Surgeon breaks cover over NHS beds crisis
Specialist wards full to breaking point. Patients with serious injuries denied care. A health service paralysed by arguments about funding. Martin Bircher, one of Britain's most senior consultants, speaks out:
One of Britain's leading trauma surgeons has broken cover to expose the scandal of a national shortage of emergency trauma beds which is leading to thousands of serious injury victims suffering in agony. In an unprecedented intervention by a senior practitioner in the NHS, Martin Bircher, a consultant at St George's hospital in London, one of Europe's leading centres in the treatment of major accident victims, has revealed a system paralysed by red tape and disputes over funding, which is putting thousands of patients waiting for treatment in specialist wards at risk. His revelations have prompted calls for a review of funding for A&E services and a shake-up in the management of Britain's leading trauma centres.
Mr Bircher says the problem is worsened by the bureaucracy of the internal market. He has become so frustrated that he has broken free of NHS strictures against speaking to the press and agreed to talk to The Independent on Sunday about the suffering patients are put through.
Every one of Britain's specialist trauma beds is full, which means some patients can wait up to three weeks after their accident before badly broken bones can be repaired. The delay, says Mr Bircher, can jeopardise recovery. With nothing but praise for frontline staff, he says patients who have been critically injured in road or other accidents have to wait an average of 12 days - often in agonising pain - before they can receive the vital specialist treatment. This is because only a limited number of hospitals have the expertise to repair smashed bones, and those hospitals have a shortage of intensive care beds. With the average cost of keeping a trauma patient at around 500 pounds a day and up to 2,000 a day in intensive care, this is also a false economy.
Reacting to the revelations Andrew Lansley, the shadow Health Secretary, said: "It is vital that clinicians are able to prioritise patients according to clinical criteria. It's only if we dispense with central targets and the bureaucratic burdens of the Department of Health that we can give GPs and local hospitals the opportunity to make services more efficient." John Pugh, the Lib Dem health spokesman, added: "This shows how counterproductive the target culture is. Patients are being shunted in and out of A&E to satisfy the expectations of Whitehall. Medical staff should feel free to act in the best interests of patients."
Squabbles over funding
Mr Bircher, who risks censure from the NHS for speaking out, said primary care trust and bed managers are involved in making the final decision as to whether a patient can be moved. If they have to move them there is often a conflict or reluctance because the new area does not want an extra cost. So after initial admission to a general hospital's emergency wards, where lives are saved, patients can find themselves waiting up to three weeks before their real recovery process can begin.
Mr Bircher, 52, cited one patient who had a motorcycle accident earlier this month and was referred to him to decide if she needed surgery to repair her badly broken pelvis. However, he did not receive the request for a week because an initial referral to another hospital was "intercepted by the primary care trust" and rerouted to a hospital that did not have a surgeon with the expertise to make the decision.
He called for emergency medicine to be funded centrally. "These are basic core services that have to be provided," he said. "We shouldn't be sending each other little bills. Trauma and other emergency services like cardiac and stroke services should be top sliced. The money should come from central government funds." Mr Bircher added that doctors and nurses on the frontline in hospitals should not be criticised. He said they do their best but are hampered by layers of managers whose major concern is the budget rather than patient care.
Delays in treatment
He said: "The delays are caused at various levels. If doctors, nurses, physiotherapists, the treating teams, were left to communicate between themselves without bureaucracy, things would happen much more quickly. In the good old days somebody would ring me up about a patient, I'd say send them across, make one call to sister on the ward and it would happen. "Now I'm loath to accept a patient unless I'm sure their injury requires surgery. If I'm unsure I ask them to send X-rays. Even in this technological age this can take two or three days. It's not unusual for them to be delayed or get lost.
"It may be decided that the patient needs an operation and we decide to bring them in. There can still be a delay because bed managers are reluctant to accept a patient for three or four days before the operation is due because of the extra costs. So the patients often come in just hours before the operation. It is not unusual for a patient to arrive in the early hours of the morning, a very short time before their surgery.
"You suddenly find the patient may develop a problem and you can't operate. So you've accepted a patient for a slot and then you can't operate. A much better system would be to have a free flow of patients to the trauma centre where we can get to know them preoperatively. But because trusts all have separate budgets, though we're all playing for the same team, there seems to be a reluctance to accept patients at an appropriate time before the operation. "You can argue whether a patient needs a hip replacement at hospital x or y," he added. "As long as it's done in a reasonable time by a good team it doesn't matter. You can't have these petty squabbles. There just isn't time with trauma."
Patients in pain
His argument is illustrated by Lucy Lynn-Evans, a 21-year-old student from London who was severely injured in a road accident last month. She was riding her scooter to Brighton when she was run over by a 10-tonne lorry which came to rest on her hip. She is alive only because a laptop in her backpack took the full force when the lorry ran over her spine. Her life was saved a second time by the staff at Redhill hospital, where she was initially taken with a smashed pelvis, smashed knee and leg broken in two places. They gave her a blood transfusion - she had lost five pints - and wrapped her hip, described by doctors as a "bag of crisps", in a sheet which was then pulled tight to keep the fragmented bones together.
This is the correct procedure. But Redhill hospital did not have the expertise to repair Ms Lynn-Evans's bones. That would require specialist surgeons and equipment that can be found only in certain hospitals around the country. All they could do in Redhill was put her on morphine and wait for a bed - which at one point she was told could take up to three weeks.
Her pain was so intense, however, that the morphine "only took the edge off it". "I was in a lot of pain, especially when they log-rolled me to change the sheet," Ms Lynn-Evans said from her hospital bed at St George's on Thursday. "It took four people to turn me. The nights were horrible. The mornings were really painful. The three weeks of waiting is an extra three weeks of pain. You just feel like you're going mad. You feel black and despairing. You want with all your heart for someone to make it better. I asked Dad to leave me outside the hospital because then it would be more likely I'd get a bed, rather than waiting by the phone. I felt despair, lying there feeling empty and feeling that I had to tackle this day by day for weeks."
Lack of beds
Ms Lynn-Evans's problem was that she was stable and not going to die; when a bed became available it would go to another more pressing case. At one point a bed became available at the John Radcliffe hospital in Oxford, but before she could be moved John Radcliffe's fund manager had to agree. The fund manager did not arrive at work until 9.30am. By the time Ms Lynn-Evans's case came to the top of the administrator's pile and permission was granted, the bed had gone. Fortunately for Ms Lynn-Evans her mother, Julie, is a psychotherapist who works in child mental health. She is also a broadcaster with a string of top NHS officials in her contacts book. She was able to make a fuss where it counts, and her daughter was moved to St George's hospital in London after only five days.
"Because of the problems with the beds I didn't know where to go to after the accident," Julie Lynn-Evans said. "Lucy was taken to Redhill on the Friday and they saved her life. I cannot thank the doctors enough. But they knew they didn't have the expertise to fix her so I was told not to go to Redhill because they were going to move her. Then at 4am I was told to go to Redhill after all. I'd spent the whole time living through a mother's worst nightmare and yet unable to go to my child. The same night as Lucy, a woman came in from a car crash. She was 63 and had a clot in her lung. Lucy was considered stable, so the woman got her bed. All the time Lucy's having no treatment. As a mother you'd do anything to help your child when you see them in so much pain. But I know that in securing a bed for Lucy, someone else had to wait longer."
Fortunately Lucy is going to make a full recovery, which she and her family put down to the excellent care they have received from surgeons, nurses and doctors at both St George's and Redhill hospitals. The delays, however, caused by bureaucracy and a shortage of beds, could have led to a very different outcome. "The delays not only cause distress to families and patient, but other serious medical issues - thrombosis, bed sores, chest infections and urine and wound infections," said Mr Bircher. "The longer the bone fragments are left displaced, the more the clot begins to form new bone, thus the harder it is to replace the fragment to the correct position.
Patients suffer
"The first step to dealing with the problem is an acceptance and realisation that the system isn't working with trauma and other emergency services in medicine. Sending each other forms and bills is not a good way of doing it. I'm acutely aware that resources are an issue. But basic emergency services should be of the highest quality. If we consider ourselves a leading nation we should have a first-class emergency healthcare system. We do not, and the situation is worsening. "It's pot luck where you go. There's not a defined system. We have to fight every day to get patients in. We have to break through the bureaucracy and develop a new system. There is a lack of intensive care beds in London and around the country which further magnifies the problem.
"Direct funding from the centre, perhaps cutting out the trusts, is perhaps a good idea. One must involve clinicians at the sharp end in the decision-making. Like the Bank of England the politicians should let it go. Doctors, honestly, know best."
Dermot O'Riordan, a member of the council of the Royal College of Surgeons, agreed that a number of services - not just trauma - needed commissioning at a higher level and in some cases co-ordinating nationally, although not necessarily centrally funding. Mr O'Riordan, the RCS council member responsible for the Delivery of Surgical Services Committee, said: "Commissioning of very specialist services, whether elective or emergency, needs to be done at a higher level than a primary care trust. Some need to be co-ordinated by the strategic health authority and some even at national level."
A spokesman for the Department of Health said: "We recognise that a very small number of patients may wait to receive appropriate care. This is because they need very specialised treatment, and critically ill patients waiting for treatment is the exception rather than the rule. "Capacity in intensive care units has improved dramatically in recent years. We now have almost 1,000 more ICU beds than in 2000 and we are looking at ways to increase capacity further."
Source
More overseas doctor concerns in Australia
The inquest into the death of a 16-year-old girl who died in a Sydney hospital after being hit by a golf ball may have to be reopened following allegations about the competence and assessment of two overseas-trained doctors involved in her care. The allegations -- aired on ABC TV's Stateline program in NSW last night -- claimed neither of the overseas doctors treating Vanessa Anderson had been "subject to any appointments or selection process".
Anderson died in 2005 while being treated for a fractured skull caused by the golf ball. The inquest at Westmead Coroners Court, which held its final hearing two weeks ago, heard there were "a number of deficiencies" in her care, including one doctor's failure to give anti-convulsive drugs as ordered by a consultant. Another doctor, anaesthetics registrar Sanaa Ismail, increased the dosage of painkilling drugs to a level the consultant in charge told the inquest was "too high".
It has now emerged that the inquest may be reopened after a senior hospital anaesthetist, Stephen Barratt, wrote to Deputy State Coroner Carl Milovanich about the allegations. In a statement to Stateline, NSW Health director-general Debora Picone said the "accuracy and relevance of a number of the assertions" made by Dr Barratt were "disputed". "The tragic death of Vanessa deserves proper investigation by the state Coroner and I do not think it appropriate to pre-empt the coronial process," Professor Picone said.
In his letter, Dr Barratt said Dr Ismail -- whom he was supervising -- had previously been judged by him to be "not safe" to treat patients after two previous incidents just months earlier. Dr Barratt also revealed he was "unhappy" with how the inquest had unfolded and added "you need the truth". Azizi Bakar, the doctor who had failed to provide the anti-convulsive drugs ordered by a consultant, was the other doctor whom Dr Barratt suggested had not been properly screened prior to employment.
Dr Ismail faced questions during the inquest over her decision to double the dose of a painkilling opiate drug, oxycodone, to treat Anderson's headache, despite the fact that she only spoke to the patient for a pre-operative check. Dr Ismail said she did not realise Anderson was already receiving Panadeine Forte, a painkiller with a high level of codeine, another opiate drug.
Dr Barratt's letter alleged that Dr Ismail's salary was being paid by the Saudi Government, an arrangement that he said was "not unusual in the public hospital system -- that is, there are many others like her". "In fact, a few months before the Vanessa Anderson incident a bureaucrat from the Department of Health came pleading with us to take more of these 'trainees'," Dr Barratt wrote.
Professor Picone said "learning exchange" arrangements was a "feature of any modern health system". Out of a total 11,000 doctors in NSW public hospitals, about 100 at any one time would be paid for by an overseas government or other agency, she said.
Alison Reid, medical director of the NSW Medical Board, refused to discuss the case specifically but said that generally applications to register doctors first had to come from a prospective employer, supported by letters from the relevant medical college. Qualifications were independently verified and certificates of good standing sought from previous regulatory bodies.
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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Tuesday, July 31, 2007
Monday, July 30, 2007
More dead from heat in government-controlled healthcare, this time in Hungary
Post below lifted from Fausta
The universal healthcare system in Hungary (PDF file) is financed through income tax and social-insurance taxes.
Maria just sent this: Hungary heatwave kills hundreds
In 2003 15,000 elderly and frail people died during a heat wave in France. Many died in the emergency rooms waiting for someone to bring them water
Out of the frying pan, into the fire? Medical desperation in Queensland, Australia
MORE than two in three people want the Federal Government to take control of Queensland's failing health system, the Queensland: Your Say survey has revealed. Data from the poll shows 69 per cent of Queenslanders have lost faith in the State Government's ability to run their health service. Despite promises that problems will be resolved, patients continue to suffer substandard levels of care, including waiting lists of up to eight years for surgery, a lack of beds, and closure of 38 maternity units in rural Queensland because of a lack of staff.
Queenslanders have spoken out loud and strong with 10,700 people raising their voices in the 2007 Sunday Mail-National Nine News Your Say survey. Readers seized the chance to share their feelings in one of the biggest responses to a survey in any Australian newspaper.
