Monday, December 31, 2007

Real competition would lower health care costs

Monday's mini missed the mark. The author insinuated that President Bush is the genesis of expensive health care. Did Bush flick his evil Republican wand, forcing prices higher? Hardly.

Neither are rising costs the products of a failure in the health care market. Rather, health care has ceased to be a free market -- it is expensive due to a lack of competition among providers. The lack of competition and high prices can be blamed solely on government intervention. If truly free market competition were allowed, the price of health care would certainly decline.

The average family of four spends about $26,000 each year for health insurance. Only around half is used for the family. The rest is taken in taxes to pay for government-run care for other people. In short, government -- not the market -- is the reason for the current health care prices.

It won't get better with universal health care. As P J O'Rourke said, "If you think health care is expensive now, wait until you see what it costs when it's free."

Families need choices. They barely have any now and surely won't under a universal health care scheme. They should have the ability to make decisions regarding their own health care without government's incessant meddling.


Deadly equality in British socialized medicine

People are not allowed to help themselves

In still yet another shuddering preview of health under Hillarycare or whatever form of socialized medicine that the mainly Democratic candidates promise to impose on us, Britain's National Health Service has issued this truly Orwellian/Kafkaesque decree.
A woman will be denied free National Health Service treatment for breast cancer if she seeks to improve her chances by paying privately for an additional drug. Colette Mills, a former nurse, has been told that if she attempts to top up her treatment privately, she will have to foot the entire 10,000 pounds bill for her drugs and care. The bizarre threat stems from the refusal by the government to let patients pay for additional drugs that are not prescribed on the NHS.

Huh? And what is the purpose of this truly potentially deadly NHS policy?
Ministers say it is unfair on patients who cannot afford such top-up drugs and that it will create a two-tier NHS. It is thought thousands of patients suffer as a result of the policy..... The Department of Health said: "Co-payments would risk creating a two-tier health service and be in direct contravention with the principles and values of the NHS."

So instead of a two tier system, good (private) and bad (public), only one system--bad--is allowed in England with no role model for improvement (private). Death, in the holy pursuit of equality, seems to be the goal.

Other solutions are up against equally twisted negative rationalizations. And beware the politician who oh so sincerely promises that a similar situation could not happen here. Oh yeah? Surrendering to government for free treatment means surrendering freedom.

Having many friends and relatives, alas, afflicted with breast cancer, this article, and previous ones on socialized health posted here, and here, and here touch me personally and deeply. While these friends and relatives are in various stages of treatment--and sadly, a few are gone--not one seems to have been denied a beneficial treatment. For some reason, Michael Moore's film, Sicko, a paean to socialized medicine, failed to mention cases like this. He didn't so we must.


Sunday, December 30, 2007

An amusing encounter

I recently had a long correspondence with Stuart Goss [], a community pharmacist in NJ. His emails consisted of a long wail about the unfairness of the U.S. health system. And no-one would deny that there are big problems with that system.

He appeared, however, to have given no thought to what the alternatives might be. He clearly thought that some sort of socialized system would automatically lead to nirvana. I reproached him about failing to consider the huge problems of ACTUAL socialized medicine systems overseas and said it was juvenile not to consider alternatives that took such problems into account.

Rather than transform our correspondence to an intelligent discussion of the alternatives, however, he not only said he wanted no further correspondence with me but also informed me that he had blocked my email address so that I COULD not email him any further.

With closed minds like that about, it is no wonder that the U.S. system has problems.

I actually think that the existing Australian system is not too bad. Mainly because both the hospitals and the insurers seem to bear a much lighter burden of red tape and regulation, private health insurance is affordable by even low income-earners in Australia. All health insurance is taken out by individuals in Australia rather than via employers and there is a Federal tax concession for low to middle income earners who do take out private insurance.

