SOCIALIZED MEDICINE

GLOOMY OUTLOOK FOR BRITAIN'S ELDERLY

What kind of world is it where a fifth of adults expect to continue working long after retirement and the most popular towns are rated by the length of their waiting lists for hip operations? This is not some make-believe, Alice-in-Wonderland world, but Britain in 2006, as experienced by pensioners and revealed by two new surveys. Coming after a report from three NHS watchdogs that concluded that older people were subjected to entrenched ageism and to "patronising and thoughtless" attitudes, the latest research raises the uncomfortable question: is this really all there is?

Ten per cent of retired people work part-time for an average of 14 hours per week to supplement their income. But with an estimated pensions gap of 57 billion pounds, this figure is set to increase dramatically, according to a survey of 500 people, both working and retired, by insurer GE Life. Almost one in five people believe that they will need to continue working part-time once they retire - double the number of those currently retired. With the average pension fund producing an income of just 4,381 pounds a year, many retired people admit that they could have planned better. A third said that they were financially unprepared, while a similar proportion were unsure how they would survive the rest of their retirement. More than half of people nearing retirement said they wished that they had started saving earlier.

It is not all doom and gloom, though, at least not if your idea of fun is a gentle promenade along a pier and easy access to affordable car parking. Southend-on-Sea in Essex is the best place to retire, according to a separate study by Yours magazine. The title, aimed at the over 50s, ranked 60 retirement destinations in Britain, taking into account factors such as house prices, council tax, shopping facilities, crime rates, hospital waiting times, the availability of NHS dentists and the weather. Southend was ranked top because it is relatively flat with a pedestrianised centre, its council tax is almost 100 pounds lower than the average, and it has a low rate of crime. It is also has seven miles of beaches, the world's longest pier, and more than 80 parks and open spaces.

Poole in Dorset came second, thanks to its natural harbour, good shops, farmers' market and affordable parking. The waiting time for a hip replacement in the town is also only 84 days, compared with a national average of 128 days. Whitehaven in Cumbria was third, with below average waiting times for a hip replacement and house prices nearly half the national average

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Call to shut hopelessly bureaucratized childrens' hospitals in Queensland, Australia

The Beattie Government is again under fire over its management of the Queensland public hospital system after a damning report called for the closure of two major children's hospitals. A medical panel commissioned by Queensland Health to review pediatric cardiac services has recommended replacing Brisbane's Mater Children's Hospital and the Royal Children's Hospital with a single new hospital. The panel also proposed pediatric services at the Prince Charles Hospital, on Brisbane's north side, be shut down.

Following a series of post-surgery and cardiac deaths, the report found the hospitals were plagued by chronic understaffing, dysfunctional governance and low morale. Its findings were revealed as Premier Peter Beattie ruled out means-testing patients or increasing co-payments for public hospitals, based on the findings of a separate report that explored other possible revenue streams for a system reeling after the "Dr Death" scandal.

Health Minister Stephen Robertson said he would have to consult more widely before shutting any children's hospitals. Admitting he was surprised by the report's findings, Mr Robertson said a single stand-alone hospital could cost the Government about $500 million. The Government yesterday established a taskforce to assess the report's proposals. "This is a big recommendation with big implications for the three hospitals involved and for the public health system's staffing, capital and budget," Mr Robertson said. A proposal to build a single children's hospital in Brisbane was raised under the Goss Labor government in 1994 but rejected.

The latest report found it was "simply impossible" to adequately staff the three existing pediatric units. "It is abundantly clear that systems and arrangements, which had been satisfactory in the past, are no longer able to meet current expectations and standards," the report says. "The service is characterised by chronic understaffing, dysfunctional governance, lack of infrastructure, lack of clinical leadership and unsympathetic line managers regarding specific pediatric needs. "With few exceptions, morale is poor, ranging through frustration and anger to cynicism, hopelessness and despair." The report found no evidence of professional incompetence or negligence among the clinicians.

Opposition Leader Lawrence Springborg said the report was an "a solid vote of no confidence in administration of health in Queensland". "If it wasn't bad enough before now, it's the kids that are suffering under this Government," he said.

Despite the hospital woes, the Government will forgo about $115 million in additional revenue for the health system after an analysis by the Allen Consulting Group found there would be inadequate financial gains from means-testing or increasing patient co-payments. But Mr Robertson refused to rule out the possibility of raising extra revenue by increasing co-payments from people receiving injury compensations payouts.

Mr Springborg said: "Victims who have taken themselves through the court process and have got compensation payments may be subjected to the Government recovering against them."

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

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

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BRITAIN SQUEEZING OUT PUBLIC HEALTH DOCTORS!

"Prevention is better than cure" must be too hard an idea for socialists

Public health is facing severe staff shortages as fewer doctors enter the specialty. Despite ambitious targets set in a White Paper in 2004, the number of public health specialists is falling. A survey by the Faculty of Public Health published today finds that there are 22 per cent fewer consultants in public health than there were in 2003.

In some areas there is little confidence that there are enough do the job. In England only 36 per cent of primary care trusts (PCTs) believe that they have sufficient capacity to deliver public health effectively - and in the East Midlands, the worst-affected area, the figure falls to only 21 per cent. Northern Ireland, Scotland and Wales are less seriously affected but over the country as a whole only 45 per cent of respondents said their team had adequate or more than adequate capability. The numbers entering the specialty are also falling, with planned recruitment for this year running 40 per cent lower than last year.

In addition, the latest restructuring of the NHS, which envisages merging PCTs and strategic health authorities, could result in the loss of up to 150 more senior positions. Professor Selena Gray, who wrote the report, said: "It demonstrates the urgent need for clear human resources guidance that protects consultants in public health during this next re-organisation and for increased resources for training."

Chris Lovitt, chairman of the Faculty of Public Health's trainee members' committee, says: "The planned massive cuts in recruitment numbers must be reversed if the future of public health is to be secured."

Public health's aim is to improve the health of the whole population by education, monitoring disease, reducing inequalities and controlling hazards, and it has been a neglected area since the Department of Health focused all its efforts on the NHS.

Justin Varney, of the British Medical Association's public health committee, said: "It is recklessly shortsighted to squeeze public health training - the very specialty that must expand to tackle the health gap between the best and worst off. In any outbreak of infectious disease or emergency, public health doctors play a key role."

Babies born in some parts of England are eight times more likely to die before their first birthday than those in other areas, according to the baby charity Bliss. The infant mortality rate in central Birmingham is 12.4 per 1,000 live births, against 1.5 in East Elmbridge and Mid-Surrey. Bliss says that the figures, taken from every primary care trust in England, show that babies in large cities in the North West and Midlands fare worst and suburban areas in the South East do best. The national average for deaths in the first year of life is 5.2 per 1,000.

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Patients vs. Paternalism

Sad truth: If a drug has no side effects it will probably have no main effects either

Decisions about drug safety and efficacy are far from easy. Tysabri, a multiple sclerosis (MS) drug that was voluntarily withdrawn from the market last year after the appearance of a previously unknown side effect, illustrates some of the conundrums that exist in drug treatment. In advance of the publication of three critical new studies on Tysabri in the current issue of the New England Journal of Medicine, a major news organization recently asked me, as a physician and former FDA official, whether I knew of examples of prescription drugs that have "efficacy but [also] serious safety issues." That is the rule rather than the exception, I responded.

Obvious examples include the antimetabolites used for traditional chemotherapy. Because these drugs are no more than poisons administered in a way intended to be more toxic to cancer cells than normal ones, it is not surprising that their side effects are often serious and even life-threatening. When I was a medical resident three decades ago, hospital gallows humor included referring to BCNU, an experimental cancer drug, as "Be seein' you." (Approved in 1977, it is still widely used.)

A more recent example is aldesleukin (also known as interleukin-2, or IL-2), a drug that has offered new hope to victims of kidney cancer and malignant melanoma. It is highly effective in a small proportion of patients but exhibits significant toxicity. The patient information booklet warns that those taking the drug "frequently experience serious, life-threatening, or fatal adverse events," including dangerously low blood pressure and reduced organ perfusion, impaired function of infection-fighting white blood cells, disseminated infection, and autoimmune disease.

Antibiotics are another class of wonder drugs that sometimes manifests significant toxicity. Chloramphenicol, a drug that is effective against a wide spectrum of bacterial infections, causes rare cases of fatal aplastic anemia, so it used only sparingly. The potent antibiotic gentamicin is often life-saving but can cause damage to the kidneys, nerves and ears. And significant numbers of patients are allergic to other important antibiotics, including the penicillins and cephalosporins.

But let us return to Tysabri, only the sixth medication approved - and the first in several years - for the treatment of MS, a common and debilitating autoimmune disease that affects the central nervous system. Following impressive results of the drug's testing in clinical trials - the frequency of clinical relapses reduced by more than half - the FDA granted accelerated approval in 2004.

However, by that time several thousand patients were being treated with Tysabri, three had contracted Progressive Multifocal Leukoencephalopathy (PML), a rare neurological disorder caused by a virus. (Because the drug suppresses certain components of the immune response regulators, clinicians and the product's developers had from the beginning been sensitive to the possibility of infections as a side effect.) Precipitously (some would say prematurely) the manufacturers of the drug voluntarily halted production and distribution and withdrew Tysabri from the market. MS patients and many neurologists were bitterly disappointed.

The three clinical studies reported in the New England Journal of Medicine bolster our confidence about both the safety and efficacy of Tysabri. In a study of almost a thousand patients that compared Tysabri to placebo, the drug cut the rate of clinical relapses by 68 percent (from 0.75 to 0.24), reduced by 83 percent the number of new or expanding brain lesions found on MRI, and slowed the clinical progression of disease. (The other currently used drugs for MS lower the occurrence of acute relapses by roughly one third.) Similar results were obtained in a second trial which compared two-drug therapy with Tysabri plus interferon beta-1a to the interferon alone.

Finally, a third study found no additional cases of PML in more than 3,000 patients (exposed to an average of 17.9 monthly doses) who had participated in clinical trials of Tysabri. The investigators concluded that the incidence of this serious side effect is approximately one in a thousand patients treated with the drug. However, it should be noted that all three of the original cases of PML occurred in patients treated with interferon beta or other immunosuppressive agents as well as Tysabri, so the risk might be significantly lower in patients treated with Tysabri alone. Many neurologists who are familiar with Tysabri in MS believe this will prove to be the case.

The "safety" of a drug is a relative thing. Safety and efficacy, the two criteria required for marketing approval of a drug, are inextricably linked. The judgments of regulators (and practicing physicians) require a global and often difficult calculation of risk and benefits, including consideration of what alternative therapies are available. We are willing to tolerate greater uncertainty and more severe side effects for a potential cure for pancreatic cancer or AIDS, for example, than for a new drug that treats heartburn. When FDA grants marketing approval, the drug is deemed to be sufficiently safe and effective to be used for the conditions on the label.

In light of previous studies and the new data published in the New England Journal of Medicine - to which the FDA should have had access months ago - the publicly available evidence certainly supports returning the drug to market, presumably with revised labeling, as quickly as possible. If that happens, physicians and patients will need to decide whether for a given individual the risk of the drug is acceptable in view of the possible benefits.

Even in view of the just-published data, one eminent neurologist who has long and extensive experience with Tysabri remains cautious: "I myself would only use the drug in patients who are 'train wrecks,'" by which he meant patients who were severely symptomatic. He feels that it is only they who "can assume a 1/1000 risk of a fatal complication and for whom such a risk is reasonable. I know many in this category with MS, because of the nature of my practice. But I would not treat that hypothetical 20-year-[old] sophomore on campus with early MS."

I have far less clinical experience than he, but given that Tysabri reduces the number of new or expanding brain lesions as measured by MRI, and that it slows the progression of the disease, it may be that some of the hypothetical 20-year-old college sophomores with MS might opt to take the drug if it makes it possible for them to live more normal lives.

When an FDA advisory committee convenes this week to make recommendations about Tysabri's fate, its members will likely confront a mishmash of testimony from patients, physicians and other experts, perhaps including even some mischief on the part of companies with competing products. As I learned during my own extensive service on advisory committees, there is astonishing variability in an individual's - even an expert individual's - interpretation of the data.

The FDA has the final say. Although society has designated the FDA as a gatekeeper between drug companies and the marketplace, the agency must beware of excessive paternalism and strive to preserve the right of patients, in consultation with their physicians, to make informed individual decisions about the available therapeutic options. Inevitably, different people will have very different comfort levels about risks and benefits.

If our society permits citizens to make risk-benefit decisions about whether or not to have elective surgical facelifts and stomach-stapling operations for weight control. Whether to buy the penis-expanders and weight-loss snake oil nostrums that are intensively advertised on TV, and whether to invest in certificates of deposit, equities or junk bonds. How can we prohibit patients from making life-and-death medical decisions about drugs that have been shown to be effective?

The notion that FDA should "err on the side of safety" sounds like a tautology, but it is an affront to patients with incurable or poorly treatable diseases: for them, there is no safety in the status quo, and we only damage them further with paternalistic public policy that prevents individuals from exercising their own judgment. If FDA must err, it should be on the side of patients' freedom to choose.

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

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

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BRITISH DOCTORS VOTE WITH THEIR FEET

Hospital consultants are spurning the National Health Service by paying for medical insurance so they can be treated privately if they become ill. A survey of 500 consultants, commissioned by Bupa, the health insurer, found that 41% of senior hospital doctors have invested in private health cover. Doctors are among the 10 occupations most likely to take out personal medical insurance, according to Bupa. More than 90% of the consultants surveyed have posts within the NHS. All of those surveyed also worked in private hospitals.

Dr Sarah Burnett, a consultant radiologist in London who worked in the NHS for 15 years, said she took out private medical insurance while she was employed in the state service because she was unimpressed with the level of care she witnessed first hand. "NHS treatment is not a pleasant experience in any way - from the standard of the food, to ward cleanliness and the chance of catching MRSA," she said. Last year Burnett was diagnosed with breast cancer, detected during a private medical screening. Within two hours of her annual check she underwent an ultrasound examination that showed multiple small tumours. An hour after that Burnett was seen by a surgeon who arranged a skin-sparing mastectomy. A few days later she was recovering from surgery. "I was lucky enough to have exceptionally prompt treatment because I choose to pay for insurance. Under the NHS I would not have been screened until 50 for breast cancer and would not have been able to catch my cancer at such an early stage," said Burnett. "The type of surgery I had is only rarely available on the NHS, depending on the expertise of your local surgeon."

The British Medical Association (BMA) argues that the consultants' wish to take out private medical cover does not demonstrate a lack of commitment to the NHS. They want speedy treatment so they can get back to looking after their NHS patients as soon as possible. Dr Jonathan Fielden, the deputy chairman of the BMA's consultants' committee, said: "Consultants may also like the anonymity of private care. One of the problems of being treated in the NHS is that consultants might find they are in a bed next to one of their patients."

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BRITAIN'S NHS NO GOOD FOR THE ELDERLY

Elderly people are being neglected and poorly treated by England's health system, inspectors say. The joint report by three public sector watchdogs said the NHS and care services treated older people with a lack of dignity and respect. The Audit Commission, Healthcare Commission and Commission for Social Care Inspection said it was being made worse by a lack of consultation. Campaigners said elderly people had become second-class citizens.

The report, which assesses the government's progress half-way through its 10-year plan to improve services for the over 50s, found while some services had improved, progress had been patchy and slow in other areas. David Behan, chief inspector of the Commission for Social Care Inspection, said: "The evidence from this study is that older people are not involved in the design of services and, consequently, services are not tailored to their needs and aspirations. "It is vital to understand and respond to the specific needs of older people." And Anna Walker, chief executive of the Healthcare Commission, said: "Older people are the biggest users of healthcare, occupying almost two thirds of our hospital beds, yet they continue to be a low priority in both the planning and development of our health service."

None of the 10 communities across England, whose public services were scrutinised, had reached all the government-set milestones to enable them to meet the standards in the national service framework. Two areas of concern were the planning of public transport and the low priority given to foot care services.

One of the worst areas, the report found, was mental health care, where older people found services deteriorating as they passed the age of 65. The vast majority of older people surveyed said they had not been asked their views on the NHS or council services in the last year, and 80% did not think they had influenced the planning of services. The report did find that steps had been taken to address age discrimination in public services and more people were being supported to allow them to live at home.

Gordon Lishman, director-general of Age Concern England, said it was "shocking" that so many social services departments were still failing to meet the needs of older people - the main users of these services. He said: "Sadly, too many older people in need of public services are currently treated as second-class citizens." Liberal Democrat health spokesman Steve Webb said: "The needs of older people are not a priority for this government."

But Care Services Minister Liam Byrne insisted that older people's access to care had been "completely transformed" although neglect was still "too big a part of the story". He said plans would be unveiled next month to improve the situation. And Professor Ian Philp, national director for older people's health, added measures had also been taken to tackle discrimination, but there was more work to do to reverse the lack of respect shown to the elderly.

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

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

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Warning ignored: Babies die

The state government was warned a decade ago that the lives of hole-in-the-heart babies were being endangered by inadequate services at Brisbane's The Prince Charles Hospital. The warning came in a secret report by Booz-Allen Hamilton recommending pediatric cardiology services be removed from Prince Charles to a new "dedicated pediatric institution".

The report's discovery is a blow to the credibility of the troubled state health department which has been accused of hiding problems with pediatric cardiology at Prince Charles. The Booz-Allen Hamilton report, which was withheld from the media, outlines many of the same flaws which are still the subject of controversy today. It warned: "The separation of pediatric cardiac services away from all other pediatric health services . . . results in compromised quality of care for the individual child." It found the "poor integration of multiple specialist services that any one child may require" resulted in "poor communication and potentially compromised care". And it warned the stability of critically ill children was compromised because they had to be ferried between one hospital and another for different specialist treatments.

A new probe was launched recently when doctors at Prince Charles warned fragmented services imperilled critically ill children with heart disease. Head of the hospital's pediatric cardiology unit Dr Nick Haas left for overseas last week after resigning as director. The new investigation team led by three professors of medicine was handed a copy of the Booz-Allen Hamilton report. Despite pledges of transparency and accountability the team's new report remains under wraps. The Booz-Allen Hamilton report recommended that Prince Charles pediatric cardiology services be integrated into a new unit at Royal Children's Hospital.

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New Drug Demagoguery

"New Drugs Hit the Market, but Promised Trials Go Undone" and "FDA: Drug Companies Drop Ball on Studies," the headlines blared. Are Americans getting untested drugs? Are drug developers taking short-cuts, or worse? Are regulators incompetent, or impotent? None of the above-although it's hard to tell that from the press coverage.

As a condition of marketing approval of a new drug, the FDA often requires the manufacturer to perform additional studies to confirm efficacy or to look for previously undetected side effects. But according to a recent FDA report, which spurred the headlines, as of the end of last September, of the 1,231 "open post-marketing commitments" to perform clinical studies, only 14 percent had been duly reported to FDA, 65 percent were "pending" (that is, had not yet started), 19 percent were considered "ongoing," and two percent were "delayed."

However, the government's evaluation and approval of new drugs is an exceedingly complex and arcane business, and these statistics can easily be misunderstood or misrepresented.

American pharmaceuticals are the most intensively tested products in history. Moving a drug through laboratory studies and then animal and human testing requires on average 12-15 years and more than $800 million in direct and indirect costs. By the time a drug company applies to the FDA for marketing approval of a new product, on average it has performed more than 70 clinical studies on at least 4,000 patients.

Even after exhaustive clinical testing, questions may remain, particularly if efficacy has been judged by improvement in a "surrogate" endpoint, such as high blood pressure as a marker for heart disease, or shrinkage of a tumor as a stand-in for actual prolonged survival.

These kinds of criteria for measuring efficacy are both common-sensical and based on a scientific rationale-and most often they do correlate with more definitive measures of benefit. Sometimes they're essential to efficient drug testing. I'm reminded of a cartoon in which two pharmaceutical scientists are contemplating a beaker that contains a new medicine. One says to the other, "It looks as though this drug will confer immortality. The trouble is, it will take forever to test it."

The FDA can require manufacturers to perform certain post-marketing follow-up studies, and according to the regulations, "once a post-marketing study commitment has been made, an applicant must report on the progress of the commitment . . . until the post-marketing study commitment is completed or terminated, and FDA determines that the post-marketing study commitment has been fulfilled or that the post-marketing study commitment is either no longer feasible or would no longer provide useful information."

That seems straightforward enough, but in practice widespread prescribing and use of a drug following FDA approval often make the mandated post-marketing studies moot. In other words, the availability of large amounts of data obtained from usage under real-world conditions-sometimes from hundreds of thousands of patients within months of approval-makes additional data from small clinical trials superfluous. In spite of that, the FDA seldom follows through to determine "that the post-marketing study commitment is either no longer feasible or would no longer provide useful information." Hence, the preponderance of post-marketing studies that are "delayed" or "pending."

Another related factor is that in recent years FDA regulators have tended to over-use the requirement for post-marketing studies-mandating them not because they're essential, but merely as a way to inoculate themselves against criticism for too-rapid approvals.

The nuances of this phenomenon have eluded some who should know better. Congressman Maurice D. Hinchey (D-New York) claims mistakenly that the FDA's demands for demonstrations of safety "continue to be blatantly ignored by the pharmaceutical industry," so he and Senators Charles Grassley (R-Iowa) and Christopher Dodd (D-Conn.) have introduced legislation that would give the FDA added authority to require drug companies to carry out post-marketing studies.

Wrong diagnosis, wrong remedy. Instead of bean-counting and indulging in demagoguery, we should be trying to ascertain what fraction of mandated post-approval studies is really necessary, and FDA should clean up its backlog of superfluous post-marketing studies.

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

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

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A total health care monopoly

When a single corporation maintains a 100% market share in its industry, most of us would consider it a monopoly, free of competition and thus detrimental to economic progress, innovation, and human needs. In California, State Senator Sheila Kuehl proposes such a system. The Democratic lawmaker seeks to force all the state's health care sector under the authority of the state government. Doctors' fees and pharmaceutical prices would be set by the state. Health care would be rationed. Private insurance would be illegal. Kuehl's plan, SB840, also known as the California Health Insurance Reliability Act, would be financed by a new 12% payroll tax imposed on workers and their employers.

Proponents of socialized medicine believe that government-controlled health care will cut costs and make medicine more available. But if it would indeed run more smoothly and inexpensively, why is it necessary to forbid-by threat of fines and imprisonment-private insurance? Kuehl and her supporters might realize that the market would provide something that the state-rationed health care system won't. Why else seek to use the violence of the state to crush market competition?

When top executives collude in smoky rooms to set prices, to strong-arm their competitors, to ration their services in concert, it is considered monopolistic. If the government is among the corrupt players in that same smoky room, offering the force and color of law to the collaboration, it is considered "single-payer health care."

Indeed, government is the greatest monopoly of all, the protector of all others. It gives favored companies special benefits and punishes less politically connected firms. It uses regulation to stifle small businesses and innovation and entrenches economic power in the hands of the few.

The most prominent private interests don't go away-they are only further absorbed into the protectionist system. It was Ted Kennedy's HMO Act in 1973 that empowered HMOs, by forcing employers who offered health insurance to their workers to include HMOs as an option. It is the Food and Drug Administration that protects Big Pharma from competition by erecting formidable barriers to entry-a small company cannot afford the hundreds of millions of dollars in bureaucratic expenses to bring a new, potentially life-saving drug to the market. It is no surprise, then, that such regulatory bodies are typically headed by former and future CEOs of the industry that they are legally empowered to police.

The most recent example is President Bush's gargantuan Medicare prescription drug benefit-at once the largest expansion of the welfare state and one of the biggest giveaways to Big Business in recent decades.

A steady move toward corporate socialism has propelled the exorbitant rise of medical costs in America. The proposed solution, even more consolidation of money and power in the hands of the politically connected, cannot solve the problem.

Small businesses, doctors who wish only to help their fellow humans, patients, and alternative medicine practitioners will suffer. Countries with socialized medicine are learning all this the hard way: surgeries are doled out according to crude predictions of how much patients will pay in taxes before they die, patients must wait two years for a routine hip replacement, and desperate refugees flee to buy in foreign nations what is prohibited in their own country. The answer is to deregulate, desocialize, decorporatize health care, to allow consumers to make their own decisions, to strip away the privileged status that the health care establishment enjoys from discriminatory licensing laws and regulatory agencies.

Fifty years ago, America had the best health care system in the world, until the federal government moved in, pushing out the free, voluntary health clinics that had graced nearly every city and major town in the country. Today's politicians recognize the problem that they've created, and yet instead of walking away and allowing the market to achieve the same magic as it does in the other relatively unregulated industries-such as computers, electronics, grocery stores, and the various wonders of the modern economy-they propose more centralized regimentation. Only a free market can liberate the people to serve one another's needs, through the market and charity.

Monopoly is inefficient and inhumane, as liberals recognized throughout the 19th century as they battled against the Big Business-Big Government partnerships in railroads and industry. Nowadays, monopoly is considered the salvation of the common man. Just because ideas change doesn't mean economic laws do. Socialism and monopoly create inefficiency, rationing, shortages, and higher costs. We must reject the total monopoly in California's medicine that Kuehl wishes to impose upon us-for the sake of our health.

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The case against mandatory coverage

Writing in the Washington Post on January 18, business columnist Steven Pearlstein argued, "the president must acknowledge that there can be no credible reform without extending health insurance for every American--every employer should be required to pay half the cost of basic health insurance for every employee." The same week, Humana co-founder and retired CEO David Jones told a Naples, Florida audience that government should mandate health coverage because the uninsured "are simply taking a free ride."