Queensland Opposition health spokesman John-Paul Langbroek said he was not surprised the public was frustrated with the State Government. "Health is such an important portfolio, and yet Beattie and Labor are not running it properly," he said. "It's certainly not a lack of money that is causing the problems because the budget has gone from $3 billion 10 years ago to $7.15 billion now."
Hospital patient Campbell Ney, 64, from Mareeba, is among Queenslanders unhappy with the system. He was last week forced to transfer from Cairns Base Hospital to Mossman Hospital because of a lack of beds. Mr Ney, who has a severe lung infection, said: "I'm a pretty easygoing sort of a bloke but this health system is off the rails."
In the past two years Federal Health Minister Tony Abbott has investigated the possibility of taking control of Queensland's health system, but yesterday told The Sunday Mail he had no plans to do so at the moment. "I'm flattered that people think the Howard Government is much better placed to fix the health system than the Beattie Government," he said. "However, the Commonwealth Government has no plans to take over the public hospital system."
State Health Minister Stephen Robertson blamed the Federal Government for failings in the health system. "Queensland's public hospitals have been short-changed by the Howard Government to the tune of $2.6 billion over the life of the current five-year Australian Health Care Agreement," he said. In a sign of falling support for public health services, the Queensland: Your Say survey revealed 64 per cent of readers had taken up private cover.
Source
Australia: Now it's the NSW ambulance service in strife
Eerily similar to the Queensland ambulance situation
AN ambulance staffing crisis is forcing rookies with just nine weeks' training onto the streets to try to save lives without proper supervision. One in three NSW Ambulance Service officers is a trainee because experienced staff are quitting in record numbers, fed up with being overworked and underpaid, front-line sources say. Last year there were twice as many resignations as in 2002. Tensions among those left behind are said to have reached breaking point, the sources say, with suicide attempts increasing. One senior officer said patient care was being compromised by the exodus of experienced officers. "Make no mistake, patients have died because of this and they will continue to die," she said.
A copy of the service's 2007 corporate culture survey leaked to The Sun-Herald paints a grim portrait of chronically poor morale and employees who feel undervalued, restricted in how they go about their work and disengaged from decision-making processes. The vast majority believe their supervisors do not deal effectively with key issues such as stress, excessive workloads, absenteeism, harassment and bullying, and are not addressing their concerns about industrial relations.
NSW Health Minister Reba Meagher last week countered criticisms of the service's capabilities by pointing to the recruitment of 327 personnel over the past four years. However, Freedom of Information figures obtained by the Opposition and seen by The Sun-Herald show 475 resignations over the same period. Novice ambulance attendants who might normally spend more than a year teamed up with two fully qualified partners are being thrown in the deep end, sources say.
A NSW Ambulance Service spokesman insisted trainees were placed under "close supervision at all times" but Health Services Union Hunter Valley officer Peter Rumball disputed this, saying the practice of pairing trainees with a single unqualified trainer to save money was commonplace. Mr Rumball said the union had repeatedly raised concerns about how one senior officer was supposed to supervise a trainee when he or she had more than one patient to treat at a time, or if the pair had to split up, or one had to stay with a patient while the other drove to hospital or went off to retrieve equipment. "Officers who come straight out of the service's rescue school get no supervision or mentoring at all," Mr Rumball said. "They are classed as fully qualified even though they have never undertaken a rescue."
A paramedic with 10 years' experience said rookies were being pushed onto the front line without proper regard for the consequences. "You have a situation where they are performing extremely demanding tasks without the proper supervision and that is where errors can be made," she said. "The way the roster system is set up is that at training stations there should be 10 fully qualified officers. "But how it is now is that out of those 10, two or three are trainee officers and are actually not qualified but they are rostered on to fill out those positions. "The trainees are being used to fill the holes and are just thrown straight in."
Opposition health spokeswoman Jillian Skinner said the number of calls she was receiving from ambulance officers in distress outstripped even those from within the ranks of the state's 40,000 nurses. "This issue is all about long-suffering ambulance officers who are under enormous stress, not getting any support and burning out," Ms Skinner said. "The fact that they're resigning at a faster rate than ever before speaks for itself. "What we're talking about is people at the coalface being forced to bear the brunt when, instead, it should be the Government dealing with it." Mr Rumball said his concerns about stress levels of the job were grave, and he knew of five colleagues who had attempted suicide in the past few years
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Post below lifted from Fausta
The universal healthcare system in Hungary (PDF file) is financed through income tax and social-insurance taxes.
Maria just sent this: Hungary heatwave kills hundreds Up to 500 people have died in the past week from a heatwave in Hungary, a top health official has said.Here in the USA, the elderly and frail move to Arizona and Florida, where they swim in cooled swimming pools and a 30C day (86oF) in the Summer is an invitation to have dinner on the veranda.
...
The daily mean temperature in the past week had reached 30C, she said.
In the southern city of Kiskunhalas, the temperature reached a record high of 41.9C.
In 2003 15,000 elderly and frail people died during a heat wave in France. Many died in the emergency rooms waiting for someone to bring them water
Out of the frying pan, into the fire? Medical desperation in Queensland, Australia
MORE than two in three people want the Federal Government to take control of Queensland's failing health system, the Queensland: Your Say survey has revealed. Data from the poll shows 69 per cent of Queenslanders have lost faith in the State Government's ability to run their health service. Despite promises that problems will be resolved, patients continue to suffer substandard levels of care, including waiting lists of up to eight years for surgery, a lack of beds, and closure of 38 maternity units in rural Queensland because of a lack of staff.
Queenslanders have spoken out loud and strong with 10,700 people raising their voices in the 2007 Sunday Mail-National Nine News Your Say survey. Readers seized the chance to share their feelings in one of the biggest responses to a survey in any Australian newspaper.
Queensland Opposition health spokesman John-Paul Langbroek said he was not surprised the public was frustrated with the State Government. "Health is such an important portfolio, and yet Beattie and Labor are not running it properly," he said. "It's certainly not a lack of money that is causing the problems because the budget has gone from $3 billion 10 years ago to $7.15 billion now."
Hospital patient Campbell Ney, 64, from Mareeba, is among Queenslanders unhappy with the system. He was last week forced to transfer from Cairns Base Hospital to Mossman Hospital because of a lack of beds. Mr Ney, who has a severe lung infection, said: "I'm a pretty easygoing sort of a bloke but this health system is off the rails."
In the past two years Federal Health Minister Tony Abbott has investigated the possibility of taking control of Queensland's health system, but yesterday told The Sunday Mail he had no plans to do so at the moment. "I'm flattered that people think the Howard Government is much better placed to fix the health system than the Beattie Government," he said. "However, the Commonwealth Government has no plans to take over the public hospital system."
State Health Minister Stephen Robertson blamed the Federal Government for failings in the health system. "Queensland's public hospitals have been short-changed by the Howard Government to the tune of $2.6 billion over the life of the current five-year Australian Health Care Agreement," he said. In a sign of falling support for public health services, the Queensland: Your Say survey revealed 64 per cent of readers had taken up private cover.
Source
Australia: Now it's the NSW ambulance service in strife
Eerily similar to the Queensland ambulance situation
AN ambulance staffing crisis is forcing rookies with just nine weeks' training onto the streets to try to save lives without proper supervision. One in three NSW Ambulance Service officers is a trainee because experienced staff are quitting in record numbers, fed up with being overworked and underpaid, front-line sources say. Last year there were twice as many resignations as in 2002. Tensions among those left behind are said to have reached breaking point, the sources say, with suicide attempts increasing. One senior officer said patient care was being compromised by the exodus of experienced officers. "Make no mistake, patients have died because of this and they will continue to die," she said.
A copy of the service's 2007 corporate culture survey leaked to The Sun-Herald paints a grim portrait of chronically poor morale and employees who feel undervalued, restricted in how they go about their work and disengaged from decision-making processes. The vast majority believe their supervisors do not deal effectively with key issues such as stress, excessive workloads, absenteeism, harassment and bullying, and are not addressing their concerns about industrial relations.
NSW Health Minister Reba Meagher last week countered criticisms of the service's capabilities by pointing to the recruitment of 327 personnel over the past four years. However, Freedom of Information figures obtained by the Opposition and seen by The Sun-Herald show 475 resignations over the same period. Novice ambulance attendants who might normally spend more than a year teamed up with two fully qualified partners are being thrown in the deep end, sources say.
A NSW Ambulance Service spokesman insisted trainees were placed under "close supervision at all times" but Health Services Union Hunter Valley officer Peter Rumball disputed this, saying the practice of pairing trainees with a single unqualified trainer to save money was commonplace. Mr Rumball said the union had repeatedly raised concerns about how one senior officer was supposed to supervise a trainee when he or she had more than one patient to treat at a time, or if the pair had to split up, or one had to stay with a patient while the other drove to hospital or went off to retrieve equipment. "Officers who come straight out of the service's rescue school get no supervision or mentoring at all," Mr Rumball said. "They are classed as fully qualified even though they have never undertaken a rescue."
A paramedic with 10 years' experience said rookies were being pushed onto the front line without proper regard for the consequences. "You have a situation where they are performing extremely demanding tasks without the proper supervision and that is where errors can be made," she said. "The way the roster system is set up is that at training stations there should be 10 fully qualified officers. "But how it is now is that out of those 10, two or three are trainee officers and are actually not qualified but they are rostered on to fill out those positions. "The trainees are being used to fill the holes and are just thrown straight in."
Opposition health spokeswoman Jillian Skinner said the number of calls she was receiving from ambulance officers in distress outstripped even those from within the ranks of the state's 40,000 nurses. "This issue is all about long-suffering ambulance officers who are under enormous stress, not getting any support and burning out," Ms Skinner said. "The fact that they're resigning at a faster rate than ever before speaks for itself. "What we're talking about is people at the coalface being forced to bear the brunt when, instead, it should be the Government dealing with it." Mr Rumball said his concerns about stress levels of the job were grave, and he knew of five colleagues who had attempted suicide in the past few years
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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Sunday, July 29, 2007
Hundreds of NHS hospital fatalities 'avoidable'
One third of deaths in hospital investigated by a patient safety watchdog could have been avoided, claims a report released today. The National Patient Safety Agency looked into 1,804 fatal hospital incidents reported to it in 2005. It found that 576 were "potentially avoidable" if there had been better communication between staff, faster recognition of the patient's deteriorating state, improved training and more accurate interpretation of test results.
Some 425 of the deaths investigated by the NPSA in 2005 were in acute or general hospitals. Of these, 71 were reported to be related to diagnostic errors, in 64 cases the patient's deteriorating condition was not recognised or not acted upon, and 43 involved a problem with resuscitation after cardiac arrest. The remainder were connected to medication errors, suicide or still-birth.
In 14 of the patients who deteriorated, no checks had been made on them for a prolonged time and changes in their vital signs such as blood pressure, heart rate or temperature were not detected. In a further 30 cases, the checks had been made but staff either did not recognise the patient's worsening condition or they did not act. In 17 other cases help was sought but there was a delay.
Professor Richard Thomson, the NPSA's director of epidemiology and research, said: "These are not new concerns but more effort is needed to recognise and act upon them. "This work helps us to further raise the profile of these issues and support a programme of activities involving a range of national organisations and individual experts. Every preventable death is a tragedy, not only for the family but for the staff involved."
The report says all staff should be trained in dealing with cardiac arrest. Among the 43 deaths involving resuscitation, the study found that many of the incidents suggested that "medical and nursing staff did not have the depth of knowledge and skills required".
It said: "In most cases the delay in starting the resuscitation was reported to be because staff did not recognise the acute situation, failed to call the resuscitation team or did not make an attempt themselves to resuscitate the patient."
Fourteen reported incidents related to the use of equipment. One such report said: "During a cardiac arrest, defibrillator found not to have the correct leads and paddle to fit the defibrillator. This caused a delay of approx five minutes during the arrest."
During 2006, the Medicines and Healthcare products Regulatory Agency (MHRA) received 141 reports of adverse incidents involving defibrillators. Many were related to problems with electrodes or batteries. In the first six months of 2007, the MHRA received 86 reports and receives an average of 14 incident reports a month on these devices, some of which are duplicate reports from manufacturers. The NPSA report said: "Several of these incidents occurred in resuscitation situations, when user error may have contributed to the incident, for example, incorrect connection of suctioning tubes."
The report stresses that there may be many similar cases which have not been reported to the NPSA. Researchers said that about 13 million people are admitted to hospitals in England and Wales each year.
The findings come as the National Institute for health and Clinical Excellence releases guidance to clinicians on how to manage patients in hospital who deteriorate rapidly. It emphasises making a complete medical assessment of the patient, regular monitoring and improving communication between staff.
Source
Australia: Fresh questions over another Muslim doctor
New South Wales Health Minister Reba Meagher says she will not speculate on the state coroner's actions following new revelations about the death of a Sydney teenager. Vanessa Anderson, 16, died in Royal North Shore Hospital two days after being hit in the head with a golf ball in 2005. ABC's Stateline program has obtained a letter detailing concerns about the Saudi Arabian anaesthetist involved in the case. The letter details two critical incidents involving the same doctor.
