Thursday, March 31, 2005


How surpising (not) that VA hospitals should be singled out for adverse mention!

If you became seriously ill, you'd expect a hospital to provide what the medical profession considers essential care. At many hospitals, you'd be wrong. Thousands of patients needlessly die each year because guidelines proven to save lives aren't followed.

Even the most basic lifesaving treatments, such as giving aspirin and other drugs known to help heart attack victims, are forgotten, with fatal results. A study last November of 315 hospitals by the Duke Clinical Research Institute found failure to follow widely accepted heart attack guidelines almost doubled the mortality rate. After seeing the data, hospitals that improved their compliance rates had 40% fewer deaths.

Now, a national system to grade how hospitals meet standards is slowly emerging, using Medicare as the primary leverage, but enticing private insurers as well. It has a lot in common with the carrot-and-stick method used to get a mule to do what you want.

Over time, hospitals will get more money if they follow guidelines, and lower fees if they neglect them. To add a further shove in the right direction, Medicare will post report cards on its Web site so the public can make comparisons.

Until recently, there has been little incentive to measure performance. Unlike most businesses, where those who offer better services or products receive the largest financial reward, health care institutions mainly get paid based on volume of services rather than whether patients get better. Under the perverse reimbursement scheme, avoidable complications that require readmission may actually be more lucrative to hospitals than getting it right the first time.

Collecting and sharing information is the first step to improved care. In 1996, only 30% of patients who needed pneumonia vaccines received them at Department of Veterans Affairs hospitals. Once physicians were made aware of that fact, the rate went up to 92%, saving an estimated 6,000 lives. The use of beta blockers, which slow the heart rate and are standard for heart attack patients, went from 70% to 98%.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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


Wednesday, March 30, 2005


With NO improvement in health care, funnily enough

Almost £1.5 billion was spent last year on extra managers and bureaucrats brought in to support Labour’s policy of “micro-managing” the health service, the Tories said yesterday. The NHS workforce survey, published last week, shows that more than 15,000 NHS managers have been recruited since Labour came to power in 1997, an average of 2,222 a year. An extra 4,169 staff a year have been brought in to clerical and administrative roles, with 29,183 extra staff employed by 2004. Chris Grayling, the Tory health spokesman, said that even with conservative estimates of salaries the extra cost was almost £1.5 billion — the equivalent of 52,000 nurses. “These are quite startling figures,” Mr Grayling said. “To be spending £1.5 billion extra on bureaucracy which could be spent on patient care, more beds or more nurses is really quite extraordinary. If ever proof were needed that the Government has got the wrong priority for the health service, this is it. We could be doing so much more for this country if we pushed funding through to frontline services.” Mr Grayling said that the calculation was based on a salary estimate of £45,000 for a manager or senior manager and £25,000 for staff doing clerical work, administration or in information technology. Using these figures, the extra spending on administrators totalled £1.42 billion in 2004, he said.

The Government last week rejected claims that its obsession with NHS performance targets had resulted in a huge number of bureaucrats responsible for monitoring and collating information. There was a 7.8 per cent rise in the number of central administration staff last year, including managers, while the number of doctors and nurses rose by 3.9 per cent. Confronted in the Commons about the figures, John Reid, the Health Secretary, said that, of the 1.3 million people employed by the NHS, only 2.8 per cent were managers. He dismissed suggestions that the number of bureaucrats was rising at double the rate of medical staff and said that the extra 8,000 doctors and 11,200 nurses recruited last year had brought their numbers to record levels.

The Healthcare Commission, the agency responsible for maintaining standards in the NHS and private healthcare, is attempting to streamline administrative work and reduce excess bureaucracy. Spending on the NHS in England has almost doubled since Labour came to power, reaching £63.6 billion last year, compared with £33 billion in 1997. Yet a key indicator known as “finished consultant episodes” – which measures work completed by senior doctors – rose by only 9.9 per cent between 1998 and 2004.

Chris Philp, chairman of the Bow Group, the centre-right think tank, said: “In the past three years there have been more managers and administrators appointed than doctors, but productivity per person has gone down.”

Gill Morgan, chief executive of the NHS Confederation, which represents NHS managers, said that it was “fed up with the demonising of hardworking managers and support staff”. Just 3 per cent of the 1.3 million NHS staff in England were managers or senior managers, while 13 per cent were in support services such as cleaning, catering, laundry and IT, she said. “Managerial and support staff are a vital part of the NHS team because they allow doctors, nurses and other frontline clinical staff to concentrate on what they do best – caring for patients,” she said



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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


Tuesday, March 29, 2005


In the U.K., of course

More than 1,500 people waited outside a dental practice on Saturday after the centre took on a new dentist. They queued for up to seven hours to go on the list of Jimena Colino, a new Spanish dentist at the Fen House Dental Practice in Spalding, Lincolnshire. Eye witnesses said the queue, which stretched for a mile, was three or four people deep.

Health minister Stephen Ladyman said the government was taking steps to tackle the shortage of dentists.

One man, from Gosberton, told BBC Radio Lincolnshire that he took a friend to register and waited for four hours with her. "Anyone that was walking that side of the road either to join the queue or to get home had to use the road because the footpath was clogged," he said. "Our friend eventually got to register at quarter past 12, she'd been there since quarter to eight."

Six dentists have been recruited by West Lincolnshire Primary Care Trust. Shadow Health Secretary Andrew Lansley said: "Five years ago Mr Blair promised everyone would have access to an NHS dentist by 2001. "Forward four years, the situation has got worse and all we get is talk about improvements. Because Labour failed to agree a new contract with the profession, dentists are voting with their feet." Mr Lansley said fewer people were now registered with an NHS dentist than seven years ago.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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


Monday, March 28, 2005


An investigation has been launched into the death of a 15-year-old Brisbane boy forced to wait three years for a kidney transplant – even though his father was a willing donor. Ken Oliphant has revealed how his son, Ben, died in his arms before the life-saving surgery could be performed. He claims the transplant was repeatedly delayed and, at one stage, he was told the operation had been cancelled because staff at the Royal Children's Hospital in Brisbane had gone on holidays. "You watch your kid die in front of your eyes and you never forget that," he said. "I couldn't understand the delay. Why did we have to wait so long when they had me as the donor?"

Mr Oliphant, 42, this week lodged an official complaint with the Health Rights Commission, an independent watchdog which reports to State Parliament. Mr Oliphant, a single father, has also spoken to police and received a written assurance from Premier Peter Beattie that his son's death will be investigated. The Royal Children's Hospital administration strenuously denies Mr Oliphant's claims. District manager Professor Alan Isles said the hospital had acted properly.

In an interview with The Sunday Mail, Mr Oliphant said he offered to donate one of his kidneys as soon as it became known Ben had suffered renal failure. However, the hospital took more than two years to accept him as a donor and then kept postponing the surgery "until it was too late". Mr Oliphant claimed the hospital tried to cover up the matter by secretly paying for Ben's funeral expenses and asking him to sign confidentiality documents, which he refused to do. "They want me to shut up and go away. They said it would not be in my best interests to make the case public," he said. "But I just want some answers. I cannot let my son die for no reason . . . this is a human life we are talking about. Ben's death was preventable. I could have had another 40 years with my son."

Mr Oliphant said Ben, the younger of two sons he had raised on his own, came home from a camp in 2002 with two lumps on his neck. Tests revealed the then 12-year-old's kidneys had failed. "They gave us two choices: wait on the transplant list or see if I was compatible," Mr Oliphant said. "It took me about two seconds to make up my mind." However, Mr Oliphant claimed hospital officials refused to operate until his son's condition had worsened, which a doctor later admitted was a mistake. "Almost every month I would ring them up but they would say that Ben had to hit rock bottom before they would operate," he said. "It was only when Ben's condition worsened in June last year that there was suddenly some urgency and they allowed me to do the donor tests."

Mr Oliphant said he passed three of the four categories needed for him to become Ben's donor. "I was a near perfect match. I am fit, not fat, I look after myself, I'm in great health. I was ready for it," he said. Mr Oliphant said after he passed a further psychiatric evaluation in September, he and Ben were booked in for the seven-hour operation, which costs about $15,000, on October 14. However, he said the surgery was cancelled and rescheduled for November only to be cancelled again. Mr Oliphant said no "valid reason" was given for the cancellations. "They told me people were not there, they had gone on holiday," he said. Mr Oliphant said that when he complained about the delay, a senior hospital official told him: "It's not over until the fat lady sings." He has identified the official in his complaint. A new surgery date was set for December 9, but Ben died on November 25.