Like many other conservatives and Republicans, they call for mandating that every individual have at least "catastrophic" insurance coverage. I know a lot of physicians and insurance brokers who support this policy, and Republican governors in at least Massachusetts and Minnesota have proposed similar ideas. Here's a quick check list of a dozen reasons why mandatory coverage isn't worth the effort:

1. "Free riders" are not really much of a problem. In a June 2003 report for Health Affairs, Jack Hadley and John Holahan reported about 3.5 percent of total health care costs are for uncompensated care. That is a trivial amount of money, far less than most stores lose to shoplifters.

2. Granted that some facilities are hit harder than others, I would venture these tend to be in areas where there are large numbers of illegal immigrants. Mandatory coverage will do absolutely nothing to solve that problem.

3. Health insurance mandates are often compared to mandatory auto insurance coverage, but the comparison falls short for several reasons. Auto mandates don't work very well and certainly don't solve the problem of uninsured motorists. And with an auto mandate you are required to insure against what your two-ton vehicle will do to other people, not to get your own car repaired.

4. In order to have a mandate, we would have to have substantial subsidies and assurances of access (you can't force people to buy what they can't afford or can't find). But once you have those provisions, you probably don't need the mandate. Very few people will absolutely refuse to carry an insurance card no matter what.

5. In order to have a mandate, the government has to decide what it is that is being mandated. Even with "catastrophic" coverage, someone has to decide what expenses go towards meeting the deductible--chiropractors? abortions? sex-change operations? herbal therapy? and on and on and on. Imagine the debates in Congress.

6. Once you've decided what to mandate, you must ensure such coverage will be available to everybody. What happens if no company wants to offer it in Montana? What if a company does offer it in Montana, but provides lousy service? Consumers will have no choice but to buy it, no matter how poor the service.

7. Once you force people to buy a product, you have to make sure the providers of that product aren't ripping them off. That means federal control over premiums. That means federal scrutiny of carrier efficiency. That means examination of administrative expenses to make sure they are "reasonable."

8. As far as I know, nobody has ever looked at the macroeconomic consequences of this idea. Having a mandate means every single individual must be insured (and pay premiums) at all times, regardless of their circumstances. I will be a witness that if I had had to do that in the early 1990s, I would never have been able to leave Blue Cross to start four different businesses, three of which are still in operation and employing 45 people in Northern Virginia. In every case, I had to tighten my belt in a whole lot of ways to get these ventures launched. Going uninsured for a while was just one of them.

9. There are much better ways to address the problem. I would note, for instance, that there were far fewer uninsured 20 years ago, before the states went crazy with mandates and small group "reforms" that dried up the market for coverage and raised costs dramatically.

10. Equalizing the tax treatment for people who buy their own coverage would also help a great deal. That way people wouldn't have to rely on their employer in deciding whether to get coverage.

11. Encouraging innovation in insurance offerings would help, too. We have already seen that HSAs are changing people's minds about the value of coverage. There may also be other approaches that would appeal to other segments of the market. Part of the reason people don't buy coverage is because they don't see much value in what is available. We need to reduce the barriers to entry, to make it easier for new approaches to be tried.

12. I know many physicians (and others) support a mandate (the California Medical Association is on record doing so), but they haven't really thought it through. If carriers are scrutinized as described above, it won't be long until physicians get the same treatment. If people are forced to buy a product and companies are forced to sell it at "reasonable" rates, it isn't much of a leap to start looking at the inputs that drive those rates. Could it be that doctors are price-gouging their patients? My goodness, we can't have that! And it's off to the races.

Mandatory coverage is an idea that won't solve the problems but will create a whole host of new problems and have serious negative consequences throughout the economy.

Source

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

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

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BRITAIN'S NHS TOO POOR TO TREAT MS

All those bureaucratic salaries have to be paid first

Patients with multiple sclerosis are being told that they cannot have drugs to prevent their disease from getting worse because the NHS cannot afford them.

Ministers have insisted that staff layoffs and hospital deficits have had no effect on patient care. But this is untrue, according to Mike Boggild, consultant neurologist at the Walton Centre in Liverpool. He says that he knows of 50-100 MS patients who have been told they cannot have the drugs, even though under an agreement reached in 2002 ministers promised that they would be provided to all those who qualified.

The MS Society said that some patients had been told they would have to wait a year before being prescribed a drug, while others had had their assessments delayed so they were not on a waiting list. Tom Elkins, of the MS Society, said the problems were greatest in Staffordshire, Sheffield and Wales. He added: "These drugs can prevent disability and there are very clearly defined eligibility criteria. But people are being told they can't have them because the NHS hasn't the money to pay for them. We're back to a postcode lottery. To get the most benefit, patients need these drugs as soon as their illness is diagnosed, not a year later."

Dr Boggild is co-leader of the risk-sharing scheme under which the drugs are provided. This was set up in 2002 after the National Institute for Health and Clinical Excellence ruled that the drugs were not cost-effective. The manufacturers share the risk of providing the drugs. If the drugs do not do what they promise, the NHS pays less for them. Under the scheme, the drugs should be guaranteed for those who are eligible. But Dr Boggild says that many patients are being blocked. "It is nothing like as bad as before the risk-sharing agreement was reached, when thousands were being denied the drugs," he said. "But the promises made by ministers are being flouted in some places. No patient newly diagnosed with MS should be made to wait."

One of the worst areas was Staffordshire, where the University Hospital of North Staffordshire NHS Trust announced last week that it was shedding up to 1,000 jobs. The Department of Health said that the trust planned to reduce costs through improved efficiency, without cutting patient services.

Andrew Colgan, 37, from Newcastle-under-Lyme, is an MS sufferer who has been told that he cannot have the drugs but was assessed in November and told he was suitable. "I saw two MS nurses and two registrars, and they were all very apologetic," he said yesterday. "They said `you are suitable, but the Primary Care Trust has withdrawn funding, so we can't prescribe the drugs'. Maybe I'll get them next year." Mr Colgan qualified as a marine scientist and worked as a teacher but has had to give up work because of his condition. The cuts at North Staffs hospital have also affected him, as he was one of the patients treated there with intravenous steroids. "The ward that caters for this is one of the ones hit by the rendundancies," he said.

However, he is entitled to treatment and was promised it under the risk-sharing agreement. "Sometimes I think they are just waiting for the start of next financial year," he said. "Maybe I'll get it then." The Department of Health said: "We have been assured they are trying to get the drugs to new patients in Staffordshire as soon as they can."

Source






2005: A bad year for health policy

The initial implementation problems of the Medicare drug benefit that went into effect January 1 are being spun by some as reflective of a structural flaw: the inclusion of free-market competition and choice. Plans offering the Medicare drug benefit have multiplied beyond all expectation--2,900 of them nationwide. Opponents argue there is too much choice, saying it is confusing seniors, angering them, and making it difficult for them to choose the "right" plan. Political columnist Harold Meyerson, for example, titled his op-ed piece on the topic, "Bewilder Thy Father and Mother" (Washington Post, November 30, 2005). Choice among many alternatives introduces complexity, says Meyerson, which is both bewildering and economically inefficient. The value of the European style "single payer" alternative, he claims, is its simplicity: It rescues us from complexity (and its resulting inefficiency); it's also said to be cheaper. This is a curious line of reasoning that we normally do not extend to other sectors of the economy. Monopoly is good for you, the argument assumes, as long as it's a government monopoly.

While most seniors clearly do find the unexpected range of choice in drug options confusing, it's worth clearing up a few misconceptions. First, the problem with the drug program is its structure as a weird benefit designed by Congress, with absolutely no analogue in the private market. It is also universal, which means it is crowding out all other coverage. The left is wrong to imply that the drug program, with its much-criticized "donut hole," or coverage gap, is somehow the product of a free-market approach to health care policy.

Second, the critics misunderstand the concept of choice. Real choice implies the personal option to keep what you have and what you like. It is the right to be free of coercion. The reality in this remarkable case is that almost half of the entire pool of eligible Medicare beneficiaries--those who are in employer-based retirement plans and those in Medicaid--will have no personal choice at all in their drug options. If employers decide they no longer wish to offer drug coverage and dump retirees into the government program, they can do that. Retirees have no say in the matter. Why? Because the employer-based system is not a consumer-based system: Employees and retirees get what their employer gives them, whether they like it or not. In this case, most retirees like their existing retirement coverage, but regardless of their wishes, they probably won't be able to keep it.

For persons eligible for Medicaid, their opinion about either Medicaid or the Medicare drug program doesn't make any difference: Congress says they are going into the Medicare drug program. Period.

The anxiety of millions of seniors is understandable. They never liked this legislation, they don't understand it, and the dynamics of a universal entitlement do not let them keep what they want or what they have. It crowds out existing coverage. The result is vast uncertainty among seniors and a political backlash against the White House and the congressional Republicans. None of this was necessary. It all could have been avoided with a targeted drug benefit for seniors who did not have coverage, especially those on low incomes. But the congressional Republican leadership aligned itself with Sen. Edward Kennedy's (D-MA) basic agenda and created a universal drug entitlement.

The carping will go on over the next few months, well into the next congressional election. But the left's agenda will be what it has always been: Impose price controls on drugs, fill up the notorious donut hole with even more federal subsidies, and tighten up the regulations on private plans to drive them out of the program once and for all.

The nation is now committed to plunging, eyes-open, arms up, and screaming, into the greatest entitlement expansion since the Great Society. The nation is committing to paying for trillions of dollars in drug benefits and trillions more that have been promised in total Medicare benefits, which nobody on Capitol Hill or elsewhere has yet figured out how to pay for. Economists at The Heritage Foundation estimate that if we decide to actually make up the $30 trillion Medicare shortfall (that's the size of the long-term unfunded liability of the program) through tax increases, that would amount to an equivalent Medicare payroll tax jump from the current 2.9 percent of payroll to 13.4 percent right away. Taxes would have to rise still higher in subsequent years.

That kind of taxation would sharply reduce disposable income, cut investment spending, retard capital formation, and cost the economy in jobs and productivity. The Heritage numbers crunchers, using the best economic modeling on the market, are working on calculating the economic impact of not paying the taxes and going straight into debt. Not a good alternative.

For health policy, 2005 was a disappointing year overall. The Medicare mess has deepened and Congress has shown no willingness to act responsibly. The federal insurance market reform proposal authored by Rep. John Shadegg (R-AZ), which would have allowed individuals and families to buy health insurance across state lines, was reported out of committee but has not even come to the floor of the House of Representatives for a vote. The Tax Reform Commission proposed capping the tax exclusion on health benefits, but it stopped short of suggesting serious reform. The Medicaid Commission has yet to signal any intention to promote serious structural reform. Nonetheless, there are reasons for optimism. For example:

* On Medicare, Senator John McCain (R-AZ), Congressman Jeff Flake (R-AZ), and 100 members of the House Republican Study Committee introduced legislation last fall to delay implementation of the drug benefit. The bills were still in committee when the drug benefit went into effect on January 1, but the mounting fiscal crisis will soon force some serious action on Medicare; it's unavoidable.

* On Medicaid, the largest health care program, with 53 million enrollees and total costs of approximately $300 million, there are some interesting state initiatives. South Carolina and Florida have introduced new options for Medicaid recipients, including health savings accounts, and are promoting choice and competition among providers to improve access to care among the poorest citizens. The big task is to promote long-term care insurance among the middle class, so that nursing home care doesn't become just another middle-class entitlement. If we do not control middle-class entitlements, we are going to shred the safety net for the poor.

Health savings accounts are also taking off. There are more than a million of these policies now in effect nationwide, and the number is rapidly growing. They are broadly affordable, and about 30 percent of the policy holders are Americans who were previously uninsured. Meanwhile, Gov. Mitt Romney (R) of Massachusetts is trying to enact an innovative insurance reform characterized by reduced regulation, defined contributions for health insurance coverage, and a robust system of private health plan competition. One of every seven dollars in the United States is spent on medical goods and services. In the past few decades, the role of personal spending has declined in health care, except for third-party payment cost-shifting to employees by employers through higher deductibles and copays.

The bigger transition, at least in terms of coverage numbers, seems to be from a highly regulated, employment-based, third-party payment system to a third-party-based government-managed system, as evidenced by the enrollment increases in Medicare and Medicaid. Congress is aiding and abetting this continued expansion of the government's role in health care.

Source:

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

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

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BRITAIN: EVER MORE "CUTS"

One of the largest staff culls in recent NHS history worsened yesterday as more hospitals announced cuts and politicians gave warning of a final total of up to 20,000 job losses. Two trusts, in the North East and Kent, said yesterday that cuts were imminent or likely involving hundreds of members of staff. The announcements took the total job losses this month to more than 3,000, with two thirds occurring in the past week.

The Conservatives yesterday accused the Government of runnning scared of a crisis that would probably result in a cut of between 15,000 and 20,000 employees across the NHS. While Gordon Brown fended off criticism for skirting round the health service’s mounting debts in his Budget statement this week, it also emerged that there would be no specific health funding debate in the wake of his speech.

County Durham and Darlington Acute Hospitals NHS Trust yesterday became the fourth trust in less than 24 hours to give warning of serious service cuts. Up to 700 posts are expected to go over the next three years. The announcement came after news from East Kent Hospitals Trust, one of the largest hospital trusts in the country, of the possibility of job cuts in an attempt to reduce a predicted 35 million pound deficit. On Wednesday night — just hours after the Chancellor addressed the Commons — the Royal Free Hospital in Hampstead, North London, and Queen Mary’s, Sidcup, Southeast London, added their names to the growing list of organisations planning to shed staff.

Andrew Lansley, the Tories’ health spokesman, said that the Government could not be allowed to hide from NHS deficits now running at about 750 million pounds. He predicted total job losses approaching 20,000, and questioned why Patricia Hewitt, the Health Secretary, was not scheduled to take part in post-Budget debates in the Commons. “The Government has mismanaged the service and much of the money it has pumped in has been wasted by bureaucracy or the mismatch of supply and demand,” he said. Although he accepted that some of the bureaucratic job losses could be the result of slack in the system, Mr Lansley said that laying-off doctors, nurses and midwives was absurd. He added that the Conservatives would do the things that Mr Brown had prevented, including allowing foundation hospitals to borrow freely to expand their services.

Mr Brown explained yesterday the absence of detail about health funding during his Budget speech by saying that the extra money for the NHS had already been announced. Health trusts would receive an extra 6 billion pounds in the next financial year and a further 6 billion the year after that, he said. “When we talk about deficits faced by some trusts, most organisations in the NHS are getting more money next year and more money the year after.” The Chancellor added that only a “small number” of trusts were affected by the highly publicised deficits. “They have got to sort their problems out,” Mr Brown said. “There is more money going into the health service. It is our duty to have more value for money.”

Announcing the likelihood of 700 job losses yesterday, hospital chiefs at County Durham and Darlington blamed changes across the NHS nationally — including the use of the private sector to carry out NHS work, and how hospitals are paid for operations. They said the job losses were not about saving money.

More here





Just one episode reported by a doctor on the NHS front-line

Don't read the rest of his reports unless you have a strong stomach. They are too awful. It sounds like the guy is working in a Communist country. But socialism is just slowed-down Communism so it figures

Third patient in is Mary, one of the local speech therapists. She is approaching retirement. I sent her husband into hospital three weeks ago in rip-roaring heart failure. He was on CCU for three days but now is on the far flung corner of Dixon, one of the medical wards. He is partially sighted due to an old stroke, and is hard of hearing. The nursing care is appalling. He has developed pressures sores on his sacrum and heels and, oddly, a suppurating area above both ears which Mary thinks is due to the oxygen mask he uses being too tight. He is losing weight because he cannot really manage to feed himself. Mary was in each day over the weekend. Uneaten food from Saturday was still on his bedside table on Sunday. Mary went to the nursing station at the end of the ward. The nurses were all eating take-away Pizza. Deep Pan pizza from Pizza Hut. Mary remembers that particularly. Mary thinks her husband is dying. She is not sure which consultant he is under, and has not been able to find a doctor to talk to. The nurses over the weekend do not speak English. She tried to tell them that her husband is partially sighted but they do not understand. They show here the nursing assessment. Under “visual problems” it says "none". Mary is in tears and asks what she should do. I suggest she phones the Chief Executive and makes a formal complaint.

I do not suppose that Pizza Hut pizzas carry harmful bacteria, but should they be on an acute medical ward?

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

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

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BRITAIN'S EVER-SHRINKING NHS

Two more hospitals last night joined the list of NHS trusts forced to cut services because of their debts, taking the number of job cuts to more than 2,000 in less than a week. The Royal Free Hospital in Hampstead, North London, and Queen Mary's Hospital in Sidcup, southeast London, became the latest to announce cuts despite six years of unprecedented government funding for the NHS. The Royal Free, which was praised by the Health Secretary last year for its work after the London bombings, said that about 480 posts will be lost under plans to achieve savings of œ25 million in the next year. The trust said it would ensure that redundancies were kept to a minimum. Hospital chiefs at Queen Mary's also gave warning that 190 jobs may be lost in an attempt to reduce a predicted œ13 million deficit.

Andrew Way, chief executive of the Royal Free Hospital NHS Trust, said that the cuts at his hospital would be part of a drive to improve staff efficiency and reconfigure wards. "These measures are not exceptional and are designed to bring the Royal Free into line with other organisations," he said. "We must achieve financial balance if we are to control our own future as the Government has made it very clear that it will not bail out organisations that fail to do so." Mr Way praised staff for their hard work in implementing the trust's "savings plan", which would help to ensure a robust financial future, but Geoff Martin, head of campaigns at London Health Emergency, accused the Royal Free of trying to smuggle the news out on Budget day. He said that the announcement helped to explain why Gordon Brown had "body-swerved the NHS question" in his speech. "Sacking nurses never looks good for the Government," Mr Martin said. "These cuts will have a devastating impact [on] emergency planning in London."

Andrew Lansley, the Tory health spokesman, said: "One year ago ministers were heralding NHS staff as the heroes who were delivering on waiting list targets. Today they are silent as the same NHS staff are threatened with redundancy. Faced with the failure of his billions to deliver corresponding improvements for patients, Gordon Brown and the Treasury have abandoned the NHS."

A Department of Health spokesman said: "We are reassured that these plans reflect the need to treat patients more efficiently and improve the organisation of services."

Source






QUEBEC GOVERNMENT GETS GOOD ADVICE



The doctor who took the Quebec government to the Supreme Court of Canada, causing it to change its policy on wait times and private health insurance, wants to see more privatization. In his Supreme Court case, Dr. Jacques Chaoulli argued "patients will continue to suffer and die" because of waiting lists. Last year, the high court ruled in response that some wait times for medical procedures in the province were unconstitutional.

In February, Quebec Premier Jean Charest announced guaranteed wait times for cataract surgery and hip and knee replacements and changes to make it legal for Quebecers to buy private insurance for those three medical services. On Tuesday, Chaoulli called the move a good first step, while urging the Quebec government to go further with privatization. "I would like that Quebecers have the best value for the public money they spend," Chaoulli said. He said the best way would be to allow more private medicine, including:

* Allowing doctors to work in both the public and private systems, such as at a public hospital and a private clinic, rather than one or the other.
* Privatizing medical schools and hospitals.
* Loosening legal restrictions that limit private insurance.

The ideas were outlined in a 40-page document Chaoulli submitted to a provincial government commission looking into health reforms.

Source

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

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

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DOES IT EVER END? THE LITERALLY DIRTY BRITISH NHS AGAIN

More than a third of NHS hospitals and other health trusts are unable to provide their staff with hot water, soap, alcohol rubs and other basic hygiene requirements whenever they need them, according to a national survey. A poll of more than 200,000 employees, conducted by the Healthcare Commission, has revealed alarming shortfalls in NHS hygiene, supposedly a key priority for the Government in its attempt to reduce hospital-acquired infections. The survey found that one in four members of staff felt that the trust they worked for did not do enough to promote the importance of cleaning hands to staff, patients and visitors.

Only 61 per cent of respondents, said that their trusts had hot water, soap, alcohol rubs and paper towels available at all times. A further 28 per cent reported high levels of handcleaning equipment, but one in five NHS workers said that they never had access to such facilities. The commission, the NHS watchdog, described the findings as a worrying neglect of a prerequisite of good healthcare. A total of 51 per cent of staff said that they had received training, learning or development about infection control in the past 12 months - suggesting that half had not.

Hospital-acquired infections, such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, have been associated with a growing number of deaths in recent years, prompting a government crackdown on poor hygiene. A total of 7,212 cases of MRSA bloodstream infection were detected in English hospitals in 2004-05. Experts suggest that up to 300,000 infections are picked up in healthcare settings every year, causing 5,000 deaths and costing the NHS as much as œ1 billion.

The National Survey of NHS Staff, published today, also highlights other areas where "significant action" is needed, including initiatives to tackle violence and discrimination....

Anna Walker, the chief executive of the commission, said that it was heartening to see the downward trend in reports of violence, harassment and bullying. But she said that work was needed to address hygiene shortcomings. "A high standard of hand hygiene is a prerequisite of safe healthcare and this is undermined if the basic facilities for cleaning hands are not always available," she said.

A spokesman for the Department of Health welcomed the positive findings and said that it was "pleasing to note that "nearly 90 per cent of staff felt that hand hygiene facilities were available either always or most of the time". [One would have expected them to have had 100% availability ever since Florence Nightingale]

Source





Congress Strengthens Long-Term Care

The Deficit Reduction Act (DRA) of 2006, signed into law by President George W. Bush on February 8, curbs Medicaid planning abuse (the sheltering of assets to make a non-eligible person eligible for Medicaid long-term care coverage) and releases the Long-Term Care (LTC) Partnership program for nationwide expansion. The latter consists of private/public partnerships that encourage people to purchase long-term care insurance by allowing them to keep their assets if they ever exhaust their insurance and have to turn to Medicaid. The DRA warns the public that long-term care is a personal responsibility, that its risk and cost should not be ignored, that Medicaid remains a safety net but only for those truly in need, and that everyone who is financially and medically qualified should begin now to save, invest, and insure for long-term care. Properly delivered, that message can prevent a great tragedy that threatens this country: It can save Medicaid for the poor while preparing most Americans to pay privately for top-quality long-term care across the full spectrum of LTC services--from home care to skilled nursing facility care.

The DRA reauthorizes "LTC Insurance Partnerships"; strengthens "undue hardship" protections for Medicaid recipients; extends Medicaid's transfer of assets look-back period from three to five years; starts any applicable eligibility penalty later to prevent "half-a-loaf" giveaways; drops the home equity exemption to $500,000 from unlimited; and closes Medicaid eligibility "loopholes" such as "transfer assets before income," "Medicaid-friendly annuities," "life estates," "partial-month transfers," and "self-canceling installment notes." These minor modifications to Medicaid's hemorrhaging eligibility system are long overdue and critically needed to begin a long process of restoring and preserving the welfare program as the long-term care safety net for the poor and to give prosperous citizens incentives to save, invest, and insure for long-term care so they will be able to pay privately for quality care when they need it.

The American Association of Retired Persons (AARP), big charities, and Medicaid planning attorneys opposed the DRA because it reduces the ability of their affluent members and clients to shelter and divest assets in order to shift the high cost of long-term care from their personal responsibility to taxpayers (who finance Medicaid), long-term care providers (who are paid too little by Medicaid to supply quality care), and the poor (who are unable to obtain the same quantity, quality, and range of services from Medicaid available to the well-to-do because they lack the "key money" to buy their way into the better Medicaid facilities). A statement by AARP CEO Bill Novelli on the House budget reconciliation vote was titled, "Transfer of Assets Provision to Punish the Innocent," and claimed, "The U.S. House of Representatives has ... approved a provision in its budget that will deny long-term care coverage to those who give money to charities, churches, and family members in need. Working with our members, AARP will continue the fight to have this ill-conceived policy reversed."

Without the improvements spelled out in the DRA, however, Medicaid will remain on its slippery fiscal slide toward collapse; LTC insurance, home equity conversion, and other private LTC financing alternatives will continue to languish; the bias in most state Medicaid programs to provide LTC in an institutional setting (i.e., nursing home) will continue, while home and community-based care will suffer; the public will remain anesthetized to the risk of not preparing for long-term care; and ultimately the baby boom generation will have to use its home equity to fund long-term care while the poor will have nowhere to turn when Medicaid disintegrates entirely.

The changes to LTC and Medicaid in the DRA will mean nothing, however, unless the states implement them, the federal government enforces them, the private sector promulgates them, and the public understands them. The states are flush with cash again. A January report on Stateline.org began, "From Massachusetts to Hawaii, signs abound that the immense pressure placed on state budgets by the fiscal crisis early this decade has eased and put tax cuts and new spending in the realm of possibility for the first time in several years." With the fiscal pressure off, states may shy away from enforcing the new Medicaid eligibility rules in DRA '06 just as they dropped the ball on the Omnibus Reconciliation Act of 1993 (OBRA '93), which contained many changes that were never enacted.

Advocacy groups are already mobilizing to fight LTC reform again. What they couldn't stop in the above-board legislative process, they'll try to kill behind the scenes in state legislatures and Medicaid agencies. Elderlaw planners are already offering a fire sale on asset transfers, and they'll soon be mobilizing to impede and repeal the DRA reforms. "Although Congress passed a new law February 1 further restricting the ability of the elderly to transfer assets before qualifying for Medicaid coverage of nursing home care, many people in most states will still have time to plan under the old rules," read an email release from Elderlawanswers.com the day after the House vote. "[T]he old rules will likely apply to transfers if the Medicaid application is filed before the state passes the complying legislation. So it may not be too late to plan, and in many cases not too late to transfer assets," the release said.