At the same time there is also a comprehensive network of "free" government hospitals that offer exactly the standard of service which you expect from any socialized system. The result is that cheapskates who don't insure and spend their money on beer and cigarettes instead go to public hospitals and get third-rate care -- as often detailed on this blog.

People who prioritize their health care by insuring, however -- nearly half of Australians -- get first-class care at Australia's huge range of private hospitals and facilities.

That all seems fair to me: "You pays your money and you takes your choice"

No ambulance: Australian woman in agony forced to take cab

Only tears saved her life -- and that was with the taxicab company. Nothing worked on the government ambulance service

MELBOURNE'S overloaded ambulance service has been forced to apologise to a woman it refused to help. Michelle Couling had her appendix removed in an emergency operation in hospital. But the 29-year-old almost didn't get there after being refused an ambulance when she called 000 for help. "I consider myself pretty lucky," she said. "It's difficult to think that they wouldn't believe me and they were going to try and diagnose me over the phone. "(My appendix) could have ruptured and I would have been here by myself without help."

Opposition health spokeswoman Helen Shardey said the health system's failings were now being exposed daily. "For this young woman, it put her life at risk," she said. "If we had enough ambulances on the road, paramedics wouldn't need to make medical assessments by phone."

Metropolitan Ambulance Service general manager operations Keith Young admitted an ambulance should have been sent. "The preliminary information is that it was human error," he said. Mr Young said it appeared checks built into the secondary triage system, which diverts about 26,000 low-priority calls a year to alternative services, had failed.

Mr Young said MAS had called Ms Couling to apologise and explain after being contacted by the Herald Sun. He said the matter was being investigated to ensure similar mistakes did not occur again. [So they always say]

Ms Couling was home alone when she fell ill about noon on Saturday, December 15. By 2am, she knew she was in trouble with sharp abdominal pain. She called her parents in Traralgon for advice. "They told me I needed to call an ambulance," she said.

Ms Couling rang 000 and was told an ambulance would be sent, but there would be a delay as ambulances were busy. She was told to call back if her pain got worse. "I hung up thinking someone was on the way so I rang my parents to reassure them that it was going to be OK." But 25 minutes later Ms Couling was in extreme pain and rang 000 back. After being put on hold for about four minutes, Ms Couling's call was transferred to a paramedic. "After a three or four minute conversation he said: 'We're actually not sending anyone out - it doesn't sound like it's an emergency to me, it sounds like you might have gastro'." The paramedic said Ms Couling should still see a doctor and suggested she get a lift or call a cab.

Not wanting to wake friends at 3am, she called a cab. "The lady said: 'Look, we're not an ambulance service - there's a delay here, too'." When Ms Couling broke down in tears, the call-taker relented. A taxi arrived about 10 minutes later and took her to the nearby Austin Hospital. Ms Couling needed three morphine doses and anti-nausea drugs to dull her pain. She was operated on at 12.30pm and is now recovering.

Ms Couling's father said the response to his daughter's call for help was "pretty ordinary". "It could have been life-threatening - they didn't know that at the time. "A system where you can ring up and get a diagnosis over the phone - I just think that's a joke." Health Minister Daniel Andrews said a doubling of MAS funding since 1999 had put 489 more paramedics and 56 extra ambulances on the road.


Saturday, December 29, 2007

Federal judge rules against S.F. on health care plan

A federal judge scaled back San Francisco's groundbreaking health insurance law Wednesday, overturning a requirement that employers cover their workers or pay a fee - the key to the city's plans to provide coverage to all 82,000 uninsured adult residents next week. U.S. District Judge Jeffrey White described San Francisco's goal as "laudable" but said its ordinance - the first of its kind in the nation, and a potential model for other California cities and the state - conflicted with a 1974 federal law that prohibits state and local governments from regulating employees' benefits.

The ruling, if it stands, will require the city to reduce plans to extend health coverage Jan. 2 to all uninsured residents who aren't already covered by the Medi-Cal program for the poor or by Medicare for the elderly.