More here


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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


Sunday, March 27, 2005

I am not going to write anything today. I am just going to refer my readers to this article about the "free" health care in Cuba.


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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


Saturday, March 26, 2005


Because demand is unlimited once you remove from people the restraint of having to pay

The two independent trustees overseeing Social Security and Medicare broke with the Bush administration's trustees yesterday, saying Medicare's financial problems far exceed Social Security's and are in urgent need of attention. Republican Thomas R. Saving and Democrat John L. Palmer said Social Security's condition has changed little since they joined the Social Security and Medicare Boards of Trustees in 2000. But in the trustees' report released yesterday, they wrote that Medicare's prospects have "deteriorated dramatically" with rising medical costs and the addition in 2003 of a prescription drug benefit. "The financial outlook for Social Security has improved marginally since 2000," wrote Saving and Palmer. "In sharp contrast, Medicare's financial outlook has deteriorated dramatically over the past five years and is now much worse that Social Security's."

The three trustees from the Bush Cabinet -- Treasury Secretary John W. Snow, Health and Human Services Secretary Michael O. Leavitt and Labor Secretary Elaine L. Chao -- chose to emphasize Social Security's problems almost exclusively at the report's release. "The numbers leave nothing to doubt about the fundamental condition of the Social Security system," Snow said. "It's on an unsustainable course." "The report speaks for itself," Leavitt said.

Unlike past years, though, neither Saving nor Palmer attended yesterday's report release. Treasury spokesman Robert S. Nichols said any attendees of the trustees' meeting that preceded the release were free to attend the news conference. Saving did attend that meeting. But in an interview, Saving said the public trustees were purposely left out of the presentation. "They didn't particularly invite us," he said. "They're doing it differently, I guess. It's not our call."

The independent trustees are appointed by the president, subject to Senate confirmation, and must come from different parties. Both Saving, from Texas A&M University, and Palmer, from Syracuse University, were appointed by President Bill Clinton. Saving has emerged as a strong supporter of Bush's plan to add private investment accounts to Social Security.

In their closing message last year, Saving and Palmer also emphasized Medicare's problems, but Saving said that this year, he and Palmer wanted to use their final report as trustees to further flesh out the changes they have seen over their tenure on the board. In so doing, they joined a chorus of policymakers worried that the political attention being lavished on Social Security may have found the wrong target. "The question in my mind is why are we talking about saving Social Security?" said Bruce Bartlett, a conservative commentator with the National Center for Policy Analysis.

While Social Security benefits are scheduled to exceed tax revenue by 2017, Medicare's trust fund, which finances hospitalization of the elderly, reached that juncture last year. The trustees project the Social Security trust fund will be exhausted by 2041, one year sooner than projected last year. But Medicare's trust will be depleted more than two decades earlier, in 2020. Last year's report projected the Medicare trust fund exhaustion date to be 2019. By 2024, Medicare's cost will have roared past Social Security's, Saving and Palmer wrote.



Drug safety experts have long pushed for replacing old-fashioned prescription pads with high-tech drug order entry software. The technology is seen as a key step toward slashing the sky-high rates of drug-related adverse events, which are estimated to kill or harm more than 770,000 Americans every year. But a new study shows that drug-order software can have a surprising dark side, introducing potentially dangerous new sources of doctor error even while it eliminates others. It indicates that introducing computer order entry and other complex software to U.S. hospitals may be more difficult than anyone had imagined.

Researchers at the University of Pennsylvania surveyed 261 interns, residents and other hospital staff who had used an old computer order-entry system at the University of Pennsylvania Hospital between 2002 and 2004. They intended to study how various workplace stresses affected prescribing error rates. To their amazement, the researchers found 22 scenarios in which the computer system itself increased the odds of prescription drug snafus. Many of the doctors surveyed said the problems were common and occurred several times every week.

"The doctors kept on talking about the [order-entry software] itself being a source of errors and stress," recalls sociologist Ross Koppel, lead author of the study, which is published in the Journal of the American Medical Association. "I said, 'No, no, no, this can't possibly be the case, every study shows that it works." But eventually, he had to agree that the residents and interns were right.

One of the big problems with the system was a poor man-machine interface. "The system just didn't make sense in terms of the way doctors actually worked," says Koppel. It made doctors wade through as many as 20 screens to see the list of drugs for a single patient. By the time a doctor got to the right screen to order a drug, the patient's name was sometimes no longer on the screen, making it easy to confuse to whom the order was going.

At other times, the software displayed multiple patient names on a single screen, making it possible to give a drug to the wrong patient, if the doctor was distracted at the moment the order was being finalized. Koppel says he spoke to one doctor who ended up giving a potentially fatal dose of a drug to the wrong patient because of this multiple-name problem. While the patient survived unscathed, the doctor was still shaken by the near-miss two years later.

The University of Pennsylvania study looked only at the downside of the order-entry software: It did not assess whether the software reduced or increased the overall rate of drug adverse events at the hospital. Other studies at Harvard University and elsewhere have found that computer order-entry systems can reduce drug errors by 55% to 80%. The University of Pennsylvania has since replaced the old software in the study with a newer version that it expects will eliminate some of the old problems.

Paradoxically, the study results could actually be good news for makers of order-entry and medical record software. It may mean that hospitals will have to spend more money over a longer period of time than they ever imagined to optimize order-entry software so that it meshes well with hospitals' intricate and fast-paced workflow. Currently only about 6% to 10% of U.S. hospitals have computer order entry, but the Bush Administration is pushing hard to increase their numbers.

Numerous companies are racing to sell order-entry, electronic medical records programs or other software systems aimed at boosting patient safety. Among others, they include General Electric, Cerner, Eclipsys, McKesson and Siemens.

No one is saying that hospitals should abandon computer order-entry, but just that more care needs to be taken in how it is implemented. "The lesson is to realize software is just a tool" not an end in itself, says Dr. David Bates, a patient safety expert at Harvard's Brigham & Women's Hospital. "Any time you introduce a new process, you have to troubleshoot it. They didn't do as good a job of doing that here." Adds Oregon Health Sciences University's Joan Ash: "There are unintended consequences" for every new software system. She says hospitals need to spend more time researching workflow to reduce the error rate and make computer systems that work better.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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


Friday, March 25, 2005


According to those who subscribe to the myth of massive waste in health care spending, the large discrepancy in the share of GDP devoted to health care (15 percent in the United States, compared with less than 10 percent in many other developed countries) reflects the inferiority of our system. They take our higher spending level as irrefutable proof of the inefficiency of our system of private and public financing relative to a more socialized approach.

Instead, I am prepared to make the following bet: ten years from now, it will be objectively clear that the United States provided significantly better health care to its citizens between 1990 and 2005 than did other developed countries. From the vantage point of 2015, the policy blunder of the past fifteen years will not be that the United States spent too much on health care, but that other countries spent too little. The socialized systems, forced to ration health care because tax revenues are not sufficient to pay for state-of-the-art care, are constraining their citizens from being diagnosed and treated as well as Americans.

I am not denying that waste exists. However, I contend that the difference between health care spending in the United States and that in other countries cannot be accounted for by the wasteful items that critics have identified.

The Usual Suspects

To examine the hypothesis that waste accounts for the difference between U.S. health care spending and spending in other countries, let us round up the usual suspects:

* spending in the last year of life
* drug company profits and advertising
* administrative overhead

An urban legend has it that close to half of all health care spending comes in the last year of life. The facts are somewhat different. The most thorough study, by Donald Hoover, et al, finds that 27 percent of Medicare spending takes place during the last year of life. Overall, 22 percent of health care spending on people over 65 takes place in the last year of life. However, only 1/3 of U.S. health care spending is for people 65 and older. Thus, as a percentage of overall U.S. health care spending, spending on the last year of life amounts to about 7 percent. That is high, but not staggering.

