Wednesday, April 12, 2006


Leading academics called yesterday for a formal audit of the National Health Service’s 6.2 billion pound IT scheme over fears that it is behind schedule, over budget and not secure. In a letter to the Commons Health Select Committee, 23 professors raised questions about the system, its progress and whether it will work.

The concerns were brushed aside by the Department of Health but are an index of growing doubts about the system, called Connecting for Health, which is designed to allow instant access to patient records and for patients to make appointments with consultants online from GP surgeries. The letter, reported in Computer Weekly, amounts to the most heavyweight challenge yet to the programme, announced four years ago by the Prime Minister. Connecting for Health, previously known as the National Programme for Information Technology (NPfIT), will link more than 30,000 GPs in England to 300 hospitals by 2012. It involves an online booking system, a centralised medical records system for 50 million patients, e-prescriptions and fast computer network links between NHS organisations.

The academics’ letter, signed by professors from Oxford, Cambridge, the London School of Economics, Edinburgh, Birmingham, York and many other departments, says that the project has been managed in a secretive way. “Concrete, objective information about NPfIT’s progress is not available to external observers,” it says. “Reliable sources within NPfIT have raised concerns about the technology. We suggest an assessment should ask challenging questions and issue concrete recommendations.”

Concerns have been heightened by a delayed report from the National Audit Office, that was expected last summer and will not be published until this summer at the earliest. “My instinct is that had they had anything good to say about it it would not have been delayed so long,” said Martyn Thomas, a computer consultant and a visiting professor at Oxford University, who is one of the signatories. “In this case there has been a lot of pressure and a political timetable set by ministers from outside. There has not been enough scrutiny.” He said that the UK Computing Research Committee, an 80-strong expert group, had offered to help, but nobody from NPfIT had been interested in talking to them.

The Department of Health responded: “The National Programme for IT is under constant review, scrutiny and audit by Parliament and government bodies. We remain confident that the technical architecture is appropriate and will enable benefits to be delivered for patients, whilst ensuring value for money to the taxpayer.”



Massachusetts politicians just built the healthcare McMansion of their dreams. Now, where do they get the money to underwrite the mortgage? Like many a thrilled new homeowner, they're not sure. Governor Mitt Romney, legislative leaders, and healthcare lobbyists are congratulating one another and basking in favorable media reaction. At the same time, they hope there is enough money to cover commitments made in this sweeping healthcare package -- especially the commitment to extend health insurance coverage to 95 percent of the population within three years.

But to some degree, the foundation for this plan is a mixture of euphoria and hope. And that's not enough. ''If Massachusetts is the national leader in setting up a new healthcare model, we have an extra-special responsibility to be sure that what we legislate will stand the test of financial scrutiny," said Ellen Lutch Bender, a longtime healthcare analyst.

Even some unabashed supporters of the package have their doubts: ''This is cutting-edge conceptual healthcare policy," said Democratic state Representative Harriett L. Stanley of West Newbury, a member of the legislative healthcare financing committee who voted for the measure. ''But we don't yet know what it's really going to cost us or where we're going to get the money from. To some extent you might call it a Hail Mary pass."

After a State House rally to celebrate passage of the legislation, John McDonough, a former state legislator who heads the advocacy group HealthCare For All, declared this package ''good enough for now." But, he, too, acknowledged, ''There are questions about the financial stability. The financing is plausible, but it could go awry." On his blog, which provides daily, informative analysis of the ups and downs of the healthcare bill, McDonough lists these concerns: ''The level of employer responsibility is minimal and does not come close to the cost borne by employers who do cover their workers; the bill leaves in place the unfair $160 million assessment on employers who do cover their workers; the individual mandate does not define clear affordability for when workers would be penalized. This will be a vitally important standard moving forward." As Judith Meredith, another healthcare advocate who celebrated passage of the legislation, said: ''The funding part worries us all."

The cost of extending health insurance coverage to an additional 515,000 people will be shared by business, individuals, and the government. Businesses with more than 10 workers that do not provide insurance will be assessed up to $295 per employee per year. Individuals who can afford insurance but don't have it are subject to state income tax penalties. And government subsidies will help poor families.

The state contribution -- coming from the Massachusetts General Fund -- is pegged at $58 million for the first year; it increases to $125 million for each of the next two years. Meanwhile, the so-called free-care pool stands to remain in the $500 million to $800 million range for at least the next three years -- and maybe longer, some healthcare specialists predict.

The expectation is that revenue generated from the business assessment and individual mandate compelling people who are uninsured to get insurance will reduce the cost of free care. But what if the projected cost-shifting doesn't play out as predicted? ''One of the stated goals was to decrease dependency on the free-care pool. Whether there will actually be a decrease in funding for the free-care pool has not been adequately answered," said Representative Jeffrey D. Perry of Barnstable, a Republican and one of only two House members who voted against the healthcare bill.

If the financing mechanism behind this conceptually-impressive legislation turns out to be inadequate, who will suffer? The hospitals and insurers will get their money. But, if the money runs out, the poor won't get the insurance coverage that makes this proposal worthy of so much excitement and media attention. ''The only redeeming part of the bill is that it says it will provide absolute coverage for the very poorest citizens. If there isn't enough money to meet those obligations, then what?" noted Secretary of State William Galvin, a critic of other aspects of this package.

This legislation pegs Massachusetts as a healthcare innovator. It may look like the most beautiful piece of property on the block. But, until the inspector declares the foundation sturdy, the acquisition may not be worth the purchase price.



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?

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