Tangerine Brigham, director of the city's health benefits program, said Wednesday that if the employer fee was struck down, city officials would limit the expanded enrollment to residents who make no more than three times the federal poverty level, or about $32,000 a year for an individual. The employer fee would let the city extend coverage to all uninsured residents.

White's ruling could also impede other state and local efforts to cover the uninsured in the absence of a national law. A state health care bill endorsed by Gov. Arnold Schwarzenegger and approved by the Assembly would be partly funded by employer fees, subject to state voters' approval.

City Attorney Dennis Herrera said he would ask the Ninth U.S. Circuit Court of Appeals Thursday for an emergency stay that would allow the employer fee to take effect as scheduled Jan. 2 while the city appealed White's ruling. Without a stay, Herrera said, "tens of thousands of San Francisco residents and workers will be deprived of critically necessary health care services." Mayor Gavin Newsom said the program has enrolled more than 6,500 people and will be enlarged next week, even without the employer fee. "We will move forward with this innovative program," he said.

An official of a restaurant association that challenged the fee said the city should reconsider other ways to fund the program, such as a quarter-cent local sales tax, which would require voter approval. A general tax increase would spread the costs among businesses, residents and tourists and "would help fund the program in a legal and sustainable fashion without crushing small businesses," said Kevin Westlye, executive director of the Golden Gate Restaurant Association, which has more than 900 members.

The ordinance, enacted last year, established a $200 million-a-year program to care for the uninsured. More than three-quarters of the money was to come from city tax dollars and patient premiums, and the rest from the employer fee that was the subject of White's ruling. Private employers with at least 20 employees and nonprofits with at least 50 employees were to be given two choices: provide health coverage, at spending levels set by the ordinance, or pay a fee to support the city health program, which was budgeted at $200 million a year.

City lawyers, joined by a group of labor unions, argued that the city was not regulating employee benefits - which federal law forbids - but was simply making health care available to workers whose employers chose not to provide it. They said federal law allows a local government to require employers to share in health care costs as long as companies can comply without setting up new health plans.

But White said the ordinance would regulate employer health plans by requiring businesses to spend certain amounts on each employee - changing their existing, federally governed plans - or pay a fee. "By mandating employee health benefit structures and administration, those (spending) requirements interfere with preserving employer autonomy over whether and how to provide employee health coverage, and (with) ensuring uniform national regulation of such coverage," the judge said.

Deputy City Attorney Vincent Chhabria, who argued the case for the city, said White's ruling was extremely broad and would prohibit any state or local government from requiring employers to spend money for health care. The program, titled Healthy San Francisco, was the result of a collaboration between Newsom and Supervisor Tom Ammiano. It began in July at two clinics in Chinatown.

The program is currently available to people earning less than the federal poverty level, which is $10,210 a year for one person or about $20,650 for a family of four. On Jan. 2, it is due to expand to those making up to three times those amounts, a limit the city was forced to impose because of Wednesday's ruling. "What the ruling does is limit overall participation," said Brigham, the program director. "There are a lot of people who earn above 300 percent of the federal poverty level who are uninsured. ... Certainly we are disappointed."


Australia: Why private health insurance is a good idea

We see below part of the reason why nearly half of Australians have private health insurance despite the fact that they can allegedly get their healthcare "free" from government hospitals. The government health system could simply not have afforded many of these procedures and would have covered it up by putting you on an interminable waiting list. The high cost of cardiac procedures is probably the real reason why the Queensland government has recently closed down or curtailed cardiac units

A claim of more than $300,000 for neurosurgery to repair a complex aneurysm has topped the 10 most expensive benefits paid by Medibank Private in the past financial year, setting a record. The fund will release its "chart toppers" today, which climbed to $2.3 million for the top 10 across Australia, representing an annual increase of 8.3 per cent. The highest benefit paid, of $304,119, was on behalf of a 59-year-old person from NSW, up from the previous financial year's top benefit of $276,247 for a coronary artery bypass on a 59-year-old person.