A coronial inquest has already heard that the same doctor gave Ms Anderson an incorrect dose of painkillers. Opposition health spokeswoman Jillian Skinner says the new details raise concerns. "The question has to be asked, why wasn't the coroner told about this earlier?" she said. But Ms Meagher said: "I think we should allow the coroner to be able to make a statement without speculating." The coroner was due to deliver his findings on Monday, but will instead discuss the new evidence with all relevant parties during a hearing.
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
One third of deaths in hospital investigated by a patient safety watchdog could have been avoided, claims a report released today. The National Patient Safety Agency looked into 1,804 fatal hospital incidents reported to it in 2005. It found that 576 were "potentially avoidable" if there had been better communication between staff, faster recognition of the patient's deteriorating state, improved training and more accurate interpretation of test results.
Some 425 of the deaths investigated by the NPSA in 2005 were in acute or general hospitals. Of these, 71 were reported to be related to diagnostic errors, in 64 cases the patient's deteriorating condition was not recognised or not acted upon, and 43 involved a problem with resuscitation after cardiac arrest. The remainder were connected to medication errors, suicide or still-birth.
In 14 of the patients who deteriorated, no checks had been made on them for a prolonged time and changes in their vital signs such as blood pressure, heart rate or temperature were not detected. In a further 30 cases, the checks had been made but staff either did not recognise the patient's worsening condition or they did not act. In 17 other cases help was sought but there was a delay.
Professor Richard Thomson, the NPSA's director of epidemiology and research, said: "These are not new concerns but more effort is needed to recognise and act upon them. "This work helps us to further raise the profile of these issues and support a programme of activities involving a range of national organisations and individual experts. Every preventable death is a tragedy, not only for the family but for the staff involved."
The report says all staff should be trained in dealing with cardiac arrest. Among the 43 deaths involving resuscitation, the study found that many of the incidents suggested that "medical and nursing staff did not have the depth of knowledge and skills required".
It said: "In most cases the delay in starting the resuscitation was reported to be because staff did not recognise the acute situation, failed to call the resuscitation team or did not make an attempt themselves to resuscitate the patient."
Fourteen reported incidents related to the use of equipment. One such report said: "During a cardiac arrest, defibrillator found not to have the correct leads and paddle to fit the defibrillator. This caused a delay of approx five minutes during the arrest."
During 2006, the Medicines and Healthcare products Regulatory Agency (MHRA) received 141 reports of adverse incidents involving defibrillators. Many were related to problems with electrodes or batteries. In the first six months of 2007, the MHRA received 86 reports and receives an average of 14 incident reports a month on these devices, some of which are duplicate reports from manufacturers. The NPSA report said: "Several of these incidents occurred in resuscitation situations, when user error may have contributed to the incident, for example, incorrect connection of suctioning tubes."
The report stresses that there may be many similar cases which have not been reported to the NPSA. Researchers said that about 13 million people are admitted to hospitals in England and Wales each year.
The findings come as the National Institute for health and Clinical Excellence releases guidance to clinicians on how to manage patients in hospital who deteriorate rapidly. It emphasises making a complete medical assessment of the patient, regular monitoring and improving communication between staff.
Source
Australia: Fresh questions over another Muslim doctor
New South Wales Health Minister Reba Meagher says she will not speculate on the state coroner's actions following new revelations about the death of a Sydney teenager. Vanessa Anderson, 16, died in Royal North Shore Hospital two days after being hit in the head with a golf ball in 2005. ABC's Stateline program has obtained a letter detailing concerns about the Saudi Arabian anaesthetist involved in the case. The letter details two critical incidents involving the same doctor.
A coronial inquest has already heard that the same doctor gave Ms Anderson an incorrect dose of painkillers. Opposition health spokeswoman Jillian Skinner says the new details raise concerns. "The question has to be asked, why wasn't the coroner told about this earlier?" she said. But Ms Meagher said: "I think we should allow the coroner to be able to make a statement without speculating." The coroner was due to deliver his findings on Monday, but will instead discuss the new evidence with all relevant parties during a hearing.
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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Saturday, July 28, 2007
BRITS PUT THE WRONG GUY ON TRIAL
They should be prosecuting the filthy hospital that gave the kid MRSA. It was the MRSA that turned a minor problem into a major one
A headmaster accused of breaching safety standards after the death of a three-year-old boy who fell from a flight of steps while pretending to be Batman insisted yesterday that the child had been told the area was out of bounds.
James Porter, 66, was giving evidence before a jury at Mold Crown Court. He is accused of breaking health and safety laws by allowing infants unsupervised access to the steps in a remote part of the playground. Kian Williams, a pupil at the private Hillgrove School, in Bangor, is said to have been playing as Batman when he leapt from the fourth step and fell headlong. The child did not need treatment for a break in the skin or a fracture but later suffered secondary swelling of the brain and died from pneumonia brought on by a MRSA-type infection, on August 11, 2004. Mr Porter denies charges that he took inadequate measures to protect young pupils from the 13 steps leading from one playground to another. He faces an unlimited fine if found guilty. The trial continues.
Source
Remember those Cuban doctors Fidel sent to Venezuela?
Growing numbers of Cuban doctors sent overseas to work are defecting to the USA. Post below lifted from Fausta. See the original for links
A large number of the defectors have fled from Venezuela, which has received some 14 000 Cuban medical professionals, more than the rest of the world combined. Currently, dozens have sought refuge in neighbouring Colombia, often living in precarious conditions, while they await permission to enter the USA.
Andres paid a price to get to Colombia. He and his wife had been assigned to the city of Punto Fijo on the northwestern coast of Venezuela, not far from the border. Their escape went smoothly until they reached the frontier, where Venezuelan guards refused to permit them to cross because the visas on their passports were valid only for travel within Venezuela. Only after Andres bribed the agents with nearly all their possessions did the guards let them leave Venezuela. "We gave them all the money we had, cellular phones, watches, and they let us cross", he said. "e were in Colombia and we had reached freedom. We felt free".
Andres and his wife were fortunate because not all defecting Cubans get across the border but are, instead, arrested and shipped back home. Once across the border, however, Andres and his wife found themselves stranded in north east Colombia's harsh Guajira desert without contacts or money to continue travel. Eventually, however, they were given a lift by truckers, who carried them to the capital, Bogota.
In Bogota, Andres has lived with two other defectors in an unused storage room provided by a church group. They have also received assistance from the UN High Commission for Refugees. But, as they wait for their US visas, many of the Cubans are fearful because of their uncertain legal status in Colombia, whose government has given few of them refugee status.
Several Cuban defectors interviewed in Bogota said that they fled not only because of oppression in their own nation, but also because of unreasonably poor and demanding work conditions in Venezuela. Andres said that he could not stand the conditions in Venezuela, where he lived in a crowded house with a leaky straw roof which he shared with fifteen other Cuban doctors waiting to be put to work.
The doctors also said that in Venezuela, Cuban minders monitored their movements, prohibiting non-work contact with Venezuelans. When not at work, the Cubans were required to be at home after 6 pm. One couple said that after they pointed out some problems with the programme, officials threatened to send them back to Cuba in retaliation.
The Cubans said that the programme they worked in, called "Inside the Barrio", was also plagued with mismanagement and inefficiency. Although many clinics were severely understaffed, newly-arrived medics sometimes sat for months waiting for assignment to a post, they said, and often conditions in the clinics were rudimentary lacking even basic medicines.
You should also bear in mind that Cuba's suffering shortages of healthcare workers because one-fifth of Cuba's health care labor supply - some 14,000 doctors and 6,000 health workers - has been contracted out to work in Venezuela. In return for these medical services, Cuba receives 90,000 barrels of discounted oil per day.
Chew on that the next time you read/hear about the charismatic-leader-helping-the-poor-offering-free-health-care-education-adult-literacy -and-job-training-initiatives-that-help-millions-of-Venezuelans/Cubans/Bolivians, and every time you hear about the excellent Cuban healthcare and other myths. Too bad the folks who have been playing SICKO at the downtown movie theater for the past 5 weeks, and the folks who watch the movie don't care much about reality.
***************************
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
They should be prosecuting the filthy hospital that gave the kid MRSA. It was the MRSA that turned a minor problem into a major one
A headmaster accused of breaching safety standards after the death of a three-year-old boy who fell from a flight of steps while pretending to be Batman insisted yesterday that the child had been told the area was out of bounds.
James Porter, 66, was giving evidence before a jury at Mold Crown Court. He is accused of breaking health and safety laws by allowing infants unsupervised access to the steps in a remote part of the playground. Kian Williams, a pupil at the private Hillgrove School, in Bangor, is said to have been playing as Batman when he leapt from the fourth step and fell headlong. The child did not need treatment for a break in the skin or a fracture but later suffered secondary swelling of the brain and died from pneumonia brought on by a MRSA-type infection, on August 11, 2004. Mr Porter denies charges that he took inadequate measures to protect young pupils from the 13 steps leading from one playground to another. He faces an unlimited fine if found guilty. The trial continues.
Source
Remember those Cuban doctors Fidel sent to Venezuela?
Growing numbers of Cuban doctors sent overseas to work are defecting to the USA. Post below lifted from Fausta. See the original for links
A large number of the defectors have fled from Venezuela, which has received some 14 000 Cuban medical professionals, more than the rest of the world combined. Currently, dozens have sought refuge in neighbouring Colombia, often living in precarious conditions, while they await permission to enter the USA.
Andres paid a price to get to Colombia. He and his wife had been assigned to the city of Punto Fijo on the northwestern coast of Venezuela, not far from the border. Their escape went smoothly until they reached the frontier, where Venezuelan guards refused to permit them to cross because the visas on their passports were valid only for travel within Venezuela. Only after Andres bribed the agents with nearly all their possessions did the guards let them leave Venezuela. "We gave them all the money we had, cellular phones, watches, and they let us cross", he said. "e were in Colombia and we had reached freedom. We felt free".
Andres and his wife were fortunate because not all defecting Cubans get across the border but are, instead, arrested and shipped back home. Once across the border, however, Andres and his wife found themselves stranded in north east Colombia's harsh Guajira desert without contacts or money to continue travel. Eventually, however, they were given a lift by truckers, who carried them to the capital, Bogota.
In Bogota, Andres has lived with two other defectors in an unused storage room provided by a church group. They have also received assistance from the UN High Commission for Refugees. But, as they wait for their US visas, many of the Cubans are fearful because of their uncertain legal status in Colombia, whose government has given few of them refugee status.
Several Cuban defectors interviewed in Bogota said that they fled not only because of oppression in their own nation, but also because of unreasonably poor and demanding work conditions in Venezuela. Andres said that he could not stand the conditions in Venezuela, where he lived in a crowded house with a leaky straw roof which he shared with fifteen other Cuban doctors waiting to be put to work.
The doctors also said that in Venezuela, Cuban minders monitored their movements, prohibiting non-work contact with Venezuelans. When not at work, the Cubans were required to be at home after 6 pm. One couple said that after they pointed out some problems with the programme, officials threatened to send them back to Cuba in retaliation.
The Cubans said that the programme they worked in, called "Inside the Barrio", was also plagued with mismanagement and inefficiency. Although many clinics were severely understaffed, newly-arrived medics sometimes sat for months waiting for assignment to a post, they said, and often conditions in the clinics were rudimentary lacking even basic medicines.
You should also bear in mind that Cuba's suffering shortages of healthcare workers because one-fifth of Cuba's health care labor supply - some 14,000 doctors and 6,000 health workers - has been contracted out to work in Venezuela. In return for these medical services, Cuba receives 90,000 barrels of discounted oil per day.
Chew on that the next time you read/hear about the charismatic-leader-helping-the-poor-offering-free-health-care-education-adult-literacy -and-job-training-initiatives-that-help-millions-of-Venezuelans/Cubans/Bolivians, and every time you hear about the excellent Cuban healthcare and other myths. Too bad the folks who have been playing SICKO at the downtown movie theater for the past 5 weeks, and the folks who watch the movie don't care much about reality.
***************************
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Thursday, July 26, 2007
Wisconsin reveals the cost of "universal" health care
When Louis Brandeis praised the 50 states as "laboratories of democracy," he didn't claim that every policy experiment would work. So we hope the eyes of America will turn to Wisconsin, and the effort by Madison Democrats to make that "progressive" state a Petri dish for government-run health care.
This exercise is especially instructive, because it reveals where the "single-payer," universal coverage folks end up. Democrats who run the Wisconsin Senate have dropped the Washington pretense of incremental health-care reform and moved directly to passing a plan to insure every resident under the age of 65 in the state. And, wow, is "free" health care expensive. The plan would cost an estimated $15.2 billion, or $3 billion more than the state currently collects in all income, sales and corporate income taxes. It represents an average of $510 a month in higher taxes for every Wisconsin worker.
Employees and businesses would pay for the plan by sharing the cost of a new 14.5% employment tax on wages. Wisconsin businesses would have to compete with out-of-state businesses and foreign rivals while shouldering a 29.8% combined federal-state payroll tax, nearly double the 15.3% payroll tax paid by non-Wisconsin firms for Social Security and Medicare combined.
