British elderly to get control of their own care budget

An amazingly sensible innovation by British standards. Will this be extended to ALL healthcare one day? We should hope it is

Elderly people will be given money to pay for their own care as part of a radical shake-up of the welfare system, Alan Johnson, the Health Secretary, will announce today. The new personal care budgets will give millions of pensioners and younger disabled people the power to decide what kind of care they want and where they buy it. Currently, elderly people are at the mercy of social workers who dictate the services they need to live in their own homes.

Under the new system, which will be introduced next April, older people or their families will set up bank accounts into which councils will pay a monthly sum. Beneficiaries will be means-tested to assess their needs before they are able to shop around for the best "personal care" packages, which will include help with getting dressed or washed, meals on wheels, cleaning services and cooking.

Mr Johnson will announce that councils in England and Wales will be given 520 million pounds over the next three years to fund the new system. "Our commitment that the majority of social care funding will be controlled by individuals through personal budgets represents a radical transfer or power from the state to the public," he will say. "Everyone, irrespective of their illness or disability has the right to self-developments and maximum control over their own lives."

Charities campaigning for better services for the elderly welcomed the move. "We welcome any move to give elderly people more choice about the services they receive in their home," said Mervyn Kohler, a special advisor for Help the Aged. "But we want assurance that they will be given guidance on the services out there. For example, who are the reputable companies? What are the different prices?" Gordon Lishman, the director general of Age Concern, said: "It is absolutely right to put older people's needs at the centre of the care system and to place a clear emphasis on preventive services. "Older people and their families will continue to need information and support to help them negotiate the best care package at the best price with care providers."

The Government devised the new system after becoming convinced that the "baby boomer" generation moving towards retirement would demand more control over the care they received. Ivan Lewis, the minister responsible for care services, admitted earlier this year that social care was one of the greatest challenges facing our society. "People are living longer and developing conditions that we've never known before. Disabled people now have, and rightly want, full and longer lives," he said. "We need a new consensus for a settlement that's fair and sustainable. We need to redefine the relationship between the state, family and citizen."

Under the changes, care homes and agencies providing high-quality home care and day services would be rewarded, while poorer performers would no longer be used by councils and the NHS.

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Big California hospital ditches Medi-Cal

In a move that reflects growing frustration over insufficient state reimbursement for health care, Sutter Roseville Medical Center has severed its contract with Medi-Cal, California's insurance program for the poor and disabled. The decision, which took effect Dec. 1, means Medi-Cal patients no longer are being admitted to the 270-bed hospital for elective surgeries. Sutter Roseville is the 15th hospital statewide that has discontinued its Medi-Cal contract since 2002; two of those hospitals have since renegotiated their contracts with the state. A total of 207 hospitals in California continue to provide the full range of services to Medi-Cal patients. The move does not affect Sutter Health's other hospitals in the region.

"Unfortunately, it's not all that uncommon," said Jan Emerson, spokeswoman for the California Hospital Association. "It's a reflection of the very, very low reimbursements that Medi-Cal pays. On average, we get about 50 cents of the dollar amount, and most hospitals can't sustain that level of loss for that amount of time."

Under the new arrangement, Medi-Cal patients will still be seen in Sutter Roseville's emergency room and trauma center, but those patients will be transferred to other facilities as soon as they are stable enough to be moved. Medi-Cal patients also will be able to get surgeries or other treatment on an outpatient basis, as well as to access laboratory, physical therapy or other ancillary medical services. State reimbursements for emergency and outpatient care use a different fee structure, according to health officials.

Sutter Roseville CEO Patrick Brady said the decision to end the contract for inpatient surgery was made after five months of negotiations in which the hospital wanted to get a much higher reimbursement rate. He said the hospital had been getting, on average, 47 percent of what its surgical care to Medi-Cal patients actually costs. "It represents quite a financial drain," he said. "We have complex patients who are very costly."

The contract change will affect an estimated 10 to 12 patients per day who would normally be in the hospital for a surgical procedure, Brady said. Those patients will be referred to other local hospitals still under contract with Medi-Cal. Those include Sutter Memorial and Sutter General hospitals, UC Davis Medical Center, Mercy San Juan Medical Center and Mercy Folsom Hospital. Each hospital negotiates separately with the state to determine reimbursement rates; the negotiated rates are kept confidential for four years.

"Our concern is for access for these recipients who are some of the most vulnerable in the state," said Tony Cava, a spokesman for the state Department of Health Care Services, the agency that oversees Medi-Cal. "We are confident they will be able to continue receiving the services they need and deserve."

The news was not very comforting to Evelyn Smith, 66, of Sacramento, whose husband landed at Sutter Roseville after collapsing on Thanksgiving. He is being evaluated for an operation to remove his gallstones. Since her husband relies on Medi-Cal, Smith said she was bothered to think he might not get the care he needs at the hospital where he was admitted. "They should treat us just as much as anyone else," she said as she was leaving the hospital Thursday. "We can't help it if we can't get insurance. We worked all our lives. We're entitled to something."

The hospital association's Emerson expects the decision at Sutter Roseville to have a significant effect on Medi-Cal patients in the Roseville area who need operations. "Especially for those who may or may not have access to transportation," she said. "They may also have to change doctors, because Sutter doctors don't necessarily have admitting privileges at Mercy or UC Davis."

Preventing other hospitals from following Sutter Roseville's dramatic move will require an infusion of money to bolster Medi-Cal and trigger a larger federal contribution for the program, said the state's Cava. He touted Gov. Arnold Schwarzenegger's stalled health care proposal as part of the solution. "The governor realizes we have to work with the hospitals and provide across-the-board increases in Medi-Cal reimbursement rates," he said.

The funding crunch in California, which ranks last in the nation in terms of its reimbursements to hospitals and doctors, has a ripple effect through the entire health care system, Emerson said. "Last year, hospitals statewide had $8.6 billion in uncompensated care and of that, $2.1 billion was directly related to Medi-Cal underfunding," she said. "When we are losing this much money, our premiums are going up because the state isn't paying its fair share."

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