People won't buy LTC insurance to avoid a Medicaid spend-down liability that does not exist. If the new Medicaid rules are implemented and enforced, the LTC Partnerships established by the DRA will be enormously successful. If not, they won't. The private long-term care insurance industry should actively support efforts to help states implement the new Medicaid rules and LTC Partnerships. Home equity conversion lenders should actively support efforts to educate the American public about the new and likely future Medicaid limits on exempt home equity. LTC providers should actively support efforts to implement the DRA in such a way as to prevent asset transfers that leave people ineligible for Medicaid but unable to pay their own way.

Source

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

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

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"WHO CARES?" IN THE BRITISH NHS

The murdering doctor below will almost certainly suffer no penalty. Even Roy Meadow got off the hook eventually. In the USA, the galoot below would be sued to oblivion

A mother died after being given penicillin before a minor operation despite telling doctors that she was allergic to the drug, an inquest was told yesterday. Teresa Innes, 38, was wearing a red allergy band on her wrist and her medical notes stated that she should not be given the antibiotic. However, a doctor at Bradford Royal Infirmary prescribed it as she was about to undergo routine surgery to drain an abscess on her thigh. She suffered anaphylactic shock which stopped her heart for 35 minutes resulting in brain damage and a persistent vegetative state from which she never recovered. The former care worker died two years later, in 2003, after Dame Elizabeth Butler-Sloss, then President of the High Court Family Division, gave the hospital permission to withdraw her artificial feeding.

At her inquest yesterday, Bradford Coroner's Court was told that Ms Innes had been for a week's holiday to Corfu in September 2001 with her son Scott, 17, and noticed an infection on her left thigh when she returned, thought to have come from an insect bite. She developed an abscess on her leg and was prescribed non-penicillin antibiotics by her GP. A week later, when there was no improvement, she returned to her GP who referred her to Bradford Royal Infirmary.

On arrival at the hospital, at least four members of staff were told of her allergy and it was logged in her notes, the inquest was told. However, during a ward round at the hospital that evening, Ms Innes was prescribed penicillin by John Griffith, a doctor, before the minor operation to drain the abscess on her thigh scheduled for that night. Her medical notes, the inquest was told, recorded that she was allergic to the drug and that she was wearing a bright red allergy band on her wrist. The operation was later postponed to the next morning, when she was given a drip containing Magnapen, a form of penicillin.

A statement by Marlene Greaves, a close friend of Ms Innes who accompanied her to hospital, was read to the inquest. Ms Greaves, who has since died, explained how Ms Innes first had an allergic reaction to penicillin in 1997, after giving it to her nephew and then licking the spoon. She took two days to recover. Ms Greaves recalled how Ms Innes was assessed in the accident and emergency department before being transferred to a ward. "Teresa made a point of telling this doctor she was allergic to penicillin but he said he already knew because it was in her notes," Ms Greaves said.

She said that Ms Innes was in pain and that it was "all she could do to lift one leg". Ms Greaves, who had been named as Ms Innes's next of kin, was called early the next morning and told that her friend was seriously ill. Ms Greaves said: "I couldn't believe what they had done and pointed out how many times they had been told about her allergy." She said she was angry at the time and did not realise how serious the situation was. "I feel in many ways Teresa was like a daughter to me. I think and hope if she was alive today she would feel the same about me," she said. "It was just at a time in her life when things were looking up for Teresa. Her life was lost through such a needless mistake."

Post-mortem examinations found that Ms Innes, whose upbringing was described as "something of a struggle", died from brain damage due to a lack of oxygen brought on by anaphylactic shock and leading to an irrecoverable persistent vegetative state. The inquest was told how, in a meeting between Ms Innes's relatives and hospital staff, Dr Griffith admitted to writing the prescription but said he had not seen the wristband. Nicholas Clarke, a doctor, who assessed her condition on arrival at the accident and emergency department, said Ms Innes came with a letter from her GP, Ian Stinson, which noted her allergy. He said he also noted the condition in her notes in "block capital letters" before handing them over to another member of staff.

Source






ANOTHER BRITISH REGULATORY FAILURE

Experts knew that drugs similar to the one that nearly killed six men at a London hospital last week could have dangerous side effects. Trials last year in the US of a similar "monoclonal antibody" caused severe toxic reactions in patients. But the British study went ahead after the regulatory authority failed to consult outside specialists who would have warned against proceeding.

Angus Dalgleish, a world expert on immunology, said at the weekend he was amazed the trial had been allowed to proceed. "The previous studies which caused similar severe side effects were in patients already suffering from cancer, but (the researchers) should have known they would get a meltdown because this drug was hitting exactly the same immune response pathways," Professor Dalgleish said.

Last week six healthy young male volunteers, who were to be paid pound stg. 2000 ($4800) for the trial, suffered catastrophic side effects within minutes of receiving an experimental drug called TGN1412, which was being tested as a potential treatment for leukemia, rheumatoid arthritis and multiple sclerosis. Two of those given the drug are still in a coma at Northwick Park Hospital, northwest London. The other four have regained consciousness and spoken to relatives.

But doctors said the four men could face months of slow recovery. The monoclonal antibody they were given can linger in the system for months, unlike most conventional drugs that are flushed out in days.

The two others were critically ill in intensive care, and relatives of one of them, Ryan Wilson, said they had been told he could be in a medically induced coma for up to a year. Ganesh Suntharalingam, clinical director of intensive care at Northwick Park Hospital, said an advisory panel was meeting regularly and developing a more detailed understanding of what had happened to the volunteers.

Professor Dalgleish said the Medicines and Healthcare Products Regulatory Agency (MHRA), which approves such drug trials, should have consulted a specialist before approving the study. "I can't understand it. They are normally super-cautious. I would have told the people doing this trial not to do it because the dangers were so great," he said. The data that should have raised the alarm were presented at a meeting of the American Society of Clinical Oncology in May last year. Professor Dalgleish -- a professor of cancer at St George's Hospital medical school, south London -- said an engineered antibody using the same pathway as TGN1412 had produced severe side effects in about half of a group of patients who were dying of cancer.

British experts told The Times last week it had been a mistake to give the drugs to six volunteers at the same time, but MHRA has defended the trial. A spokesman said the MHRA had reviewed the dossier of data that the drug's developer, TeGenero, had produced and confirmed that all was in order. Given the same data, the agency would approve the trial again, he said. "We have (since) given the trial protocol to a new set of assessors and they came to the same conclusions. There was nothing wrong with it."

In Germany, where the drug was developed, prosecutors said they were examining whether to start an investigation into the biotech company TeGenero. And the body responsible for licensing trials, the Paul-Ehrlich-Institut, hinted changes would be needed in the way trials were run. Their spokeswoman told German radio: "We are all going to think about whether to start off with a single person for studies where there is a risk of this kind."

Source

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

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

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The Titanic of health care

Comment from Melanie Phillips in Britain

Has there ever been a more bizarre notion of political responsibility? The NHS is currently engulfed by a deep financial crisis as it careers towards a deficit of between 600 million pounds and a staggering 1 billion. Operations are being cancelled. Hospitals and primary care trusts have frozen staff vacancies. Managers are even threatening to withhold tax and national insurance contributions because they don’t have enough cash to pay them. The service is descending into chaos. As result, the NHS Chief Executive Sir Nigel Crisp has walked the plank. The Government’s insistence that he took early retirement entirely of his own volition is frankly incredible. In fact, he very decently acknowledged responsibility for the service’s problems, as well as for its successes.

So a career beached in ignominy? Hardly. For Sir Nigel has been given a life peerage -- one of only a handful in the Prime Minister’s gift for public servants who have made a particularly distinguished contribution. For this failure to stop the NHS sliding into financial chaos, which has caused him to depart so precipitately from his post, Sir Nigel has therefore been rewarded with a Whitehall plum. Confused? In the surrealist and unending disaster epic that is the NHS, very little makes any sense. Unprecedented amounts of money have been hurled at the service by the Chancellor -- and yet we learn that, some four years on, the NHS appears to be going bust. So how can this have happened?

The immediate reason is that almost all this largesse has been swallowed up by salaries, pensions, drugs, IT systems and other commitments which cost far more than had been expected. As result, virtually no money was left for improving the actual delivery of services to patients, without what are euphemistically called ‘efficiency savings’ – or cuts to you and me. These were so vague as to be next to useless. So almost all the Chancellor’s extra billions disappeared into the mechanics of the system. Meeting the demands by ministers for more, better and faster treatment sent the service shooting into the red.

In a more honourable age, the Health Secretary presiding over such a shambles would have fallen on her scalpel. But here, surely, is the explanation for the ennoblement of Sir Nigel. His peerage was a sop to sweeten the bitter pill of being made the fall-guy for a politician who was determined not to take the rap. Sir Nigel should not have been sacked, because the job he was given was simply impossible. He was being expected to turn round a service which was being driven off the rails by the incoherence, arrogance and incompetence of Government policy.

What has happened has tested to destruction the old excuse that the problems of the NHS were due to lack of money. We now spend more on health care than the European average, but it has vanished into a managerial black hole. An unprecedented level of spending has simply produced an unprecedented level of crisis. This was entirely predictable; indeed, it was in fact predicted by many commentators. The government was warned that this would happen by Nick Bosanquet, the distinguished professor of health policy; it was warned by the influential Reform think tank; it was warned by the OECD, which said that such an enormous amount of money simply could not be processed efficiently in such a short amount of time.

The Government ignored all of them. Instead, it pressed forward with one ill thought-through and incoherent policy innovation after another. The reason Sir Nigel was unable to constrain NHS spending was that its managers were being driven to meet unrealistic ministerial targets -- in particular, the policy of reducing treatment waiting times. It was this policy which meant that more patients had to be processed faster, even though there wasn’t the money to do it. It was this policy which grossly distorted clinical priorities. It was this policy which shunted patients onto ‘ghost’ waiting lists -- which didn’t officially exist -- to artificially massage the figures downwards. And all this to provide the illusion of improvement, so that ministers could make an empty boast that would hoodwink the voters.

Now the Health Secretary Patricia Hewitt claims that only ‘a very small minority'’ of hospitals and NHS bodies have serious financial problems. One shudders to imagine what she thinks a large problem would look like. It should not have been Sir Nigel who resigned but the Health Secretary herself. The notion of ministerial accountability, however, seems to have gone out of the window altogether. Indeed one of the reasons for creating an NHS executive was to enable ministers to do precisely what Ms Hewitt has done -- to wash their hands of the mess that their own policies create. They keep the service under control so tight that it cripples it -- and yet they refuse to accept responsibility when things go wrong.

But although the Government won’t admit this, Ms Hewitt’s own job is also impossible. This is because the NHS is simply unmanageable. Since the mid-seventies, government after government has tried to reform it. Yet every one has made things worse so that the service merely lurches from crisis to crisis. The reason is that it is simply too big. According to some measures, it is the third largest employer in the world. In England and Wales it employs around 1.3 million people, or around one in every 40 people. It is just not possible to manage such a monster from an office in Whitehall.

The bitter irony is that the very premise of the NHS is proving its undoing. Taxpayers’ money is spent on the nation’s health care by ministers -- who thus inevitably tell the service what to do. And what that means is that no government can solve the NHS crisis, because government itself is the problem. Instead of a health service funded by the Treasury, therefore, the solution has to be a different model of funding altogether. The fairest and most efficient alternative is a form of social insurance as practised in Europe, where waiting lists are virtually unknown. Patients purchase healthcare from providers of their choice, with the state guaranteeing levels of provision covering the poorest in society.

Our NHS is a shibboleth because people assume it is the only system that is fair. But this is simply untrue, as anyone who has seen the often shameful way that it treats those who are both poor and elderly can testify. The present system is already a lottery which will become dramatically more unfair as the population ages and new treatments become available. Cancer care alone is forecast to cost an extra 15 billion pounds by 2011. The consequent rationing will become unendurable and unsustainable.

Sir Nigel has gone, but there is no sign that Ms Hewitt has the faintest idea how to address this crisis. She’s still talking about bringing down waiting times to 18 weeks. But as Professor Bosanquet says, this policy – which has not even been properly thought through – should be abandoned before it causes yet more distortions, chaos and patient distress. In the longer term, radical thinking is required. The NHS is the Titanic of health care. Rearranging the deck-chairs yet again will not save it from sinking.






MORE DESPERATE SHUFFLING OF THOSE DECKCHAIRS

"Patients with some serious conditions could be treated at home rather than in hospital in order to try to cut the number of emergency admissions. The Health Secretray Patricia Hewitt is expected to announce the move as part of Government plans to tackle the NHS cash crisis. Ms Hewitt is said to be preparing plans to encourage people with conditions such as asthma and heart disease to be cared for at home by community nurses. The Department of Health believes the measures could save the cash-strapped NHS up to 400 million pounds a year, according to a BBC report. But the Tories accused her of trying to get "healthcare on the cheap" and said the plans would threaten patient care.

Ms Hewitt said: "If we could cut these unplanned emergency admissions by 30% and patients would have improved lives and hospitals would be able to plan their services better. "The potential savings from those PCTs (Primary Care Trusts) that have many more emergency admissions than the average is almost 2.5 million pounds per PCT."

Shadow health secretary Andrew Lansley said the Government should "let professionals get on with the job of determining how patients are cared for". Dr Beverly Malone, general secretary of the Royal College of Nursing, said: "We are very supportive of care moving from the hospital to the community. "But right now there are not enough nurses in the community to take care of these patients. District nurses are already working flat out."

Source





1,000 staff to go from just one British public hospital

A cash-strapped hospital is to cut up to 1,000 jobs in a desperate attempt to reduce debts of more than 15 million pounds. The University Hospital of North Staffordshire in Stoke warned around three-quarters of the redundancies will be compulsory. Some 370 nursing and midwifery posts are expected to go. Pat Powell, the hospital representative for leading trade union Unison said: "The hospital claims the job cuts will not affect patient care, but we feel they will inevitably affect services."

Hospital chiefs said they were "saddened" by the cuts but the move was essential to address their huge deficit. There are already strict controls in place on recruitment to vacant posts. Managers said they planned to improve efficiency. Antony Sumara, Chief Executive, said: "I am deeply saddened that we now find ourselves in this position. "However, I firmly believe we will be a very strong trust, able to go forward confidently and provide first class services for our patients and good working conditions for our staff."

Source

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

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

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AUSTRALIA'S PUBLIC HOSPITAL MELTDOWN

Just one weekend's news from the three most populous States below:

NSW hospitals close surgery for long periods

Waiting lists are set to rise as some of the state's largest public hospitals prepare to shut down elective surgery for up to three weeks over Easter. Doctors have labelled the closures as a cost-saving exercise with many hospital budgets already stretched to breaking point, months before the end of the financial year. Except for emergency cases, hospitals including Westmead, Wagga Wagga, Mona Vale, Manly and St Vincent's, are shutting down or reducing elective surgery services for about a fortnight next month. Staff at Ryde Hospital, in north-west Sydney, have been told no elective surgery will be carried out for three weeks.

Australian Medical Association NSW president Dr John Gullotta said next month's close-down period was longer than previous years. "We really have to ensure that these shutdowns don't get longer and longer every year," he said. "It is a blatant cost-saving exercising. It's an attempt to constrain the budgets. "It's also forcing further cancellations of elective surgery and increasing the list."

But a spokeswoman for NSW Health Minister John Hatzistergos said the number of patients waiting longer than 12 months for elective surgery had been halved, decreasing from more than 7000 in February 2005 to about 3400. Latest figures show more than 56,000 patients are waiting for surgery in NSW.

The Easter shutdown comes after many hospitals closed their operating theatres for up to six weeks during Christmas. Dr David Jollow, a visiting gynaecologist at Manly and Mona Vale hospitals, said those hospitals normally only closed for one week at Easter. "It's all to do with saving money," he said. "I don't how much money they save by doing these things. "I think realistically if they were really keen to get rid of the elective surgery waiting list, they would be open 52 weeks."

Dr Gullotta said close-downs were becoming so common, some hospitals did not provide elective surgery for up to three months of the year. Health Opposition spokeswoman Jillian Skinner said it was not a case of hospital staff wanting time off at Easter. "We really do have part-time hospitals and it's not because doctors want to take leave," she said. "It's because the Government can't afford to run them."

Source





Victoria's health system in big trouble too

A severely-ill pensioner says she was taken off a drip at a Melbourne hospital emergency ward and told to leave -- because no public beds were available. Another woman in agony after a procedure at the hospital claims she was denied painkillers and told that she should have brought her own. The Health Services Commissioner is being called on to investigate the allegations against Casey Hospital.

The claims come as waiting lists soar and specialists say vital tests to check for bowel cancer in at-risk Victorians are being secretly cancelled. In the first case, a woman, 61, who was too frightened to be named, said she had suspected pneumonia and had been referred to the hospital by her doctor. The woman, who had needed treatment for pneumonia three times previously, had a temperature of 38, was vomiting and struggling for breath, her distraught husband said. On arrival at Casey's emergency department, the Pakenham woman was put on an intravenous drip and blood tests were taken for analysis at Monash Medical Centre.

But her husband alleged that when she had said she did not have private health insurance, the emergency duty doctor had told her there were no beds available and she had to leave. Her husband said he learned later that the blood tests had not been forwarded to Monash for analysis.

In the other case, a woman, 43, who went into Casey for an epidural steroid injection to ease back pain, said she had been denied painkillers despite being in the worst agony of her life. "I couldn't move -- I've never felt pain like that in my life," she said. "When I asked for painkillers the staff said I should have brought my medication -- even though I was not told that before I came in."

Opposition health spokeswoman Helen Shardey said the cases were "appalling" and should be investigated by the Health Services Commissioner. "The treatment of these patients appears to have been cruel to the extreme," she Shardey said. Casey Hospital said it could not comment specifically on the cases because no complaints had been received.

Source






The coverups never end in the Queensland health system



Ambulance officers have been gagged from mentioning delays or bed shortages at hospital emergency departments. A top-secret email has gone out to staff warning them not to use the words "ramping" or "access block" when sending radio messages to Queensland Ambulance Service communications centres. Ramping, or access block, is when hospitals refuse entry to paramedics and patients because no beds are available. Ambos have been told to use the terms only on a telephone. If they can't get through on the secure land-line after two attempts, they are advised to use their radio, with the provision: "Do not refer to ramping or access block." Sources said the order had come from "high places" in the State Government due to concerns that media and the Opposition were being tipped off about the problem.

The Government has been under fire after reports that Royal Brisbane and Women's, Mater and Caboolture hospitals were diverting emergency patients. Queensland Health figures in February revealed nine of Queensland's 23 major hospitals were at capacity, and many others were struggling to cope with their workload.

A frontline ambo, who declined to be identified, told The Sunday Mail that paramedics and communications officers had been advising each other by radio when ramping occurred, and they were pleased to see the issue brought to public attention. "Some crews are being ramped for several hours at a time and, while the paramedics can readily give treatment to a ramped patient, a ramped ambulance crew is, of course, unable to respond to any emergencies," he said. "Multiply that by five or six crews and you can see the size of the problem if an emergency goes off."

The ambo said an email was sent out this week "explicitly telling them to never use the radio when discussing ramping". "There is only one reason for this, and that is to stop the media picking up on the frequency and severity of the problem," he said. It was not the first time ambos had been gagged. The Sunday Mail reported exclusively last May that staff were threatened with $3000 fines if they spoke out publicly about their controversial new roster system. QAS bosses closed down paramedics' online forum last September due to contentious issues being raised there by concerned officers.

The ambo speculated pressure had been put on QAS by Queensland Health or a Government minister: "Perhaps the QAS thinks that by gagging staff, the problem of ramping doesn't exist." Opposition health spokesman Bruce Flegg said the email was "unbelievable". "It is political interference of the very worst kind," he said. "This Government would rather cover up the problem than try to fix it."

Source






This guy should have been a crook

He would have had no problem then -- even if he had been struck off overseas

A highly respected foreign doctor working in Brisbane may be kicked out of the country because the Federal Government does not want to pay for medical treatment for his Australian-born son. The Indian doctor, a member of the Royal Australian College of General Practitioners and the Australian Medical Association, has a temporary resident visa, valid until 2008. He recently applied for permanent residency for him and his family. But the Immigration Department has stalled after a report from the Commonwealth Medical Officer said the doctor's infant son would require ongoing orthopedic and pediatric care for a minor disability.

The Queensland Government has expressed its outrage to Canberra as it struggles to employ 300 new doctors over 18 months to solve its health crisis. Deputy Premier Anna Bligh has written to Federal Immigration Minister Amanda Vanstone asking her to intervene and approve the application. She said the doctor was highly regarded by Queensland Health. "I find it remarkable that, at a time when Australia is facing critical doctor shortages, (the Immigration Department in Canberra) would disregard an application for permanent residency by a highly qualified, well-regarded medical professional on the grounds that his son suffers a disability, despite the fact the child was born in Australia and the family has taken full responsibility for his current and future medical needs," Ms Bligh said.

The doctor, who had been in Australia since 2003, had worked at Ipswich and Logan hospitals, at Wacol and Borallon prisons, at Aboriginal health centres and as a GP in Brisbane. Ms Bligh said the family was prepared to meet all future medical costs and take full responsibility for the care and support of their two-year-old son. The doctor, who asked not to be identified, declined to comment on his case for fear of upsetting immigration officials.

The State Government had received letters of support from patients of the GP. He also received backing from Health For All, an organisation sponsoring overseas-trained doctors, after he had helped train foreign doctors and set up their patient database. "We desperately need doctors," said director Madonna Abella. "It would be good if the Department of Immigration could change its policy to make it more attractive for overseas-trained doctors to come here."

AMA Queensland president Steve Hambleton also urged Senator Vanstone to intervene. "We have to be a bit more tolerant, open and welcoming," he said. An Immigration Department spokesman said a final decision had not been made. But he confirmed medical advice said the doctor's son "does not meet the health requirement". The department had invited the doctor to supply further medical opinion to support his application.

Source





BRITISH NHS TO CUT DENTISTRY

Cuts, cuts and more cuts, despite getting more and more money

Dentists are expected to remove more than half a million children from lists entitling them to free NHS treatment when a new pay deal comes into effect next month. Thousands of practitioners are likely to reject the contract offered by the government and quit the National Health Service to treat only patients prepared to pay, according to a survey of NHS primary care trusts. The trusts, which provide GP and dental care locally, have admitted that thousands of children will be hit. Some have already written to patients warning them that from April 1 both adults and children will be obliged to find another dentist unless they are prepared to pay for treatment or buy insurance.

The NHS has been losing dentists to the private sector since 1992 when it introduced changes to their payments. Tony Blair pledged in 1999 that everybody would be able to see an NHS dentist within two years, but the exodus has continued. It is expected to accelerate when the new employment contract for dentists takes effect and children will be removed en masse from dentists' lists for the first time. A Sunday Times survey of 29 primary care trusts found that 133,000 patients, about 40% of them children, have been told they will no longer be able to get NHS treatment from their current dentist after the end of the month. There are 302 primary care trusts in England and, if the pattern is reflected across the country, about 830,000 adults and 550,000 children will be dropped by their dentists.

The Dental Practitioners Association said the figures were a "reasonable estimate". Among those who have already received a warning is Adette Lodge, 34, from Gloucester, who was told that her three children, aged 12, nine and five, would no longer be offered NHS treatment. She said: "I was shocked, upset and angry. It is important that children's teeth are formed properly in their early years. If their parents can't pay, care is being taken away from them."

Among those leaving the NHS is John Renshaw, who was chairman of the British Dental Association until last month. He said he regretted that some parents would not be able to afford dental fees and that children would be left without care. "I have been committed to the NHS for the last 37 years but the new contract has forced me to make this decision," he said. "It was not an easy decision but it had got to the point where the NHS was not supporting the kind of service we wanted to offer our patients. "There will be some patients who will not pay. I expect the number of children who are not getting dental care will increase."

Graham Barnby, honorary vice-president of the British Dental Health Foundation, runs two dental practices in north Dorset. One has told 1,000 patients, including children, that they will no longer be offered NHS treatment. Barnby said: "We have put in place low-cost insurance for children. The reaction from parents has been mixed. Just the other day we had one parent who paid the fees for their children for a year. "Other patients have said, `I know my rights under the health service and I have a right to NHS treatment'. I feel sorry for those who cannot afford to go private."

The new system pays dentists a fixed rate for a series of treatments. Some dentists argue that the fees are not high enough to pay for high-quality care. The Department of Health insists that patients thrown off practice lists will be able to find another NHS dentist in the area. Rosie Winterton, the health minister responsible for dentistry, said: "The early signs are that the vast majority of dentists will sign up to the new contracts."

Source

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

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

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Is Socialized Medicine the Answer?

By Arnold Kling

"When you think of the problem of health care costs, you shouldn't envision visits to the family physician to talk about a sore throat; you should think about coronary bypass operations, dialysis, and chemotherapy." - Paul Krugman and Robin Wells, "The Health Care Crisis and What to Do About It", The New York Review of Books, March 23, 2006

In fact, when you think of the problem of health care costs, you should think of MRI examinations for back pain, colonoscopies to screen for colon cancer, and non-emergency visits to cardiologists, gastroenterologists, and other specialists. These are expensive procedures that often do not affect the outcome for the patient. Advanced medical technology and referrals to specialists make up what might be termed "premium medicine."

Premium medicine often falls in a gray area that is in between unnecessary health care and acute care. The procedures have some medical justification, but they are not always cost-effective.

Krugman and Wells correctly point out that our health care financing systems, both public and private, are unraveling under the pressure of premium medicine. However, they make an unproven case that, in their words, "honest-to-God socialized medicine" would be so efficient that it would make premium medicine affordable, at least until technology and medical know-how expands even further. In the long run, they see health care rationing by government as the only solution for controlling health care costs.