This employment tax is on top of the $1 billion grab bag of other levies that Democratic Governor Jim Doyle proposed and the tax-happy Senate has also approved, including a $1.25 a pack increase in the cigarette tax, a 10% hike in the corporate tax, and new fees on cars, trucks, hospitals, real estate transactions, oil companies and dry cleaners. In all, the tax burden in the Badger State could rise to 20% of family income, which is slightly more than the average federal tax burden. "At least federal taxes pay for an Army and Navy," quips R.J. Pirlot of the Wisconsin Manufacturers and Commerce business lobby.
As if that's not enough, the health plan includes a tax escalator clause allowing an additional 1.5 percentage point payroll tax to finance higher outlays in the future. This could bring the payroll tax to 16%. One reason to expect costs to soar is that the state may become a mecca for the unemployed, uninsured and sick from all over North America. The legislation doesn't require that you have a job in Wisconsin to qualify, merely that you live in the state for at least 12 months. Cheesehead nation could expect to attract health-care free-riders while losing productive workers who leave for less-taxing climes.
Proponents use the familiar argument for national health care that this will save money (about $1.8 billion a year) through efficiency gains by eliminating the administrative costs of private insurance. And unions and some big businesses with rich union health plans are only too happy to dump these liabilities onto the government.
But those costs won't vanish; they'll merely shift to all taxpayers and businesses. Small employers that can't afford to provide insurance would see their employment costs rise by thousands of dollars per worker, while those that now provide a basic health insurance plan would have to pay $400 to $500 a year more per employee.
The plan is also openly hostile to market incentives that contain costs. Private companies are making modest progress in sweating out health-care inflation by making patients more cost-conscious through increased copayments, health savings accounts, and incentives for wellness. The Wisconsin program moves in the opposite direction: It reduces out-of-pocket copayments, bars money-saving HSA plans, and increases the number of mandated medical services covered under the plan.
So where will savings come from? Where they always do in any government plan: Rationing via price controls and, as costs rise, waiting periods and coverage restrictions. This is Michael Moore's medical dream state.
The last line of defense against this plan are the Republicans who run the Wisconsin House. So far they've been unified and they recently voted the Senate plan down. Democrats are now planning to take their ideas to the voters in legislative races next year, and that's a debate Wisconsinites should look forward to. At least Wisconsin Democrats are admitting how much it will cost Americans to pay for government-run health care. Would that Washington Democrats were as forthright.
Source
Another wonderful triumph for goodwill -- but no thanks to NHS bungling: "A couple were advised to abort their unborn child amid fears he would be severely disabled - but he was born healthy. Heather O'Connor, 19, and Jamie Bramley, 24, from Stockport, were told by St Mary's Hospital, Manchester, that scans indicated part of baby Jake's brain could be missing. But after seeking a second opinion the couple continued with the pregnancy. The Central Manchester and Manchester Children's University Hospitals NHS Trust said it would "not actively recommend or dissuade" patients from choosing a termination."
***************************
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
When Louis Brandeis praised the 50 states as "laboratories of democracy," he didn't claim that every policy experiment would work. So we hope the eyes of America will turn to Wisconsin, and the effort by Madison Democrats to make that "progressive" state a Petri dish for government-run health care.
This exercise is especially instructive, because it reveals where the "single-payer," universal coverage folks end up. Democrats who run the Wisconsin Senate have dropped the Washington pretense of incremental health-care reform and moved directly to passing a plan to insure every resident under the age of 65 in the state. And, wow, is "free" health care expensive. The plan would cost an estimated $15.2 billion, or $3 billion more than the state currently collects in all income, sales and corporate income taxes. It represents an average of $510 a month in higher taxes for every Wisconsin worker.
Employees and businesses would pay for the plan by sharing the cost of a new 14.5% employment tax on wages. Wisconsin businesses would have to compete with out-of-state businesses and foreign rivals while shouldering a 29.8% combined federal-state payroll tax, nearly double the 15.3% payroll tax paid by non-Wisconsin firms for Social Security and Medicare combined.
This employment tax is on top of the $1 billion grab bag of other levies that Democratic Governor Jim Doyle proposed and the tax-happy Senate has also approved, including a $1.25 a pack increase in the cigarette tax, a 10% hike in the corporate tax, and new fees on cars, trucks, hospitals, real estate transactions, oil companies and dry cleaners. In all, the tax burden in the Badger State could rise to 20% of family income, which is slightly more than the average federal tax burden. "At least federal taxes pay for an Army and Navy," quips R.J. Pirlot of the Wisconsin Manufacturers and Commerce business lobby.
As if that's not enough, the health plan includes a tax escalator clause allowing an additional 1.5 percentage point payroll tax to finance higher outlays in the future. This could bring the payroll tax to 16%. One reason to expect costs to soar is that the state may become a mecca for the unemployed, uninsured and sick from all over North America. The legislation doesn't require that you have a job in Wisconsin to qualify, merely that you live in the state for at least 12 months. Cheesehead nation could expect to attract health-care free-riders while losing productive workers who leave for less-taxing climes.
Proponents use the familiar argument for national health care that this will save money (about $1.8 billion a year) through efficiency gains by eliminating the administrative costs of private insurance. And unions and some big businesses with rich union health plans are only too happy to dump these liabilities onto the government.
But those costs won't vanish; they'll merely shift to all taxpayers and businesses. Small employers that can't afford to provide insurance would see their employment costs rise by thousands of dollars per worker, while those that now provide a basic health insurance plan would have to pay $400 to $500 a year more per employee.
The plan is also openly hostile to market incentives that contain costs. Private companies are making modest progress in sweating out health-care inflation by making patients more cost-conscious through increased copayments, health savings accounts, and incentives for wellness. The Wisconsin program moves in the opposite direction: It reduces out-of-pocket copayments, bars money-saving HSA plans, and increases the number of mandated medical services covered under the plan.
So where will savings come from? Where they always do in any government plan: Rationing via price controls and, as costs rise, waiting periods and coverage restrictions. This is Michael Moore's medical dream state.
The last line of defense against this plan are the Republicans who run the Wisconsin House. So far they've been unified and they recently voted the Senate plan down. Democrats are now planning to take their ideas to the voters in legislative races next year, and that's a debate Wisconsinites should look forward to. At least Wisconsin Democrats are admitting how much it will cost Americans to pay for government-run health care. Would that Washington Democrats were as forthright.
Source
Another wonderful triumph for goodwill -- but no thanks to NHS bungling: "A couple were advised to abort their unborn child amid fears he would be severely disabled - but he was born healthy. Heather O'Connor, 19, and Jamie Bramley, 24, from Stockport, were told by St Mary's Hospital, Manchester, that scans indicated part of baby Jake's brain could be missing. But after seeking a second opinion the couple continued with the pregnancy. The Central Manchester and Manchester Children's University Hospitals NHS Trust said it would "not actively recommend or dissuade" patients from choosing a termination."
***************************
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Wednesday, July 25, 2007
Government health insurance expenditure eaten up by bureaucracy
Many people are still wondering what happened to the billions of pounds spent on the NHS over the last five years. Apart from slightly improved waiting lists and massively increased doctors wages, there is still a lot to do to explain where the money has gone. However history gives us a sort of precedent for this.
It comes from Lyndon B Johnson’s Great Society and the introduction of Medicare/Medicaid in 1965. At the time, health care spending in the US was a mere 5% of GDP. Today it has exploded to a staggering 16.5% of GDP. An economics professor named Amy Finkelstein from MIT has shown what happened after the implementation of the new state health insurance. She concluded that it is not, as conventional wisdom has it, ageing populations and medical progress, but rather the expansion of the insurance industry itself that is the the real driver of healthcare costs. Her views stirred up the thinking about health care spending since first published last year.
Finkelstein discovered the proof by sifting through long-forgotten paper records in MIT's library. There, she found that hospital spending soared after the federal Medicare program began in 1966. Finkelstein had the papers scanned and shipped to a company in Cambodia, where it took 18 months to turn the records into usable data. The story they told was dramatic. In regions such as the South, where most seniors had no insurance, health spending soared after Medicare. But in New England, where many already had coverage, Medicare had much less impact on costs.
What we begin to understand from her findings is why spending huge sums of money does not necessarily improve health services; the cash simply gets swallowed up in this highly complex system. This supports the argument for devolution of health care purchasing power to the consumer, offering a fair chance that it will be spend more wisely than by any third party, be it governments, HMOs or even paternalistic private insurance.
Source
Socialized waste
Four of the top 10 companies in the $11.4 million business last year of providing power scooters, wheelchairs, prosthetic limbs and other medical equipment to D.C. Medicaid recipients have come under investigation. At least six other "durable medical equipment," or DME, dealers also are being investigated, including one suspected of selling a recipient a walker, then billing the government for a $13,500 deluxe power scooter.
The D.C. Department of Health confirmed the investigations in response to a Freedom of Information Act request by The Washington Times. Agency attorneys withheld several records, saying the documents are "investigatory records compiled for law enforcement," therefore exempt from public disclosure. Officials also would not release the names of the companies under investigation.
The situation raises questions about whether fraud and mismanagement, which have plagued the District's Medicaid transportation program in recent years, also have surfaced in the DME program. The Medical Assistance Administration (MAA), an arm of the health department, oversees the city's more than $1 billion in Medicaid spending, which is funded by federal and local governments to provide health care for the poor.
Nearly 90 DME companies, mostly in the District and Maryland, received a combined $11.4 million in fiscal 2006 to supply the city's poor. The figure is up from $10.1 million in 2005 and $9.8 million in 2004. And while officials say overall costs remain within budget, MAA spending could increase by 40 percent compared to 2004 figures. Already, MAA had paid out more than $12 million in fiscal 2007.
Source
***************************
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Many people are still wondering what happened to the billions of pounds spent on the NHS over the last five years. Apart from slightly improved waiting lists and massively increased doctors wages, there is still a lot to do to explain where the money has gone. However history gives us a sort of precedent for this.
It comes from Lyndon B Johnson’s Great Society and the introduction of Medicare/Medicaid in 1965. At the time, health care spending in the US was a mere 5% of GDP. Today it has exploded to a staggering 16.5% of GDP. An economics professor named Amy Finkelstein from MIT has shown what happened after the implementation of the new state health insurance. She concluded that it is not, as conventional wisdom has it, ageing populations and medical progress, but rather the expansion of the insurance industry itself that is the the real driver of healthcare costs. Her views stirred up the thinking about health care spending since first published last year.
Finkelstein discovered the proof by sifting through long-forgotten paper records in MIT's library. There, she found that hospital spending soared after the federal Medicare program began in 1966. Finkelstein had the papers scanned and shipped to a company in Cambodia, where it took 18 months to turn the records into usable data. The story they told was dramatic. In regions such as the South, where most seniors had no insurance, health spending soared after Medicare. But in New England, where many already had coverage, Medicare had much less impact on costs.
What we begin to understand from her findings is why spending huge sums of money does not necessarily improve health services; the cash simply gets swallowed up in this highly complex system. This supports the argument for devolution of health care purchasing power to the consumer, offering a fair chance that it will be spend more wisely than by any third party, be it governments, HMOs or even paternalistic private insurance.
Source
Socialized waste
Four of the top 10 companies in the $11.4 million business last year of providing power scooters, wheelchairs, prosthetic limbs and other medical equipment to D.C. Medicaid recipients have come under investigation. At least six other "durable medical equipment," or DME, dealers also are being investigated, including one suspected of selling a recipient a walker, then billing the government for a $13,500 deluxe power scooter.
The D.C. Department of Health confirmed the investigations in response to a Freedom of Information Act request by The Washington Times. Agency attorneys withheld several records, saying the documents are "investigatory records compiled for law enforcement," therefore exempt from public disclosure. Officials also would not release the names of the companies under investigation.
The situation raises questions about whether fraud and mismanagement, which have plagued the District's Medicaid transportation program in recent years, also have surfaced in the DME program. The Medical Assistance Administration (MAA), an arm of the health department, oversees the city's more than $1 billion in Medicaid spending, which is funded by federal and local governments to provide health care for the poor.
Nearly 90 DME companies, mostly in the District and Maryland, received a combined $11.4 million in fiscal 2006 to supply the city's poor. The figure is up from $10.1 million in 2005 and $9.8 million in 2004. And while officials say overall costs remain within budget, MAA spending could increase by 40 percent compared to 2004 figures. Already, MAA had paid out more than $12 million in fiscal 2007.
Source
***************************
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Tuesday, July 24, 2007
NHS negligence kills little boy
A hospital has apologised to the parents of a baby who died when doctors failed to spot a serious heart condition after mixing up his X-rays. Staff at the Royal Cornwall Hospital in Truro thought that one-year-old Jack Garland was teething and sent him home with painkillers. After a second X-ray two weeks later, they realised that he had mitochondrial respiratory complex, a rare genetic complaint. He was taken immediately to Great Ormond Street Hospital, but died 16 days later of heart failure and a brain haemorrhage.
Jack’s father, Ben Garland, 31, from Truro, said: “Those two weeks when he was first sent home were crucial. The hospital’s mistake cost my son his fighting chance. To hold him while they turned the machines off is something I will never forget. All we want is someone to be honest and say they will take responsibility.”