It was followed by a 46-year-old Victorian - the youngest person on the list - who required removal of a tumour from their adrenal gland at a cost to the fund of $283,211. The oldest patient was 83 and needed cardiac surgery, costing the fund $230,876. Last year, the largest benefit paid was $276,247 for a coronary artery bypass. Five of the 10 claims were for heart-related procedures.

The fund paid $1.95 billion for hospital, medical and prosthesis benefits in 2006-07, representing 750,000 hospital admissions. The five most common overnight procedures claimed for were natural birth, at an average cost of $5234, followed by caesarean ($7601), rehabilitation ($8546), knee replacement ($19,065) and keyhole surgery for gall bladder removal ($5120). The five most common same-day procedures were colonoscopy, at an average cost of $1321, chemotherapy ($547), renal dialysis ($351), gastroscopy ($924) and cataracts ($3096).

Medibank's industry affairs manager, Craig Bosworth, said the "chart toppers" showed that medical care was increasingly expensive. "The odds are at some point in our lives we will need to go to hospital. The other certainty is that health care costs will continue to rise and, as the chart toppers list shows, can hit incredibly high levels," he said.

NSW patients were paid a total of $485 million for hospital, medical and prosthesis benefits. The top 10 claims in NSW totalled $1.73 million, the same as Victoria, compared with $1.25 million for Western Australia, $1.69 million for Queensland, $1.14 million for South Australia, $787,000 for Tasmania and $529,000 in the ACT. In the NSW top 10, four claims were for cardiac surgery, two were for aneurysm repair, two for stomach surgery, one for vascular surgery and another for a complex fractured thigh which ranked seventh with a benefit paid of $134,435.


Friday, December 28, 2007

Health care for all in California?

Governor Schwarzenegger's plan could prove too ambitious

The issue of universal health care looks set to become a key topic in the run up to next year's US presidential election. With Congress stalled on enacting a nationwide plan, individual states are starting to take matters into their own hands. In California, Governor Arnold Schwarzenegger has just won approval from legislators for a major health-care reform which will expand coverage to most of the state's uninsured.

It took nearly a year of sometimes fractious haggling, but legislators in America's most populous state have done what many predicted they could not. They have approved a bill to extend health insurance to virtually everyone in the nation's most populous state - all 36 million of them. True, the measure has still to be approved by the state Senate and ratified in a popular vote, but it is nonetheless a considerable achievement.

A jubilant Arnold Schwarzenegger emerged to hail the vote a "giant step forward". He believes the un-glamorously titled Health Care Security and Cost Reduction Act could eventually provide a template for the entire nation.

But ironically, the greatest opposition to his plan comes from members of his own party. Republican lawmakers point to California's $14bn deficit as evidence that the so-called Golden State cannot afford such an ambitious measure. Other opponents argue that it will lead to tax increases - from a governor who previously vowed not to raise taxes.

The governor's plan would require all Californians to obtain health insurance by 1 July 2010 - providing subsidies for those who would otherwise have struggled to pay the premiums. It would promote preventive care and also compel insurance companies to spend 85% of those premiums on patients...


Australia: Government hospital incompetence kills baby

MAREEBA'S model midwife maternity unit's reputation is being seriously questioned after the death of a baby that hospital staff have said "was likely to have been preventable". The death of the baby at the Mareeba Maternity Unit while a 19-year-old woman was in labour has been blamed on a culture of fear, lack of training and a breakdown in procedure by staff. The incident is being investigated by the Health Quality and Complaints Commission, after an internal investigation.

The Cairns Post has obtained copies of Queensland Health's internal reports and memorandums into the May 2007 death. It found the handling of the birth by staff may have "contributed to the baby not being born alive" and described the death as "likely to have been preventable".