Krugman and Wells point out that other countries use government-financed health care, and that in those countries health care outcomes are not notably worse while spending is less. They would have us believe that people in other countries receive the same treatment at lower cost.

In fact, Americans consume more premium medicine than citizens of other countries. To some extent, this may produce better results that are obscured in the data used to compare health outcomes on a national basis. Longevity, for example, is affected by many factors other than health care.

The main reason that other countries can spend less on health care is that the availability of medical services is limited by government policy. The health care rationing that Krugman and Wells believe is inevitable for the United States takes place today in other countries. Health care rationing is one way to try to cut back on medical procedures that are not cost-effective. However, it would represent a radical change for the American health care consumer.

Today, the United States has two large government health care programs - Medicare and Medicaid - that do not display the efficiency that Krugman and Wells ascribe to single-payer health care systems. In fact, Krugman and Wells admit that Medicaid and Medicare are in dire financial straits. Notwithstanding the allegedly lower administrative costs in government programs, and despite the government's use of its leverage to hold down the fees charged by health care providers, the spending by the U.S. on its elderly population, on a per capita basis, is as high relative to that of other countries as is spending on the under-65 population. In other words, our elderly are heavy consumers of premium medicine, so that within the United States there is no sign that single-payer health care can reduce health care spending.

Krugman and Wells write:

"The medical profession, understandably, has a bias toward doing whatever will bring medical benefit. If that means performing an expensive surgical procedure on an elderly patient who probably has only a few years to live, so be it. But as medical technology advances, it becomes possible to spend ever larger sums on medically useful care. Indeed, at some point it will become possible to spend the entire GDP on health care. Obviously, we won't do this. But how will we make choices about what not to do?"

They argue that eventually we will need government rationing of health care. But they say that this issue can be deferred, because in the short run the shift to a government-run health care finance system would save enough money to allow us to continue to afford premium medicine.

Krugman and Wells believe that the efficiency of socialized medicine is a sure thing, and that health care rationing is a far-off possibility. In fact, if the United States were to adopt government-financed health care, the results would be the reverse. Efficiency would fail to improve, and instead it would most likely deteriorate. Rationing would be a sure thing.

The opposite approach is to have consumers bear more of the cost of health care decisions, with a safety net consisting of long-term catastrophic insurance with very high deductibles. This would put an unfamiliar burden on Americans to assess the costs and benefits of our specialist visits, MRI exams, and so on. No doubt, some of us would make mistakes. But these would be our individual responsibility, not a collective crisis.

In my view, either single-payer health care or a return to individual responsibility represents a radical change. It would be more prudent to have individual states experiment with these alternatives before we commit to any single approach at a national level.






Bush's Answer to Hillarycare

In his State of the Union address, President Bush devoted only a few sentences to health policy. But as the president was speaking, the administration released a five-page document describing health policy proposals so sweeping and bold, they are comparable in scope to Hillary Clinton's proposals of a decade ago. If the White House devotes the energy and political capital necessary to see them through, these reforms will leave a lasting mark on social policy in this country.

In 2003, the president signed legislation that theoretically allows every nonelderly American to establish a Health Savings Account (HSA). His proposed changes will make HSAs more affordable, flexible and available to more people.

Patient Power.

The idea behind HSAs is quite simple. Individuals should be able to manage some of their own health care dollars through accounts they own and control. They should be able to use these funds to pay for out-of-network doctors, diagnostic tests and other out-of-pocket expenses. They should be able to profit from being wise consumers of medical care and by having account balances that grow tax-free and eventually become available for nonmedical purchases. To enable people to make more of these types of decisions on their own, the president is proposing to (1) increase the amount people can contribute to their HSAs, (2) make it easier for people to obtain one and (3) encourage everyone to have one. (The tax breaks, portability and chronic illness features described below apply only to HSA plans.)

Patients will respond to the financial incentives created by HSAs in different ways. Some will seek information about diseases, treatments and health care providers over the Internet. Some may bypass primary care physicians altogether and directly order their own diagnostic tests or seek online specialist consultations. Others may bypass brand name drugs for less-expensive generic and therapeutic substitutes and over-the-counter drugs. When people spend their own money, they will generally not spend a dollar on health care unless they get a dollar's worth of benefit.

Tax Fairness.

For the first time in 60 years, individually-purchased insurance and employer-purchased insurance would compete on a level playing field under the tax law if the President has his way. There would literally be no reason for an employer to offer insurance (instead of wages) unless there were clear efficiencies or other advantages from group purchase. The main reason companies today provide their workers with health insurance rather than pay higher wages is the tax law. In contrast to taxable wages, every dollar an employer spends on employee health insurance premiums avoids federal income and payroll taxes, as well as state and local income taxes. For a middle-income employee, this generous tax subsidy means that government is effectively paying for almost half the cost of the insurance. People who purchase health insurance on their own get virtually no tax relief, however. They must buy their insurance with after-tax dollars. As a result, a middle-income family effectively pays twice as much if they have to buy insurance directly.

The president proposes making premiums an above-the-line deduction (available even to taxpayers who do not itemize) for individually-purchased HSA policies. And there would be a credit to offset payroll taxes on the income used to pay premiums.

Portability.

One of the most radical reforms the president is proposing is to allow employers to purchase individually-owned, personal and portable insurance for their employees — insurance that would travel with them from job to job. Although few specifics are available, the genesis of this idea is a plan designed by the National Center for Policy Analysis and Blue Cross/Blue Shield of Texas. The administration is proposing to take this idea nationwide — allowing federally regulated insurers to sell such policies in every state.

One of the peculiarities of the current system is that the health plan most of us have is not a plan that we chose; rather, it was selected by our employer. Moreover, we can easily lose coverage because of the loss of a job, a change in employment or a decision by our employer. Virtually all employer health insurance contracts last only 12 months. At the end of the year, the employer — in search of ways to reduce costs — may choose a different health plan or cease providing health insurance altogether.

All too often, a switch in health plans means changing doctors too, since each plan tends to have its own network. Additionally, different employer plans have different benefit packages. So some services, like mental health, may be covered under one employer's plan but not under the next employer's plan. These disruptions affect some families more than others. For people who are healthy, they may amount to minor inconveniences. But if an employee (or a member of the employee's family) has a health problem, it means discontinuity of care. One study of chronically ill workers found that workers who rely on their employers for health coverage have 40 percent less job mobility compared to similar workers who obtain their health coverage elsewhere. This "job lock" can lower the potential incomes of the workers affected.

Under the president's proposal, employers initially would pay most of the premiums (as they do today). But this insurance would be owned by the employees and would travel with them as they move through the labor market. Thus employees would get portable insurance (a characteristic of individual insurance), but at group insurance prices.

Chronic Illness.

Equally radical is the president's proposal to allow employers to make special deposits to the HSAs of the chronically ill. Until now, HSAs have not been designed with sick people in mind. But they could be. Employers currently make different premium payments for employees, depending on their expected cost; similarly, the president's plan would allow them to deposit different amounts into their HSAs.

Studies show that with a modest amount of training, people with chronic conditions — like diabetes or asthma — can manage their own health care and achieve results at least as good as and at less cost than traditional care. If they could also manage the dollars involved, we could align financial incentives with health incentives. For instance, if asthmatics with HSAs monitor their condition and avoid trips to the emergency room, they would not only improve their health, they would also benefit financially. Diabetics who monitor their blood glucose levels and avoid costly complications would realize financial benefits as well as health benefits from their decisions. Pilot programs for the disabled are already showing very positive results (in Medicaid, of all places!). These programs allow patients to choose some of their health care providers, and give patients an account with which to pay for health care services. Considering that chronic patients spend about 70 percent of all health care dollars, this is not a minor reform. It is a huge reform.

A National Insurance Market.

In an ideal world, you would be able to go online and buy insurance in a national marketplace instead of being forced to buy in the state where you live. Thanks to the Supreme Court you can now buy wine across state lines, which has led to a big drop in costs for many consumers. When you can buy insurance the way you buy wine, insurance premium costs will plummet as well.

Many cities and towns have only one insurer. In these markets, policies are often offered on a "take it or leave it" basis. They may be overpriced, with benefits that do not fit the needs of many individuals and families. But with few or no alternatives, buyers must purchase a less desirable plan or forgo insurance altogether. Furthermore, state governments regulate health insurance excessively. And they do so in 50 different ways. In addition to taxes, price controls and regulations governing access to insurance, states require health insurance buyers to pay for extra benefits they may not want or need. Studies estimate that as many as one out of every four uninsured Americans has been priced out of the health insurance market by these regulations and mandated benefits.

The president proposes to allow insurers licensed in any one state to sell insurance in every other state under the rules and regulations of the home state. This is a major step in the direction of replacing 50 over-regulated markets with one large, relatively free and less-costly market.

A New Health Care Vision.

All of these reforms will make health insurance more affordable and more accessible. They will reshape the health care marketplace by empowering patients and turning them into true consumers of care. They will strengthen the doctor-patient relationship and allow doctors to be agents of their patients rather than agents of third-party payers. All in all, they are a vast improvement over the current system.

Source

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

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

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DREADFUL NEWS FOR THE LEFT: GUESS WHICH COUNTRY IS THE FIRST TO HAVE ACHIEVED HEALTHCARE EQUALITY?

Yes. It is that awful dog-eat-dog capitalistic USA that has achieved equal medical care for all. The prestigious (and distinctly Leftist) "New England Journal of Medicine" says so. They report research findings that say that the poor get roughly the same care as the rich. That does not happen in Canada or Britain. There the rich get prompt treatment while the poor get put on waiting lists for years. The academics who did the study below were mightly miffed at such pesky findings and tried to play them down by noting that very few people got cared for according to a theoretical ideal. That being put on a waiting list for years is REALLY non-ideal care is however obvious. If the poor get roughly the same treatment as the rich in the USA, they get very good care indeed.

"Startling research from the biggest study ever of U.S. health care quality suggests that Americans - rich, poor, black, white - get roughly equal treatment, but it's woefully mediocre for all. "This study shows that health care has equal-opportunity defects," said Dr. Donald Berwick, who runs the nonprofit Institute for Healthcare Improvement in Cambridge, Mass.

The survey of nearly 7,000 patients, reported Thursday in the New England Journal of Medicine, considered only urban-area dwellers who sought treatment, but it still challenged some stereotypes: These blacks and Hispanics actually got slightly better medical treatment than whites.

While the researchers acknowledged separate evidence that minorities fare worse in some areas of expensive care and suffer more from some conditions than whites, their study found that once in treatment, minorities' overall care appears similar to that of whites. "It doesn't matter who you are. It doesn't matter whether you're rich or poor, white or black, insured or uninsured," said chief author Dr. Steven Asch, at the Rand Health research institute, in Santa Monica, Calif. "We all get equally mediocre care."

The researchers, who included U.S. Veterans Affairs personnel, first published their findings for the general population in June 2003. They reported the breakdown by racial, income, and other social groups on Thursday. They examined medical records and phone interviews from 6,712 randomly picked patients who visited a medical office within a two-year period in 12 metropolitan areas from Boston to Miami to Seattle. The group was not nationally representative but does convey a broad picture of the country's health care practices. The survey examined whether people got the highest standard of treatment for 439 measures ranging across common chronic and acute conditions and disease prevention. It looked at whether they got the right tests, drugs and treatments.

Overall, patients received only 55 percent of recommended steps for top-quality care - and no group did much better or worse than that. Blacks and Hispanics as a group each got 58 percent of the best care, compared to 54 percent for whites. Those with annual household income over $50,000 got 57 percent, 4 points more than people from households of less than $15,000. Patients without insurance got 54 percent of recommended steps, just one point less than those with managed care. As to gender, women came out slightly ahead with 57 percent, compared to 52 percent for men. Young adults did slightly better than the elderly. There were narrow snapshots of inequality: An insured white woman, for example, got 57 percent of the best standard of care, while an uninsured black man got just 51 percent. "Though we are improving, disparities in health care still exist," said Dr. Garth Graham, director of the U.S. Office of Minority Health. Graham, who is black, pointed to other data showing enduring inequality in care, including a large federal study last year. He also said minorities go without treatment more often than whites, and such people are missed entirely by this survey.

Some experts took heart in the relative equality within the survey. "The study did find some reassuring things," said Dr. Tim Carey, who runs a health service research center at the University of North Carolina-Chapel Hill. But all health experts interviewed fretted about the uniformly low standard. "Regardless of who you are or what group you're in, there is a significant gap between the care you deserve and the care you receive," said Dr. Reed Tuckson, who is black and a vice president of United HealthGroup, which runs health plans and sells medical data.

Health experts blame the overall poor care on an overburdened, fragmented system that fails to keep close track of patients with an increasing number of multiple conditions. Quality specialists said improvements can come with more public reporting of performance, more uniform training, more computerized checks and more coordination by patients themselves."

Source




More on the corrupt, wasteful and and secretive inner workings of a long-established socialized medicine bureaucracy

A Queensland Health employee yesterday gave secret "in-camera" evidence to a federal health inquiry alleging the State Government has been illegally taking money from Medicare. The former head of the controversial health inquiry into surgeon Jayant Patel, Tony Morris, QC, yesterday told a federal House of Representatives Health and Ageing Committee hearing the concerned QH employee made the claims to him earlier this week. Mr Morris told the hearing the anonymous QH staffer was so concerned she wanted to expose how the department was "cost shifting" Medicare funds by bulk-billing patients without referrals and deliberately overcharging for health services. "(This is) the most scandalous stuff and, fortunately, I was able to tell that particular whistleblower about the existence of this committee," Mr Morris said.

Committee chairman Alex Somylay, a federal liberal backbencher, later confirmed the QH employee would be afforded protection by being allowed to give her evidence during a closed hearing. "We know that cost shifting is rampant, just the same as blame shifting is rampant between the Commonwealth and the state (governments)," Mr Somylay said. He also launched an attack on Queensland Premier Peter Beattie for the State Government's unwillingness to take part in the hearing or even allow QH staff to give evidence.

Mr Morris said it was sad that after last year's three health inquiries that QH staff were still too scared to blow the whistle on on-going systemic departmental problems for fear of retribution.

The hearing was also told that in Queensland only 20c out of every dollar was actually spent providing care to patients and that there were more bureaucrats working for QH than there were beds in public hospitals.

Mr Morris said the culture within QH would not change unless clinicians started running hospitals and not "bean counters" who had yet to pass a "St John's Ambulance" first-aid course. "The only patients at (QH's head office in) Charlotte St (in Brisbane's CBD) are the odd public servant who scalds himself on the tea trolley," Mr Morris said. He was also critical of the "band-aid" approach taken by the State Government to fix the doctor shortage crisis at Caboolture, saying it was simply a reaction to help save political face. "(It) is a quick fix solution that will help the people in Caboolture (in the short term)," he said. "It's a very expensive band-aid (solution), but a band-aid solution none the less," he said.

It was not all bad news for Mr Beattie, however, with Mr Morris praising him for his success in securing an additional 80 placements at universities for medical students. However, he said that based on the current need for locally trained doctors in Queensland, exposed during his inquiry, the current need to fill public hospitals with home-grown clinicians would not occur before 2038.

Source






More secrecy about a tragic public medicine failure in the same health system

But plenty of "spin" now the matter has come to light

A secret investigation is under way to determine whether infants are dying unnecessarily because of inferior pediatric cardiac services in Queensland. The inquiry by an independent team of interstate and overseas medicos follows complaints that services have for years been poorly funded and fragmented. Up to eight babies died from one procedure which has now been stopped.

The team is due to complete its report by Monday. It threatens to be another political bomb for the Beattie Government which was warned at least five years ago of dangerous pitfalls in the system.

Much of the probe centred on Chermside's Prince Charles Hospital pediatric intensive care unit following the deaths of several children there, and other Brisbane hospitals. The investigators examined concerns raised by three leading specialists: Dr Tony Slater, Dr Rob Justo and Dr Cameron Ward. The director of the pediatric intensive care unit at Prince Charles, Dr Nikolaus Haas, resigned after the inquiry began. Dr Michael Cleary, director of medical services at Prince Charles, said: "Because of the confidential nature of the inquiry, I can't comment on Dr Haas." Later, he phoned back and said: "Dr Haas has resigned from Prince Charles as the director of pediatric intensive care. "He has been discussing a possible change for about a year. His resignation is in no way linked to the inquiry." The German-born Dr Haas did not return calls.

The investigating team of Professor Tim Cartmill and Professor Craig Mellis from Sydney and Professor Frank Shann from Melbourne has been joined by New Zealand's leading pediatric cardiologist, Dr Tom Gentles. They enlisted University of Queensland mathematician, Professor Annette Dobson, who was asked to examine mortality statistics "benchmarked against data from other national and international centres".

Between 300 and 400 children are born each year in Queensland with congenital heart disease requiring surgery. All but minor operations are conducted at Prince Charles Hospital. "A vast majority of these children do well and survive with good life expectancy," said Dr Tony Slater, whose work spans the Royal Children's, Prince Charles and the Mater Children's hospitals. "This is very sensitive, delicate stuff. "There are a number of people from different disciplines who thought we would benefit from outside advice. The individuals at Prince Charles have done a very good job. The question now is: Is this the right system for the future?"

More here

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

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

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"COMPASSIONATE" SOCIALISM AT WORK IN BRITAIN AGAIN

A baby girl suffering from a rare heart defect has had surgery cancelled seven times because of a shortage of intensive-care beds. Lily Cater, who had her second birthday yesterday, has had an operation for pulmonary atresia — a life-threatening condition linked to underdevelopment of the heart — repeatedly rescheduled at Birmingham Children’s Hospital. The condition, which affects about three children a year in Britain, requires an intensive- care bed for post-operative recuperation. However, pressure on the Birmingham unit has meant that the 19 beds available have been taken up with children at immediate risk of death on each occasion.

The parents of Lily, who is not expected to live beyond her fifth birthday if she does not have the operation, said that it was appalling that the NHS could not provide enough beds for such crucial surgery. Michala Cater, of Bradford, West Yorkshire, said that it was immensely frustrating to know the hospital had the expertise, but not the facilities, to carry out the operation. “We could understand it being cancelled a few times but seven is ridiculous,” she said. “Lily is getting bluer and bluer by the day. I just want them to operate and make our little girl better.” Mrs Cater, an accounts manager, added: “It’s agonising for all of us. Every time we get a date for the operation we get mentally prepared, pack our bags and make all the arrangements and then it doesn’t happen.”

Lily was first due to be operated on a month ago. She was listed as an urgent case after her parents, who initially took her to Leeds General Infirmary, approached doctors in Birmingham for a second opinion. Mrs Cater and her husband, Paul, a construction worker, have founded the Lily Cater Cardiac Trust in the hope of raising funds to improve research into the condition. Patients with pulmonary atresia suffer from a lower level of oxygen in their blood — normally about three-quarters that of a healthy person — due to underdevelopment of arteries linking the heart and the lungs. As a result, the heart has to work twice as hard. Lily also has a hole in her heart, problems with feeding and breathing, and poor circulation. The complex operation, which involves inserting a plastic tube to connect an unused artery to create another channel for blood flow, and closing the hole in her heart, has a 20 per cent fatality rate.

Birmingham Children’s Hospital NHS Trust said that the organisation had extended its apologies [Big of them!!] to the Cater family for the additional anxiety caused. It said that all relatives of a child awaiting heart surgery were always given warning of the possibility of delays. “Cancelling surgery is not something we do lightly or for any reasons other than to accommodate emergency cases or when the unit is full,” an official said. “Of course, we understand that this is very stressful for Lily and her family but it is impossible for the trust to guarantee that any operation will not be cancelled at short notice, and all families waiting for heart surgery are told this. “However, every effort will be made to ensure that Lily’s operation proceeds as soon as possible.”

The British Heart Foundation said that only 49 children in Britain were born alive with this rare defect between 1985 and 1999. Children with pulmonary atresia require lifelong follow-ups by a cardiologist to check how their heart is working. These children risk developing infection in the heart’s walls or valves, known as endocarditis, before and after surgery. [So scrap the kid, seems to be the thinking]

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Universal Health Care and Euthanasia

Post lifted from Part Time Pundit

There are two events that should give people pause when considering universal health care. First is Hurricane Katrina and several facilities euthanisizing patients not because of terminal illness, but because they didn?t think they could move them. Second is Charlotte Wyatt who doctors want to euthanize (or more accurately let die) because they don?t think she is worth saving. A court has rules that the doctors can make this decision even though it is contrary to the will of the parents. In the first case, it is people making mistaken practical judgments. In the second case, it?s little more than outright eugenics.

It is one thing to let some one commit suicide because they've lived a full life and have little hope of recovery. It is another to mandate death to people because they aren't worth taking care of. The first case can be called "right to die". The second case is more properly called the "right to kill". Confusing the two makes it easier for the "right to die" crowd to be a "right to kill" crowd.

Right now it is particularly difficult for people to be put to death against their stated (or their family members) will in the United States; that is until universal health care is introduced (and hopefully it never will be). To summarize, the government can't be trusted to know which phone calls belong to terrorists and which belong to moms planning on getting their kids to soccer practice. The government can't be trusted to get industry advice and not sell out to the rich. The government can't be trusted even to hold prisoners captured on the field of battle. PLEASE PLEASE PLEASE TAKE ALL MY MEDICAL RECORDS AND HAVE COMPLETE CONTROL OVER MY HEALTH CARE!!!

The problem comes in that the government uses different priorities to make decisions than people do. For instance, the Irish Health Service had other priorities in mind when deciding on health care for the elderly. Or stateside, an Illinois pension fund seems to be operating under different priorities then actually keeping pensions around for teachers. Bureaucrats like wasting money, when they waste too much there isn?t enough to take care of business. Apply this to health care and it means people without money who have come to rely on public health care will get screwed.

What happens when people get screwed by the health care system? Well they'll be euthanized more often than they are now. New Orleans medical professionals decided that it was too much effort to try to keep them alive so they killed them. Not because they were terminally ill. Not because they were in incredible pain. It was because they assessed the situation and didn?t think it worth trying to find a way to help them. The difference is when they aren't the government, they'll be prosecuted. When they are operating with a government imprimatur, they'll get away with it more likely than not. The government will decide who is worth treating and who should die based on some dollar calculation.

If the NSA can't be trusted to listen to some phone calls, what makes people think that this health care calculus will be honest?

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

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

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Private savings accounts don't attract less educated

This article would also seem to indicate a limited future for health savings accounts

Recent research by behavioral psychologists might shed some light on why President Bush had difficulty in selling his concept of private retirement accounts as a central feature of reforming Social Security. As you might recall, the president promoted the plan through the idea of moving to an "ownership society" and providing the opportunity of choice regarding our retirement funds.

However, according to a team of psychologists from Swarthmore and Stanford, who discussed the results of their work recently in the New York Times, Americans do not uniformly welcome more choices into their lives. Specifically, whereas higher-income, better-educated individuals welcome the empowerment of more choice, working-class Americans, who represent the majority of our workforce, often do not. "For them, being free is less about making choices that reflect their uniqueness and mastery and more about being left alone, with their personality, integrity and well-being intact."

When college students were asked to pick adjectives that capture what "choice" means to them, those from homes with college-educated parents were more likely to select the words "freedom," "action" and "control," whereas those from homes whose parents had only a high-school education more often selected "fear," "doubt" and "difficulty." Other tests that these psychologists report appear to confirm that those with more education put greater value on items that they were able to choose, whereas those with less education tend to value articles they receive the same, whether or not they chose them.

Polling on Social Security private accounts appears consistent with the general research of these psychologists on the issue of freedom and choice. According to polling done by the Pew Research Center about a year ago, 46 percent of those polled favored introduction of private Social Security retirement accounts and 38 percent were opposed to the idea. Looking into the reasoning of those who favor private accounts, most said they favor them because "Individuals will have more control." This is twice the number who responded that they favor them because the accounts will earn more money. Of those opposed to private accounts, most of the opposition came from those who expressed fear that the accounts would be potentially too risky.

Further examination showed breakdown that is consistent with education and income. Fifty percent of those with a college education favor private accounts whereas only 35 percent of those with less than a high-school degree do. More than half of those earning more than $50,000 per year favor private accounts whereas only 38 percent of those earning less than $20,000 a year do.

The specific polling on Social Security private accounts appears consistent with the more general work reported by the behavioral psychologists regarding the propensity to embrace more choice. Those who are better educated view it positively and as an opportunity and those more poorly educated view it negatively and as a threat.

Blacks, who are on average less wealthy and less educated than whites, are far less supportive of private accounts than whites - 36 percent of blacks favor them compared to 46 percent of whites. However, on the issue of school choice, blacks and whites are equally supportive of vouchers. Polling done by the Joint Center on Political and Economic Studies shows 48 percent of blacks and 48 percent of whites favor vouchers.

What conclusion might be drawn here? Why would polling regarding choice on private accounts appear consistent with more general research correlating level of education and preference for independence of choice, but school choice not correlate I think that the inner-city public schools are so bad that there leaves little question to blacks that they would be better off if they had the option of choosing where to send their child to school.

My guess is that the team of psychologists from Swarthmore and Stanford provides us with an accurate picture when they report that lower income, less educated individuals embrace freedom to choose less enthusiastically than higher income, more educated individuals. However, the correlation breaks down when a status quo-blocking choice is so clearly unattractive that even those naturally disinclined to loosen the reins of control want choice introduced.

Regarding Social Security private accounts, it has been my view that the current system based on payroll taxes and government determined benefits hurts low-income folks more than high-income folks. For them, the payroll tax confiscates the only funds they have available to save and invest.