John Watkins, chief executive of the Royal Cornwall Hospitals Trust, said in a letter to Jack’s parents that a senior doctor had reviewed the first X-ray and could “clearly” see that the child had an enlarged heart. Mr Watkins wrote: “The doctor is at a loss to explain how this happened and can only deduce that the person who reported Jack’s X-ray reported on the wrong film. The conclusion is that it was a failure of the system that caused Jack’s X-ray to be overlooked and not attributable to one individual.” The trust said that a thorough review was under way. The hospital had a 31million pound deficit at the time and had cut 300 staff, although the trust said that no jobs had been cut that would have compromised clinical care.
Source
Hospital rankings coming in Australia
HOSPITALS face closer scrutiny of their performance in areas such as patient safety and infection rates under a scheme the federal Health Minister, Tony Abbott, will put to state governments. Mr Abbott told the Herald he was planning to propose hospital "league tables" on safety, and quality measures be included as part of the hospital funding agreement between the federal and state governments. The transparency measures would enable patients to compare the record of different hospitals in such areas as surgical infection rates, unplanned readmissions and waiting times for elective surgery.
Citing new research showing that Australia has fallen behind other countries in the release of individual hospital performance data, Mr Abbott said such information was readily available elsewhere. "Why should we not have it here?". The research says that, by some estimates, adverse events and infections in Australian hospitals generate $2.5 billion in expenditure every year, but improvements are impeded by the lack of comparative data on hospital performance. Besides letting patients know how hospitals rated on different indicators, it would also help hospitals to identify strengths and weaknesses and spur improvements, Mr Abbott said.
A frequent argument against publishing such information was that it was hard to compare hospital outcomes. But Mr Abbott said the public would be able to factor in differences such as some hospitals having a higher rate of problems because they took on more difficult cases. The Federal Government wanted to see such information included in the next Australian Health Care Agreements, which provide for federal funding of public hospitals and are scheduled for renegotiation with the states after the federal election.
A study undertaken for the Australian Centre for Health Research says "very little" analysis has been published in Australia to assess the hospital system and even less undertaken to determine whether hospitals are working in concert with other parts of the system, such as general practitioners. "This raises the risk of wasted funds, poor health outcomes and reduced access for patients," it says. The report recommends the Government take the lead in defining what standard care information should be collected.
The publication of hospital performance indicators had triggered the establishment of "infomediaries" - companies which analysed the performance figures and could help patients make decisions about their health and how to manage it, in addition to providing a guide to quality care. The research was headed by David Charles, who said that the health system had avoided the trend towards greater transparency that had been accepted in many other sectors of government and business in the past 20 years.
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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A hospital has apologised to the parents of a baby who died when doctors failed to spot a serious heart condition after mixing up his X-rays. Staff at the Royal Cornwall Hospital in Truro thought that one-year-old Jack Garland was teething and sent him home with painkillers. After a second X-ray two weeks later, they realised that he had mitochondrial respiratory complex, a rare genetic complaint. He was taken immediately to Great Ormond Street Hospital, but died 16 days later of heart failure and a brain haemorrhage.
Jack’s father, Ben Garland, 31, from Truro, said: “Those two weeks when he was first sent home were crucial. The hospital’s mistake cost my son his fighting chance. To hold him while they turned the machines off is something I will never forget. All we want is someone to be honest and say they will take responsibility.”
John Watkins, chief executive of the Royal Cornwall Hospitals Trust, said in a letter to Jack’s parents that a senior doctor had reviewed the first X-ray and could “clearly” see that the child had an enlarged heart. Mr Watkins wrote: “The doctor is at a loss to explain how this happened and can only deduce that the person who reported Jack’s X-ray reported on the wrong film. The conclusion is that it was a failure of the system that caused Jack’s X-ray to be overlooked and not attributable to one individual.” The trust said that a thorough review was under way. The hospital had a 31million pound deficit at the time and had cut 300 staff, although the trust said that no jobs had been cut that would have compromised clinical care.
Source
Hospital rankings coming in Australia
HOSPITALS face closer scrutiny of their performance in areas such as patient safety and infection rates under a scheme the federal Health Minister, Tony Abbott, will put to state governments. Mr Abbott told the Herald he was planning to propose hospital "league tables" on safety, and quality measures be included as part of the hospital funding agreement between the federal and state governments. The transparency measures would enable patients to compare the record of different hospitals in such areas as surgical infection rates, unplanned readmissions and waiting times for elective surgery.
Citing new research showing that Australia has fallen behind other countries in the release of individual hospital performance data, Mr Abbott said such information was readily available elsewhere. "Why should we not have it here?". The research says that, by some estimates, adverse events and infections in Australian hospitals generate $2.5 billion in expenditure every year, but improvements are impeded by the lack of comparative data on hospital performance. Besides letting patients know how hospitals rated on different indicators, it would also help hospitals to identify strengths and weaknesses and spur improvements, Mr Abbott said.
A frequent argument against publishing such information was that it was hard to compare hospital outcomes. But Mr Abbott said the public would be able to factor in differences such as some hospitals having a higher rate of problems because they took on more difficult cases. The Federal Government wanted to see such information included in the next Australian Health Care Agreements, which provide for federal funding of public hospitals and are scheduled for renegotiation with the states after the federal election.
A study undertaken for the Australian Centre for Health Research says "very little" analysis has been published in Australia to assess the hospital system and even less undertaken to determine whether hospitals are working in concert with other parts of the system, such as general practitioners. "This raises the risk of wasted funds, poor health outcomes and reduced access for patients," it says. The report recommends the Government take the lead in defining what standard care information should be collected.
The publication of hospital performance indicators had triggered the establishment of "infomediaries" - companies which analysed the performance figures and could help patients make decisions about their health and how to manage it, in addition to providing a guide to quality care. The research was headed by David Charles, who said that the health system had avoided the trend towards greater transparency that had been accepted in many other sectors of government and business in the past 20 years.
Source
***************************
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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Monday, July 23, 2007
Bush sinks SCHIP
Sorry about that! Seriously: Democrats are trying to introduce socialized medicine piece by piece and SCHIP was going to be a large piece of that. But Bush has seen through it
President Bush yesterday rejected entreaties by his Republican allies that he compromise with Democrats on legislation to renew a popular program that provides health coverage to poor children, saying that expanding the program would enlarge the role of the federal government at the expense of private insurance. The president said he objects on philosophical grounds to a bipartisan Senate proposal to boost the State Children's Health Insurance Program by $35 billion over five years. Bush has proposed $5 billion in increased funding and has threatened to veto the Senate compromise and a more costly expansion being contemplated in the House.
"I support the initial intent of the program," Bush said in an interview with The Washington Post after a factory tour and a discussion on health care with small-business owners in Landover. "My concern is that when you expand eligibility . . . you're really beginning to open up an avenue for people to switch from private insurance to the government."
The 10-year-old program, which is set to expire on Sept. 30, costs the federal government $5 billion a year and helps provide health coverage to 6.6 million low-income children whose families do not qualify for Medicaid but cannot afford private insurance on their own.
About 3.3 million additional children would be covered under the proposal developed by Senate Finance Committee Chairman Max Baucus (D-Mont.) and Republican Sens. Charles E. Grassley (Iowa) and Orrin G. Hatch (Utah), among others. It would provide the program $60 billion over five years, compared with $30 billion under Bush's proposal. And it would rely on a 61-cent increase in the federal excise tax on cigarettes, to $1 a pack, which Bush opposes.
Grassley and Hatch, in a joint statement this week, implored the president to rescind his veto threat. They warned that Democrats might seek an expansion of $50 billion or more if there is no compromise. They also said that Bush should drop efforts to link the program's renewal to his six-month-old proposal to replace the long-standing tax break for employer-based health insurance with a new tax deduction that would help people pay for insurance, regardless of whether they get it through their jobs or purchase it on their own.
"Tax legislation to expand health insurance coverage is badly needed, but there's no Democratic support for it in the SCHIP debate," said Grassley, the ranking Republican on the finance panel. "In the meantime, our SCHIP initiative in the Finance Committee takes care of a program that's about to expire in a way that's more responsible than current law and $15 billion less than the budget resolution calls for."
But Bush said he was not persuaded. "I'm not going to surrender a good and important idea before the debate really gets started," Bush said. "And I think it's going to be very important for our allies on Capitol Hill to hear a strong, clear message from me that expansion of government in lieu of making the necessary changes to encourage a consumer-based system is not acceptable." The Senate committee is scheduled to consider the compromise legislation today, and the House is expected to try to pass its own version before the congressional recess in August.
Rep. Rahm Emanuel (Ill.), the House Democratic Caucus chairman, said he is "bewildered" that Bush is fighting the expanded funding for a program supported by Republicans and Democrats alike. "This is the chance for him to finally be a uniter and not a divider," Emanuel said. "You have consensus across party and ideology, and a unity on the most important domestic issue, health care -- except for one person."
A recent analysis by the Congressional Budget Office concluded that the program would require about $14 billion in new money over five years -- on top of the current $5 billion in annual funding -- merely to keep covering the same number of children, in part because of rising health-care costs. Secretary of Health and Human Services Mike Leavitt, accompanying Bush yesterday, said: "We disagree with that number."
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Sorry about that! Seriously: Democrats are trying to introduce socialized medicine piece by piece and SCHIP was going to be a large piece of that. But Bush has seen through it
President Bush yesterday rejected entreaties by his Republican allies that he compromise with Democrats on legislation to renew a popular program that provides health coverage to poor children, saying that expanding the program would enlarge the role of the federal government at the expense of private insurance. The president said he objects on philosophical grounds to a bipartisan Senate proposal to boost the State Children's Health Insurance Program by $35 billion over five years. Bush has proposed $5 billion in increased funding and has threatened to veto the Senate compromise and a more costly expansion being contemplated in the House.
"I support the initial intent of the program," Bush said in an interview with The Washington Post after a factory tour and a discussion on health care with small-business owners in Landover. "My concern is that when you expand eligibility . . . you're really beginning to open up an avenue for people to switch from private insurance to the government."
The 10-year-old program, which is set to expire on Sept. 30, costs the federal government $5 billion a year and helps provide health coverage to 6.6 million low-income children whose families do not qualify for Medicaid but cannot afford private insurance on their own.
About 3.3 million additional children would be covered under the proposal developed by Senate Finance Committee Chairman Max Baucus (D-Mont.) and Republican Sens. Charles E. Grassley (Iowa) and Orrin G. Hatch (Utah), among others. It would provide the program $60 billion over five years, compared with $30 billion under Bush's proposal. And it would rely on a 61-cent increase in the federal excise tax on cigarettes, to $1 a pack, which Bush opposes.
Grassley and Hatch, in a joint statement this week, implored the president to rescind his veto threat. They warned that Democrats might seek an expansion of $50 billion or more if there is no compromise. They also said that Bush should drop efforts to link the program's renewal to his six-month-old proposal to replace the long-standing tax break for employer-based health insurance with a new tax deduction that would help people pay for insurance, regardless of whether they get it through their jobs or purchase it on their own.
"Tax legislation to expand health insurance coverage is badly needed, but there's no Democratic support for it in the SCHIP debate," said Grassley, the ranking Republican on the finance panel. "In the meantime, our SCHIP initiative in the Finance Committee takes care of a program that's about to expire in a way that's more responsible than current law and $15 billion less than the budget resolution calls for."
But Bush said he was not persuaded. "I'm not going to surrender a good and important idea before the debate really gets started," Bush said. "And I think it's going to be very important for our allies on Capitol Hill to hear a strong, clear message from me that expansion of government in lieu of making the necessary changes to encourage a consumer-based system is not acceptable." The Senate committee is scheduled to consider the compromise legislation today, and the House is expected to try to pass its own version before the congressional recess in August.
Rep. Rahm Emanuel (Ill.), the House Democratic Caucus chairman, said he is "bewildered" that Bush is fighting the expanded funding for a program supported by Republicans and Democrats alike. "This is the chance for him to finally be a uniter and not a divider," Emanuel said. "You have consensus across party and ideology, and a unity on the most important domestic issue, health care -- except for one person."
A recent analysis by the Congressional Budget Office concluded that the program would require about $14 billion in new money over five years -- on top of the current $5 billion in annual funding -- merely to keep covering the same number of children, in part because of rising health-care costs. Secretary of Health and Human Services Mike Leavitt, accompanying Bush yesterday, said: "We disagree with that number."
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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Sunday, July 22, 2007
British woman dies waiting for brain scans
A high-flying television producer died from a suspected epileptic fit while waiting for vital brain scans on the NHS. Laura Price, 30, who worked on shows such as Big Brother and Strictly Come Dancing, was found dead in her home just hours after she had been discharged from casualty.
The evening before she died, Miss Price, from Notting Hill, west London, had begged a junior A&E doctor for anti-seizure drugs but had been told they could only be prescribed by a neurologist.
Two days earlier she had visited a specialist at Charing Cross hospital and was told she would have to wait six weeks for a brain scan. She had felt "concerned and afraid" at having to wait that length of time for a test before being treated for a recurrence of childhood epilepsy, Westminster coroner's court heard.
She had not had a seizure for more than 10 years, but after a series of "strange episodes", including a numb face and flashing lights in her vision, she had visited her GP and was referred to the specialist.