The report is a damning assessment of the teenager's care. In it, the nurse unit manager reported that clinical decisions made throughout the episodes of care were a contributing factor and stated "something should have been done sooner". The report also cited an ill-defined model of care, a reluctance of non primary midwives to take responsibility and a lack of managerial leadership, collaboration and communication as a possible contributing factor to the death.

A source told The Cairns Post babies were dying and mothers were being damaged and placed at significant risk of dying with "full acknowledgement and support of Queensland Health management". The whistleblower said Queensland Health was ignoring the situation. "This unit is allowed to continue to function, despite significant safety concerns raised by the staff working at the Mareeba Maternity," they said. "There is a strong culture of bullying and harassment . midwives and other nursing staff who have raised concerns have not been supported or even listened to by management and have been bullied, encourage to leave, from the workplace. "There have been numerous cases of disasters or near disasters that have been brought to Queensland Health management attention with no interim safety measures put in place to protect this community and its mothers."

Cairns and Hinterland Health Service district manager Angela Beckett said a small number of complaints from staff about unsafe working practices formed part of the complaint made to the HQCC being investigated. "Regarding complaints of bullying and harassment, specialist staff from the Workforce Directorate and the Northern Area Health Service have been working with the staff of the Mareeba Maternity Unit to improve communication and relationships and to ensure that the culture within the unit is open and honest," she said. Mrs Beckett said an internal audit of clinical work practices at the maternity unit and the district found there were no concerns about patient safety. "If the district had any concerns about patient safety, the district would not have hesitated to close the unit down," she said.


Thursday, December 27, 2007

NHS told to return to the past

Nurses should take back responsibility for cooking and cleaning in hospitals instead of letting private contractors do the work, a medical expert says. Many doctors are afraid of being treated in their own hospitals, while a lack of support from the Government has left elderly patients at risk from hospital-acquired infections and malnourishment, according to academics writing in the British Journal of Hospital Medicine. Dame Betty Kershaw, the Emeritus Dean of Sheffield University School of Nursing and Midwifery, says that the NHS is offering an extremely poor service to older people in clinical settings and those being cared for in their homes. Recent attempts by ministers to lower rates of MRSA and Clostridium difficile infections through a “deep clean” of hospitals will not have any significant impact, she writes.

Dame Betty, a former president of the Royal College of Nursing, recommends giving responsibility back to nurses for tasks such as cleaning and catering. “We must return the power and control of nursing care to the ward sister (or the equivalent senior nursing post in the community) if we are to improve standards, address the serious loss of patients’ dignity and deal with the growing number of hospital-acquired infections,” she says. “The proposed ‘deep clean’ will be merely papering over the cracks. Cleaning staff need to be employed by the NHS, not contracted out.”

Gordon Brown announced the “deep clean” at the Labour Party conference, insisting that “a ward at a time, walls, ceilings, fittings and ventilation shafts, will be disinfected and scrubbed clean”. Health workers believe that the high volume of bed turnover in wards is a more serious issue. But the latest official report from the Department of Health suggests that dirty wards and high bed-occupancy rates no longer contribute significantly to the spread of MRSA.

Dame Betty is joining a debate prompted by Sir Roy Calne’ Emeritus Professor of Surgery at the University of Cambridge, who in a previous editorial for the journal declared that attitudes and standards in the NHS had changed so much that many doctors were afraid of being treated in their own hospitals. “As a consequence of bad treatment of nurses, the unions have become very strong and discipline has deteriorated, so that it is almost impossible to dismiss an unsafe nurse whose poor practice endangers patients,” he said.

Like Dame Betty, Sir Roy wants to see ward sisters in control of ancillary activity. He believes that a two-tier system of NHS treatment now exists, putting elderly patients at particular risk. He compared the high standards of flagship units with the “dismal” environment of geriatric wards, which were so dangerous they had become “a lottery for euthanasia from infection and malnourishment”.