But if my conclusions above are correct, we probably won't see private Social Security accounts until low-income people in general conclude the status quo is not an acceptable option.

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UK: "Over-efficient" surgeon must delay operations

A senior surgeon has made a public apology to patients whose operations are being postponed - because he has been too efficient. Peter Cox, a general consultant surgeon at the West Cornwall Hospital, Penzance, and his colleagues have been told to slow down by the local health authorities. Not only has Mr Cox met the current six-month waiting list target but he has surpassed it. As a result, more than 50 of his patients are being sent letters telling them that their surgery dates will be put back.

The perverse state of affairs has come about because the Royal Cornwall Hospitals Trust - which yesterday announced 300 redundancies and an 8 million pound deficit - has treated 4,600 patients more than were budgeted for in this financial year. Mr Cox said yesterday: "This is all about finance. The thing that really annoys me is that I cannot see how this will really save any money. All they are doing is deferring the payments to a later date. "Now I will have spaces in my operating list. They may give me other patients who are close to the waiting time deadline but this will take some time to organise."

In a letter to The Cornishman, newspaper Mr Cox said: "I am writing this letter to apologise to the 50 or more patients who have been given dates for operations under my care, who will shortly receive letters explaining why they have been delayed. "Although I have tried to prevent this, I am powerless to do so. The directive has come from the Primary Care Trust for the next financial year. "They have informed the Royal Cornwall Hospitals Trust that they will not pay for routine operations unless the patients have waited at least 18 weeks from the time that they were put on the list. "This is particularly upsetting to me because my team has set up an out-patient booking system where patients are given dates for their operations, either in out-patients or within 24 hours after seeing me, in line with government directives. "This has been working particularly well and has enabled me to see and operate on patients in a timely fashion." Mr Cox said his patients, waiting for operations for conditions including hernias, varicose veins and piles, will now have to wait weeks longer in pain and discomfort. His waiting list had been down to five or six weeks, he added.

The directive has come from three primary care trusts: West of Cornwall, Central Cornwall, and North and East Cornwall. They said in a statement that hospitals had "over-performed" and apologise for the disruption. "We will ensure that those patients whose operations have been postponed will have a new date within four weeks," they added. Last December a colleague of Mr Cox, Alastair Paterson, a surgeon at the Mermaid breast cancer centre, at the Royal Cornwall Hospital in Truro, was told he could only deal with urgent cases.

Source






More crookedness in the Queensland public health system

Doctors whose allegedly poor treatment caused the deaths of eight Queenslanders are escaping scrutiny despite the medical board's vow to prosecute disgraced surgeon Jayant Patel. The circumstances of the "unquestionably sub-optimal" care are known only because of an exhaustive investigation into almost 90 deaths originally linked to Dr Patel.

The board strategy to ignore the eight deaths but take on Dr Patel in the Health Practitioners Tribunal prompted his defence lawyer to accuse the board of a dangerous "double standard". "This can only be a political exercise to make the medical board look good in light of its neglect in the past," solicitor Damian Scattini said. "The doctors involved in the other eight deaths are still practising. "The board should be checking to ensure these other eight doctors are up to scratch, instead of focusing on someone who will never practise again."

Dr Patel, who is blamed for more than 13 deaths after exhaustive expert analysis, did not contribute to the deaths of the forgotten eight, according to the expert medical witness for Queensland Health and the royal commission-style inquiries, vascular surgeon Peter Woodruff. Responsibility for the demise of the eight has been sheeted home to other doctors in Brisbane and Bundaberg, who have not been reviewed or audited despite their culpability being raised more than six months ago, The Courier-Mail has learned. Of the eight deaths, four are classified by Dr Woodruff as the result of "medically caused mishap or injury or a lack of reasonable care". He said the treatment of the four, three of whom were women, was "unquestionably sub-optimal". The patients had not been expected to die within a month of a surgical procedure because they were in otherwise healthy condition.

Of the remaining four deaths, doctors other than Dr Patel were "significant contributors". As these four patients suffered terminal conditions such as cancer, they were more likely to die within a month of surgery than an otherwise healthy patient.

The findings of Dr Woodruff were accepted without challenge by the health inquiry's commissioner Geoff Davies, QC, and his predecessor Tony Morris, QC. The findings in relation to Dr Patel's contribution to 13 deaths are the basis for the regulatory body's action for "unsatisfactory professional conduct" in the Health Practitioners Tribunal. The findings underpin a police brief of evidence to Director of Public Prosecutions Leanne Clare, who may seek charges of manslaughter, grievous bodily harm and fraud.

Medical board executive officer Jim O'Dempsey said the health inquiry had made no findings in relation to the doctors linked to the eight deceased patients, however inquiry sources said this did not indicate a clearance.

Dr Patel's shocking United States disciplinary history was overlooked by the Medical Board for the two years he was Director of Surgery at Bundaberg Base Hospital.

Source

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

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

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DEBUNKING THE SOCIALIZED MEDICINE MYTHS

Health care is once again moving to the top of the national political agenda. The early evidence is that this debate will be dominated by misinformation and misconceptions. Advocates of a government-run, national health-care system will do everything they can to frighten Americans and discredit consumer-directed health care. But we would be advised to look at the facts and not the scare tactics.

The Claim: The U.S. spends too much on health care

The Facts: It is true that the United States spends more on health care than any other country. Why is that a bad thing? There is no "right" amount to spend on health care or anything else. The United States spends more on athletic shoes than any other country. No one speaks of the athletic shoe crisis. Economists consider health care a "normal good," meaning that spending rises or falls with income. As incomes rise, people demand more and better health care. America's wealth determines its spending on healthcare.

The real problem is the fact that the people spending the money are not the people paying the bills. Because those purchasing health care are able to pass the bill onto third parties, the usual market disciplines don't apply. True health-care reform would focus on giving consumers a greater stake in the decision-making process.

The Claim: Though we spend more, we get less

The Facts: America offers the highest quality health care in the world. Most of the world's top doctors, hospitals and research facilities are located in the United States. Eighteen of the last 25 winners of the Nobel Prize in Medicine either are U.S. citizens or work here. U.S. companies have developed half of all the major new medicines introduced worldwide over the past 20 years. And Americans played a key role in 80 percent of the most important medical advances of the past 30 years. If you are diagnosed with a serious illness, the United States is the place you want to be. Tens of thousands of patients from around the world come to this country every year for treatment.

Critics of American health care often point out that other countries have higher life expectancies or lower infant mortality rates, but those two indicators are bad ways to measure the quality of a nation's health-care system. In the United States, very low-birth-weight infants have a much greater chance of being brought to term with the latest medical technologies. Some of those low-birth-weight babies die soon after birth, which boosts our infant mortality rate, but in many other Western countries, those high-risk, low-birth-weight infants are not included when infant mortality is calculated.

Life expectancies are also affected by other factors like violent crime, poverty, obesity, tobacco, and drug use, and other issues unrelated to health care. When you compare the outcome for specific diseases like cancer or heart disease, the United States outperforms the rest of the world.

The Claim: A government-run health-care system would expand access to care

The Facts: The one common characteristic of all national health care systems is that they ration care. Sometimes they ration it by denying certain types of treatment altogether. More often, they ration indirectly, imposing cost constraints through budgets, waiting lines, or limited technology. One million Britons are waiting for admission to National Health Service hospitals at any given time, and shortages force the NHS to cancel as many as 100,000 operations each year. Roughly 90,000 New Zealanders are facing similar waits. In Sweden, the wait for heart surgery can be as long as 25 weeks. In Canada more than 800,000 patients are currently on waiting lists for medical procedures.

The Claim: Health care is too complex for average Americans to make decisions about price and quality.

The Facts: Health care is increasingly high-tech and complex, but so are many other products and services that Americans purchase everyday without specialized expertise. A consumer does not need to know how an internal combustion engine works in order to buy a reliable car, or how silicon chips are manufactured before he selects a computer. When consumers have good information about product prices, quality and safety, they naturally gravitate toward the goods and services that offer the highest value for the lowest price.

There are numerous studies that show health-care consumers make decisions about price and quality. The current problem with the healthcare sector is that there isn't enough good information available for consumers to make sound decisions about which healthcare provider or facilities offer the best value. But that's rapidly changing as providers respond to increased consumer empowerment. At the same time, patient advocacy companies are springing up to help health-care consumers make informed choices. When consumers, rather than insurers or employers, control the money, markets naturally respond.

The U.S. health-care system represents one-seventh of the American economy, and is literally a matter of life and death for millions of Americans. Here's hoping that they'll be able to sort the facts from the fallacies in the coming debate.

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A FRANK SUMMARY OF CANADIAN HEALTH CARE

When all is said and done, the philosophy on which Canada's ailing medicare system is based is this. That Canadians are perfectly content to eat sawdust, as long as they can be assured that no one is ever going to be allowed to buy a steak. Sure, guys like Premier Dalton McGuinty, Ontario Health Minister George Smitherman and, sadly, even Prime Minister Stephen Harper, dress up this basic premise with a lot of fancy talk these days. But that's all it is. Talk. And talk is cheap. Unfortunately, Canadian medicare isn't. It's now one of the world's most expensive health care systems while its efficiency is generally middle-of-the-pack, internationally.

But that's what happens when you share a philosophy of centralized, state-controlled medicine with such enlightened outposts as Cuba and North Korea. It's laughable. Indeed, if you want to assess Ottawa's real "expertise" in health care, look at virtually any remote native reserve where the feds are actually in charge of it. And this is the government that presumes to lecture the provinces on how to deliver health care?

The provinces are just beginning to address the implications of the now-famous Supreme Court of Canada ruling that put them on notice that if they cannot deliver medically necessary services in a timely way, then they will have to stop preventing patients from seeking that care on their own. In recent weeks, Quebec, and Alberta have proposed some baby steps in that regard, so that patients can use their own money to pay for faster care in some limited circumstances. Alberta went a bit further than Quebec in its ideas, but that's all they are. They're just suggestions by Alberta Premier Ralph Klein, who is notorious for talking a tough game about reforming medicare and then running away at the first predictable, hysterical reaction, by Canada's powerful pro-medicare lobby.

Many in this crowd have been wrong about some of the most important health care policy decisions made in Canada over the past few decades. That would include the brilliant plan to control health care costs by reducing the number of doctors which ... surprise! ... helped lead us to today's doctor shortage. Many of these same folks used to feed us the line that there was really nothing wrong with medicare that a little "more" tax money couldn't fix - with the "more" never being defined.

Some even argued that if Canadians were wondering why grandma had to wait a lot longer than the family dog for an MRI, this was only because they had succumbed to neo-con propaganda. While that tactic pretty much died with the Supreme Court ruling, these folks haven't given up. Today, anytime anyone makes any suggestion to fix the status quo - no matter how small - the same old chorus sings the same old chant: That it will all lead to "two-tier, U.S.-style health care."

Yawn. We suggest the next time you hear this, ask those doing the singing three questions: (1) How much more of our tax money will it take to "fix" medicare? (2) How long will it take to fix? (3) What do you mean by "fix"? See if you can get any answers. And if you can, see if the answers don't scare you half to death. Which will, of course, put you on another waiting list.

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

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

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THE AMA VIEW:

America's $1.9 trillion per year health care system has a very bad case of the shakes. Last month, the U.S. Centers for Medicare and Medicaid Services actuaries told us health spending will consistently outpace gross domestic product growth. They speculated health care costs would consume one-fifth of GDP by 2015. Media outlets trumpeted $1 in $5 as the "cost" by 2015. What they missed is the fact that, right now, we’re spending $1 in $6, or 16 percent of GDP.

And both parties continue to miss what I see as a looming revolution in health care in this country. It is a revolution in payment systems, in pricing systems, in the way care is delivered and the ways patients become decision-makers not passive consumers. Medicare and Medicaid face bankruptcy. Health insurance plans draw the ire and fire of premium-paying employers, their workers (our patients) and regulators, alike. The books written thus far on how best to reform the system would fill a bookcase to overflowing.

Meanwhile, the physicians of America continue delivering the finest quality of medical care to the most people of any nation on earth. The spending – nearly 18 times that of 1970 on a per capita basis – has paid rich dividend. One University of Chicago study claims increases in longevity from 1970 to 1990 produced $2.8 trillion in perceived value every year for the nation. Show me a stock I can buy for $1.90 and sell for $2.80, and I'll make that deal every time.

So, what’s wrong? Why are 46 million Americans uninsured and another 15 million underinsured, dreading the catastrophic impact of an accident or major illness? Why are double-digit medical liability insurance premium increases driving out obstetricians and others high-risk medical specialties? Why are our medical schools producing too few physicians to meet impending demand? How has the medical profession gotten itself locked in the jaws of price controls and stifling red tape?

The answers are many and varied, but one thing is perfectly obvious. As high-priced management consultants will tell you, the system is perfectly designed to produce the kinds of results we have. Reform proposals fixated on cost will only exacerbate system problems. Reform proposals fixated on patient value-received are what we so badly need. That is why the American Medical Association proposed a series of small changes at the margin, to begin to steer the massive Ship of Health Care into safe waters.

Medical liability reform has to begin, we believe, by placing caps on the non-economic damages in cases where negligence occurs. A $250,000 cap seems reasonable [Most Australian States have a similar cap]. It is working well in California and other states that have tried it. A federal limit seems appropriate. Pending that, the AMA is working at the state level to support reforms one at a time.

Medicare, the preeminent argument for preventive health care, is under siege in Congress. In its four-decade lifespan, Medicare evolved a physician payment system that now is counterproductive to the Congressional intent of fair payment for services received. Now Congress calls for zero growth this year and a cumulative 26 percent cut in physician payments by 2012. Some call this cost control. I would call it false economy, even disastrous when, in the same period, physicians will shell out 15 percent more in operating expenses. Unless we replace the fatally flawed physician payment formula, more and more doctors will be forced to take on fewer and fewer new Medicare patients. And this at the time when Baby Boomers turn 65 by the hundreds of thousands a week.

The AMA wants to see those 46 million uninsured Americans given some help, as well. Far from advocating another entitlement program from Washington, we are pressing for the adoption of a consumer-driven, market-based plan to expand coverage through a combination of individually owned insurance, sensible insurance market reforms and direct payments to those who need them.

Health Savings Accounts are part of the answer for many. The initial popularity of HSAs, the experience of the first 3 million users, surprised many. That 1 million of them formerly were uninsured is an encouraging indicator. Once the majority see the advantages of HSAs coupled with low- or high-deductible insurance – the kinds we choose for our cars – the days of one-size-fits-all health care coverage will be numbered.

Making economic changes at the margin is one strategy we advocate. Making positive change in individual lives and the practice of medicine is another. The AMA is providing effective programs to help improve the health of individuals, calling attention to the hundreds of billions of dollars of waste caused by just eight behaviors that can, in fact, be changed. The combined health care costs, lost wages, lost productivity and other societal costs of tobacco, alcohol and drug abuse; accidents and violence; obesity; teen pregnancy, sexually transmitted disease and suicide tally in the hundreds of billions of dollars a year. That's why we're working so hard to lead patients from slavery to these cruel masters to freedom to lead happier, healthier, more productive lives.

Finally, physicians themselves, recognize the need to increase the quality and effectiveness of what they do every day. Continuous quality improvement has been the watchword of American medicine since 1848, when the AMA was formed, to this very day. No other profession can boast the kinds of quality and productivity gains American medicine has racked up in the last 15 decades. But the price of that reputation is to add to it, recalling how it was won and who benefits from the process. When seniors enjoy another decade of lively living, when infant leukemia rates decline, when chronic diseases are controlled, society benefits.

Collective benefits of healthcare reform cannot be predicted with accuracy. But, when I read that one-third of early adopters of HSAs formerly were uninsured or when I read that quality improvement pays enormous dividends in cost-avoidance, I'm convinced reforms, transparency and performance enhancement are keys to a richer future for us all.

Our focus is on our patients. And they appreciate our efforts. A recent Harris Interactive poll tells us 86 percent of Americans trust their physician at a time when other polls show approval ratings for government and big business in the 30-percentile range. Our challenge is clear. We are committed to meeting it. Not for ourselves. Not even for our profession. But for the patients of America.

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Foreign medics 'lack basic skills' in Tasmanian public hospitals

Medical staff at Tasmania's biggest hospital have expressed "grave concerns" about the competence of some overseas-trained doctors, warning the doctors are unable to perform basic medical procedures. Documents obtained by The Australian under Freedom of Information laws reveal some overseas-trained doctors (OTDs) have "significant difficulties with clinical procedures" at Royal Hobart Hospital. "Nursing and medical staff have expressed grave concerns about the level of clinical competence of some OTDs appointed at resident medical officer level," says a briefing note from RHH management to state Health Minister David Llewellyn.

It lists "areas of weakness" identified by medical staff as including unfamiliarity with basic medical procedures, such as insertion of IVs, prescription and documentation of IV fluids, common medications, drug charts and drug brand-names. Other shortcomings include lack of knowledge of arterial blood gases, blood cultures and catheterisation, filling out patients' progress notes, sterile techniques as well as basic health precautions.

Health is the biggest issue at Tasmania's election on Saturday. An EMRS poll in yesterday's Sunday Examiner showed Labor was likely to retain government, but that its hold on a parliamentary majority might swing on a handful of votes in two or three seats.

Tasmania relies more heavily than any other state on overseas-trained doctors in public hospitals. The Government yesterday said it had recently acted to improve support for such medics. RHH chief executive Peter Leslie said his hospital was now "setting the example for the rest of the nation in supporting OTDs", including an orientation program and clinical support and training

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

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

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CARING CANADA AGAIN

The recent Cancer Advocacy Coalition of Canada report on cancer care has raised many issues that Ontarians must wake up and pay attention to. Yes, research has provided many new, effective chemotherapy treatments; however, if you get cancer in Ontario, good luck. The provincial government has only approved funding for six of them. As a person currently fighting cancer, I have not chosen my disease well.

As the federal and provincial governments continue to debate a catastrophic drug plan, and provinces continue to duplicate review processses and create further delays to drugs becoming available, people are dying. The reality is the Ontario government is making life-and- death decisions about patient care, leaving loved ones to ask "what if?" The current "plan" to deal with this issue, as far as I can tell, is to let people die while waiting.

The government needs to start calculating the economic loss for not treating cancer patients. Had these patients who have died while waiting been allowed to remain alive as productive and tax-paying citizens, they would have "paid off" the cost of their treatment in their ensuing working years.

Those who are choosing to avoid premature death are re-mortgaging their homes, using their children's education savings, cashing in their RRSPs and yes, even fundraising to pay for treatment. The lack of honesty, forthrightness and a publicly debated plan has decimated the Ontario health-care system. Accessibility to care is determined by where you live, which cancer centre you attend and the fortitude of the oncologist assigned to your case.

I agree with Terrence Sullivan, honest public debate needs to happen over this issue and from that debate have a plan developed. Personally, I would like to know who at Cancer Care Ontario or the Ministry of Health and Long-Term Care is going to decide the dollar value of my life. I need to be a part of that decision.

Finally, I have some advice for our youth. In addition to having RRSPs or university savings accounts, open a "health plan savings account." If we continue down the road where expensive cancer drugs will only be available through private clinics, you will need it.

For those of us already diagnosed with cancer, it is too late. Too late for additional insurance; too late for extra savings and soon, tragically, it will be too late for treatment.

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States Take Lead in Medical Malpractice Reform

Congress has been trying to fix the problem of runaway medical malpractice litigation for years. President Bush made malpractice reform a campaign issue in both 2000 and 2004. But after a decade of hearings, bills and floor fights, Washington has yet to devise a cure for the problem. But while Washington lawmakers are stymied, some states are making great strides in developing effective alternative medicines.

Texas, for example, recently enacted a comprehensive tort-reform measure that led malpractice insurers to reduce rates significantly. Among other things, the measure limits non-economic damages (e.g., cash awards for pain and suffering, mental anguish and other difficult-to-estimate damages) in medical malpractice cases. Since the reforms took effect in 2004, Texas has gained more than 3,000 physicians, including such much-needed specialists as obstetricians and orthopedic surgeons. Other states, such as Georgia and Mississippi, once known as a "tort hell," have followed suit with their own reform packages.

Research has shown that only 2 percent of injured patients ever file a lawsuit and only 17 percent of lawsuits involve actual physician negligence. Yet truly injured plaintiffs now wait five years or more to have their cases decided by a slow, cumbersome system. And the few plaintiffs who do manage to win must fork over most of their awards to pay lawyers, expert witnesses and courtroom fees.

And still doctors in some specialties are forced to make life-or-death, often-split-second decisions on which concerns about malpractice suits weigh all too heavily. For example, half of all neurosurgeons -- who specialize in operating on the brain, nerves and spinal cord -- are sued every year.

But medical malpractice reform shouldn't come down to a clash between protecting patients' rights and allowing good doctors to stay in practice. Many state reforms continue to focus on capping the amount that can be awarded to patients for damages caused by physician error or negligence, but that needn't be the only prescription.

Innovative proposals such as special health courts, which use medically trained judges and court-appointed expert witnesses to better decide tough scientific questions, promise to make the system faster and fairer for both patients and doctors. Other alternatives include setting up procedural rules to encourage prompt settlement of malpractice cases and allowing patients to buy insurance before going in for a procedure, much the same way airline passengers can purchase trip insurance.

And the best way to solve the medical malpractice problem is for policymakers to promote the right kind of competition in health care -- competition that encourages health-care providers to improve quality and eliminate the medical mistakes that cause injuries. Consumer-driven options, such as health savings accounts and price transparency, could help. Empowered consumers, armed with choice and accurate, understandable information, can patronize providers who do the best job and cut off those who underperform. The result? Fewer injuries, fewer lawsuits, and a safer, better health-care system for us all.

When it comes to addressing the medical malpractice crisis, some states have shown that they have the right medicine to achieve positive results. But more innovative thinking is needed at the state level to ensure that patients, rather than trial lawyers, come first.

Source

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

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

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AT LAST: A JUDGE CRACKS DOWN ON LEGAL ABUSE

Predatory litigation and abuse of legal procedures generally is a major problem in obstructing and making more costly good health care provision in the USA. And a large part of the blame has to rest with judges who allow and reward lawyers for such abuses. So it is good to hear of one judge cracking down on legal abuse. The article below is written in a very colourful style but what it reports does seem refreshing

Aetna Insurance, perhaps the US's largest, and most profitable health insurer has the litigation manners of a whiney four-year old gone too long without a nap. In essence, a Federal Judge, so to speak, last Tuesday March 7th, 2006 took them aside, pulled their pants down to their ankles, and whacked them solidly, and repeatedly, on their bare butt... Publicly..

Aetna, being sued by Cavitat Medical Technologies on several counts, has had a history, in this case, so far, of bad behavior you can read about in my earlier articles - including the sending of thugs to my home in a clear attempt to dissuade me from writing about them.

The Cavitat v. Aetna case is a "Donnybrook" - a battle for supremacy. It is the first outright challenge, by the public, of "the decision process" Aetna insurance, and its affiliates, uses to determine exactly what health care offerings they will pay, or not pay, for. Cavitat, in essence, has accused Aetna, of using questionable standards, and dubious individuals (the "quackbusters"), to evaluate health care offerings - and is being very specific in those accusations. The case, if successful, will force Aetna to use standards more in line with the reality of health care - and Aetna is pulling out all of the stops to try and stop this attempt.

But Cavitat, last week, played a new card Aetna didn't expect. They brought in well known California Litigator Carlos F. Negrete to take over as lead trial attorney - and Aetna started to seriously "whimper"... First they tried to block Negrete's entry into the case - and that's when the Judge yanked down their pants... In essence, after the Judge whacked Aetna's butt, she made them take their pile of "Motions," and and dump them in the trash bin themselves. Her words, eyeball-to-eyeball, so-to-speak, with Aetna's counsel, while they stood there, so-to-speak, with their pants down, were:

If anyone has an expectation that this case is going to be won or lost on motion practice or that the battles with regard to motion practice are going to be somehow determinative, I urge you to put aside that notion. The goal here is to have a full and fair opportunity for both parties to present evidence as to disputed facts and apply the law. I know that these two parties don't like each other. It's apparent. I also know that there are several ways to handle a lawsuit. Some people play hardball, some people play softball; but I will tell you right now that the goal here is to have a fair process. And I have very little tolerance for hyperbole, attacks between counsel, or unnecessary motion practice. So I urge you to get focused on what it is you need to try and let's get on with it. Any need for clarification or further explanation?

Aetna, as you may have read in my earlier articles, made a counter-accusation earlier in the case, which, in essence, the Judge tossed out for lack of substance last month. It appears, from this hearing, and Aetna's attorney's behavior, that Aetna can't seem to find a "defense" against Cavitat's onslaught. - and needs to rely on tricks... Aetna's Motions for this hearing, were, basically, a rehash of the counter-accusation they already had tossed out. The trial starts in June, and the Judge said about that:

We invite jurors to give comments after every single trial; and you might well find those comments interesting, particularly the comments that have arisen from civil litigation. They will be apparent to you. They are comments like: "No more exhibits. Do the attorneys think we are dumb? Why do the attorneys put on repetitive evidence? Why couldn't the parties settle this case?" These are the kinds of comments that jurors make. And I urge you to consider that as you start fine-tuning your presentation for trial. We are asking jurors to resolve this civil dispute; and jurors do not like, in my experience, to have their time wasted or their intelligence insulted, and they particularly are resistant to situations where they are asked to make a determination between parties where they believe that the parties could have resolved the case themselves.