The high rate of spending in the last year of life may not be easy to avoid. When people throw around the claim that much money is wasted on the terminally ill, the implication is that doctors are hovering over dying patients, larding them with futile diagnostic procedures and surgeries. Although some of this takes place, it is not the primary cause of heavy spending in the last year of life.

The most expensive people to care for are invalids. And the simple fact is that people are more likely to be invalids in the last year of life than earlier in life. So, in any population, you will observe health care spending rise as you get closer to the death of the person. This Rand Study by Joanne Lynn and David M. Adamson provides an insightful perspective.

"Improved public health and medical treatments have translated into far fewer deaths from acute causes such as childbirth or infections. Currently, the most common causes of death are heart disease, cancer, stroke, chronic respiratory disease, injury, and diabetes. Dementia and multi-factorial frailty shape the last years of life for a large part of the population...Americans will usually spend two or more of their final years disabled enough to need someone else to help with routine activities of daily living because of chronic illness."

Thus, the 7 percent that we spend on the last year of life is more a reflection of the changing nature of old age, which in turn reflects improved care of acute illnesses. However, even if we emptied the nursing homes and spent nothing on patients in the last year of life, this would still reduce our health care spending as a proportion of GDP by only 1 percentage point, which would keep it several percentage points above the level in other countries. Contrary to myth, the magnitude of what the United States spends on patients in the last year of life is not a factor in our excessive spending relative to other developed countries.

Another usual suspect is the evil pharmaceutical industry. However, total profits of pharmaceutical companies are about one-half of one percent of GDP. In the short run, stringent price regulation could reduce health care spending by perhaps one or two tenths of one percent of GDP. The long run effects of reducing the incentive to develop pharmaceuticals could be adverse, because pharmaceuticals often substitute for more expensive therapies. Another suspected cause of the high cost of health care is malpractice premiums and defensive medicine. I am in favor of malpractice reform. However, the fact is that such reform will not make much of a dent in our nation's health care budget. Malpractice reform is not a magic bullet, either.

Overhead and Efficiency

A more plausible suspect is administrative overhead in the U.S. health care system. For example, a study by Steffie Woolhandler, et al concluded that, "administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada." Their view is that switching to a Canadian style national health insurance system would reduce administrative costs. I wish that economists had been involved in doing the study. My concern is that the measures of administrative cost may be misleading. For example, the authors make much of the fact that the U.S. health care system hired administrative workers at a higher rate than the Canadian system.

However, hiring administrative workers is not by itself an indication of inefficiency. In a fee-for-service system as in the United States, physicians have an incentive to spend their time doing procedures. They will want to off-load as much paperwork as possible to clerical staff. In a different health care system, where physicians are paid something more like a flat salary, two factors are at play. One is that there is less paperwork, which is good. The other factor, however, is that physicians have less incentive to offload paperwork, because spending time doing administrative work themselves will not lower their incomes. More administrative workers could be a symptom of more paperwork, or a more efficient system for handling paperwork, or both. A careful study needs to sort this out.

Switching from a fee-for-service system to a straight-salary system would reduce measured administrative costs. However, it produces a different kind of economic inefficiency. It breaks the connection between work effort and pay for health care providers. Doctors will be paid for showing up, not necessarily for putting in a full day's work.

Reducing administrative overhead is a desirable goal in U.S. health care. However, many factors are involved. The main potential benefit from nationalizing the health care system would come from replacing the fee-for-service model. How much this would save is debatable, but using the most extravagant estimates it is unlikely to reduce our health care spending by more than 2 percent of GDP.

The Real Culprits

While the usual suspects receive attention that is disproportionate to their true impact on U.S. health care spending, two important factors receive relatively little attention: physician compensation; and the utilization of high-tech procedures. Both of these are much higher in the United States than elsewhere. Physicians are paid more than twice as much in the United States as in other developed countries. Because physician services are about one fourth of all health care spending, we could eliminate one eighth of our health care spending by reducing doctor salaries to the levels of other countries.

The other big factor is utilization of high-tech procedures, such as MRI's, CT scans, and open-heart surgery. If Americans would cut back on the utilization of these procedures, that would reduce health care spending by hundreds of billions of dollars.

The question is whether our medical care would deteriorate if we were to pay our doctors much less while at the same time reducing our utilization of expensive capital resources. It seems reasonable to conjecture that the quality of diagnosis and treatment ultimately would suffer.

Infant Mortality and Longevity

One of the reasons that pundits are fixated on health care costs is that health care benefits are difficult to measure. Over the next decade, I believe that we must and we will develop more useful statistics on health care outcomes and health care quality. In the meantime, two commonly-used statistics used to compare health care quality across countries are not particularly informative. These are infant mortality and longevity.

Most health care spending is not focused on reducing infant mortality. Infant mortality is very low in all industrial countries, so any differences across countries are of little significance. It is questionable whether differences in measured rates of infant mortality are due to differences in definition. The United States attempts to save most premature infants and counts the failures as infant mortality. In some other countries, deaths of premature infants may be treated for statistical purposes as incomplete pregnancies, which takes them out of their infant mortality statistics.

Longevity calculations are not a sensitive measure of improvement in medical care. In my essay on lifespan, I showed how the longevity number is calculated as a peculiar weighted average of the survival rates for different population cohorts. I produced a simplified example in which the longevity number came out to be 68.9 years. In that example, suppose that 10 percent of the people who otherwise would die at age 60 instead receive treatment that allows them to live at least to age 80, when they die at the rate of other 80 year-olds. In that case, the overall longevity number would increase by less than 1.5 years, to 70.3 years. In international comparisons, such an increase easily could be swamped by other demographic and genetic factors.

Moreover, even if we controlled for other factors, the increase in longevity due to medical treatment will take many years to work its way into the actual longevity calculations. For example, my wife was treated for breast cancer a few years ago. If she had not been treated, she might still be alive today, but she would almost certainly have died by age 55. As of today, therefore, her successful treatment counts for no increase in longevity as it is conventionally calculated. In twenty or thirty years, however, the difference will be quite noticeable (certainly to me).

In another ten or fifteen years, it may be possible to document a significant increase in life extension for people over the age of 55 in the United States compared to what is now occurring in other countries. However, as the example of my wife illustrates, superior medical care will not necessarily show up in the backward-looking statistics that are calculated currently.

Two Hypotheses

There are two hypotheses about the difference in health care spending between the United States and other countries. One hypothesis is that it is due to a higher proportion of waste in the U.S. health care system. The other hypothesis is that Americans are getting better health care. There is not a shred of doubt in my mind that the U.S. health care system is rife with inefficiency. I will have suggestions for alleviating the problems in future essays. What I seriously doubt, however, is that the inefficiency of our system so dramatically exceeds that in other health care systems that we have no better quality health care to show for our expenditures. The more carefully one examines the facts pertaining to the arguments used to justify that hypothesis, the less convincing it becomes. At this point, my personal bet would be that most of what we are getting for our larger expenditure is better health care. All that I know for certain is that more research and better measurement are needed before sober people can draw conclusions.

(Article from the excellent Arnold Kling)


Figures revealing that patients are waiting longer for elective surgery are proof that it will take more than just money to ensure Australians receive the medical care they need. In 2002-03, the federal and state governments poured a record $16.1 billion into public hospitals, and state governments announced they would spend $240 million on initiatives specifically aimed at reducing waiting lists. But in some states patients waited months longer for many common surgical procedures in 2004 than they did in 2002.

Hospitals are under unprecedented pressure to meet budgets by cutting bed numbers and limiting access to operating theatres as the demand for medical treatment exceeds the number of doctors, nurses and hospital beds available. Resources are so stretched that a busy night in the emergency department of most public hospitals throws the next day's surgery list for elective procedures into disarray. A surgeon at one of the country's largest public hospitals told The Australian he has only about five hours a week access to the operating theatre to perform elective surgery.

The number of public hospital beds fell almost 10 per cent between 1996 and 2002. Nursing home beds are also in short supply, leaving an estimated 2000 elderly people with nowhere to go but hospital.

The National Healthcare Reform Alliance, which represents 22 national health groups, argues that the first step should be the creation of a single health organisation to manage the entire health system. It claims the move would save an estimated $2billion a year on duplicated administration. Administration is one of the fastest-growing items of spending in hospitals. In 2001-02, hospitals nationally spent $992million on administration - the third-biggest item behind wages and medical-surgical supplies.

