per child worse than it was seven years ago. Given that 4 out of 10 children aren't registered with a dentist, that should hardly be a surprise.

At the moment, dentists are allowed to choose how much private work they do. For many, their only commitment to the NHS is to those exempt from dental charges, such as children. The new contract will take away that freedom, and NHS dentists will be obliged to see everyone. The BDA says children are bound to suffer. Last year the National Audit Office found that spending on the NHS had increased by 75% since 1990-91, but spending on NHS dentistry had risen by 9%. But the government presents a different set of figures. "We've invested an extra £368m in improving NHS dentistry," says the health minister Rosie Winterton. "There are 170 extra places at our dental schools and we've recruited the equivalent of 1,000 new dentists." Although that doesn't take into account the total number of dentists leaving the NHS.

It's no wonder people are going abroad for "dental holidays". Alan Scott-Barrs and his wife, Yasmin, both needed urgent dental work but couldn't get it done on the NHS. He needed caps and root fillings, but was told — at 75 — he was too old for anything other than a new set of dentures, which he didn't need. And she faced up to a year's wait. The private cost of the work in the UK would have been £18,000. On a dental holiday in Poland they paid £4,800.

The government has picked up on the idea and is bringing in dentists from overseas. There are, for instance, 117 Polish dentists in the NHS. "But the level of treatment they offer is limited," says Ian Mills, who runs a dental practice in Devon. "They're not general dental practitioners, and are more inclined to hand things on to a specialist. It takes a long time for them to be acclimatised. Then they're going back home."

Another short-term solution has been the opening of "phone and go" dental-access centres. These solutions are designed to offer the full range of dental treatments to those who have been unable to register with a dentist. But they are costly to run — on average, £80 per patient, which is more than a normal dental practice charges. They prioritise emergencies, not routine checkups, and offer no continuity of care. They are not a long-term solution. Which is why the government has started to put more money into dental schools. The number of training places is set centrally, and until 2004 stood around 800 each year. From October this year, the figure will rise to 1,000. Bristol University Dental School, for instance, is admitting 82 students this year rather than 53. But the students won't be fixing teeth until 2010. Even then, there's no guarantee they will be fixing them in the UK.

NHS dentists are paid a set fee for each item of work they do. It's an accounting nightmare. There are 400 separate fees for individual items of work, whether it's a filling or a crown, but as the fees are not high they end up seeing 40-50 patients a day. That compares with private dentists, who average 10-15 patients a day. NHS dentistry is about keeping the chair busy; it's all about drill and fill. So private dentistry is tempting. Especially when, according to the Consumers' Association, fees are three times higher than in the NHS. But only 1,000 UK dentists are exclusively private. The rest mix private work with the NHS. Some treat children on the NHS, but only if the parents are prepared to go private. When NHS dentists say they feel unrewarded, it's all relative. The average dentist earns £60,000 a year, but there is a huge disparity. Some NHS-only dentists earn £30,000, while others, especially in the southeast, earn six-figure salaries. In 2003, for the first time, dentists' private earnings topped their NHS earnings, with 51% of their overall income coming from charges, according to the analysts Laing & Buisson. Dr Stephen Shimberg sees both sides.

He has his own private practice in Manchester and an NHS practice in Oldham. "Generally, dentists do well — NHS and private," he says. "Private is more relaxed. The patient comes in, and agrees or disagrees with the treatments and the fees you propose. NHS is different. Fees are small, so you have to work harder to achieve your salary on the treadmill."

The running cost of a dental surgery averages at £100 per hour. It's classed as a small business, and attracts business rates. It needs highly specialised equipment — typically worth £40,000 — which is bought and maintained by the dentist. The dentist is solely responsible for the cost of implementing guidelines such as disabled access and cross-infection control procedures, and staffing the surgery with at least one nurse and one receptionist. To have an NHS crown fitted, for instance, a patient needs to visit the surgery at least twice. The impression is £5 and the laboratory fee £40. If the crown fits the first time, and no more visits are necessary, the dentist's profit is £15. That is then split with the practice. There is no income if the patient is a bad payer or doesn't keep their appointment. And that is a crown: one of few dental procedures that makes a clear profit. "If a new patient comes in for an NHS denture," says Shimberg, "it would be cheaper to give them a £10 note and tell them to go elsewhere. There used to be compensations. Doing fissure sealants for kids, for instance, was always well paid. Not any more. But dentists have to stay on the right side of the red line. When your bank manager asks about your income, there's no point saying, ÔIt doesn't really matter because I'm great with my patients.'"

Like private dentists, NHS dentists run their business for profit, and some have been tempted to "work the system". It's one reason why the number of complaints received by the General Dental Council (GDC) has increased steadily since 1995. "Studies show that dentists replace fillings far more than necessary," says Aubrey Sheiham, professor of dental public health at University College London, "and if they suffer a drop in income, they replace their patients' fillings more often. What these studies show is that replacing fillings is not closely related to the need to replace them but to the 'business' of the dentist. Because the criteria for replacing fillings are vague, it is not difficult to convince a patient that a filling needs replacing." In other words, the existing system encourages fraud.

The 2006 contract should get round that. Instead of paying dentists for every item of work they do, it will pay them a salary and — in theory — give them more time to focus on the patient. The new contract is being piloted in 25% of Britain's dental practices and has been well received. But it's only a pilot, so nobody knows what to expect when it comes into effect next April.

The government has worried dentists by talking about performance indicators called Units of Dental Activity. Essentially they are targets. "But you can't really target patient treatments," says Dr Shimberg. A recent online poll suggested that over 50% of dentists were unhappy with the new contract and would resign from the NHS if it were not redrafted. Another survey indicated that charges under the new scheme would increase for at least 70% of patients

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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