I can't wait to see how Aetna insurance is going to put "quackwatch.com's" Stephen Barrett on the stand, and explain how, and why, this old fart, who works out of his basement in Allentown, Pennsylvania, hasn't had a license to practice medicine since 1993, couldn't pass the exams to be certified as a Psychiatrist, has, at best, only had part time employment throughout his career, and was formally declared by the US Court system as "biased, and unworthy of credibility," has become Aetna's NUMBER ONE expert on health care practices.

Even more, I can't wait to hear how Aetna explains how, and why, they use formally discredited Robert S. Baratz, "Bobbie Bogus," as their expert on Dentistry, etc...






You can trust your regulators to protect you

When they get around to it, maybe

NSW health authorities waited almost 18 months before investigating an overseas-trained doctor banned elsewhere in the state for misdiagnosing 208 patients. The doctor, who is still registered to work in NSW as a general practitioner unsupervised and as a pathologist under strict supervision, is believed to have moved to Queensland where he can work without restriction as a GP.

The Illawarra Area Health Service banned Farid Zaer in April 2004 and began to review 6300 patient records after it suspected the doctor had failed to correctly analyse tests for many diseases, including cancer. Three months later it notified the Hunter New England Area Health Service, where the doctor had worked between 1999 and 2001, that it was investigating him. The Hunter service did not begin to review the records of 7300 patients diagnosed by Dr Zaer until last month. In March last year the Illawarra service found Dr Zaer had underdiagnosed 92 patients, overdiagnosed 106 and failed to correctly diagnose a further 10.

The Medical Board of Queensland was notified on September 29 last year that conditions had been imposed on Dr Zaer's practice as a pathologist in NSW. "Even though he is not registered to practise as a pathologist in Queensland, the board still wrote to Dr Zaer and advised him that it was considering imposing similar conditions on his general registration," the board's executive officer Jim O'Dempsey told The Weekend Australian. The board will consider the matter at a meeting this month.

The case comes only a month after Queensland police recommended the Indian-trained surgeon Jayant Patel face at least 28criminal charges relating to 13patient deaths and more than 30 cases of patient harm at Bundaberg Base Hospital. Dr Patel was director of surgery at the Bundaberg hospital for two years before he returned to the US last April.

Dr Zaer, who trained at the University of Bombay in India, can work as a junior pathologist in NSW under supervision by an area health service director of pathology or by a staff specialist. He can work in NSW as a GP without supervision. Debra Graves, chief executive of the Royal College of Pathologists of Australia, said the case was worrying. "I have no idea why the area health services weren't talking to each other."

Rosemary Aldrich, acting director of clinical governance for the Hunter New England Service, defended the delay of the investigation until last month. "While concerns might have been raised in the Illawarra, if there were no concerns raised ... in the New England area, we had no way of knowing whether there was a risk or not," she said. "Until we had some more robust evidence that there might have been a risk, which we received once we were made aware of the Illawarra's definitive review, then we were able to make a judgment and respond."

Dr Zaer worked at the Wollongong Medical Centre, south of Sydney, as a GP until two weeks ago. "We never had any problems with his work as a GP," said centre manager Theo Aroney. "General practice is very different to the work involved as a pathologist. My understanding is that there was controversy regarding some of his diagnostic results while looking under a microscope, which is very different to what we do in general practice." Dr Zaer did not return phone calls from The Weekend Australian.

Source






Philippines nurse shortage



For years, the Philippines has provided nurses to the hospitals of the world's rich nations, but a recent escalation in the exodus of medical workers has left the local health-care system on the verge of collapse. Lured by higher salaries abroad and fed up with political instability at home, over 100,000 nurses -- including former doctors -- have left the Philippines in the last decade and are now working overseas, studies show. Experts say the "brain drain" is also a result of the government's policy of encouraging Filipinos to work abroad so they can send back billions of dollars a year, which fuel local consumption, the main engine of the country's economic growth.

"In two to three years, the health-care system would collapse," said Jossel Ebesate, secretary general of the Alliance of Health Workers (AHW), a group of medical workers. He added that of the roughly 1,600 private hospitals in the country, only 700 were now operational due to the shortage of nurses and doctors. Former health secretary Jaime Galvez Tan says the nurses who remain in the Philippines are overwhelmed by the number of patients they must take care of. At some hospitals on the southern island of Mindanao, there is one nurse for 55 patients, said Tan, now a professor at the University of the Philippines. The ideal ratio is one nurse to four patients, he said. Even at the government-run Philippine General Hospital in Manila, the country's largest medical institution, the nurse-to-patient ratio is 1-to-26, a study by Tan shows.

What is even more worrying, Tan said, is the recent trend of doctors leaving the Philippines after enrolling in nursing schools so they can work as nurses overseas. "I expect more negative impact because 80 percent of doctors have taken up nursing," he said. While many developed countries impose high barriers for allowing foreign doctors to continue to practice, they are willing to accept nurses with open arms due to the shortage at home, which is expected to continue due to aging populations. Tan says that in the United States alone, there is a shortfall of 150,000 nursing jobs in 2005, adding that the number is predicted to hit 800,000 in 2010.

Doctors from the Philippines can expect higher wages abroad, even if they work as nurses. Pepi Ocampo, a student at Manila's De La Salle University, says he's decided to enroll in a nursing school rather than a medical school after graduating from college. "At first, I wanted to become a doctor, but I realized that it was not practical," he said. "I decided to go into nursing as I want to earn lots of money ... My parents suggested that I become a nurse. They were interested more in the pay." The basic monthly salary for nurses working in public hospitals in the Philippines is around 9,900 pesos ($190) and 7,000 pesos for those in private institutions. In the United States or Britain, they would earn between 100,000 to 120,000 pesos, AHW's Ebesate said. The entry level salary for doctors at public hospitals in the Philippines is about 12,500 pesos, while doctors at private clinics earn about 17,000 a month.

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

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

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THE DOWNWARD SPIRAL IN LOS ANGELES

The loonies in charge of California medical services think that just a new regulation will conjure unavailable doctors and nurses out of thin air

Busy county emergency rooms turned away ambulances 8 percent more often in 2005 than the year before, prompting officials to impose new limits on how long the facilities can remain shut. Some public hospitals closed their emergency rooms to ambulances an average of 20 hours a day while some private hospitals were shuttered for 12 hours or more, according to data from the county Emergency Medical Services Agency. At times, almost all of the emergency rooms in the county were closed to ambulances. Emergency room directors attributed the overload to population growth, a greater number of seriously ill patients, greater use of the facilities for routine care and the permanent closure of nine medical centers and emergency rooms during the past four years.

When emergency rooms force ambulances to divert to other locations, patient care is delayed and paramedics are prevented from responding to other calls. County officials responded to the problem by cutting the amount of time emergency rooms can remain shut. Current policy allows overwhelmed emergency rooms to close for two-hour periods. The new policy would allow diversions for one-hour periods, and require emergency rooms to remain open for at least 15 minutes before returning to diversion status, said Carol Meyer, director of the Emergency Medical Services Agency.

The guidelines will go into effect in a couple of weeks, she said. Some experts in emergency medicine, however, say the changes don't address the reasons for the closures. "It's window-dressing," said Dr. Marc Eckstein, medical director for the Los Angeles Fire Department. "I don't see how that's going to help anything." The county previously cut emergency room closure times from eight hours to four hours in 2001 and from four hours to two hours in 2002.

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SHUFFLING THE DECKCHAIRS ON THE NHS TITANIC

Even The Economist (article below) can suggest only that medical procedures in Britain's NHS be made more efficient. No mention of sacking the huge dead-weight of bureaucrats who are eating up most of the funds available. A British bureaucrat would keep his job through a nuclear winter

The Royal Free in north London and the Princess Alexandra in Harlow, a few miles away from Stansted airport in Essex, are two very different hospitals. One is a teaching hospital with a turnover of 350 million pounds ($615m) a year. The other is a much smaller district hospital with an annual turnover of 120m. But they have a common problem. Each will be in the red in the financial year ending this March. Across the National Health Service, a deficit of around 800m is now expected for 2005-06. This is far worse than the 250m shortfall in 2004-05, which followed a period of small surpluses (see chart). And it also marks a deterioration from the position in December, when a deficit of 620m was forecast for this year.

The inability of the NHS to balance its books despite unprecedented growth in its funding from taxpayers has caused trouble at the top. This week Sir Nigel Crisp, the 54-year-old chief executive of the NHS, said that he would be taking early retirement. Only a few months ago, his stock was so high that he had been in the running for the top job in the civil service. Sir Nigel may be going but the hot political questions remain. Why should there be any deficit at all after seven years in which the NHS budget has doubled? And how are its finances to be put right?

At both the Royal Free and the Princess Alexandra, generous pay awards conceded by the government are contributing to their financial difficulties. John Gilham, chief executive at the Princess Alexandra, says that the funding it received for “agenda for change”, the pay deal for nurses and non-medical staff, has not fully covered the extra cost. This shortfall is contributing about a third of the hospital's £4.8m deficit this year. This fits in with the overall picture in the NHS. According to the King's Fund, a health-policy think-tank, higher pay swallowed 50% of the cash increase for hospitals in 2005-06. The outlook for next year is not much better, with almost 40% of the planned boost to spending set to be absorbed by extra pay. The King's Fund also highlights other pressures on hospital budgets, such as greater spending on new drugs and compensation payments for clinical negligence.

Yet despite these big general cost pressures, the overall deficit is not spread uniformly across the health service. In December, when the deficit was forecast at 620m, a quarter of the 600 NHS organisations ran a gross deficit of 950m, with some offsetting surpluses elsewhere. In January, the government identified 62—the Royal Free and Princess Alexandra were not among them—which accounted for most of the gross deficit. Of these, 18 required urgent intervention, with managerial and financial “turnaround” teams sent in to help them. This suggests that the NHS's financial malaise reflects a set of local difficulties caused by poor managerial performers rather than a more general problem. Understandably, this is an explanation that the government has tended to stress. What has happened, arguably, is that stricter accounting rules have exposed underlying financial problems that should have been tackled long ago.

The main response of hospitals to these financial strains must be to raise efficiency. At the Royal Free, where the deficit was heading for £15m, savings of £10m have been made in this financial year to bring it back to 5m. According to Peter Commins, the trust's finance director, these have been achieved mainly by shortening the time patients stay in hospital and by increasing the rate of day-case surgery. At the Princess Alexandra, annual efficiency savings of 3% have been made in the past three years. Mr Gilham is introducing “lean management”—a technique that is common in industry—into the hospital. The main goal, he says, is to reduce waste by getting things right the first time. That requires standardisation of treatment procedures wherever possible.

The pressure for higher efficiency will increase next month for all hospitals, whether or not they are having to deal with deficits. A new payments system is being introduced to sharpen competition among hospitals. It sets a national tariff for treatments, which means that hospitals are paid according to how busy they are rather than receiving budgets based on previous funding levels. At present, the new system is limited for most hospitals to elective care, such as cataract removals, but in April it will be extended to emergency work and outpatient visits.

Mr Commins says that the payments change will have a big effect, leading hospitals to shed services when they cannot provide them competitively. With so much riding on the new payments system, it was thus a grave embarrassment to the government when the tariff for 2006-07 had to be withdrawn for amendments towards the end of February. That should prove a temporary setback, but it was an unfortunate prelude to what will be a turbulent and crucial financial year.

The NHS is running out of excuses and time. The big boost to spending is due to end in spring 2008, when the NHS will have to adapt to much tighter budgets. Quite simply, the health service has got to work harder for its money. In some places, there will have to be closures of excess capacity. The deficits spell out in red ink the case for reform

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

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

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Canadianizing the Golden State: California marches backward on health care

A plan to outlaw private health insurance in California has been proposed by state Sen. Sheila Kuehl (D-Los Angeles). Senator Kuehl's bill, SB840, proposes to create the California Health Insurance Agency, a state government run single payer system for financing the health care of all Californians. Her bill, if enacted, would abolish all private health insurance in the Golden State. Her legislation essentially aims to replicate the system of socialized medicine in Canada which, until a recent court ruling in Quebec, made all private health care illegal. Her health care proposal is more authoritarian than the health care systems in the United Kingdom or Germany in which citizens can buy private insurance if they so choose.

Remarkably, Kuehl's proposal to socialize California's health care is being made just at the time when the Canadian system it resembles is falling apart at the seams. For instance, Canada's single payer system is projected to absorb more than half the budgets of most Canadian provinces. In addition, the amount of time a Canadian patient must wait before receiving medical care is notorious. "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years," said Dr. Brian Day in a recent New York Times article on Canada's health care crisis.

Kuehl flatly denies that her plan is "government-run health care." She prefers to style it as "a publicly administered finance system." Of course, as the old saying goes: "He who pays the piper, calls the tune." In this case, the new California Health Insurance Agency (CHIA) will be paying, and thus every health care provider and patient in the state would have to dance to its tune.

Kuehl maintains that her government single payer health insurance system will cover all Californians including the one-fifth who are uninsured now and be cheaper at the same time. How? In order to control rising health care costs, Kuehl's plan pegs annual growth in health spending to growth in California's economy. But is that the right amount of spending? In fact, we know that as people earn more, they generally choose to spend higher percentages of their incomes on health care. For instance, economic studies show that for every one percent increase income, families generally prefer to increase their spending on health care by 1.6 percent.

Let's consider a simplified example of how Kuehl's plan would lead to less spending on health care than most Californians would like. Take the California median household income of $50,000 and assume that each household spends an average of 20 percent, or $10,000, on health insurance and out-of-pocket medical expenses each year. Then let's assume that California's economy continues to grow and that median family income climbs to $80,000.

If economists are right, this means that California families on average would prefer to spend $19,600 annually on health care. In other words, people would rather buy health care than the biggest houses or fastest cars that they could afford with a higher income. However, under Kuehl's proposal to fix health care spending at the growth rate of the economy, California health insurance bureaucrats would allocate only an average of $16,000 per year to each family. And since it would be illegal for California families to buy supplemental private insurance, they would be getting much less access to doctors and modern treatments than they would prefer.

Like all politicians Kuehl promises voters all good things. For example, she vows that under CHIA, "You will choose your own doctor and you and your provider, not insurance agents, will decide your care. All needed services, drugs, hospital stays, therapies, and medical equipment will be covered."

Looking at the fine print, you find that Kuehl's government-run single payer system will be cheaper because it will actually ration health care. In other words, decisions about what treatments will be available to Californians and when they will become available will be in the hands of government health care bureaucrats. Just like the Canadian socialized health care system, the new California Health Insurance Agency will determine how much it will pay pharmaceutical companies for new more effective medicines. This means that Californians, like Canadians today, will wait a long time, possibly forever, to get access to modern therapies. In 2002, Sally Pipes, head of the Pacific Research Institute, a free-market think tank in San Francisco noted,, "One hundred new drugs were launched in the United States from 1997 through 1999. Only 43 made it to market in Canada in that same period. Canadians are still waiting for many of them."

California health bureaucrats will also set doctors' fees. Kuehl likens her plan to the Federal government's Medicare system for seniors. She overlooks the fact that physicians are fleeing Medicare in droves because the program doesn't adequately reimburse them. Doctors are like anybody else; they work less when they get paid less. If Kuehl's system is adopted, you will eventually see waiting lines lengthening and doctors treating fewer and fewer patients. California doctors and other health care workers will leave for other states where they are better compensated, and few new doctors, nurses and other personnel will be attracted to California. Another side effect will be that many of California's innovative biotech companies will relocate to friendlier business environments.

Kuehl plans to finance the California Health Insurance Agency through a dedicated payroll tax in which employers would pay 8.2 percent and workers would pay 3.8 percent. And when the system runs short of money, as it inevitably will, the new health bureaucracy will impose cost control measures that include the "postponement of introduction of new benefits or benefit improvements; a temporary decrease in benefits; a postponement of planned capital expenditures, and limitations on aggregate reimbursements to manufacturers of pharmaceutical and durable and nondurable medical equipment." Translation: California health care bureaucrats, not doctors or patients, will be deciding what new treatments will be offered; what new hospitals and laboratories will be built; and what new drugs and new biomedical technologies will be permitted in the state.

Today, as the Canadian health care system implodes, more and more Canadians are seeking private medical care across the border in the United States. Within a decade after Kuehl's single payer system has been adopted, I predict that many Californians will similarly be fleeing across the border into Arizona and Nevada looking for modern private medical care in state-of-the-art hospitals and clinics.

Source






A NOW FAMILIAR STORY IN SOCIALIZED MEDICINE SYSTEMS

As in Australian States, Britain is closing public hospital wards

Two NHS trusts announced ward closures and job losses yesterday as Tony Blair defended the Government’s handling of the health service. Royal Cornwall Hospitals NHS Trust, which faces an 8.1 million pounds shortfall this year, said that it would cut 300 jobs because of the financial pressures. Trafford NHS Trust in Greater Manchester, which is 9 million pounds in debt, said that it closing two in-patient wards at Altrincham General Hospital because it was unable to provide 24-hour care.

The cutbacks came as Mr Blair faced a barrage of questions in the Commons about the circumstances surrounding the departure of Sir Nigel Crisp, who announced on Tuesday that he was leaving his post early. Referring to comments made by Sir Nigel in an interview with The Times, David Cameron, the Tory leader, accused Mr Blair of sacking the chief executive and urged ministers to take responsibility for failures in the NHS. Despite five years of unprecedented funding, the annual deficits of the NHS are now expected to approach 900 million pounds, with hospitals already being forced to cut back on services.

Last week doctors and nurses in Surrey and Sussex Strategic Health Authority, one of England’s biggest authorities, covering 2.5 million people, were told to block all “new investment” unless it produced savings elsewhere. Its shortfall is now close to 100 million pounds. Health experts say that up to a quarter of hospitals are in serious financial difficulty, but targets have been met since 2000 as a result of annual funding doubling to almost 80 million pounds.

The pressure group Reform estimates that the NHS will have about 600 million pounds for new programmes next year after cost pressures of 3.8 billion pounds and the deficit of close to 1 billion pounds are subtracted from an additional spending allocation of 5.4 billion pounds. It called on the NHS to suspend hospital building programmes under the Private Finance Initiative (PFI) yesterday. The Department of Health says that funds will come from efficiency savings.

Citing Sir Nigel’s admission to The Times that the NHS was in a “bad patch”, including some worsening structural and managerial problems, Mr Cameron called on Mr Blair to face up to Labour’s failings and admit to sacking the chief executive.

Mr Blair defended his reform programme and said that the deficit was less than 1 per cent of the annual cost of the NHS. He added that 50 per cent of the debt was in only 6 per cent of trusts. “It’s true that in your area there is a substantial financial deficit, but there’s also been massive real-term increase in the amount of money going in — money you voted against,” he told Mr Cameron. “What we have to have is a proper system of financial transparency.” Mr Blair also paid tribute to Sir Nigel as “a superb public servant who in the past few years has overseen a transformation of the health service”. He denied that he had been pressured to step down. Sir Ian Carruthers, a highly regarded NHS manager, and Hugh Taylor, a career civil servant, have been brought in as short-term replacements for Sir Nigel, 54. The search for a longer-term successor is expected to take up to five months

Source

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

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

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KAISER GOES HI-TECH

Joyce Bonner has relied on Kaiser Permanente for her health care the past 40 years. Except for the birth of her third son, at the Morse Avenue hospital 36 years ago, most of her doctor's visits have been routine - the kind of preventive maintenance for which the health care giant is best known. In the view of Bonner and other Sacramento-area members, that image of Kaiser is evolving, growing wider with the addition of the kind of high-tech medical care typically associated with university teaching hospitals and speciality medical groups. Bonner, 64, was among the first in the region to benefit from one of those sophisticated medical advances: a cochlear implant to restore her hearing.

Other highly specialized services also are finding a home at Kaiser centers in the Sacramento area. With the recent addition of two radiation oncology centers in Roseville and Rancho Cordova, cancer patients can now stay inside the Kaiser system for radiation therapy. And patients who need complex vascular surgeries are no longer sent to Stanford. Autistic children will have a special center for their care in Rancho Cordova beginning in June. And starting next month, infertile couples can opt for in vitro fertilization at Kaiser's Point West offices.

While patients have to pay out of pocket for some of the new offerings, many are part of the overall benefits packages. Driving the change over the past few years are membership growth, increased demand for broader services and a shift in the way Kaiser has positioned itself in the health care marketplace. "There has been an explicit effort to focus on the quality of care, becoming more of a quality leader rather than the low-cost leader," said Jill Yegian, director of health insurance at the California Healthcare Foundation, a health policy group. "Kaiser is trying to adjust to the fact that managed care as we knew it has undergone significant setbacks," said Walter Zelman, director of the California Policy Institute at the University of Southern California who worked on the Clinton health care reform proposal in the early 1990s. "People are concerned about quality, about having choice."

But that can be more costly. Jerry Fleming, a Kaiser senior vice president and health plan manager, acknowledged that Kaiser premiums on average have jumped about 10 percent per year the past two years, emphasizing that actual increases vary depending on the buyer's use of services. "We are in a competitive marketplace, so we have to bring in a premium that allows us to be effective," he said. Regardless, local Kaiser leaders say they are in a good position to offer increasingly specialized medical services.

Kaiser Permanente's market share has grown steadily in the Sacramento region; with nearly 647,000 members, it owns 34 percent of the market, up from 26 percent a decade ago. Kaiser's is a unique system in which its Permanente Medical Group works under contract with the Kaiser Foundation Health Plan, but the doctors are responsible for all medical decisions and drive the direction of care. "Our focus here is to do the right thing," said Dr. Richard Isaacs, an ear, nose and throat specialist and physician-in-chief at Kaiser's South Sacramento and Elk Grove facilities. "That's one of the powers of the system. There is no administrator telling me what to do." Mostly, Kaiser doctors are paid an annual salary that does not depend on the number of patients they see or on the cost of the procedures they do.

While many perceive Kaiser's approach as miserly, the doctors' lack of financial incentive pleases Bonner, who is glad her $50,000 cochlear implant surgery was done only after careful medical evaluation. Kaiser covered the entire cost of the procedure, which involves implantation of the device into the skull. The retired state analyst had been losing her hearing for decades because of otosclerosis, a condition that produces abnormal bone growth in the middle ear. Completely deaf in one ear and with just 10 percent of her hearing left in the other, doctors two years ago deemed her eligible for the implant, which processes sounds from the environment into electrical signals then sends them into electrodes implanted in the patient's cochlea.

Beyond the surgical risks, Bonner was initially reluctant to take the plunge because she would have had to make numerous four-hour trips to Oakland from her home in Volcano, in Amador County. She changed her mind last October, when doctors at Kaiser's South Sacramento facility began offering the surgery. Although the sounds she hears are different from how she remembers them, every one has been thrilling: "I can hear so many sounds I hadn't heard in years and years, like birds chirping, the car keys dropping, the water running," she said.

Kaiser patients unable to get pregnant will also have additional options soon. Dr. Jack Rosanz, Kaiser's physician in chief in Sacramento, said the new in-vitro fertilization program addresses demand, and physician recruitment problems. He said the medical group lost two top-notch reproductive endocrinologists because it lacked an IVF program. Dr. Kenneth Vu, a reproductive endocrinologist from the University of Hawaii, will run the program for couples who have exhausted other infertility treatments. "This is the next step for treatment," he said. "We have to do something to meet these women halfway. When we have to go outside the system, the sense is that the system failed." He said about 150 to 180 women have sought IVF treatment outside of Kaiser over the past couple of years. Kaiser has invested about $2.8 million to develop the program. Patients will pay out of pocket an estimated $8,000 fee for services, which includes the medications.

In some cases, Kaiser has looked very attractive to highly specialized doctors, who see opportunity in bringing their expertise into the large system with strong support systems in place. Kaiser now boasts the largest neurosurgery department in the Sacramento region, for example, with nine surgeons and two interventional neuroradiologists. Dr. Edie Zusman, director of adult neurosurgery at Sutter Neuroscience Institute, who began her career at Kaiser, has noticed the growth since her departure. "The emphasis in Kaiser at the time was on generalized neurosurgery rather than specialty programs," she said. "(Now) they are making important steps to meeting their members' needs."

It was a factor that attracted Dr. Victor Rodriguez, a highly sought after vascular surgeon specially trained to repair massive and complex aneurysms. "I've had offers elsewhere, but I like this place," he said. "I like the freedom to expand and grow. If you have the training, you want to be able to do these things."

Kaiser still has its limitations. It sends its heart surgery patients to Mercy hospitals. Some of the most complex neurosurgeries are done at UC Davis. And patients needing organ transplants are sent to the Bay Area. Still, there are more expansion plans on tap. Highest on the list: a move to establish the Sacramento area's fourth trauma center.

Source






USELESS BRITISH HEALTH BOSS REWARDED WITH A PEERAGE

The head of the NHS was forced out of his job yesterday after secret government forecasts revealed that hospital deficits were likely to spiral to œ900 million this year. Sir Nigel Crisp was given a peerage to ease his early departure after Tony Blair was said to have become anxious that the NHS had "taken its foot off the pedal". Sir Nigel had survived a reshuffle of senior executives in January after forecasts that hospitals were heading for debts of 623 million pounds. But days later he is understood to have learnt that pre-dicted deficits were running at more than 800 million pounds and he realised that he could not carry on.

One source said that pressure from Downing Street had been "intense" over the past six months after Sir Nigel was told that Mr Blair wanted to see results by April 2007 from all the effort and extra funding put into reform. Senior departmental officials were left in no doubt that success in transforming the NHS was a key part of Mr Blair's plans to leave a lasting legacy in transforming the public services. The source said: "The PM accepts it will be tricky financially but wants to see something to show for it at the end of that period [2006-07]." Downing Street said that Mr Blair had ten peerages to give out during the Parliament. Mr Blair's spokesman said: "The esteem in which the Prime Minister held Sir Nigel was illustrated by the fact he had recommended him for a life peerage."