Any plan to cut waiting lists must start with measures to keep people out of hospitals in the first place. Many argue that money saved on administration could be spent on public health schemes designed to prevent illnesses. In January 2004 a year long study of patients admitted to Sydney's Prince of Wales Hospital revealed 79 per cent of elderly patients could have been kept out of hospital if they'd received earlier treatment by a GP.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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


Thursday, March 24, 2005

What a disgrace! Superbug kills day-old baby

In a British public hospital, of course

LUKE DAY weighed a healthy 7lb 7oz. Neither his mother nor hospital staff had any cause for concern about his health - yet 36 hours after he was born, Luke was dead: the youngest known victim of MRSA, the hospital superbug. A post-mortem examination at Great Ormond Street Children's Hospital revealed that Luke died from septicaemia caused by MRSA which is thought to have entered his bloodstream through his umbilical cord. The microbiologist who led the hospital's investigation into his death told The Times that he was very concerned that he had not been able to establish how Luke had acquired the bug or why it had killed him so quickly.

No trace of it was found in his family, in the hospital or in the staff who treated him. The hospital has denied accusations by Luke's parents of a cover-up after MRSA initially failed to appear on their son's death certificate.

MRSA, methicillin-resistant Staphylococcus aureus, is one of a group of bacteria commonly found on the skin. It is difficult to treat because it is resistant to commonly used antibiotics. Luke showed no sign of it when he was born naturally in Ipswich Hospital on February 2. His mother Glynis, 17, wept as she recalled how her joy at giving birth had turned to despair. "Luke seemed fine. His temperature did go down but he went under a heater for a bit and he was fine again. There was no indication that he was ill at all."

Shortly before 7 o'clock on the evening of February 3 a nurse came to check on her, Ms Day said. "She then went to walk out and glanced in the cot. I wasn't taking much notice because people were always coming in and out. It was when she grabbed him and ran outside and didn't come back for a little while that I suddenly clicked something might be wrong. "I went out to find him and they said they were resuscitating him. I just broke down. I couldn't believe it. I want something done about it, even though it's not going to bring him back."

When the family went to register Luke's birth and death they found that the death certificate made no mention of MRSA as the cause of death. His father, Kevin Fenton, 24, refused to sign it until the form had been changed.

Glynis's mother Kathy Day, 55, has quit her job as a support worker for day patients at the hospital because she feels she can longer support the NHS. "The whole family feel the whole truth about Luke's death should be known. A baby has died from MRSA in an NHS hospital. People need to know. We do not want other families to go through the pain we have suffered over the last few weeks. He was so beautiful when he was born and I was so happy that I had a little grandson at last. My daughter had got everything ready: a cot, a pram and clothes for a baby boy. Friends and family had donated toys and teddy bears. He was all ready to move into Glynis's room at the family home. There was no warning at all." He even had a natural playmate ready after his mother's twin sister gave birth to a daughter two months earlier.



There is a bumper sticker on the car ahead of me as I drive down Interstate 93. In white letters on a navy background, it proclaims: ''Single-Payer Health Care!'' That's it. There is no argument, no attempt at logic or emotion or humor -- just an impatient demand for the drastic transformation of one-seventh of the US economy. And note the exclamation point. That is to communicate earnestness, certitude, and indignation -- classic elements of the liberal approach to policymaking: When promoting radical change, passion and good intentions are what matter most. Real-world consequences count for far less.

As it happens, the real-world consequences of single-payer healthcare -- also known as socialized medicine or national health insurance -- are well-documented. Single-payer care exists in Canada, New Zealand, Great Britain, and much of Western Europe. And wherever it has been tried, writes John C. Goodman, president of the National Center for Policy Analysis, ''rationing by waiting is pervasive, putting patients at risk and keeping them in pain.''

In ''Lives at Risk,'' a book published last summer, Goodman and two co-authors, Gerald Musgrave and Devon Herrick, showed that a single-payer system, far from proving a panacea, would make American healthcare much worse than it is. (Some of the book has now been adapted into a monograph for the Cato Institute, ''Health Care in a Free Society.'') The claims endlessly repeated by proponents of socialized medicine -- that it is more efficient, more equitable, and more affordable than American healthcare -- are belied by decades of data from countries that have gone the single-payer route.

There is no denying the grass-is-greener appeal that the idea of nationalized health coverage holds for many Americans. Just recently, town meeting members in 21 Vermont communities, including Burlington and Montpelier, the state's two leading cities, voted to endorse a statewide single-payer system. Some of those town meetings might have voted the other way if members had first read ''Lives at Risk.'' The facts of socialized medicine aren't nearly as pretty as the myths.

It is routinely claimed, for example, that single-payer systems ''guarantee'' every citizen the right to healthcare. In reality, countries with nationalized systems invariably limit healthcare to control costs. The result, of course, is ever-lengthening wait lists. Around 25 percent of patients undergoing elective surgery in Canada, Australia, and New Zealand -- and around 36 percent in Britain -- have to wait more than four months for a turn in the OR (The figure in the United States: 5 percent). According to the Fraser Institute, a Vancouver think tank, the average Canadian patient waited 8.3 weeks for an appointment with a specialist in 2003 -- and another 9.5 weeks before getting treated.

Lengthy waits are not trivial. Delays in Britain for colon cancer treatment are so protracted that 20 percent of cases considered curable at the time of diagnosis are incurable by the time of treatment. Last year a lawsuit was filed against 12 Quebec hospitals on behalf of 10,000 breast-cancer patients who had to wait more than eight weeks for radiation therapy. A ''right to healthcare?'' Socialized medicine guarantees only the right to stand in line -- and often to get sicker while you wait.

But when you finally do get to the head of the line in a single-payer country, at least the quality of the care you receive will be top-notch, right?

Alas, wrong. During your last medical appointment, did the doctor have more than 20 minutes for you? The answer is yes for 30 percent of Americans -- but for only 20 percent of Canadians, 12 percent of Australians, and 5 percent of Britons. Because the number of doctors in Canada is artificially restricted, the country suffers from overstressed physicians and undertreated patients. Thus, while the average US doctor sees 2,222 patients annually, the average Canadian doctor must somehow make time for 3,143.

Consider another measure of medical quality: access to lifesaving technology. British scientists helped develop kidney dialysis in the 1960s, yet today Britons use dialysis at one-third the rate Americans do. If you need a coronary bypass, you are five times more likely to get it in the United States than in Canada (and eight times more likely than in Britain). Access to CT scanners? MRI machines? Lithotripsy units for treating kidney stones? Angioplasty? When it comes to one kind of high-tech medical procedure after another, the average American patient is far likelier to get treatment than his single-payer counterpart. That is why Americans often have a better chance at beating a condition -- such as prostate cancer, renal failure, or heart disease -- that would kill them elsewhere.

The Spectator, a British journal, summed up the issue in the headline of its Feb. 12 cover story: ''Die in Britain, survive in the US.'' The American healthcare system is far from perfect, as Goodman and his co-authors make amply clear. But more government control of that system -- and less private-sector choice -- will not make it better. As our friends in Canada, Britain, and other countries with national health insurance can attest, single-payer healthcare looks better on a bumper sticker than it does in real life.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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


Wednesday, March 23, 2005


Hospitals across the country are running up huge debts despite the billions of pounds of extra funding going into the NHS, figures seen by The Times reveal. The official government statistics show that at the end of the last financial year, nine hospital trusts had deficits of more than 10 million pounds, 14 had deficits of more than 5 million pounds, and another 39 of more than 1 million pounds. Overall, almost one third of all NHS trusts were in deficit, with the total standing at more than 350 million pounds. However, experts believe that the situation now might be even worse, with many hospitals having to cancel operations, shed staff and close wards to try to claw back money before this financial year ends.

St George's and Hammersmith hospitals, in London, have already closed beds, while Leeds Teaching Hospital announced plans to shed 230 beds and four operating theatres. Airedale trust, which is predicting a 2.9 million pounds deficit, has had to cut some non-urgent surgery while South Tees trust with a debt of 25 million pounds, admitted that it was now increasingly hard to balance the books. "In recent years we have gone from a situation of being able to balance the books year on year to one where we have to effectively borrow from next year to try and balance this year's books," managers wrote in a special staff briefing. Experts said that the deficits were the result of hospitals expanding too fast to try to cut waiting times. They also overestimated the amount of money that they would get from central government, and underestimated the cost of implementing the new consultants contract.

