Mass. Universal Care Faces Year-2 Reality

Post below lifted from Democracy Project. See the original for links

For those who like to believe there's a free lunch, the table at Massachusetts' universal health care scheme is being pared. For those states, like California considering a similar scheme the politicians say will cost $14 billion, on top of an already $14-$18 billion budget deficit, better look again. The Boston Globe reports on Massachusetts' changes for 2008: "The changes will probably cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay."

Costs of the Massachusetts universal scheme are, also, running 31% over expectations. In California terms, that could be an extra $4.3 billion. In addition,

The connector postponed until February a decision on the most controversial step that would save the state money: increasing copayments and other out-of-pocket costs for tens of thousands of patients with an income above the poverty level. Commonwealth Care members currently pay much less than those with private insurance to visit a doctor, get prescription drugs, or get hospital care.

The Massachusetts universal health care scheme is fulfilling expectations, of those who saw it as a fiscal and, even worse, patient care disaster in the making.





Babies dying due to NHS confusion

Scores of premature babies may be dying unnecessarily across England because the NHS mismanaged a reform of neonatal units in 2003, parliament's spending watchdog reveals today. Health ministers provided 73 million pounds over three years to link up hospital neonatal units in 23 regional networks that could provide specialist services to save premature and low birth weight babies. But the National Audit Office finds that the Department of Health did not issue instructions for the units to be adequately staffed. As a result the service was overstretched. Its specialist nursing workforce was nearly 10% below strength. There were not enough cots to respond to every emergency and there was a lack of specialist 24-hour transport to move babies and mothers to other hospitals.

Jacqui Smith, when health minister in 2003, said she agreed with recommendations from the British Association for Perinatal Medicine for minimum staffing ratios. But the government did not order NHS trusts to implement them. The NAO says there was "confusion" over whether staffing ratios were mandatory, making it difficult for unit managers to convince NHS trusts they needed more staff. Half the 180 units providing neonatal services did not meet the approved ratio for high dependency care of one nurse to two babies. And only 24% met the intensive care ratio of one nurse to one baby.

The NAO acknowledges that the 2003 reform improved standards, leading to fewer babies travelling long distances for suitable treatment. But the improvement was not as great as ministers anticipated. Every year about 60,000 newborn babies need specialist care - about 10% of all births. In 1975 half the premature babies with a low birth weight died and many were stillborn. By 1995 the proportion had fallen to one sixth. In 2003 ministers said the reorganisation could save an extra 200-300 lives a year, but by 2005 the mortality rate had fallen by only about 120.

Units had to close to new admissions on average about once a week in 2006-07, mainly due to a lack of cots or staff shortages, the NAO says. A third of the units had a cot occupancy rate of more than 70% - the maximum recommended to avoid harming babies through increased risk of infection or inadequate levels of care. Only half the units provided round-the-clock specialist transport services. Staff often had to leave the unit to accompany a baby on a transfer, leaving colleagues even more overstretched.

Hospital managers had little idea of the service's real costs. Intensive care cot charges varied from 173 pounds a day to 2,384.

The NAO says it found wide variations in the death rates of the networks, not all of which could be explained by the social characteristics of their catchment areas. In 2005, the south-west Midlands network had the highest death rate at 4.8 babies per 1,000 live births. Surrey and Sussex had the lowest at 1.8 per 1,000.

Karen Taylor, NAO director of value for money in health, said babies needing the most intensive care were the least likely to receive adequate service. "The organisation and provision of care is not satisfactory," she added. However parents were likely to express high levels of satisfaction and even those whose babies died were usually grateful for the efforts made by staff.

A spokeswoman for the premature baby charity Bliss said: "More babies are being born each year in England, and more are being admitted to neonatal units. The report has found there is no strategic plan in place to manage this increasing demand." Dr Sheila Shribman, the Department of Health's maternity tsar, said: "While the UK is one of the safest places to give birth, we recognise there is still more to do. We will be working closely with the NHS to look at these services in the light of the issues highlighted in the report."

Source