On the night before she died Miss Price entered her flatmate Sarah Jackson's room in a confused state. Miss Jackson told the court: "I was very concerned and called an ambulance." Once at Charing Cross hospital Miss Price begged a doctor for drugs. Dr Christina Coppel, who treated her, told the inquest it would have been against hospital guidelines to prescribe them without a neurologist.
At lunchtime the next day Miss Price was found lying on the floor and an ambulance pronounced her dead at the scene. A post mortem examination concluded it was a sudden unexpected death in epilepsy. Dr Paul Knapman, the coroner, returned a verdict of natural causes. Yesterday, her parents said they were considering legal action against Hammersmith Hospitals NHS Trust.
Source
Dangerous public hospital negligence in Australia
Safety experts say too little is being done to stop patients being harmed or even killed by avoidable errors in Australian public hospitals
PATRICIA Skinner has experienced the sharp end of medical mistakes. She spent 18 months with a pair of 15cm scissors in her abdomen. Why? Because doctors forgot to take them out at the end of an operation. [What happened to the before-and-after count that should have been routine procedure?] "It was agony ... my husband would drive over a bump in the road, and I would scream,'' recalls Skinner. "My husband would say, `What's the matter with you?', and I thought I had cancer. I said to my doctor, `I feel like I've been knocked to the ground and someone's been kicking me with steel-capped boots'.'' In a way, of course, something had. But unfortunately for Skinner, now 79, for some time medical staff refused to believe anything was wrong. She had had major surgery, they told her; what did she expect?
The truth was only discovered after Skinner herself eventually insisted on an X-ray, which was performed at Sydney's St George Hospital [A notorious hospital] in October 2002, 18 months after surgery at the same hospital to remove bowel polyps. "They did the X-ray twice, because I don't think they could believe what they were seeing,'' Skinner says. She went straight back to the hospital, and had surgery to remove the scissors the very next day. But after so long inside her, the scissors - which in the meantime had moved from her abdomen to near her coccyx, the tailbone at the base of the spine - had become partially overgrown by her own tissues. To get them out, doctors had to cut out a chunk of Skinner's bowel as well.
What she wanted then was an explanation of how it could have happened, but Skinner and husband Don had little joy here either. "They said at the time that scissors were `too big to lose', which was absolute nonsense,'' Skinner tells Weekend Health. "Was somebody off sick, or was somebody working for hours and got tired? I said there must have been a reason, but I wasn't allowed to talk to anybody. If you can understand what happened, you think, `OK, I can accept that'. But when you don't know, there's nothing to accept.''
The X-ray images and her story were reported around the world, and eventually Skinner, now 72, accepted compensation from the hospital, the size of which is confidential. The hospital also changed its counting procedures to make sure equipment is properly accounted for after operations.
Sadly, as Australia's first national report on serious mistakes shows, Skinner's experience is far from unique, either in terms of the mistake or the culture of secrecy and denial that surrounded it. The report, published this week by the Australian Institute of Health and Welfare and the Australian Commission on Safety and Quality in Health Care, recorded 130 instances of "sentinel events'' reported by 759 public hospitals in 2004-05. These events fell into one of eight categories of serious events that were agreed by Australian Governments in 2004.
As The Australian reported this week, nearly half (41 per cent) of the 130 events were in the category of wrong site or wrong patient - where an operation or test was performed on the wrong part of the patient's body, or on the wrong patient altogether. Retained instruments - the category that Skinner would have fallen into - took second place, accounting for 27 cases.
The factors that contributed to these and other incidents were varied: staff ending their shift giving inadequate briefings to other staff starting a shift, or staff acting when they didn't know the full facts. For example, in one incident a patient was transfused wiTh blood intended for another patient with an incompatible blood type - a potentially fatal mistake - because the co-ordinating nurse only knew of one transfusion request, and when a courier delivered some blood she assumed - wrongly - that it was meant for that patient. Other reasons included staff not following rules or guidelines, or not recording information on charts or other documents properly.
The report's authors say the reasons for doctors and nurses not reporting mistakes in the past include "fear of litigation and adverse publicity'', and admit that while low, the numbers of sentinel events in this week's report are likely to rise in future editions as doctors and nurses start to feel more comfortable about owning up after something has gone wrong. Even so, outgoing commission chief executive Diana Horvath rejected suggestions the numbers were merely the tip of the iceberg, claiming they were instead "a substantial part of it''.
But independent safety experts disagree, and it's not as if you have to look far to find other examples of medical mistakes every bit as horrifying as that which happened to Pat Skinner. In a bulletin sent to its members earlier this year, doctors' insurance company MDA National revealed an unnamed 24-year-old patient suffered nightmares after a "throat pack'' - a wad of absorbent gauze or dressing to soak up blood and other fluids during surgery - was left in place after prolonged oral surgery. "The patient coughed up the throat pack some hours later on the (recovery) ward,'' the bulletin said. "He was very distressed ... although the pharynx was sucked out under direct vision at the end of the procedure, the bloodstained pack was not seen until the patient coughed it up several hours post-operatively. "Sporadic reports of this complication continue to occur, sometimes with disastrous consequences for the patient.''
MDA National said measures that might help avoid repeat occurrences included labelling patients' foreheads if throat packs were used, and recording the pack on the list of items that have to be accounted for at the end of the procedure.
In another case in the same bulletin, a 35-year-old patient went to an emergency department complaining of severe renal colic. He asked for a painkiller called hydromorphone, also known as Dilaudid, which he had previously found to be the most effective medication. Instead the doctor ordered hydromorphine - a drug eight times more powerful - because she did not realise the difference. The bulletin said this patient did not suffer any negative long-term effects from the overdose, although it added that some other previous mix-ups involving hydromorphone "have resulted in patient deaths''.
This week's report said the reporting culture was improving, and numbers of reported events will be higher in future reports. But other safety experts think Horvath's suggestion that this week's figures already represent a significant proportion of the problem is little short of ridiculous. Steve Bolsin, associate professor of patient safety at Victoria's Geelong Hospital, says the "notion that 130 adverse events is the majority of the iceberg is completely erroneous. Previous work has shown that between 5 and 10 per cent of admissions have adverse events associated with them, and things may be worse in general practice. So there's a huge need to begin to improve in these areas.''
Bolsin points to the findings of the groundbreaking Quality in Australian Health Care Study (QAHCS), published in the Medical Journal of Australia 12 years ago (1995;163:458-71), which claimed that up to 16 per cent of hospitalised patients would suffer an adverse event, and that 50 per cent of these would be preventable. Of these preventable events, 10 per cent would lead to permanent disability or death.
Some doctors have been bitterly critical of the QAHCS findings, saying it was biased and found a much higher rate of adverse events than a similar US study. Had the same analysis applied in Australia as in the US, they say, the rate of adverse events reported in QAHCS would have been up to 25 per cent less. With 4.3 million hospitalisations in public hospitals in 2004-05, the QAHCS suggests Australia's toll of serious adverse events should be closer to 35,000 than 130. But even a 25 per cent pullback from that figure still paints a worrying picture.
A follow-up editorial in the MJA two years ago (2005;182:260-1) asked if there was any evidence that health care had become any safer in the decade since the 1995 report, and promptly answered the question itself: "Unfortunately, the answer is no''.
Adverse events are also associated with significant costs. Another study in the MJA last year (2006;184:551-5), conducted in 45 major Victorian hospitals, found each adverse event contributed an extra $6826 in costs, and the total cost for all the events in the participating hospitals in 2003-04 was $460 million - over 15 per cent of direct hospital costs.
Bolsin says there are "an incredible number of adverse events going on that are not being reported'' through the existing channels. However, a pioneering scheme already piloted at his own hospital in Geelong could hold the answer. For the pilot, 14 anaesthetic registrars used personal digital assistants (PDAs) fitted with special software to report adverse events to a central database, identifying them in one of four categories - events causing death, serious outcomes such as extended hospital stay or permanent harm, transient or minor harm, and "near miss'' adverse events that had no bad effect on the patient. Researchers combed through the notes of cases where no incidents had been reported, to check how many incidents had been missed.
The findings, reported last year in the International Journal for Quality in Health Care (2006;18(6):452-7), found an adverse incident was reported for 156, or 3.5 per cent of the 4441 anaesthetic procedures reported, nearly half (46.2 per cent) of which were near misses. Only one incident was identified in the case notes as having been missed, giving a reporting rate via PDAs of 99.5 per cent - far higher than has been achieved anywhere else in the world. Bolsin says PDAs can also be used to download appropriate clinical practice guidelines and other relevant information to help guide doctors, use of which he says has been proven to improve treatment outcomes.
So far, however, there has been limited enthusiasm from health bureaucrats for implementing a PDA-based system for adverse event reporting. "If we are really serious about safety in health care, we have to start using these technologies, and we have to start using them effectively and constructively,'' Bolsin says.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
A high-flying television producer died from a suspected epileptic fit while waiting for vital brain scans on the NHS. Laura Price, 30, who worked on shows such as Big Brother and Strictly Come Dancing, was found dead in her home just hours after she had been discharged from casualty.
The evening before she died, Miss Price, from Notting Hill, west London, had begged a junior A&E doctor for anti-seizure drugs but had been told they could only be prescribed by a neurologist.
Two days earlier she had visited a specialist at Charing Cross hospital and was told she would have to wait six weeks for a brain scan. She had felt "concerned and afraid" at having to wait that length of time for a test before being treated for a recurrence of childhood epilepsy, Westminster coroner's court heard.
She had not had a seizure for more than 10 years, but after a series of "strange episodes", including a numb face and flashing lights in her vision, she had visited her GP and was referred to the specialist.
On the night before she died Miss Price entered her flatmate Sarah Jackson's room in a confused state. Miss Jackson told the court: "I was very concerned and called an ambulance." Once at Charing Cross hospital Miss Price begged a doctor for drugs. Dr Christina Coppel, who treated her, told the inquest it would have been against hospital guidelines to prescribe them without a neurologist.
At lunchtime the next day Miss Price was found lying on the floor and an ambulance pronounced her dead at the scene. A post mortem examination concluded it was a sudden unexpected death in epilepsy. Dr Paul Knapman, the coroner, returned a verdict of natural causes. Yesterday, her parents said they were considering legal action against Hammersmith Hospitals NHS Trust.
Source
Dangerous public hospital negligence in Australia
Safety experts say too little is being done to stop patients being harmed or even killed by avoidable errors in Australian public hospitals
PATRICIA Skinner has experienced the sharp end of medical mistakes. She spent 18 months with a pair of 15cm scissors in her abdomen. Why? Because doctors forgot to take them out at the end of an operation. [What happened to the before-and-after count that should have been routine procedure?] "It was agony ... my husband would drive over a bump in the road, and I would scream,'' recalls Skinner. "My husband would say, `What's the matter with you?', and I thought I had cancer. I said to my doctor, `I feel like I've been knocked to the ground and someone's been kicking me with steel-capped boots'.'' In a way, of course, something had. But unfortunately for Skinner, now 79, for some time medical staff refused to believe anything was wrong. She had had major surgery, they told her; what did she expect?
The truth was only discovered after Skinner herself eventually insisted on an X-ray, which was performed at Sydney's St George Hospital [A notorious hospital] in October 2002, 18 months after surgery at the same hospital to remove bowel polyps. "They did the X-ray twice, because I don't think they could believe what they were seeing,'' Skinner says. She went straight back to the hospital, and had surgery to remove the scissors the very next day. But after so long inside her, the scissors - which in the meantime had moved from her abdomen to near her coccyx, the tailbone at the base of the spine - had become partially overgrown by her own tissues. To get them out, doctors had to cut out a chunk of Skinner's bowel as well.
What she wanted then was an explanation of how it could have happened, but Skinner and husband Don had little joy here either. "They said at the time that scissors were `too big to lose', which was absolute nonsense,'' Skinner tells Weekend Health. "Was somebody off sick, or was somebody working for hours and got tired? I said there must have been a reason, but I wasn't allowed to talk to anybody. If you can understand what happened, you think, `OK, I can accept that'. But when you don't know, there's nothing to accept.''
The X-ray images and her story were reported around the world, and eventually Skinner, now 72, accepted compensation from the hospital, the size of which is confidential. The hospital also changed its counting procedures to make sure equipment is properly accounted for after operations.
Sadly, as Australia's first national report on serious mistakes shows, Skinner's experience is far from unique, either in terms of the mistake or the culture of secrecy and denial that surrounded it. The report, published this week by the Australian Institute of Health and Welfare and the Australian Commission on Safety and Quality in Health Care, recorded 130 instances of "sentinel events'' reported by 759 public hospitals in 2004-05. These events fell into one of eight categories of serious events that were agreed by Australian Governments in 2004.
As The Australian reported this week, nearly half (41 per cent) of the 130 events were in the category of wrong site or wrong patient - where an operation or test was performed on the wrong part of the patient's body, or on the wrong patient altogether. Retained instruments - the category that Skinner would have fallen into - took second place, accounting for 27 cases.
The factors that contributed to these and other incidents were varied: staff ending their shift giving inadequate briefings to other staff starting a shift, or staff acting when they didn't know the full facts. For example, in one incident a patient was transfused wiTh blood intended for another patient with an incompatible blood type - a potentially fatal mistake - because the co-ordinating nurse only knew of one transfusion request, and when a courier delivered some blood she assumed - wrongly - that it was meant for that patient. Other reasons included staff not following rules or guidelines, or not recording information on charts or other documents properly.