The disclosure has caused a political storm just a day after Gordon Brown put Labour's handling of the public services at the heart of its election campaign. "Despite the hard work of NHS staff and billions of pounds worth of taxpayer investment, resources are being wasted and swallowed up by additional bureaucracy and the pursuit of government targets," Andrew Lansley, the Shadow Health Secretary, said. "Eight years ago, Mr Blair said it would be `24 hours to save the NHS', but today more than one in three hospitals is in deficit, resulting in closed wards and cancelled operations."

The Liberal Democrat MP, Edward Davey, who received the figures as part of a parliamentary answer, added: "These startling figures show that Labour has failed to get the extra health cash to the frontline. "As hospitals struggle to break even, it is operations that are being cancelled and nurse vacancies that are not being filled."

However, a Labour spokesman said that the deficits needed to be seen within the wider perspective of NHS growth. "These deficits are a tiny proportion of overall NHS spending. The very worst thing that could happen to the NHS is if we had a Tory government which would immediately take 1.2 billion pounds and use it to subsidise the private medical insurance of the wealthy few."

The biggest deficit of all was recorded by the North Bristol NHS Trust, at 48.7 million pounds. Royal United Hospitals Bath recorded a deficit of 26.7 million pounds, while Worcestershire Acute Hospitals owed 23.8 million pounds.

Nigel Edwards, of the NHS Confederation, which represents health service managers, said that hospital deficits this year were likely to be higher, but not uniformly. He added that the crisis differed from those in the past, when there was simply not enough money. "This time it is the result of over-expansion, combined with some fierce cost pressures" he said. "Many hospitals have expanded too fast and got ahead of themselves, while others underestimated the cost of the consultants contract."

A spokeswoman for North Bristol NHS Trust said: "This is a historical deficit and a permanent solution is being sought. "In 2003-2004 the trust achieved a break-even position after making savings of 16 million pounds against the previous year's deficit. This year we plan to deliver a savings plan of more than 19 million pounds. Staff have worked extraordinarily hard to deliver these saving. The number of agency staff shifts has been cut to 200 this year, compared with 5,200 in 2002. Five per cent of services in administrative and corporate departments such as human resources have also been cut."

The hospital with the second-largest deficit, Royal United Hospitals Bath, said that it hoped to avoid any cuts to pay off the deficit. "The expectation is that this deficit will not need to be repaid," John Williams, finance director of the trust, said.

From The Times


Patients across Australia are waiting longer than ever for elective surgery, despite governments pouring hundreds of millions of dollars into the hospital system to cut waiting times. The average time to wait for some of the most common procedures, including cataract removal and hip and knee replacements, has lengthened in most states over the past two years. Figures obtained by The Australian show the average waiting time for a knee replacement increased by more than a month in South Australia and the ACT to 160 days and 204 days respectively. Surgeons are calling for the health system to be restructured, warning that more funding alone will not fix the problem. "Governments are trying to make an unworkable system look good," said Don Sheldon, associate professor of surgery at the University of Sydney.

State governments are estimated to have spent more than $240 million in the past two years to cut elective surgery waiting times. The average wait for a total hip replacement blew out from 107 to 132 days in South Australia, 136 to 154 days in the ACT, 48 to 52 days in Queensland and 113 to 127 in Victoria. In New South Wales, almost 17per cent of patients who needed surgery to repair a perforated eardrum waited more than a year; in South Australia, 23 per cent waited more than a year. Health ministers in Tasmania, Western Australia and the Northern Territory would not release the 2003-04 figures. Waiting times improved most significantly in NSW and Victoria. However, the 2003-04 statistics, which will be released in May, reveal that across most states waiting times increased more often than they fell.

Professor Sheldon said operating theatres remained closed and beds lay empty as public hospitals struggled to cope with greater demand for health services. "There's a lot of rearranging of deckchairs on the Titanic, but we need to look at what's causing the problem."

Australian Healthcare Association executive director Prue Power, whose group represents public hospitals, said waiting times would remain lengthy until the system was restructured to allow greater analysis of how money was being spent. The states and territories spend $7.5 billion a year on public hospitals. Modelling by the University of Canberra calculated that giving one tier of government sole responsibility for health would reduce duplication and save $1billion a year, Ms Power said. "While there are two levels of government (that are) funding the health system, they will always blame each other. It's not transparent and there's no way to really track the money." Ms Power said policy makers were underestimating the strain the ageing population had put on public hospitals. "People are living longer and technology is improving so that we can put prostheses into the hips and knees of elderly patients and that obviously increases costs."

University of Adelaide professor of surgery Guy Madden said older patients in particular were waiting longer for elective surgery. "The resources are being dragged into the more urgent areas, and patients waiting for elective surgery to treat degenerative conditions are waiting longer, and they are often older patients," he said. Dr Sheldon said the elderly often needed more expensive treatment than younger patients. "Now you see people in their 90s having open-heart surgery and elderly patients are more likely to end up in intensive care. A bed in intensive care costs $2000 a day to run, compared to about $1000 a day for an ordinary bed in a public hospital." Hospital administrators were trying to treat more patients with fewer resources, he said. "Many smaller hospitals have closed and in some large hospitals you've got 450 beds doing the same work that almost 2000 beds were doing 30 years ago."

Dr Madden said limited access to operating theatres, rather than a shortage of medical staff, had led to the long waiting times. "I think we have the surgical workforce there in the majority of cases, but there is bed block and theatre block. "Some surgeons have only half a day a week access to the operating theatre for elective cases and that's not enough."



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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


Tuesday, March 22, 2005


If socialists took over the Sahara, the old joke goes, there would soon be a shortage of sand. This innate ability to produce shortages shows itself in Europe's present health care situation. More and more people go to see doctors, more and more use drugs and are knowledgeable about health care and yet - instead of clinics and hospitals thriving - national health insurance systems in the European Union are on the verge of financial collapse. They run big deficits, which grow along with the number of patients.

Last month nurses and doctors in many of the public healthcare institutions in Poland went on strike. Radiologists do not want to work longer, nurses want their salary raises paid at last and all protest against the government's new proposal to make hospitals and clinics part of the market economy. But they have already survived several such restructurings, even when they boiled down to putting people out of work without improving the system.

Under the new rule hospitals would not receive state help unless they start to reduce their debts or work out new deals with creditors. Still, since they would be allowed to issue bonds, and take on new debts, the system would not change much. The law, however, has just been rejected in parliament by the opposition. The leader of Civil Platform - one of the opposition parties - explained that the idea of transforming hospitals into companies is just another kind of experiment and the system cannot handle making hospitals comply with simple economic rules.

And the system is this: year after year ineffective public healthcare institutions are running into debts and year after year the state intervenes and with its magic wand makes the hospitals free of their liabilities. Translation: the state makes us all pay the debts of hospitals, preserving a chronically ill public healthcare system. The Ministry of Health explains that the main reason for the growing deficits was that the hospitals and services provided by them were underinvested, that the National Health Fund usually reimburses less than the services are worth. Consequently, the state is responsible for the underinvested services that made hospitals run into debts and left healthcare institutions facing bankruptcy and begging for help.

The Ministry of Health admits that directors of public hospitals usually lack managerial skills and that the public healthcare system is badly organized. The system was allowed to continue, however, leading this year to $2 billion of adjudged liabilities or 0.7 percent of country's GDP, and the adjudged liabilities constitute only about 66 per cent of total debt. The debt was increasing every year, in the period from 2001 to 2004, by about 125 percent on average in comparison with the preceding year. At the same time the number of healthcare institutions without debts was decreasing: at the end of 2001 there were about 44 percent of hospitals without debts, but at the end of 2003 there were only 36 percent. They are in debt mainly to social security, to the providers of drugs and medical equipment and then to their workers......

The situation in France also can give the Polish health minister some cold comfort. It is estimated that by the end of 2004, social health insurance accumulated a $42 billion deficit, about 2.5 percent of French GDP. To "remedy" the situation the French minister of health and social welfare proposes that the deficit be taken over by the National Reimbursement Fund for Social Debt and that future generations will pay off the debt. Furthermore, he proposes to raise social contribution rates, reimburse less per medical contact and make pharmaceutical companies contribute more to the system.