Sir Nigel told The Times that he had walked, not been pushed. But he acknowledged that he had planned to stay for at least another year, and would have preferred to go when the service was "on the up". He denied any breakdown in relations with Patricia Hewitt, the Health Secretary, but there had been whispers for some time that ministers had lost confidence in him. More significant was a growing feeling in the senior echelons of the NHS that Sir Nigel, 54, could not pull it round. With many strategic health authority chief executives due to lose their jobs in the latest merger plans, loyalty to him ceased to have much value.

Insiders linked the fresh urgency from Downing Street to the appointment in December of Professor Paul Corrigan as Mr Blair's health adviser. Professor Corrigan is said to have believed that a shake-up of executives at the very top was necessary. Sir Nigel is to be replaced by two older men: Sir Ian Carruthers, 55, will become acting chief executive of the NHS, and Hugh Taylor, also 55, will become acting permanent secretary, two jobs combined by Sir Nigel.

The Conservatives said that Sir Nigel was the scapegoat for ministers' errors. Andrew Lansley, the Shadow Health Secretary, said: "Sir Nigel's rushed departure is a clear admission that the NHS centrally is in a crisis. Ministers can try to blame Sir Nigel but they are responsible. The NHS is plunging into the red because ministers raised costs and pushed targets without regard to the overall impact on services."

Since Sir Nigel took office in 2000, he has been responsible for spending more than 30 billion pounds in extra funding from the Chancellor. Yet he will leave office at the end of the month with the NHS facing its largest deficit since 1999. He said yesterday: "The deficits are clearly going to be too big, and I'm sorry we are going through a bad patch. There are three reasons for it. In some areas there are structural problems, which are getting worse. "The changes being made in the primary care trusts meant that there was less psychological pressure on managers to get the finances right. And we now have more transparency - financial problems that were disguised are now revealed."

Sir Nigel's fate was sealed after a panicky memo sent to the heads of strategic health authorities in February ordered them to stop within 72 hours all discretionary spending that did not affect clinical priorities. NHS finances had failed to show signs of recovery between December 2005 and January 2006, a time of year when deficits traditionally shrink. This year they grew, indicating a loss of control.This also came as a shock to Sir Nigel and made him question whether the SHAs were reporting accurately to him any longer. No 10 denied that Sir Nigel was "carrying the can" for the cash problems, saying taking responsibility was part of leadership. Traditionally ministers, not civil servants, carry the can

Source

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

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

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DRUG SCARES HURT PATIENTS

In the wake of last year's Vioxx panic, it would be easy to imagine that unexpected news about new drugs will be mostly bad. But two stories last week remind us why that's not the case, and that an excess of caution--whether due to regulation, litigation or fear--can itself be harmful to public health.

The first story concerns Erbitux, the ImClone cancer drug that became infamous after its initial rejection by the Food and Drug Administration in December 2001 led to an insider trading scandal that counted Martha Stewart as a victim. We said from the start that the FDA had made a bad call, and Erbitux was eventually approved to treat colon cancer.

Well, it turns out Erbitux works for other cancers too. Last Wednesday the FDA approved the drug for a new indication--head and neck cancer--based on data showing a whopping 20-month survival advantage over traditional chemotherapy alone. In fact, Erbitux represents the first significant advance for head and neck tumors since the 1950s.


That Erbitux worked in head and neck tumors was fairly obvious from early trial results even at the time it was first rejected for colon cancer. Dr. Mark Thornton, one of the FDA medical reviewers who finally helped push Erbitux through in 2004, tells us there was "extremely compelling" data on Erbitux for head and neck cancer as early as 2000. He adds that "it was hard to argue against providing it to patients" at the time it was first rejected.

Another man for whom the latest news on Erbitux is bittersweet is Frank Burroughs, who founded the Abigail Alliance for Better Access to Developmental Drugs in honor of his daughter, who died of head and neck cancer while trying to obtain Erbitux and other treatments. "This news serves as yet another reminder that the biggest 'ImClone scandal' of 2001 had nothing to do with Martha Stewart, but instead resulted from the FDA's failure to approve a drug that had been proven safe and effective for thousands of patients," the Alliance said in a statement.

In short, Erbitux is a perfect example of why it's important to get active drugs with reasonable safety profiles out before all the efficacy data is refined to the 10th decimal place, as the FDA always tries to insist. Such data are never going to be complete anyway. Think of all the new benefits that still keep being discovered for humble aspirin.

The second good-news story last week concerns Tysabri, the multiple sclerosis treatment that was voluntarily withdrawn last year (read: lawsuit panic) after three patients on the drug developed a rare neurological infection. This possible side effect wasn't entirely surprising, given that MS is a degenerative neurological disorder caused by immune system dysfunction and Tysabri works by depressing parts of the immune system. But it was also clear, as we editorialized at the time, that the patients in question had been treated with other immuno-suppressive drugs too, and that the risks of untreated or poorly treated MS probably outweighed the risks of taking Tysabri.

Well, now several new studies reported in the New England Journal of Medicine appear to support the point that Tysabri's risks are small and its potential benefits big. Tysabri appears to cut the rate of clinical relapses by 68%, and reduce by a whopping 83% the number of new or expanding brain lesions found in MS patients.

And remember that since MS is a degenerative disease there's no way to undo the damage in patients denied the right to weigh Tysabri's risks and benefits for themselves. This week an FDA panel will meet to consider Tysabri's re-introduction to the market and MS patients are expected to be there in force. "This drug worked for me, and I want to be able to have the choice to make an informed decision," said Cheryl Bloom, who also told Bloomberg news service she will be paying her own travel expenses from Idaho to have her voice heard.

A common theme in the story of these two different drugs is the issue of informed consent. Our philosophy is that patients and doctors dealing with fatal or degenerative diseases ought to have the maximum possible autonomy in treatment decisions. We now know that the FDA could have extended a lot of lives had it followed that principle with Erbitux from the start. And it has an opportunity to extend and improve many more if it decides to help facilitate Tysabri's return to the market.

Source






THE "GREEN" FDA

In yet another GOP contribution to limited government, an advisory committee at the Food and Drug Administration has recommended a ban on Primatene Mist, an over-the-counter asthma spray. This menace to society is propelled by chlorofluorocarbons. CFCs are considered injurious to the ozone layer.

The ozone-friendly FDA suggests that people use CFC-free prescription asthma nebulizers. That’s swell, unless you lack health insurance, pharmaceutical coverage, or the time to see a doctor — or if you need asthma relief right now.

Primatene is perfect for emergencies. I once suffered an asthma attack while visiting friends in lovely but secluded Bucks County, Pennsylvania. That weekend, I happened to forget my prescription inhaler. Rather than visit a pricey hospital emergency room or locate and awaken a doctor to write a prescription at 11:00 P.M., I had my friends drive me to a drug store where I bought some Primatene for about $12. Yes, I did inhale. And I felt much better.

Now, the Bush administration wants to deny asthmatics that freedom, choice, and comfort. If Primatene’s three million customers routinely emptied their atomizers into the air, this restriction might be ecologically sound. However, as Heritage Foundation senior policy analyst Ben Lieberman says: “The amounts of CFCs used in these inhalers is so small, it makes sense to exempt them for several more years until comparable alternatives are available.”

“To put people at risk from asthma, in order to address these inconsequential or even imaginary risks to planetary ozone, takes the precautionary principle to unconscionably absurd new levels,” says Paul Driessen, my Atlas Foundation colleague. “This is a good issue for anyone who favors equal access to affordable health care. This asinine rule would hit poor people hardest, resulting in more frequent, serious, and fatal attacks for them than for upper-crust people, like those who walk the halls of the FDA.”....

On deregulation, the GOP can redeem itself somewhat by revisiting an issue it dropped in 2001. Mandated under the 1992 Energy Policy Act signed by the elder President Bush, 1.6-gallon low-flow toilets have annoyed Americans who prefer the one-flush power of 3.5-gallon traditional toilets. Despite their superior performance, the old toilets are illegal. Amazingly, America now boasts a black market in classic commodes.

Despite ample histrionics during the so-called “Republican Revolution,” Rep. Joe Knollenberg’s (R., Mich.) bill to repeal the low-flow law languished in committee. This election year, roll-call votes to repeal this regulation should tell Americans whether their senators and representatives favor toilet freedom or toilet socialism.

Here’s an idea: Uncle Sam should retreat from asthmatics’ lungs, viewers’ cable boxes, and everyone’s toilets. That should give public servants in Washington more time to track and kill terrorists.

More here

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

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

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THE AUSTRALIAN PUBLIC HEALTH DEBACLE

I have three brief news items below about shortcomings in the Australian public health system and also below are two longer articles. It all does help to explain why nearly half of Australians have health insurance that enables them to go to our many excellent private hospitals rather than the overstretched public facilities. The trouble is that lots of Australians still believe the lie that the politicians have been telling them for years -- that everybody will be given as much "free" medical care as they want or need


Why did the Australian taxpayer EVER fund this stuff?: "Patients seeking facelifts, breast and penile enlargements, tattoo removals and liposuction have been banished from the waiting lists at NSW public hospitals. Instead, the 2000 patients awaiting nip'n'tuck cosmetic procedures will be forced to shop around private health facilities to have their operations. "Unless there is a legitimate medical reason, I don't see why NSW taxpayers should be funding these types of surgery," Health Minister John Hatzistergos said. "Most cosmetic surgery should ideally be undertaken within specialist private health facilities. "By reducing clinically unnecessary procedures, doctors will be ensuring more surgery time for people with real health needs," Mr Hatzistergos said. The new elective surgery policy will be announced today by Mr Hatzistergos in a dramatic move to streamline waiting lists and give priority to patients queueing for procedures such as hip and knee replacements, cataract removal and gallstone surgery".



Who cares about the patient in a public hospital? "Vital tests to check for bowel cancer in at-risk Victorians are being secretly cancelled and cut back, surgeons and specialists claim. Investigative colonoscopies were postponed indefinitely by some hospitals last month and scaled back by others, worried doctors said this week. The surveillance procedures are done on Victorians who have a family history of bowel cancer or are considered high risk for other reasons. Surgeons said the procedures were postponed indefinitely at Box Hill, Maroondah and Angliss hospitals in mid-February and scaled back at several others. A specialist said: "People are being left in purgatory -- their procedures are being postponed indefinitely." The surgeons' claims have been backed by the Cancer Council Victoria, with director Prof David Hill saying he had received similar reports. "We are hearing at the coal face that this is happening," Prof Hill said. It is believed cash-strapped hospitals have chosen to drop colonoscopies because it allows them to save money while also appearing to have maintained their care standards".



Roadside births soar as wards close: "The number of roadside births in Queensland has soared as maternity wards shut their doors across the state. Thirty-six of Queensland's 84 public maternity wards have closed over the past decade - coinciding with a 70 per cent increase in roadside births since 2001. Latest Queensland Health figures obtained by The Sunday Mail reveal 277 babies were born on the roadside in 2004, up from 162 three years earlier. Lobby group Maternity Coalition state president Bruce Teakle said women were having to travel up to 1000km to have a baby. "It's a huge concern - it's not good enough that on average five women a week give birth on the side of a road," he said. "Women are travelling further in labour, and that means more roadside births. "It's something that can be very distressing, and it's just not a good start to family life".





Up to 1300 Australians per year die waiting for public hospital help

Up to 1300 Australians die each year waiting to be treated in or admitted to public hospitals. A review of deaths at four public hospitals found patients forced to wait more than eight hours for treatment were 30 per cent more likely to die than those admitted when the hospital was not overcrowded. "Overcrowding is endemic in all large tertiary hospitals in Australia," said Peter Sprivulis, associate professor of emergency medicine at the University of Western Australia. "The situation has been deteriorating for about 15 years."

The two studies of more than 60,000 admissions at Canberra Hospital, Royal Perth Hospital, Fremantle Hospital and the Sir Charles Gairdiner in Perth found delays in treatment caused more than 130 deaths a year. "It's probably five to 10 times that amount nationally," Professor Sprivulis told The Australian. "It is well known that people who experience delays in getting treatment do worse. "For example, if a patient has a very serious infection they are more likely to die if they don't get the antibiotics on time."

Professor Sprivulis said medical errors were also more likely to occur when hospital resources were stretched. "Overcrowding is often associated with placing inpatients on an incorrect ward -- such as medical patients placed in emergency department corridors, which can cause potential adverse events."

The West Australian study, published in the Medical Journal of Australia, analysed hospital admissions via emergency departments in the three years to June 2003. It found 120 deaths a year were linked with overcrowding in the West Australian hospitals. The Canberra Hospital study looked at how many patients died within 10 days of presenting to the emergency department in 2002, 2003 and 2004. It attributed 13 deaths a year to overcrowding in the emergency department.

Drew Richardson, chair of road trauma and emergency medicine at Canberra Hospital, said further studies were needed to determine the extent of the problem. "The magnitude of the association of overcrowding and mortality in the ACT is around 13 additional in-hospital deaths annually. "That's similar to the number of people killed on the roads in the ACT each year, and if replicated in other studies, this association would represent a significant health issue," Professor Richardson said.

Peter Cameron, head of Monash University's pre-hospital and emergency trauma group, said increasing the number of hospital beds would not ease pressure on public hospitals. "Increasing the number of hospital beds temporarily alleviates access block, but does not solve the problem -- the beds quickly fill and the problems recurs." Professor Cameron said hospitals needed to find a better way to balance the dual demands of managing critically ill patients while still providing elective surgery. "Moving patients quickly from acute hospitals to more appropriate facilities increases hospital bed availability. "Access to rehabilitation, residential aged care and community outreach programs is an essential component of an efficient and well managed health system," Professor Cameron said.

He also called for better disease prevention strategies. Research had shown increasing flu vaccination uptake in the over-65s to greater than 90 per cent would reduce the need for acute hospitalisation in that age group by up to 40 per cent.

Source




Bureaucrats bleeding the NSW public health system

The Labor Government keeps the shackles on our doctors and nurses and our whole health system is crumbling.... Where does it start? It starts with the Government accepting federal health funding and banking it straight into consolidated revenue and then failing to forward the entirety of that money on to our state healthcare system. They get away with this because long ago the Wran Labor government started voting doctors off hospital boards and kicking them out of hospital administration, working through every hospital in Sydney, and then replacing them all with bureaucrats. Then doctors in the Health Department were also replaced by bureaucrats.

This is dangerous: A bureaucrat's first rule is to look after his own, a creed which begins to explain why today there are 1.8 hospital administrators for every patient. It's why the old nurses' quarters at Royal Prince Alfred, a building that used to be full with 1400 nurses all prepared to tend to our sick, is now wall-to-wall with administrators making economic decisions about our health care. Not a nurse to be seen.

Wran's illusion of care, which has been copied by following state governments, happened so long ago that we have been conditioned to accept it. Much of what truly happens inside hospitals is never discovered because the Government covers its tracks by gagging doctors and leaning over nurses, threatening them with their jobs. "The money is not going where it is needed," a doctor whispered in this ear. "We keep telling the Government this and they keep telling us to get stuffed."

He would speak only under condition of anonymity. Why? Because doctors are gagged by the Government. Any doctor that speaks out is in danger of losing their job. Now some - just some - of the truth can be told. He said patients were being discharged from hospital three and four days after receiving a coronary artery bypass graft. Why? Because the bureaucrats need the beds to meet their bottom line. Who cares if patients still dangerously ill are being told they are ready to go home and are discharged. He said no elective surgery was booked for the days leading up to public holidays like the Easter break. Why? Because penalty rates are too severe. The only theatres kept open are for emergency and casualty patients.

Then he said 30 per cent of beds across Sydney hospitals were closed. Why? Because every bed requires three different nursing shifts and two different doctors, working 12-hour shifts each day. Along with that comes cooks, cleaners, laundry and other ancillary staff. Close one bed down for a day and the bureaucrats save around $1000. lose 50 beds down and they get a call from head office and a recommendation for the next promotion. That is the reward of the loyal bureaucrat, whose god is numbers. They close down as many beds as possible to save money while at the same time discharging patients as soon as possible to increase the turnover . . . and therefore the cash.

And throughout we suffer the great insult - a Federal Government snipping from us a portion of our salaries for the Medicare levy, to support that health system. Money, remember, that goes straight into consolidated revenue and then fails to get redistributed, in its entirety, into state health care. This is the bureaucracy we deal with in government - and it is time for it to stop.

Doctors are tired of sending sick people home early or turning them away. Recently a leading surgeon quit a major public hospital frustrated at being unable to get his patients booked in for operations. "What's relevant is that the Government will not put the money into the system," the doctor whispered.

These are grounds that the next state election should be fought on. No doubt there will be some who will consider it unrealistic, others will say the problems are too deeply entrenched to ever be satisfactorily repaired. But if you can't hope for a better, more humane way you might as well throw it all away.

More here

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

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

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BRITAIN'S NHS GOES WACKY

Cherie's magic magnets cure

NHS accountants are so impressed by the cost-effectiveness of a "magnetic leg wrap" called 4UlcerCare that from Wednesday doctors will be allowed to prescribe it to patients.

Magnetic therapy, which was pioneered in ancient Egypt, has become one of the pillars of modern alternative medicine. Its adherents include Cherie Blair, Bill Clinton and Sir Anthony Hopkins, the actor. Although its merits are challenged by traditional medics, it is used to treat joint pains, sports injuries, backache, muscle soreness and period pain. It is also used on animals - 4UlcerCare was inspired by a dog named Kiri, which developed severe arthritis. Conventional treatments did not help and, after researching the use of magnets, Kiri's owner, Derek Price, made a magnetic collar. The dog made a remarkable recovery, which led Price to start manufacturing magnetic treatments for animals and people. Magnopulse, of which he is managing director, has sold more than 1m therapeutic magnets since 1997 to treat arthritis, swollen ankles, period pains and varicose veins.

The NHS Prescription Pricing Authority has ruled that 4UlcerCare is not just good for patients but also a good use of NHS cash. It believes the magnets will save money on bandages and nurses' time by healing the wounds. It has included magnets on the official list of items that can be prescribed on the NHS. The NHS has even done a cut-price deal with the manufacturers, buying treatments at 13.80 pounds instead of the normal price of 29 pounds.

Critics of magnetic therapy say it is no more effective than a placebo, however. Only last month a paper in the British Medical Journal by Professor Leonard Finegold, from Drexel University in Philadelphia, and Professor Bruce Flamm, from Kaiser Permanente Medical Center in Riverside, California, cast doubt on the treatment. "Patients should be advised that magnet therapy has no proven benefits. If they insist on using a magnetic device, they could be advised to buy the cheapest - this will alleviate the pain in their wallet," they wrote.

It is not known exactly how magnets work. Adherents believe they improve circulation because they attract the iron in blood towards them and, in doing so, increase the supply of oxygen to the wound. They may also reduce painful acidity in tissue.

More here






BUT NO FUNDING FOR SOME TREATMENTS THAT DO work

I guess Brits might have to wait until Cherie Blair backs it

The patient with a cerebral tumour may well complain of a headache. Classically, such headaches are worse in the mornings after the patient has been lying flat all night. They are usually across the forehead, affect both sides of the head and are made worse by coughing, straining or vomiting. Over time they tend to last longer and longer into the day and are increasingly likely to be associated with dizziness, nausea, clumsiness and a disturbed gait. Other people often notice subtle changes in the personality of their friend or relative. In one case in four, it is these observed changes that first draw attention to the possibility of a brain tumour. The patient may become difficult, obstinate or aggressive. Their behaviour and language may change and they may begin to show a Jekyll-and-Hyde side to their nature.

Seizures can also be an early symptom. If the tumour is pressing on some precise spot in the brain, it may give rise to related symptoms - for example, pressure on nerves leading to the eye may cause double vision. Although only a few headaches are related to cerebral tumours, these cancers are not as rare as people like to think - 10 per cent of solid cancers are within the brain, and these account for 1 per cent of all deaths in the UK. Unfortunately, treatment of the common brain cancers has not improved dramatically in the past 30 years, although modern surgery and radiotherapy are giving patients a longer survival time....

In this distressing field of medicine there has recently been a glimmer of hope - not a huge breakthrough but a significant one. Treatment has been introduced that can prolong survival time by 20 per cent in those suffering from a glioma. Gliomas account for 60 per cent of brain tumours. A licence was recently granted for the insertion of a chemotherapeutic, biodegradable disc or wafer, the size of a 5p piece, into the tumour site at surgery, with the intention of destroying the glioma tentacles that have escaped the surgeon's knife.

Unfortunately the National Institute for Clinical Excellence (Nice) is reluctant to recommend that the NHS pays for it and is equally reluctant to pay for temozolomide, another advance in the treatment of gliomas: 26 per cent of patients taking temozolomide were alive two years after treatment, compared with only 10 per cent who had radiotherapy alone. These latest treatments have been widely adopted by countries much poorer than Britain.

Source

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

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

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SCREWY U.S. REGULATIONS

Two years ago, the University of Washington School of Medicine paid the government $62 million to settle a Medicare billing dispute. In addition to its legal expenses, the medical school paid more than $750,000 for a high-powered, outside committee to review what happened and write up a report. Obviously, the medical school learned an expensive lesson. But will the lesson help improve patient care? We doubt it.

The title of the 111-page report summarizes the emphasis: "Achieving Excellence in Compliance." The document uses the word "compliance" 620 times, and recommends a new objective for the school: achieving "a culture of compliance" in addition to the more traditional medical school goals of research, teaching and patient care. To implement the recommendations of the report, the school is spending money for more lawyers, more layers of staffing, re-educating physicians and more oversight of who bills for what and how.

Unfortunately, the process is eerily like that for many businesses where the Sarbanes-Oxley law has resulted in complicated, expensive and difficult-to-comply-with rules. Once upon a time, an organization could be successful by ethically providing goods and services to customers and clients. The ethical guidelines for this behavior were ultimately based on underlying and universal moral rules, such as those prohibiting stealing or cheating. Understandable and enforceable laws and contracts often reflected those ethics. Over time, many lost sight of the underlying moral code but still followed the ethical codes set up by business or professional organizations.

More recently, complicated laws governing business and professional behavior are causing increased emphasis on compliance to the often arbitrary rules, sometimes leaving common sense and ethics behind. Judges agreeing with new ideas put forth by trial lawyers or government prosecutors often defeat rather than fulfill justice. Many enterprises, probably now including the UW medical school, visualize these exceedingly complicated rules as an impenetrable briar patch. It's easy to understand why they now concentrate their compliance resources in the areas targeted by government enforcers. Because it's impossible to consistently comply with all the myriad rules, the goal becomes damage control; the modus operandi becomes risk management. Instead of being a uniform and solidifying bedrock underpinning civilization, law enforcement has become an unmarked minefield destroying lives and enterprises almost willy-nilly.

In medicine, Congress is now considering "pay for performance" and "best practices" incentives that would reward doctors for following government guidelines (i.e., rules) on how to treat patients with particular conditions or diseases. One difficulty with this government micromanagement is that the scientific studies used to establish the "best practice" rules typically include patients with a given condition, such as congestive heart failure and a narrow range of possibly complicating factors. Researchers do not further analyze patients with a significant complicating factor because it would take too many such patients to generate a statistically significant result. For these patients, there's no "best practice" science to unerringly guide the doctor in treatment. For example, a patient with heart failure might have a past history of a previous stroke and also come down with pneumonia on top of the heart failure. It would be rare for an up-to-date scientific study to account for even this relatively simple set of complicating factors. And, medical advances quickly outdate these studies.

In addition, research funds for promising but politically-incorrect treatment methods, such as chelation therapy and hyperbaric oxygen therapy, is cut off by the medical-political complex controlling almost all research grants.

Most people want doctors with experience in treating their condition rather than a technician treating them based on a printout from the best-practices computer.

There's a huge disconnect between the goals of compliance and excellent patient care. "Compliance" implies there's something to comply with, such as government billing and practice rules. But successful patient care often depends on creative insight. The practice of medicine is as much an art as a science. If it were only science and technique, we'd have high-school-graduate best-practices technicians following computer printouts rather than medical doctors taking care of patients. Why waste all that time and money for college plus five to ten years of medical training?

We agree that doctors should be moral, honest and ethical. But "compliant" as a primary motivation? Ethical should cover that base. The more energy and costs expended on compliance, the less is left over for patient care. The alternative is for increased costs of medical care, without any added patient benefit. Ironically, although the government insists that Medicare recipients get first class medical care at the same time it clamps down on medical costs, the result of more compliance efforts will be decreased access and higher costs.

If the University of Washington succeeds in "achieving excellence in compliance," it may avoid further government penalties, but patients will ultimately pay the price, both in the quality of care and dollars.

Source






Queensland hospital bed crisis continues despite political hot air

There seems to be NOTHING they can do to make their public medicine system work properly

As Premier Peter Beattie announced on Thursday that Queensland's health system had "turned the corner", 49 Queenslanders were on hospital gurneys in emergency departments statewide, waiting for proper beds. This was in spite of Queensland Health data showing that during the last six months of 2005 the five Brisbane public hospitals admitted fewer patients than in the same period in 2004. Admissions to the Mater General, for example, were down almost 20 per cent. The data shows all five hospitals have been operating at peak capacity for most of the past week. Statewide, this has contributed to dozens of patients every day being forced to wait in hospital emergency departments while staff struggle to find beds for them. Yesterday 64 people were waiting for beds; on Wednesday (the day before Mr Beattie's declaration) 72 were in limbo across the state.