The report's authors say the reasons for doctors and nurses not reporting mistakes in the past include "fear of litigation and adverse publicity'', and admit that while low, the numbers of sentinel events in this week's report are likely to rise in future editions as doctors and nurses start to feel more comfortable about owning up after something has gone wrong. Even so, outgoing commission chief executive Diana Horvath rejected suggestions the numbers were merely the tip of the iceberg, claiming they were instead "a substantial part of it''.
But independent safety experts disagree, and it's not as if you have to look far to find other examples of medical mistakes every bit as horrifying as that which happened to Pat Skinner. In a bulletin sent to its members earlier this year, doctors' insurance company MDA National revealed an unnamed 24-year-old patient suffered nightmares after a "throat pack'' - a wad of absorbent gauze or dressing to soak up blood and other fluids during surgery - was left in place after prolonged oral surgery. "The patient coughed up the throat pack some hours later on the (recovery) ward,'' the bulletin said. "He was very distressed ... although the pharynx was sucked out under direct vision at the end of the procedure, the bloodstained pack was not seen until the patient coughed it up several hours post-operatively. "Sporadic reports of this complication continue to occur, sometimes with disastrous consequences for the patient.''
MDA National said measures that might help avoid repeat occurrences included labelling patients' foreheads if throat packs were used, and recording the pack on the list of items that have to be accounted for at the end of the procedure.
In another case in the same bulletin, a 35-year-old patient went to an emergency department complaining of severe renal colic. He asked for a painkiller called hydromorphone, also known as Dilaudid, which he had previously found to be the most effective medication. Instead the doctor ordered hydromorphine - a drug eight times more powerful - because she did not realise the difference. The bulletin said this patient did not suffer any negative long-term effects from the overdose, although it added that some other previous mix-ups involving hydromorphone "have resulted in patient deaths''.
This week's report said the reporting culture was improving, and numbers of reported events will be higher in future reports. But other safety experts think Horvath's suggestion that this week's figures already represent a significant proportion of the problem is little short of ridiculous. Steve Bolsin, associate professor of patient safety at Victoria's Geelong Hospital, says the "notion that 130 adverse events is the majority of the iceberg is completely erroneous. Previous work has shown that between 5 and 10 per cent of admissions have adverse events associated with them, and things may be worse in general practice. So there's a huge need to begin to improve in these areas.''
Bolsin points to the findings of the groundbreaking Quality in Australian Health Care Study (QAHCS), published in the Medical Journal of Australia 12 years ago (1995;163:458-71), which claimed that up to 16 per cent of hospitalised patients would suffer an adverse event, and that 50 per cent of these would be preventable. Of these preventable events, 10 per cent would lead to permanent disability or death.
Some doctors have been bitterly critical of the QAHCS findings, saying it was biased and found a much higher rate of adverse events than a similar US study. Had the same analysis applied in Australia as in the US, they say, the rate of adverse events reported in QAHCS would have been up to 25 per cent less. With 4.3 million hospitalisations in public hospitals in 2004-05, the QAHCS suggests Australia's toll of serious adverse events should be closer to 35,000 than 130. But even a 25 per cent pullback from that figure still paints a worrying picture.
A follow-up editorial in the MJA two years ago (2005;182:260-1) asked if there was any evidence that health care had become any safer in the decade since the 1995 report, and promptly answered the question itself: "Unfortunately, the answer is no''.
Adverse events are also associated with significant costs. Another study in the MJA last year (2006;184:551-5), conducted in 45 major Victorian hospitals, found each adverse event contributed an extra $6826 in costs, and the total cost for all the events in the participating hospitals in 2003-04 was $460 million - over 15 per cent of direct hospital costs.
Bolsin says there are "an incredible number of adverse events going on that are not being reported'' through the existing channels. However, a pioneering scheme already piloted at his own hospital in Geelong could hold the answer. For the pilot, 14 anaesthetic registrars used personal digital assistants (PDAs) fitted with special software to report adverse events to a central database, identifying them in one of four categories - events causing death, serious outcomes such as extended hospital stay or permanent harm, transient or minor harm, and "near miss'' adverse events that had no bad effect on the patient. Researchers combed through the notes of cases where no incidents had been reported, to check how many incidents had been missed.
The findings, reported last year in the International Journal for Quality in Health Care (2006;18(6):452-7), found an adverse incident was reported for 156, or 3.5 per cent of the 4441 anaesthetic procedures reported, nearly half (46.2 per cent) of which were near misses. Only one incident was identified in the case notes as having been missed, giving a reporting rate via PDAs of 99.5 per cent - far higher than has been achieved anywhere else in the world. Bolsin says PDAs can also be used to download appropriate clinical practice guidelines and other relevant information to help guide doctors, use of which he says has been proven to improve treatment outcomes.
So far, however, there has been limited enthusiasm from health bureaucrats for implementing a PDA-based system for adverse event reporting. "If we are really serious about safety in health care, we have to start using these technologies, and we have to start using them effectively and constructively,'' Bolsin says.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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Saturday, July 21, 2007
Myths & Fact About The American Health Care System
Since the release of Michael Moore's "sicko" movie, the U.S. health care system and its alleged failure have been widely debated. But while the U.S. health care system is far from perfect, it is much better than Michael Moore would have you believe. Furthermore, the real shortcomings that it does have are not the effect of its free market elements, but to various regulations and factors unrelated to the health care system.
This will not be a direct review of "sicko", a movie which I haven't seen. But it will of course be a indirect attack on the movie's thesis. For a listing of the lies present in the movie, see this review.
Myth: "The U.S. has a purely free market health care system"
Fact: The U.S. health care system is indeed more market driven than in most other countries, but nearly half of all health care costs is paid for by the government. Already in 2004 roughly 45% of health care costs were government funded a proportion which has likely increased since then due to Bush's Medicare expansion.
Furthermore, the system is burdened with heavy regulations, which contributes to raising its costs, as The Economist recently reported in an interesting article.
Myth: "The U.S. health care system leaves 45 million (or whatever number is claimed)without health insurance"
Even setting aside that a significant proportion of these uninsured are illegal immigrants, which in Sweden is completely excluded from the health care system, this is only true in the sense that nearly 9 million in Sweden is without health insurance. Everyone in America over the age of 65 is covered by the Medicare program and low income earners below the age of 65 can get their health care paid by the Medicaid program. And besides, one can always simply go to an emergency room and demand care there since federal law prohibits hospitals from denying people care there, a possibility which has created some problems in the border regions to Mexico since illegal immigrants have been very good at taking advantage of this (more about this in the link in the beginning of this paragraph).
And if you are unable to pay, government will have to compensate the hospitals.
Myth: "Market mechanisms are responsible for the high costs of the American health care system"
Fact: That the U.S. health care system has a very high cost level is one of the few criticisms of it which is basically true. Regardless of how you calculate, U.S. health care costs are higher than anywhere else in the world. It should however be pointed out that many -including reportedly Michael Moore- exaggerate just how much more expensive it is by comparing the cost in PPP-adjusted dollars per capita. Since the U.S. is still the third richest country (After Luxembourg and Norway) in the world according to that method of comparison and because a higher average income will for various reasons drive up the cost in PPP-adjusted dollars this kind of comparison will exaggerate the relative extra cost, while greatly underestimating it in dirt poor Cuba.
Health care costs in the U.S. are roughly 15% of GDP compared to roughly 10% in countries like France, Canada and Cuba. What is then the cause of these higher costs? Well, in part it is actually (see below) the case that U.S. health care quality is higher, and quality costs. And as is also described below, an unhealthier lifestyle among many Americans also contributes to pushing up costs. Moreover, as discussed above various regulations have contributed to pushing up costs (see aforementioned The Economist article) and furthermore American doctors and nurses have much higher pay relative to the rest of the population than in most other countries.
And it is also the case that the American health care system in practice function as an Atlas which carries the world's medical research costs on its shoulders. In Sweden, Canada and most other countries, the government health system purchases medicine for very low prices which doesn't cover the research costs needed to produce it. Drug companies still reluctantly agrees to this since the prices they receive still give them a small profit given the completion of the research needed to produce it and because they can in the United States charge prices which covers not only cost of production but also the cost of research and more. This factors means that real health care costs are overestimated in the United States while being underestimated in the favorite countries of Michael Moore and other socialists.
If the United States were to act as other countries and pay the same low prices for medicin -something which many leading Democrats have advocated- as other countries this would of course contribute to a significant short term reduction in U.S. health care costs. The problem is that this would mean that new research would be unprofitable and so few or no new medicines would appear which in the long run would raise health care costs everywhere.
Myth: "Despite its higher costs, the World Health Organizations ranking show that the American health care system ranks only number 37 in quality".
Fact: No, it doesn't show that at all. The ranking is actually only to a small extent a ranking of health care quality. If you check its details it measures mostly other things. What is being measured is mostly things like a population's health level (why this is not a good indicator of health care quality see below) and to what extent financing and treatment is in accordance with the WHO:s socialist ideals. That socialist systems are better in accordance with socialist ideals is hardly surprising and is definitely not a valid indicator of health care quality. The only one of their indicators which measures quality is "level of responsiveness" which is based on patient satisfaction and how quickly and efficient the system works. And in this category the American health care system is....number one!
Myth: "The somewhat shorter life expectancy and somewhat greater health problems of the United States shows that its health care system doesn't work as well"
Fact: No, it doesn't show that at all. These indicators vary mainly due to other factors, primarily different life style factors. Sweden's and Denmark's health care systems -and the economic system in general- are basically the same, yet life expectancy is a few years higher in Sweden. The difference is caused by the fact that Danes have a less healthy life style than Swedes. Hong Kong has an very high life expectancy and low level of health problems "despite" having a health care system largely privately financed like in the U.S. And as Michael Moore himself is a perfect illustration of, the United States have a higher proportion of people who are fat and/or for other ways live a unhealthy lifestyle. This will both contribute to raising the cost of the system and worsening these health indicators.
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Since the release of Michael Moore's "sicko" movie, the U.S. health care system and its alleged failure have been widely debated. But while the U.S. health care system is far from perfect, it is much better than Michael Moore would have you believe. Furthermore, the real shortcomings that it does have are not the effect of its free market elements, but to various regulations and factors unrelated to the health care system.
This will not be a direct review of "sicko", a movie which I haven't seen. But it will of course be a indirect attack on the movie's thesis. For a listing of the lies present in the movie, see this review.
Myth: "The U.S. has a purely free market health care system"
Fact: The U.S. health care system is indeed more market driven than in most other countries, but nearly half of all health care costs is paid for by the government. Already in 2004 roughly 45% of health care costs were government funded a proportion which has likely increased since then due to Bush's Medicare expansion.
Furthermore, the system is burdened with heavy regulations, which contributes to raising its costs, as The Economist recently reported in an interesting article.
Myth: "The U.S. health care system leaves 45 million (or whatever number is claimed)without health insurance"
Even setting aside that a significant proportion of these uninsured are illegal immigrants, which in Sweden is completely excluded from the health care system, this is only true in the sense that nearly 9 million in Sweden is without health insurance. Everyone in America over the age of 65 is covered by the Medicare program and low income earners below the age of 65 can get their health care paid by the Medicaid program. And besides, one can always simply go to an emergency room and demand care there since federal law prohibits hospitals from denying people care there, a possibility which has created some problems in the border regions to Mexico since illegal immigrants have been very good at taking advantage of this (more about this in the link in the beginning of this paragraph).
And if you are unable to pay, government will have to compensate the hospitals.
Myth: "Market mechanisms are responsible for the high costs of the American health care system"
Fact: That the U.S. health care system has a very high cost level is one of the few criticisms of it which is basically true. Regardless of how you calculate, U.S. health care costs are higher than anywhere else in the world. It should however be pointed out that many -including reportedly Michael Moore- exaggerate just how much more expensive it is by comparing the cost in PPP-adjusted dollars per capita. Since the U.S. is still the third richest country (After Luxembourg and Norway) in the world according to that method of comparison and because a higher average income will for various reasons drive up the cost in PPP-adjusted dollars this kind of comparison will exaggerate the relative extra cost, while greatly underestimating it in dirt poor Cuba.
Health care costs in the U.S. are roughly 15% of GDP compared to roughly 10% in countries like France, Canada and Cuba. What is then the cause of these higher costs? Well, in part it is actually (see below) the case that U.S. health care quality is higher, and quality costs. And as is also described below, an unhealthier lifestyle among many Americans also contributes to pushing up costs. Moreover, as discussed above various regulations have contributed to pushing up costs (see aforementioned The Economist article) and furthermore American doctors and nurses have much higher pay relative to the rest of the population than in most other countries.
And it is also the case that the American health care system in practice function as an Atlas which carries the world's medical research costs on its shoulders. In Sweden, Canada and most other countries, the government health system purchases medicine for very low prices which doesn't cover the research costs needed to produce it. Drug companies still reluctantly agrees to this since the prices they receive still give them a small profit given the completion of the research needed to produce it and because they can in the United States charge prices which covers not only cost of production but also the cost of research and more. This factors means that real health care costs are overestimated in the United States while being underestimated in the favorite countries of Michael Moore and other socialists.