More here


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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


Monday, March 21, 2005


You've actually paid for it in advance. Getting what you paid for is the problem

A letter from the Moncton Hospital to a New Brunswick heart patient in need of an electrocardiogram said the appointment would be in three months. It added: "If the person named on this computer-generated letter is deceased, please accept our sincere apologies." The patient wasn't dead, according to the doctor who showed the letter to The Associated Press on condition of anonymity. But there are many Canadians who claim the long wait for the test and the frigid formality of the letter are indicative of a health system badly in need of emergency care.

Americans who flock to Canada for cheap flu shots often come away impressed at the free and first-class medical care available to Canadians, rich or poor. But tell that to hospital administrators constantly having to cut staff for lack of funds, or to the mother whose teenager was advised she would have to wait up to three years for surgery to repair a torn knee ligament. "It's like somebody's telling you that you can buy this car, and you've paid for the car, but you can't have it right now," said Jane Pelton. Rather than leave daughter Emily in pain and a knee brace, the Ottawa family opted to pay $3,300 for arthroscopic surgery at a private clinic in Vancouver, with no help from the government. "Every day we're paying for health care, yet when we go to access it, it's just not there," said Pelton.

The average Canadian family pays about 48 percent of its income in taxes each year, partly to fund the health care system. Rates vary from province to province, but Ontario, the most populous, spends roughly 40 percent of every tax dollar on health care, according to the Canadian Taxpayers Federation. The system is going broke, says the federation, which campaigns for tax reform and private enterprise in health care. It calculates that at present rates, Ontario will be spending 85 percent of its budget on health care by 2035. "We can't afford a state monopoly on health care anymore," says Tasha Kheiriddin, Ontario director of the federation. "We have to examine private alternatives as well."

The federal government and virtually every province acknowledge there's a crisis: a lack of physicians and nurses, state-of-the-art equipment and funding. In Ontario, more than 10,000 nurses and hospital workers are facing layoffs over the next two years unless the provincial government boosts funding, says the Ontario Hospital Association, which represents health care providers in the province.

In 1984 Parliament passed the Canada Health Act, which affirmed the federal government's commitment to provide mostly free health care to all, including the 200,000 immigrants arriving each year. The system is called Medicare (no relation to Medicare in the United States). Despite the financial burden, Canadians value their Medicare as a marker of egalitarianism and independent identity that sets their country apart from the United States, where some 45 million Americans lack health insurance. Raisa Deber, a professor of health policy at the University of Toronto, believes Canada's system is one of the world's fairest. "Canadians are very proud of the fact that if they need care, they will get care," she said. Of the United States, she said: "I don't understand how they got to this worship of markets, to the extent that they're perfectly happy that some people don't get the health care that they need."

Canada does not have fully nationalized health care; its doctors are in private practice and send their bills to the government for reimbursement. "That doctor doesn't have to worry about how you're going to pay the bill," said Deber. "He knows that his bill will be paid, so there's absolutely nothing to stop any doctor from treating anyone." Deber acknowledges problems in the system, but believes most Canadians get the care they need. She said the federal government should attach more strings to its annual lump-sum allocations to the provinces so that tax dollars are better spent on preventive care and improvements in working conditions for health-care professionals.

In Alberta, a conservative province where pressure for private clinics and insurance is strong, a nonprofit organization called Friends of Medicare has sprung to the system's defense. It points up the inequities in U.S. health care and calls the Canada's "the most moral and the most cost-effective health care system there is in the world." "Is your sick grandchild more deserving of help than your neighbor's grandchild?" It asks. Yes, says Dr. Brian Day, if that grandchild needs urgent care and can't get it at a government-funded hospital. Day, an English-born arthroscopic surgeon, founded Cambie Surgery Center in Vancouver, British Columbia - another province where private surgeries are making inroads. He is also former president of the Arthroscopy Association of North America in Orlando, Fla. He says he got so frustrated at the long delays to book surgeries at the public hospitals in Vancouver that he built his own private clinic. A leading advocate for reform, he testified last June before the Supreme Court in a landmark appeal against a Quebec ruling upholding limits on private care and insurance.

George Zeliotis told the court he suffered pain and became addicted to painkillers during a yearlong wait for hip replacement surgery, and should have been allowed to pay for faster service. His physician, Dr. Jacques Chaoulli, said his patient's constitutional rights were violated because Quebec couldn't provide the care he needed, but didn't offer him the option of getting it privately. A ruling on the case is expected any time. If Zeliotis had been from the United States, China or neighboring Ontario -- anywhere, in fact, except Quebec -- he could have bought treatment in a private Quebec clinic. That's one way the system discourages the spread of private medicine - by limiting it to nonresidents.

But it can have curious results, says Day. He tells of a patient who was informed by Ontario officials that since Ontario couldn't help him, they would spend $35,000 to send him to the United States for surgery. Day said his Vancouver clinic could have done it for $12,000 but the Ontario officials "do not philosophically support sending an individual to a nongovernment clinic in Canada."

Canadians can buy insurance for dental and eye care, physical and chiropractic therapy, long-term nursing and prescriptions, among other services. But according to experts on both sides of the debate, Canada and North Korea are the only countries with laws banning the purchase of insurance for hospitalization or surgery. Meanwhile, the average wait for surgical or specialist treatment is nearly 18 weeks, up from 9.3 weeks in 1993, according to the Fraser Institute, a right-wing public policy think tank in Vancouver. A Fraser study last year said the average wait for an orthopedic surgeon was more than nine months.

Prime Minister Paul Martin's Liberal government has pledged $33.3 billion in new funding to improve health in all provinces and territories over the next 10 years. But critics aren't impressed. "It won't make a difference," said Sally C. Pipes, a Canadian who heads the conservative Pacific Research Institute in San Francisco. "They need to break the system down, or open the system up to competition." Pipes is a big supporter of the Bush administration proposal to allow Americans to divert some of their payroll taxes into medical savings accounts. She claims the two-tiered system feared by Canadian liberals already exists because those with connections jump to the head of the medical queue and those who can afford it can get treated in the United States. "These are not wealthy people; these are people who are in pain," said Pipes.

Another watershed lawsuit was filed last year against 12 Quebec hospitals on behalf of 10,000 breast-cancer patients in Quebec who had to wait more than eight weeks for radiation therapy during a period dating to October 1997. One woman went to Turkey for treatment. Another, Johanne Lavoie, was among several sent to the United States. Diagnosed with invasive breast cancer in 1999, she traveled every week with her 5-year-old son to Vermont, a four-hour bus ride. "It was an inhuman thing to live through," Lavoie told Toronto's Globe and Mail.

"This is the first time someone has decided to attack the source of problems - the waiting list," said Montreal attorney Michel Savonitto, who is representing the cancer victims. "We're lucky to have the system we do in Canada," he told the court. "But if we want to supply proper care and commit to doing it, then we can't do it halfway."

An estimated 4 million of Canada's 33 million people don't have family physicians and more than 1 million are on waiting lists for treatment, according to the Canadian Medical Association. Meanwhile, some 200 physicians head to the United States each year, attracted by lower taxes and better working conditions. Canada has 2.1 physicians per 1,000 people, while Belgium has 3.9, according to the Organization for Economic Cooperation and Development. The World Health Organization in 2000 ranked France's health system as the best, followed by Italy, Spain, Oman and Australia. Canada came in 30th and the United States 37th.

Alberta Premier Ralph Klein is pushing what he calls "the third way" - a fusion of Canadian Medicare and the system in France and many other nations, where residents can supplement their government-funded health care with private insurance and services. But some Canadians worry even partial privatization would be damaging. "My concern is that the private clinics would only serve to further drain the scarce physician resources that we already have," said Dr. Saralaine Johnstone, a 31-year-old family physician in Geraldton, a papermill hamlet in northern Ontario. "We first need to guarantee that everybody has access to quality health care," she said, "and we just don't have that."



