INAPPROPRIATE NHS HOSPITALS

Billions of pounds are being spent on hospitals for the NHS that will not be suitable for the planned new patterns of care. A new report claims that the NHS could be left with “white elephants” — huge hospitals that will take 30 years to pay off, when the future of healthcare lies with smaller, more flexible units closer to where people live. The report says that awareness of this in the Department of Health has brought capital investment of all kinds to a shuddering halt just as new policies are changing the ways in which care will be delivered. Opportunities for investing in appropriate new buildings are likely to be missed as the system lurches into the stop part of a “stop-go” cycle.

The report, whose lead author is Professor Nick Bosanquet, of Imperial College, is published by Reform, the market-oriented think-tank that was the first to predict the NHS funding crisis and the need to cut jobs. Reform backs the Government’s health initiatives, such as payment by results, patient choice and the White Paper Our Health, Our Care, Our Say, which seeks to move more care away from hospitals and into primary care, but its report, Investment in the NHS, gives warning that the NHS has spent the past decade building over-large and expensive units and now faces a freeze on the kind of investment that can lead to service improvement.

The evidence that investment has stopped comes from the NHS accounts, which show that there was an underspend of 1.2 billion last year on the capital account, double the level of 2004-05. The report predicts that the current financial year will also show a large underspend. The first large NHS acute hospital to have a self-contained single room for every patient is being planned, with managers predicting a reduced incidence of MRSA, speedier recoveries and cost savings. Pembury Hospital, in Kent, will be demolished and rebuilt for 330 million pounds.

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INDIAN UPDATE

I mentioned a month ago that Blue Ridge were considering this. It seems they have now gone ahead. Sad when health costs could send a business broke

Don't look now, but that operation you've been putting off may be outsourced - to India. American companies are encouraging workers to travel to India and other countries for costly medical procedures, Business Insurance magazine reports. "It saves you literally tens of thousands of dollars," said Bonnie Blackley, benefits director at Canton, N.C.-based Blue Ridge Paper Products. A heart valve replacement, for example, that runs between $68,000 and $198,000 in the United States costs only $18,000 in India.

Blackley said that although her company's survival depended on keeping medical costs in check, local health care providers "offered no extra discount or anything." So she contracted with IndUShealth, a "medical tourism" company that specializes in arranging employee travel to accredited hospitals and board-certified physicians in India.

Because of lower labor costs, India, Thailand, Singapore, Mexico and Costa Rica could pose some stiff competition for U.S. medical providers. "We've globalized every other industry. Why not health care?" said Ted Nussbaum, director of North American health care consulting at Watson Wyatt Worldwide in Stamford, Conn.

But Chuck Kelley, medical director at Outrigger Enterprises Inc. in Honolulu, told the magazine it will be hard to persuade employees to travel abroad for medical care. "Health care treatment is a very personal issue for Americans, and when they are sick, they want to be close to their family and in the care of providers they know and trust - even if they are not the best," Kelley said. "They will settle for inferior and more expensive treatment to be home."

Companies like Blue Ridge plan to give their employees a financial incentive to go abroad by offering to cover them and their dependents for any out-of-pocket costs.

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

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