If the United States were to act as other countries and pay the same low prices for medicin -something which many leading Democrats have advocated- as other countries this would of course contribute to a significant short term reduction in U.S. health care costs. The problem is that this would mean that new research would be unprofitable and so few or no new medicines would appear which in the long run would raise health care costs everywhere.
Myth: "Despite its higher costs, the World Health Organizations ranking show that the American health care system ranks only number 37 in quality".
Fact: No, it doesn't show that at all. The ranking is actually only to a small extent a ranking of health care quality. If you check its details it measures mostly other things. What is being measured is mostly things like a population's health level (why this is not a good indicator of health care quality see below) and to what extent financing and treatment is in accordance with the WHO:s socialist ideals. That socialist systems are better in accordance with socialist ideals is hardly surprising and is definitely not a valid indicator of health care quality. The only one of their indicators which measures quality is "level of responsiveness" which is based on patient satisfaction and how quickly and efficient the system works. And in this category the American health care system is....number one!
Myth: "The somewhat shorter life expectancy and somewhat greater health problems of the United States shows that its health care system doesn't work as well"
Fact: No, it doesn't show that at all. These indicators vary mainly due to other factors, primarily different life style factors. Sweden's and Denmark's health care systems -and the economic system in general- are basically the same, yet life expectancy is a few years higher in Sweden. The difference is caused by the fact that Danes have a less healthy life style than Swedes. Hong Kong has an very high life expectancy and low level of health problems "despite" having a health care system largely privately financed like in the U.S. And as Michael Moore himself is a perfect illustration of, the United States have a higher proportion of people who are fat and/or for other ways live a unhealthy lifestyle. This will both contribute to raising the cost of the system and worsening these health indicators.
Source
***************************
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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Friday, July 20, 2007
Corrupt "backroom deal" in British health system
The Department of Health did “a backroom deal” with a private company that broke Treasury guidance, could not demonstrate value for money and lacked clear benefits, the Public Accounts Committee has concluded. The deal, to create a joint venture between the health information company Dr Foster and the department’s information centre, resulted in a loss of 2.8 million pounds in its first year instead of the small profit predicted.
Last week the director of the information centre, Professor Denise Lievesley, who was responsible for signing off on the deal, resigned after only two years in the job. She claimed that it was the right time for her to pursue other activities, including her forthcoming presidency of the International Statistical Institute. No connection to the imminent PAC report was acknowledged.
The PAC is not critical of Dr Foster, which was set up to make better use of data produced by the NHS. But it does question whether the agreement was good value for taxpayers’ money. Edward Leigh, MP, the chairman of the committee, said: “By pursuing its backroom deal with Dr Foster LLP, the Department of Health failed in its duty to be open to Parliament and the taxpayer. “There was no fair and competitive tendering competition, as laid down in public sector procurement guidelines. And Treasury guidance on joint ventures between public and private sectors was ignored. Instead, the deal was handed to Dr Foster on a plate. “Without the competitive pressure inherent in a tender process, the Department’s Information Centre simply cannot demonstrate that it paid the best price for its 50 per cent share of the joint venture. Certainly, the 12 million that it paid, 7.6 million of which went straight into the pockets of Dr Foster’s shareholders, was between a half and a third higher than its financial advisers’ evaluation.”
The permanent secretary of the department, Hugh Taylor, told the committee that while there were other companies working in health informatics, Dr Foster stood out “in terms of its national profile and the range of its products”. But the committee did not consider this an adequate excuse for ignoring due process and paying over the odds.
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
The Department of Health did “a backroom deal” with a private company that broke Treasury guidance, could not demonstrate value for money and lacked clear benefits, the Public Accounts Committee has concluded. The deal, to create a joint venture between the health information company Dr Foster and the department’s information centre, resulted in a loss of 2.8 million pounds in its first year instead of the small profit predicted.
Last week the director of the information centre, Professor Denise Lievesley, who was responsible for signing off on the deal, resigned after only two years in the job. She claimed that it was the right time for her to pursue other activities, including her forthcoming presidency of the International Statistical Institute. No connection to the imminent PAC report was acknowledged.
The PAC is not critical of Dr Foster, which was set up to make better use of data produced by the NHS. But it does question whether the agreement was good value for taxpayers’ money. Edward Leigh, MP, the chairman of the committee, said: “By pursuing its backroom deal with Dr Foster LLP, the Department of Health failed in its duty to be open to Parliament and the taxpayer. “There was no fair and competitive tendering competition, as laid down in public sector procurement guidelines. And Treasury guidance on joint ventures between public and private sectors was ignored. Instead, the deal was handed to Dr Foster on a plate. “Without the competitive pressure inherent in a tender process, the Department’s Information Centre simply cannot demonstrate that it paid the best price for its 50 per cent share of the joint venture. Certainly, the 12 million that it paid, 7.6 million of which went straight into the pockets of Dr Foster’s shareholders, was between a half and a third higher than its financial advisers’ evaluation.”
The permanent secretary of the department, Hugh Taylor, told the committee that while there were other companies working in health informatics, Dr Foster stood out “in terms of its national profile and the range of its products”. But the committee did not consider this an adequate excuse for ignoring due process and paying over the odds.
Source
***************************
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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Thursday, July 19, 2007
NHS fails diabetics
The majority of NHS trusts are not giving people with diabetes enough help in managing the condition at home, a watchdog has warned. The Healthcare Commission said most primary care trusts were offering basic diabetes care such as yearly check-ups. But it warned that almost 130 out of more than 150 failed on home support.
Offering services to help patients manage their weight or plan an exercise regime are seen as crucial in reducing complications like heart problems. As such, they could also save the NHS millions of pounds each year. In 2002, about œ1.3bn - or 5% of NHS expenditure - was used to care for people with diabetes. Estimates from 2006 suggest this could even have crept up to 10% of total spending, the commission said.
Managing diabetes at home by controlling weight, or giving up smoking, have been touted as a key means of tackling complications of the condition. As well as heart problems, these include blindness, kidney failure and limb amputation.
Beefing up community services and the potential for self-management of long-term conditions such as diabetes is also one of the key planks of government policy. Diabetes is seen as a growing problem in the UK. According to the watchdog, the number of diagnosed and undiagnosed cases is likely to have risen by 15% between 2001 and 2010. Some 9% of this was due to increasing numbers of obese people, and a further 6% was the result of an ageing population, it suggested.
The Healthcare Commission said PCTs had to do better in supporting people to manage their condition.
Source
Ethically-challenged NHS doctor
A doctor accused of wrongly causing a health scare over the MMR vaccine paid children 5 pounds each to give blood samples at his son's birthday party, a disciplinary hearing has been told. Andrew Wakefield abused his position as a doctor and showed "a callous disregard" for the distress and pain that the children - thought to be as young as 4 - might suffer, the General Medical Council was told.
The allegations emerged yesterday along with charges connected to research by Dr Wakefield and his former colleagues, John Walker-Smith and Simon Murch, that claimed the combined vaccine against measles, mumps and rubella carried serious health risks. The doctors appeared before the GMC's fitness-to-practise panel charged with serious professional misconduct, which they deny. All three are accused of performing procedures, such as colonoscopies, barium meals and lumbar punctures, on children that were "contrary" to the children's clinical interests and conducted without the proper ethical approval and consent forms.
The GMC accused Dr Wakefield of bringing the profession into disrepute by taking blood from children at his son's party at some point before March 20, 1999, when he joked about the incident while giving a presentation at the Mind Institute, California. Footage was shown on ITN last night of the episode. Dr Wakefield is seen on video saying: "And you line them up - with informed parental consent, of course. They all get paid 5 pounds , which doesn't translate into many dollars I'm afraid. But . . . and . . . they put their arms out and they have the blood taken. All entirely voluntary." [Laughter] He says that two of the children fainted, while one was sick over his mother, which drew laughter from the audience.
Dr Wakefield is then heard joking: "People said to me, `Andrew, look, you know, you can't do this, people, children won't come back to you. [Laughter] I said, `You're wrong'. I said, `Listen, we live in a market economy. Next year they'll want 10 pounds'"
The MMR controversy began after the doctors published their research in The Lancet in 1998, claiming that the jab overloaded the immune system, causing bowel problems and also autism and other illnesses. Further research has quashed these conclusions. At the time, all three doctors were employed at the Royal Free Hospital's medical school in Hampstead, North London. They conducted the study on 11 British children without approval from the hospital's ethics committee, the GMC was told.
The list of allegations against Dr Wakefield took more than an hour to read out. One of the key accusations is that he failed to declare that he was being paid for advising solicitors on legal action by parents who believed their children had been harmed by MMR. Another charge is that he ordered subsequent studies "without the requisite paediatric qualifications". He is also alleged to have allowed one child - Child 10 - to be given an experimental cocktail of drugs, known as "transfer factor", with the view to it being developed into a new measles vaccine. Dr Wakefield admitted being involved in proposals to set up a company to manufacture the drug. The father of Child 10 was to be the company's managing director.
It was alleged that he did not reveal that he had accepted 50,000 pounds from the Legal Aid Board for research to support legal action by parents who believed their children were harmed by MMR. He was also accused of being "dishonest" and "irresponsible" when submitting his views about MMR for publication.
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
The majority of NHS trusts are not giving people with diabetes enough help in managing the condition at home, a watchdog has warned. The Healthcare Commission said most primary care trusts were offering basic diabetes care such as yearly check-ups. But it warned that almost 130 out of more than 150 failed on home support.
Offering services to help patients manage their weight or plan an exercise regime are seen as crucial in reducing complications like heart problems. As such, they could also save the NHS millions of pounds each year. In 2002, about œ1.3bn - or 5% of NHS expenditure - was used to care for people with diabetes. Estimates from 2006 suggest this could even have crept up to 10% of total spending, the commission said.
Managing diabetes at home by controlling weight, or giving up smoking, have been touted as a key means of tackling complications of the condition. As well as heart problems, these include blindness, kidney failure and limb amputation.
Beefing up community services and the potential for self-management of long-term conditions such as diabetes is also one of the key planks of government policy. Diabetes is seen as a growing problem in the UK. According to the watchdog, the number of diagnosed and undiagnosed cases is likely to have risen by 15% between 2001 and 2010. Some 9% of this was due to increasing numbers of obese people, and a further 6% was the result of an ageing population, it suggested.
The Healthcare Commission said PCTs had to do better in supporting people to manage their condition.
Source
Ethically-challenged NHS doctor
A doctor accused of wrongly causing a health scare over the MMR vaccine paid children 5 pounds each to give blood samples at his son's birthday party, a disciplinary hearing has been told. Andrew Wakefield abused his position as a doctor and showed "a callous disregard" for the distress and pain that the children - thought to be as young as 4 - might suffer, the General Medical Council was told.
The allegations emerged yesterday along with charges connected to research by Dr Wakefield and his former colleagues, John Walker-Smith and Simon Murch, that claimed the combined vaccine against measles, mumps and rubella carried serious health risks. The doctors appeared before the GMC's fitness-to-practise panel charged with serious professional misconduct, which they deny. All three are accused of performing procedures, such as colonoscopies, barium meals and lumbar punctures, on children that were "contrary" to the children's clinical interests and conducted without the proper ethical approval and consent forms.
The GMC accused Dr Wakefield of bringing the profession into disrepute by taking blood from children at his son's party at some point before March 20, 1999, when he joked about the incident while giving a presentation at the Mind Institute, California. Footage was shown on ITN last night of the episode. Dr Wakefield is seen on video saying: "And you line them up - with informed parental consent, of course. They all get paid 5 pounds , which doesn't translate into many dollars I'm afraid. But . . . and . . . they put their arms out and they have the blood taken. All entirely voluntary." [Laughter] He says that two of the children fainted, while one was sick over his mother, which drew laughter from the audience.
Dr Wakefield is then heard joking: "People said to me, `Andrew, look, you know, you can't do this, people, children won't come back to you. [Laughter] I said, `You're wrong'. I said, `Listen, we live in a market economy. Next year they'll want 10 pounds'"
The MMR controversy began after the doctors published their research in The Lancet in 1998, claiming that the jab overloaded the immune system, causing bowel problems and also autism and other illnesses. Further research has quashed these conclusions. At the time, all three doctors were employed at the Royal Free Hospital's medical school in Hampstead, North London. They conducted the study on 11 British children without approval from the hospital's ethics committee, the GMC was told.
The list of allegations against Dr Wakefield took more than an hour to read out. One of the key accusations is that he failed to declare that he was being paid for advising solicitors on legal action by parents who believed their children had been harmed by MMR. Another charge is that he ordered subsequent studies "without the requisite paediatric qualifications". He is also alleged to have allowed one child - Child 10 - to be given an experimental cocktail of drugs, known as "transfer factor", with the view to it being developed into a new measles vaccine. Dr Wakefield admitted being involved in proposals to set up a company to manufacture the drug. The father of Child 10 was to be the company's managing director.
It was alleged that he did not reveal that he had accepted 50,000 pounds from the Legal Aid Board for research to support legal action by parents who believed their children were harmed by MMR. He was also accused of being "dishonest" and "irresponsible" when submitting his views about MMR for publication.
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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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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