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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


Sunday, March 20, 2005


The Ohio State Medical Association (OSMA) Frivolous Lawsuit Committee scored a major victory on behalf of Ohio physicians recently when a Stark County judge formally sanctioned a trial attorney for filing a frivolous lawsuit against a Canton-area physician. The judge also ordered the trial attorney to pay $6,000 to the physician as reimbursement for legal expenses incurred as a result of the frivolous suit. "We are very pleased with the positive ruling in this case," said Almeta E. Cooper, OSMA general counsel and advisor to OSMA's Frivolous Lawsuit Committee, which was instrumental in filing the "motion for sanctions" against trial attorney Catherine Little. "Physicians support the patient's right to seek compensation if they are wrongly injured. But when physicians are needlessly and carelessly named as defendants in a lawsuit, then that is clearly an abuse of the judicial system." The OSMA Frivolous Lawsuit Committee is believed to be the first of its kind in the nation.

The case centers on a medical liability lawsuit filed against Dr. Zev Maycon by Little and her client, Benjamin Barbato. In the suit, Barbato claimed unnecessary severe physical, mental and emotional pain and suffering resulting from a perforated colon caused by a surgical procedure that Dr. Maycon did not even perform. In his written opinion, Judge Roger G. Lile found that Little willfully violated a state court rule, known as Rule 11, that bars baseless court filings. Specifically, Lile found that Little's own physician expert witness did not offer any statement or opinion that Dr. Maycon's treatment of Barbato failed to meet the prevailing standard of medical care. In addition, Lile noted that when Dr. Maycon's attorney asked Little to drop Dr. Maycon from the suit because of the lack of evidence, Little "advised not in terms of evidence, but rather in terms of the lack of an offer of money, which would be the basis of Dr. Maycon's release from litigation." "Such a response," Judge Lile continued, "is clearly frivolous under (Ohio law) as is the retention of Dr. Maycon in this case."

OSMA created the Frivolous Lawsuit Committee in 2004 to identify potential cases in which physicians could seek judicial relief against trial attorneys who file frivolous suits, which all available actuarial evidence shows is one of the primary drivers behind soaring liability insurance premiums for physicians. To date, the OSMA Frivolous Lawsuit Committee has reviewed more than 111 cases submitted by Ohio physicians who believe that they are the victims of a frivolous lawsuit. Lile's ruling is currently being appealed.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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


Saturday, March 19, 2005


The good cheer of the writer below amazes me after the enormous damage that has been done to her by MRSA -- something not found in British private hospitals

You thought it was difficult to get into an NHS bed? Try getting out when the bureaucrats say no. In my own case you might have thought they would urge me to be gone, for I was a bad patient. Normally I have a high pain threshold, but that Monday as I came round from the general anaesthetic the pain was sensational and I took it personally. Returned to my ward, the curtains drawn around my bay, I heard the sounds of a nearby patient being prepared to be wheeled to the operating theatre. I also heard a woman shouting ‘Do not let Dr Mooney operate on you. Dr Mooney is a bad doctor.’ Dr Mooney was the surgeon who had just operated on me. The woman shouting these denigrations was, I realised, myself. ‘Do not let Dr Mooney touch you,’ I yelled. ‘Dr Mooney is known for the dreadful pain he causes!’

The staff nurse jerked my curtains open and flounced in. Perhaps she didn’t know that patients coming out of general anaesthetic can be distinctly queer in the head. In any case, she and I were soon screaming at one another. From then on, it was war. As I became more conscious I called for morphine. She said it was too soon for me to have more morphine. ‘You will become addicted.’ ‘Everyone except nurses knows,’ I informed the ward at the top of my voice, ‘that you rarely become addicted when morphine is dealing with pain.’

I was desperate to go home. On Friday my consultant sauntered in, surrounded by his adoring team. I am in love with my consultant. Second only to God, he is the most eminent surgeon in his field, eccentric, with a camp sense of humour. ‘You can go home today,’ he said, winked and moved on.

Overjoyed, I began to gather up my things to put in my bag. I can walk only with sticks, so I can’t carry my own bag. Six years ago I had a hip replacement, legacy of a riding accident, in this same hospital (‘flagship of the NHS’). Along with the replacement, the vile MRSA was planted deep in my thigh bone. Three separate replacements were destroyed by the infection before the doctors concluded that I had MRSA — ‘a surgeon’s nightmare’. Well, yes. Also a patient’s catastrophe. With one leg four-and-a-half inches shorter than the other, I found that being crippled put paid to my forte of flying around the world to interview heads of state and suchlike.

The staff nurse appeared. ‘You cannot leave until Monday.’

‘Where is the professor? He told me I can go home today.’

‘He has left the ward.’

At this moment my friend Lady Jane appeared, bearing a basket of smoked salmon and buttered brown bread and red grapes. ‘The hospital won’t let me leave until Monday,’ I told her. ‘Everybody knows that nothing happens in hospital at the weekend. They just don’t want to be bothered with the paperwork on a Friday.’ ‘My driver is parked outside,’ said Jane. ‘Where are your shoes?’ Fifteen minutes later we were in the ward’s reception area.

A woman who looked like a pig and was not in uniform appeared to be the bureaucrat in charge. ‘You cannot leave the hospital until Monday,’ she said. ‘Mrs Crosland’s consultant told her she can go home today,’ Jane replied politely.

‘That will not be possible. She is taking a dangerous drug, and her papers will not be ready until Monday.’

‘I shall be responsible for Mrs Crosland,’ said Jane. ‘I’ll see that a nurse stays with her and administers her drugs.’

A charming Asian in a special nurse’s uniform now appeared. She said she would speak to my consultant. Five minutes later she was back. ‘He says that’s fine.’ The bureaucrat looked deeply aggrieved. ‘That’s not very nice,’ she said.

Soon, however, something strange happened: in defeat, the bureaucrat changed personality and became a human being. She didn’t even look like a pig any more. What is more, she called for a wheelchair. Jane pushed me to the front door. Freedom! My incarceration by the NHS was over".



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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


Friday, March 18, 2005


A 94-YEAR-OLD woman drowned herself in a harbour because she could not bear returning to hospital, her family said yesterday. Alice Weeks had been suffering extreme pain with an inflamed gall bladder, but was frightened of attending hospital again. Relatives said the widow's fear stemmed from her last visit, when a female patient, thought to have had psychiatric problems, repeatedly woke her up in the night by standing over her bed and staring at her.

Mrs Weeks, who lived alone, walked out of her home in Poole, Dorset, last Friday evening using her Zimmer frame and walking stick. A couple having dinner in the Quay Thistle Hotel noticed her walking behind a shed by the Fisherman's Dock on Poole Quay at around 8pm.

She is thought to have jumped into the water shortly afterwards, but her body was not found until it was spotted by a fisherman the next morning. Her Zimmer frame and walking stick were found neatly left behind the shed. A post-mortem examination revealed that she had died of drowning. It also showed that she had an inflamed gall bladder, which would have caused extreme pain.

Marian Wood, her daughter, and Grace Collins, her niece, believe that the frightening experience during her earlier stay in Poole hospital in January had put her off returning. She felt particularly vulnerable because she had to take her hearing aid out at night and would be woken up with a start by the patient looming over her bed. Mrs Wood said: "Despite the pain she was in, she had been put off returning to Poole hospital because of this frightening experience that happened to her in January.....

A spokesman for Poole General Hospital said that an investigation was under way. He added: "We were not aware of this incident in January while she was staying at the hospital, otherwise we would have reassured her."

More here


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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Thursday, March 17, 2005


Five thousand people a year in England and Wales may be dying unecessarily because of failings in treating strokes. The estimate from the Stroke Association, is based on the latest survey of stroke treatment published yesterday, which shows that some hospitals continue to deliver “lamentable care”. Overall, the audit shows some improvements, with more stroke units and higher scores for most key indicators of care. But treatment for the third most common cause of death, and leading cause of disability, still lags behind other developed countries. “There are huge problems in the delivery of stroke care,” said Dr Tony Rudd, president of the British Association of Stroke Physicians. “Even though 40 per cent of patients are now being treated in stroke units, they are still not being treated as a medical emergency. More than 40 per cent of patients who need an urgent scan aren’t getting it. Even in stroke units, a third of patients don’t have their swallowing reflex checked. Half the people who have a stroke will have lost the ability to swallow. “If this isn’t checked and they are given their tea and cornflakes for breakfast, it’s going to end in pneumonia.”