So urgent has the demand for beds become that management at Queensland's largest hospital, the Royal Brisbane and Women's, has told staff to move discharged patients into a transit lounge to free beds, and that beds are not to stay vacant longer than 30 minutes. The situation is not confined to Brisbane, with most regional hospitals also forced to accommodate people in emergency departments while staff look for beds.

The number of public hospital beds in Queensland dropped from 10,115 in 1994-95 to 9340 in 2004-05. In this time Queensland's population grew by 25 per cent. The bed shortage is likely to hit the politically sensitive issue of elective-surgery waiting lists harder. Two new studies to appear tomorrow in The Medical Journal of Australia have found hospital and emergency department overcrowding to be associated with increased mortality; and show the hospital bed closures have resulted in hospital occupancies over 95 per cent.

Mr Beattie yesterday continued to defend his proclamation that the state's health system had "turned the corner". He said securing new pay deals for doctors and nurses was "absolutely fundamental" to turning the corner to improve health. "If you haven't got doctors and nurses it doesn't matter how many beds you've got you'll never reduce waiting times," he said. "The core issue here was to get a pay package that satisfied our doctors and satisfied our nurses. They were the two big challenges - and to make sure, we trained more doctors for the future." Mr Beattie said hospital bed numbers and waiting lists were among the "longterm, systemic" issues that would take time to resolve because of Queensland's population growth. "That's why we had a five-year plan," he said.

Queensland Opposition health spokesman Bruce Flegg said all of Queensland's major hospitals "are suffering serious bed shortages that is causing a critical situation of access-block in emergency departments". "Clearly Queensland Health has not turned the corner, and Mr Beattie should be ashamed of himself for trying to pull the wool over the eyes of Queenslanders," Dr Flegg said. Australian Medical Association Queensland president Steve Hambleton said yesterday that "the health system is nowhere near fixed yet". He said the $1 billion pay rise over the next three years, given to nurses this week, was "recognition of their value to the system, but the money was not a solution alone". "Fixing Queensland's health system will depend on the co-operation of all those in the health profession," Dr Hambleton said.

Source

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

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

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WAL-MART IS THE HAM IN THE SOCIALIZED MEDICINE SANDWICH

With the war on Wal-Mart now heating up in nearly three dozen state legislatures, I put a call in to someone who was in on the ground floor in pushing to force the retailer to spend more on health care for its employees. What Maryland's Delegate James Hubbard, a Democrat from Prince George's County, had to say was revealing of both why he backed his state's "Wal-Mart bill" and what this fight is really about: expanding Medicaid and other taxpayer-funded health-care entitlements.

Let's first understand that the drive to enact anti-Wal-Mart legislation has very little to do with the retail giant except in two respects: dipping into its very deep pockets, and using the controversy surrounding the company to mask the larger agenda of expanding already-bankrupt entitlement programs. Of course, in this war legislators have a ready made ally in the AFL-CIO, which has its own reasons for going after the nonunionized company.

With that, let's turn to Mr. Hubbard. He began our conversation by pointing out that the Wal-Mart bill--which forces companies with more than 10,000 employees to spend at least 8% of their payroll on health care or pay the state the difference--was always intended to be just the first step. Four years ago, he made his intentions clear by introducing legislation to increase cigarette taxes and to use the tax code to compel employers to provide health insurance. Under his legislation the revenue from these taxes would be dumped into a new state fund that would then be used to expand Medicaid eligibility to families with incomes up to 300% of the poverty line (up from 200% now). But even in a legislature with large Democratic majorities, his bill stalled.

So Mr. Hubbard and others settled on a new approach--pushing through smaller, bite-sized pieces. The first piece was the Wal-Mart bill. It passed last year and was enacted last month, when the Legislature overrode Gov. Robert Ehrlich's veto. Two weeks ago Mr. Hubbard was at it again, this time introducing a new bill to mandate that companies with at least 1,000 employees spend 4.5% of their payroll on health care or pay the state the difference. Once this piece is in place, Mr. Hubbard told me, the next step will be to create a similar mandate--perhaps 2% or 3%--for companies with fewer than 1,000 employees. Each year, Mr. Hubbard hopes to expand the mandate to include ever smaller companies with the ultimate goal of "health coverage for all Marylanders."

Mr. Hubbard noted how effective splitting the difference can be in moving legislation toward a larger goal. "If you give up 80% of what you want to get 20%," he said, "after five years you will have nothing left to give up." Mr. Hubbard also noted a quirk in the system that made raising taxes and expanding the Medicaid rolls attractive. With the federal government paying half or more of every dollar spent on Medicaid, states were essentially leaving federal dollars on the table by not expanding the program.

It is within this context that we should view the National Governors Association's meeting in Washington this week. Like all interest groups, the states' chief executives are determined not to leave town empty-handed; and every year a top agenda item for them is getting more federal dollars to cover the ever-expanding cost of Medicaid. And who could blame them? After all, the federal government created Medicaid as a tiny program in the 1960s. Today it eats up, on average, about a quarter of each state's budget and grows every year at a rate that outstrips inflation and threatens to gobble up dollars needed for education and other priorities.

Yet Mr. Hubbard isn't the only state lawmaker who has figured out that he can leverage the federal Treasury to his advantage by expanding Medicaid eligibility. New York is well ahead on this learning curve. According to a recent study published by State Policy Reports, the Empire State receives more federal dollars per capita than any other state and more than twice the national average.

What's now dawning on Wal-Mart CEO Lee Scott is that his company is a middleman in this exchange. So on Sunday he spoke directly to the governors and said there was "too much politics" in state bills taking aim at his company. Of course, that's exactly why more states will target Wal-Mart and other employers in order to raise revenue to expand Medicaid, unless someone in Washington puts a stop to it.

Source






Foreigners get free surgery on Medicare in Australia too

Sick foreigners are using the Medicare cards of Australian citizens to get free medical treatment in our hospitals. The Medicare fraud, which is costing taxpayers millions of dollars a year, is possible because our outdated Medicare [ID] cards carry no proof of identity. A Daily Telegraph investigation has found a Victorian man was convicted and fined for allowing his father, a foreigner, to use his Medicare card to claim benefits for laser eye treatments and medical consultations worth more than $3300. He told investigators he had committed the fraud because he could not afford to pay for his father's treatment when he came to visit Australia.

A Sydney woman discovered last year that someone received a free kidney operation using her Medicare card after it was stolen. She only discovered the fraud when she visited her specialist for a routine appointment and he asked her how she was feeling after the surgery.

In 2003-04 Medicare Australia investigated 137 reports of members of the public defrauding Medicare. A recent Auditor General's report found 500,000 Medicare cards were still registered to patients who had died. Some citizens have two Medicare cards - one which lists them as a male, the other as a female.

It is not just foreigners who are using stolen Medicare cards to defraud taxpayers. In Western Australia a man has been jailed for 12 months on 80 counts of fraud when he was found to have used another person's Medicare card to get taxpayers to pay for medical services and narcotics. A deregistered Queensland doctor used 21 stolen identities involving Medicare cards to get hold of 19,650 morphine tablets. The fraud cost the Pharmaceutical Benefits Scheme $50,000 and the tablets had a street value of $2 million. Police in Western Australia have uncovered an organised crime syndicate that was using multiple identities and Medicare cards to get taxpayers to pay for medical services. The fraud is estimated to have been worth more than $19,000. These are just some of the fraud cases that have been uncovered by Medicare Australia but the full scale of the problem could be much larger.

Medicare says less than 1 per cent of the $9 billion worth of claims a year it pays out are fraudulent but that still means fraud could be costing taxpayers up to $90 million a year. Human Services Minister Joe Hockey will soon take to Cabinet plans for a new Medicare smartcard that would carry a person's photograph and other identification and help combat Medicare fraud. The enhanced identity safeguards would make it difficult for an imposter or a non-taxpaying foreigner to use another person's Medicare card to claim rebates or get free public hospital treatment.

Source

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

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

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THE HEARTLESS CANADIAN SYSTEM AGAIN

Two stories below about what "caring" Leftists create:

No mercy for man waiting for surgery:

A mentally disabled Elliot Lake man will have to live with a painful stomach condition for a few more months because Sudbury Regional Hospital (SRH) has a limit on the surgery he needs. The middle-aged man, who was born with his stomach in the wrong place, suffers from severe and painful dry heaves. His condition can be cured by a procedure called laparoscopic anti-reflux surgery, which would change the position of his stomach. However, the hospital has limited Sudbury's two thoracic surgeons to doing just 25 of these surgeries in a fiscal year, and they have already surpassed their limit.

The man was originally scheduled for surgery at Sudbury Regional Hospital in December, but the procedure was cancelled twice, says Heather Tasse, a home support worker for Community Living Algoma who helps to care for the man. The man's surgeon, who has asked not to be named, told Tasse the hospital isn't allowing him to perform any laparoscopic anti-reflux surgeries from the beginning of February until the end of March, when the fiscal year ends.

Demand for his services has been increasing over the past few years. He is one of only a few doctors in the province able to perform anti-reflux surgery in a minimally invasive fashion. Tasse says her client is near the top of the surgeon's 14-month waiting list, because he is in so much pain. "How can you put a cap on people's health?" asks Tass‚. "Maybe more people should ask why (the surgeon) is being limited in the number of these procedures he does. I mean, that's ludicrous."

SRH chief of staff Dr. Chris McKibbon says the hospital has many surgical priorities, and must decide how to allocate funding within their tight budget. The hospital puts a cap on many types of surgeries, not just laparoscopic anti-reflux surgery, he says. "One of the things that you need to understand is that we're funded for particular volumes of all kinds of things. We project how many cardiac surgeries, knee replacements and cataracts we're going to do," says the doctor. "The struggle is try to do the best we can to get it right and actually deliver on our commitments. So is this (capping numbers of surgeries) unique? Not at all."






Couple face long, painful wait for care. Man, wife need knee, hip surgeries:

Incapacitated by joint damage, Joan and Don Brigden have squeezed their lives into two rooms by installing their bed and a shower downstairs. She is 70 and was slated for hip replacement since May; he is 68 and was to get a new knee in September. But then their files and referrals got lost between two Gatineau hospitals. The couple from Bowman, 70 kilometres north of Ottawa, had to start from scratch, facing an eight-month wait for a consultation.

"She's gone from using a cane to a walker to a wheelchair in four months," Don Brigden said of his wife. "We are literally living in two rooms. It's terrible. We shouldn't have to suffer this way."

Montreal orthopedic surgeon Ethan Lichtblau "inherited" the two cases in December after a referral from a family doctor in Hawkesbury, Ont. The Brigdens had expected their suffering would end shortly. They were looking forward to doing their grocery shopping together once again. But this week, they found themselves on yet another waiting list. Lichtblau's hospital, Santa Cabrini, has shut its operating room to knee and hip replacements because of budget restrictions.

When is Quebec's plan of guaranteed wait times going to kick in?, Don Brigden demanded. The Brigdens say they understand surgery delays aren't the hospital's or the surgeon's fault. "But from where I'm sitting, it doesn't seem fair," Joan Brigden said. "You can't blame the doctors - it's the friggin' system," her husband added. "We paid taxes all our lives for this and now they tell us they don't have the money to do it right away."

Tired of waiting for the pain to abate, other Gatineau-area patients have paid $15,000 for hip surgery, done in a private clinic in Laval. The Brigdens are going to wait until Santa Cabrini opens again to knee and hip surgeries in April. "It's just a shame we have to wait that long. She should be walking around being functional," Don Brigden said of his wife. "It's just not right."

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

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

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NOW READ HOW IT IS IN 2006 CANADA:

Since the year 2000 article I put up yesterday, the Canadian government has still not changed its stance. It is only defiant private entrepreneurs who are, with the help of the courts, beginning to alleviate the Canadian health service shortages

The Cambie Surgery Center, Canada's most prominent private hospital, may be considered a rogue enterprise. Accepting money from patients for operations they would otherwise receive free of charge in a public hospital is technically prohibited in this country, even in cases where patients would wait months or even years in discomfort before receiving treatment. But no one is about to arrest Dr. Brian Day, who is president and medical director of the center, or any of the 120 doctors who work there. Public hospitals are sending him growing numbers of patients they are too busy to treat, and his center is advertising that patients do not have to wait to replace their aching knees.

The country's publicly financed health insurance system - frequently described as the third rail of its political system and a core value of its national identity - is gradually breaking down. Private clinics are opening around the country by an estimated one a week, and private insurance companies are about to find a gold mine. Dr. Day, for instance, is planning to open more private hospitals, first in Toronto and Ottawa, then in Montreal, Calgary and Edmonton. Ontario provincial officials are already threatening stiff fines. Dr. Day says he is eager to see them in court. "We've taken the position that the law is illegal," Dr. Day, 59, says. "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years."

Dr. Day may be a rebel (he keeps a photograph of himself with Fidel Castro behind his desk), but he appears to be on top of a new wave in Canada's health care future. He is poised to become the president of the Canadian Medical Association next year, and his profitable Vancouver hospital is serving as a model for medical entrepreneurs in several provinces.

Canada remains the only industrialized country that outlaws privately financed purchases of core medical services. Prime Minister Stephen Harper and other politicians remain reluctant to openly propose sweeping changes even though costs for the national and provincial governments are exploding and some cancer patients are waiting months for diagnostic tests and treatment.

But a Supreme Court ruling last June - it found that a Quebec provincial ban on private health insurance was unconstitutional when patients were suffering and even dying on waiting lists - appears to have become a turning point for the entire country. "The prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services," the court ruled.

In response, the Quebec premier, Jean Charest, proposed this month to allow private hospitals to subcontract hip, knee and cataract surgery to private clinics when patients are unable to be treated quickly enough under the public system. The premiers of British Columbia and Alberta have suggested they will go much further to encourage private health services and insurance in legislation they plan to propose in the next few months.

Private doctors across the country are not waiting for changes in the law, figuring provincial governments will not try to stop them only to face more test cases in the Supreme Court. One Vancouver-based company launched a large for-profit family medical clinic specializing in screening and preventive medicine here last November. It is planning to set up three similar clinics - in Toronto, Ottawa and London, Ontario - next summer and nine more in several other cities by the end of 2007. Private diagnostic clinics offering MRI tests are opening around the country.

Canadian leaders continue to reject the largely market-driven American system, with its powerful private insurance companies and 40 million people left uninsured, as they look to European mixed public-private health insurance and delivery systems. "Why are we so afraid to look at mixed health care delivery models when other states in Europe and around the world have used them to produce better results for patients at a lower cost to taxpayers?" the premier of British Columbia, Gordon Campbell, asked in a speech two weeks ago.

While proponents of private clinics say they will shorten waiting lists and quicken service at public institutions, critics warn that they will drain the public system of doctors and nurses. Canada has a national doctor shortage already, with 1.4 million people in the province of Ontario alone without the services of a family doctor. "If anesthetists go to work in a private clinic," Manitoba's health minister, Tim Sale, argued recently, "the work that they were doing in the public sector is spread among fewer and fewer people."

But most Canadians agree that current wait times are not acceptable. The median wait time between a referral by a family doctor and an appointment with a specialist has increased to 8.3 weeks last year from 3.7 weeks in 1993, according to a recent study by The Fraser Institute, a conservative research group. Meanwhile the median wait between appointment with a specialist and treatment has increased to 9.4 weeks from 5.6 weeks over the same period. Average wait times between referral by a family doctor and treatment range from 5.5 weeks for oncology to 40 weeks for orthopedic surgery, according to the study. Last December, provincial health ministers unveiled new targets for cutting wait times, including four weeks for radiation therapy for cancer patients beginning when doctors consider them ready for treatment and 26 weeks for hip replacements. But few experts think that will stop the trend toward privatization.

Dr. Day's hospital here opened in 1996 with 30 doctors and three operating rooms, treating mostly police officers, members of the military and worker's compensation clients, who are still allowed to seek treatment outside the public insurance system. It took several years to turn a profit. Today the center is twice its original size and has yearly revenue of more than $8 million, mostly from perfectly legal procedures. Over the last 18 months, the hospital has been under contract by overburdened local hospitals to perform knee, spine and gynecological operations on more than 1,000 patients. Since the Supreme Court ruling in June, it began treating patients unwilling to wait on waiting lists and willing to pay their own money.

Now Dr. Day says he is considering building a full-service private hospital somewhere in Canada with a private medical school attached to it. "In a free and democratic society where you can spend money on gambling and alcohol and tobacco," Dr. Day said, "the state has no business preventing you and me from spending our own money on health care."

Source







Another hole in an Australian government health service: "A paramedic shortage has forced the Queensland government to search interstate and overseas for ambulance staff. The Department of Emergency Services today launched a major advertising campaign in newspapers throughout Australia and New Zealand to fill 144 paramedic positions. However, Queensland Emergency Services Minister Pat Purcell said he was not concerned by the staff shortage and the need to search beyond the state. "Paramedics are not coming here at the moment so that is why we are going elsewhere with the advertising," Mr Purcell said. "I don't know why they wouldn't want to come and work here as it's the most professional (paramedic) service in Australia." [Pay?] The positions needed to be filled throughout Queensland by September next year, he said".

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

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

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CANADIANS ARE SLOW LEARNERS

The article below is from the year 2000!

Full Hospitals Make Canadians Wait and Look South

MONTREAL: Dressed in her orchid pink bathrobe and blue velour slippers, Edouardine Boucher perched on her bed at Notre Dame Hospital here on Friday and recounted the story of her night: electric doors constantly opening and closing by her feet, cold drafts blowing across her head each time an ambulance arrived in the subzero weather, and a drug addict who started shouting at 2:30 a.m., ''Untie me, untie me.'' But as nurses hurried by on Friday morning, no one thought it remarkable that Ms. Boucher, a 58-year-old grandmother awaiting open heart surgery, had spent a rough night on a gurney in an emergency room hallway. After all, other hallways of this 3-year-old hospital were lined with 66 other patients lying quietly on temporary beds.

To explain overflowing hospitals here and across the nation, Canadian health officials are blaming the annual winter flu epidemic. But, at the mention of flu, Daniel Brochu, the veteran head nurse here, gave a smirk and ran his pen down the patient list today: ''Heart problem, infection problem, hypertension, dialysis, brain tumor, two cerebral hemorrhages.'' On Thursday, he said, crowding was so bad that he was able to admit one patient only after the ambulance crew agreed to leave its stretcher.

When Canada's state-run health system was in its first bloom, in the 1970's, Americans regularly trooped up here on inspection tours, attracted by Canada's promise of universal ''free'' health care. Today, however, few Canadians would recommend their system as a model for export. Improving health care should be the federal government's top priority, said 93 percent of 3,000 Canadians interviewed last month by Ekos Research Associates. In another poll last month, conducted by Pollara, 74 percent of respondents supported the idea of user fees, which have been outlawed since 1984. ''There is not a day when the newspapers do not talk of the health crisis,'' said Pierre Gauthier, president of the Federation of Specialist Doctors of Quebec. ''It has become the No. 1 problem for Quebecois and for Canadians.''

In Toronto, Canada's largest city, overcrowding prompted emergency rooms in 23 of the city's 25 hospitals to turn away ambulances one day last week. Two weeks ago, in what one newspaper later called an ''ominous foreshadowing,'' police officers shot to death a distraught father who had taken a doctor hostage in a Toronto emergency room in an attempt to speed treatment for his sick baby. Further west, in Winnipeg, ''hallway medicine'' has become so routine that hallway stretcher locations have permanent numbers. Patients recuperate more slowly in the drafty, noisy hallways, doctors report. On the Pacific Coast, ambulances filled with ill patients have repeatedly stacked up this winter in the parking lot of Vancouver General Hospital. Maureen Whyte, a hospital vice president, estimates that 20 percent of heart attack patients who should have treatment within 15 minutes now wait an hour or more.

The shortage is a case of supply not keeping up with demand. During the 1990's, after government deficits ballooned, partly because of rising health costs, the government in Ottawa cut revenue-sharing payments to provinces -- by half, by some accounts. Today, the federal budget is balanced, but 7 hospitals in Montreal have been closed, and 44 hospitals in Ontario have been closed or merged.

Ottawa also largely closed the door to the immigration of foreign doctors and cut the number of spaces in Canadian medical schools by 20 percent. Today, Canada has one medical school slot for every 20,000 people, compared with one for 13,000 in the United States and Britain. With a buyout program, Quebec induced 3,600 nurses and 1,200 doctors to take early retirement. And across the nation, 6,000 nurses and at least 1,000 doctors have moved to the United States in recent years. At the same time, demands on Canada's health system grow every year. Within 30 years, the population over 65 is expected to double, to 25 percent.

Unable to meet the demand, hospitals now have operation waiting lists stretching for months or longer -- five years in the case of Ms. Boucher.

As a result, Canada has moved informally to a two-tier, public-private system. Although private practice is limited to dentists and veterinarians, 90 percent of Canadians live within 100 miles of the United States, and many people are crossing the border for private care. Last summer, as waiting lists for chemotherapy treatments for breast and prostate cancer stretched to four months, Montreal doctors started to send patients 45 minutes down the highway to Champlain Valley Physicians' Hospital in Plattsburgh, N.Y. There, scores have undergone radiation treatment, some being treated by bilingual doctors who left Montreal. Business has been so good that the Plattsburgh hospital, which was on the verge of closing its cancer unit, has invested half a million dollars in new equipment. And on the Quebec side, the program has allowed health authorities to boast that they have cut the list of cancer patients who have to wait two months or more, to 368 today from 516 last summer.

In Toronto, waiting lists have become so long at the Princess Margaret Hospital, the nation's largest and most prestigious cancer hospital, that hospital lawyers drew up a waiver last week for patients to sign, showing that they fully understood the danger of delaying radiation treatment.

With the chemotherapy waiting list in British Columbia at 670 people, hospitals in Washington have started marketing their services to Canadians in Vancouver, a 45-minute drive. A two-tier system is also being used for other kinds of operations. ''I would like to buy mother a plastic hip for Christmas, so she doesn't have to limp through the year 2000 in excruciating pain,'' Margaret Wente, a newspaper columnist for The Globe and Mail in Toronto, wrote last month. ''I could just drive her to Cleveland, which is fast becoming the de facto hip-replacement capital of Southern Ontario.''

Allan Rock, Canada's health minister, disapproves of such attitudes. In an essay in the same newspaper, he wrote sarcastically: ''Forget about equal access. Let people buy their way to the front of the line.'' In defense of Canada's state health system, he wrote, ''Its social equity reflects our Canadian values.'' Mr. Rock, who hopes to become prime minister one day, said that health delivery could be improved through better, computerized planning. He attacked a proposal in Alberta to allow private hospitals, warning readers, ''The precedent may be set for American for-profit health-care providers looking to set up shop in Canada.''

But the idea that there may be room in Canada's future for private medicine is gaining ground. ''We have no significant crises in care for our teeth or our animals, largely because dentists and veterinarians operate in the private sector,'' Michael Bliss, a medical historian, wrote on Wednesday in The National Post, a conservative newspaper. ''So we have the absurdity in Canada that you can get faster care for your gum disease than your cancer, and probably more attentive care for your dog than your grandmother.'' In Ontario, Canada's wealthiest province, the waiting list for magnetic resonance imaging tests is so long that one man recently reserved a session for himself at a private animal hospital that had a machine. He registered under the name Fido.

To Ms. Boucher, who jealously guarded her 15 square feet of corridor space today, such cocktail circuit anecdotes were not amusing. Glumly eating her cold breakfast toast, she said, ''It scares us to get sick.''






ANOTHER AUSTRALIAN PUBLIC HOSPITAL SYSTEM IN REVERSE GEAR

I have posted a lot on the meltdown in the State of Queensland but it seems that the State of Victoria has big problems too. In both States, the number of hospital beds provided has declined while demand has increased!

Dozens of beds have closed in the face of soaring patient numbers as Victoria's public hospital system struggles to meet demand. More than 180 beds have dropped out of the public hospital system in the eight years to 2003-04, while patient numbers have increased 30 per cent. At the same time the number of people languishing on hospital waiting lists has jumped more than 40 per cent. Despite the drop in bed numbers, stressed staff are dealing with hundreds of thousands more patients each year.

Australian Medical Association state president Dr Mark Yates said Victorian hospitals were running at nearly 95 per capacity and struggling to cope. "What we need to see is an increase in the number of beds in Victoria so that our hospitals can run more efficiently," Dr Yates said. He said the biggest loss of beds was across intensive care departments.

Ben Hart, spokesman for acting Health Minister Gavin Jennings, said a worldwide shortage of intensive care nurses was responsible for the lack of intensive care beds in Victoria. According to figures from the Australian Institute of Health and Welfare, the number of public hospital beds dropped 184 from 1996-97 to 2003-04.

Opposition health spokeswoman Helen Shardey said the drastic shortage of beds was putting patients at risk. "Where are these beds? What's happened to them, why aren't they available to patients who need them? The Government needs to fess up," Ms Shardey said. "The Bracks Government promised an extra 900 hospital beds and not only have they not delivered on that promise, but bed numbers are still going down. "That causes enormous problems and huge blockages in the system: elective surgery is cancelled, the emergency department is under pressure, ambulances are put on bypass. "No excuses should be accepted by the public."

In the eight years to 2003-04 there was a 31.9 per cent increase in the number of patients admitted to hospital. In 2003-04, 1,187,529 patients were admitted to hospital in Victoria. While the number of people admitted for at least one night rose just 3.5 per cent to 510,713 patients in the latest figures, the number of patients admitted for day procedures rose more than 60 per cent to 652,364 in 2003-04. According to the State Government's Hospital Services Report, elective surgery waiting lists blew out 40 per cent.

Source

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

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

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