The National Sentinal Audit for Stroke is funded by the Health Commission and carried out by the Royal College of Physicians. The first was in 1998, and this is the fourth, which is based on returns from all hospitals in England, Wales and Northern Ireland in April last year. The audit found that 82 per cent of hospitals in England now had a stroke unit, compared with 74 per cent in 2001. This is the first audit to cover every NHS trust. They were given a score, out of a maximum of 100, for their adherence to 12 basic standards such as time spent in a specialist stroke unit, access to emergency brain scans and rehabilitation services.

The best performing hospitals were North Wiltshire and Devizes Area Stroke Unit and London’s Royal Free Hampstead NHS Trust, which both scored 93 in the audit. Bottom were the Grantham and District Hospital, with 25, and the Royal Oldham Hospital at 27.

The audit found only marginal improvements in rehabilitation services since 2001. The percentage of patients receiving a physiotherapy assessment within 72 hours of admission to hospital increased from 59 per cent to 63 per cent. Patient assessment by an occupational therapist within seven days increased from 51 per cent to 57 per cent.



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.

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Wednesday, March 16, 2005


Casualty departments have revealed that they are jeopardising patient care and deliberately distorting official waiting times in a desperate effort to meet government targets. Eight out of ten accident and emergency units admit that they discharge patients too soon, give them sub-standard care or send them to the wrong wards to deal with them within the four-hour target.

Today’s major survey by the British Medical Association also casts serious doubt on the accuracy of government statistics on A&E waiting times. Three-quarters of hospitals say that they use a range of tactics during monitoring periods to manipulate the figures. Half say that extra staff have been brought in during weeks in which monitoring takes place, while a quarter admitted that non-emergency surgery was cancelled. One in six hospitals even resorts to the “direct manipulation of the data” to make it appear that they have met the A&E target.

The news turns the spotlight on government claims about NHS improvements, pushing health to the top of the election agenda. It also comes the day after Tony Blair was publicly criticised by a gynaecologist who told him that target-setting in A&E was “actually jeopardising patient care”. Amara Sohail from Basingstoke said: “As someone working within the system, we don’t see more money coming in. Targets don’t work.” She said that the pressure on emergency medical staff would lead to “serious mistakes”.

Mr Blair told her: “If you went back a few years, I think most people would say that accident and emergency departments are a lot better than they were.” He added that he was prepared to look again at the issue of A&E waiting times to ensure that they were “sufficiently flexible”.

The target — that 98 per cent of patients be seen, treated, admitted or discharged within four hours — is due to come into force at the end of this month. The Government says that by the end of last year 96.8 per cent of patients were being seen within this time. But the survey backs data collected from patients by the Healthcare Commission, which also suggested that targets were far from being achieved.

The claim has met with an angry response from the Government. John Hutton, the Health Minister, said it gave “a deliberately distorted picture of the changes that have taken place in A&E departments”. He went on: “Chief executives of NHS trusts are responsible for signing off their performance data. If any doctors have concerns about patient care or fiddling of figures, they have a clinical duty to take them up with their medical director or chief executive or, failing that, with their strategic health authority or the Department of Health. To date we have received no formal complaints.”

The survey was sent to all 200 A&E departments in England, and 163 of them replied. Of the half that said they had failed to meet the Government’s 97 per cent end-of-year target, most cited a lack of beds, delays in accessing specialist opinion or diagnostic services and staff shortages.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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


Tuesday, March 15, 2005


The rapid advance of medical science over the past century means patients now have more therapies available to them than ever before. Historically, patients relied on physicians to provide them with information about medical developments. With the arrival of managed care in the 1970s, physicians have seen their caseloads rise. According to an article in the May 2004 Journal of the American Medical Association, physicians spend less than one minute discussing treatment during a 20-minute office visit, on average. About half the time, doctors fail to ask patients whether they have any questions about what has been discussed during the visit. As doctors become more hurried, they have less time for patient education. Patients are finding it increasingly necessary to take matters into their own hands.

The Internet gives patients a powerful new tool with which to educate themselves and manage their health care needs. Many Web sites provide clinical information and resources directly to patients. These include sites dedicated to providing information on treatment alternatives, clinical trials, and prescription drugs, as well as resources for patients afflicted with specific diseases. A few hours on the Internet can substitute for a face-to-face education that would be costly for a patient. Recent reports, including a January 26, 2004, article in American Medical News, suggest it may actually save the doctor valuable time when patients inform themselves before an office visit.

Another trend that may explain consumers' interest in health information is the rise of consumer-driven health care plans. The heath insurance company Aetna, for example, found enrollees in its health reimbursement arrangement (called HealthFund) were more likely to use the Internet to manage their own care. A February 2004 study found HealthFund enrollees used HealthWise (an Internet health information Web service) twice as often as the control group, and the health information Web site InteliHealth 48 percent more often. HealthFund enrollees also searched formularies for drug price information almost twice as often as the control group.....

Home pregnancy tests are so common they are sold in pharmacies, grocery stores, and even inexpensive dollar stores. Ovulation predictor tests and tests for menopause, cholesterol, and other conditions also are widely available. For about $50, parents can buy an EarCheck Middle Ear Monitor that uses sonar to check for fluid behind the eardrum, which may indicate an ear infection. One of the most common reasons kids see a doctor, ear infections account for 20 million office visits annually in the United States. Likewise, kids often develop sore throats that don't require a physician visit. Families can buy a QuickVue Strep Test for about $90, providing 25 tests. The simple test differentiates strep infections, which require a physician visit, from viral infections, which do not.

Why do patients value having more knowledge about what ails them without having to run to the doctor's office? Probably so they can make better decisions about which symptoms require consultations and which they can treat themselves.....

More here:


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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


Monday, March 14, 2005


The purpose of Sally Pipes' new book, the author says, is "to provide the reader with an easy-to-understand guide" to the problems of affordability, accessibility, and quality of health care in the United States and Canada. Miracle Cure: How to Solve America's Health Care Crisis and Why Canada Isn't the Answer seeks out the best approach to solving the complex problem of health care reform while simultaneously preserving the positive attributes of each country's health care system.....

In Miracle Cure, Pipes convincingly demonstrates that although the American and Canadian systems appear to differ dramatically, "they both suffer from symptoms of the same disease--the disease of central control." In the foreword, economist Milton Friedman, a senior research fellow at the Hoover Institution, states, "What should be mutually satisfactory cooperation between patient and physician turns all too often into a bureaucratic nightmare."

Each chapter presents information the general public rarely receives from media sources. "One of the best-kept secrets," writes Pipes, "at least from the media and policymakers who continually talk of a drug cost 'crisis' for low-income seniors, is that there are already programs, both sponsored by governments and private companies, that significantly subsidize this group's purchases of prescription drugs." According to Pipes, "Nearly 20% of seniors, the poorest one in five, were receiving highly subsidized prescription drugs [through state-sponsored or private-sponsored plans for seniors]. An administrative fee of $12 purchases a month's supply of any Eli Lilly and Co. product for lower income seniors or disabled. ... The same is true for Novartis Products [and] Pfizer."

The chapters on consumer-driven health care clearly describe the potential tangible and intangible benefits of health savings accounts (HSAs) and health reimbursement arrangements (HRAs). "HSA plans combine a high-deductible insurance policy with a tax-free savings account dedicated to paying for expenses below the insurance deductible," explains Pipes. Authorized in late 2003 by the Medicare Modernization Act, these plans will soon be widely available to taxpaying citizens under age 65 and may be extended to everyone in the relatively near future, offering cost constraints motivated by preservation of personal savings and implemented by enhancement of the patient-physician relationship. In addition, they avoid the austerity seemingly implied by the term "high-deductible" health insurance.

Part Two of the book, "The Canadian Solution: Legalize Competition," notes that in Canada, the sole third-party payer is the government. "Canada is the only Western country in which private insurance for publicly insured procedures is actually outlawed," notes Pipes. The federal and provincial governments jointly administer the Canadian health care system, called "Medicare." Over time, power in the system has shifted gradually to the federal government, because it controls the funds......

In the conclusion of the book, she writes, "The greatest risk to both systems is not that they will go bankrupt. It is that they will come to see human beings as nothing but cost centers. ... We will lose more than access, affordability, and quality in health care. We will lose our humanity."

More here


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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