The health workers’ union Unison says that the number of cleaners in the NHS has halved in the past 20 years. There have been concerns that hospitals are hiring the cheapest cleaning contracts and cutting corners. The standard of hospital food has also been recently criticised by the Healthcare Commission and the Royal College of Nursing.

Sir Roy said that boosting pay and morale among nurses would help to restore standards. “The shortage of nurses as a result of poor pay and perceived poor status has forced us to rely on the services of nurses from abroad, often from countries which can ill afford to lose their nurses,” he wrote.

Ministers argue that the increased focus on tackling hospital-acquired infections has contributed to a 27 per cent fall in the probability that a patient will acquire MRSA compared with 2001. But the Government is still expected to miss a three-year target to halve rates of MRSA by April.

A report published by the Department of Health concludes that high bed occupancy, greater use of temporary nursing staff and low cleanliness scores were correlated with higher MRSA rates up to 2003-04, but that in recent years these links have weakened to the point where they are not statistically significant. “One possibility is that trusts have become significantly better in recent years at understanding and meeting these challenges,” the report adds. Ann Keen, the Health Minister, said: “We have given the NHS comprehensive guidance on infection control and this report is consistent with our interventions and support beginning to bear fruit.”


Wednesday, December 26, 2007

NHS "Target" insanity

Targets intended to cut long waits in hospital Accident and Emergency [ER] units have cost the NHS in England 2 billion pounds over the past five years, an assessment of healthcare information has concluded.

The extra costs come from patients who are in danger of having to wait more than four hours in A&E – the target limit – and are admitted to hospital “just in case”. Many are later discharged the same day, suggesting they had no real need to be admitted, with today – Christmas Eve – having the highest proportion of patients sent out on the day of admission.

Primary care trusts have to pay as much as 1,000 pounds per admission, compared with about £100 for a patient treated in A&E. So the costs of admitting a patient – even for less than a day – are large. Data collected by the CHKS Group, an independent provider of healthcare information, suggest that over the past five years, about two million extra patients were admitted to hospital through A&E units in England. But in Scotland and Northern Ireland, which do not have the four-hour target, there has been no increase in admissions. In Wales, which implemented the target later, the rise was delayed, but began to appear in 2005.

Dr Paul Robinson, Head of Market Intelligence at CHKS, said: “There is no obvious clinical reason why growth in emergency admissions should differ between countries in the UK. However, the A&E target in England has clearly had an impact and potentially cost the taxpayer more than 2 billion. “It is only England that showed this increase, and it is difficult to see why other places did not, unless the A&E targets were the cause. “There are some other possible explanations, including changes to out-of-hours care, and NHS Direct. But a large proportion of the increase must be due to the target. It’s another example of how targets that are good in principle can have unexpected effects”.

The A&E target was introduced in the NHS Plan of 2000 and came fully into force in England at the end of 2004. It charges hospitals with ensuring that patients attending A&E departments should be admitted, transferred or discharged within four hours. A hospital is deemed to have met the target if 98 per cent of patients are dealt with within four hours. Studies have shown that the target causes a huge flurry of activity as the four-hour wait nears its end, with a substantial proportion of patients being dealt with in the last 20 minutes.

Between 2002 and 2006 emergency admissions to English hopsitals rose by 20 per cent, a total increase of 720,000 a year. Admissions through A&E accounted for 37 per cent of this increase. CHKS analysis of NHS data shows that more than a quarter of emergency admissions are discharged the same day. The majority of these are patients admitted through A&E. CHKS data shows that “same day” discharges after admission through A&E rose by 65 per cent between 2001 and 2005, when the target was being introduced in England.

Each week, Friday is the peak day for patients to be discharged on the same day they are admitted. But Christmas Eve is a Friday writ large. People prefer not to be admitted for Christmas and doctors prefer to keep them out of hospital, Dr Robinson said. But to discharge so many more on Christmas Eve – 8 to 10 per cent more than on an average day – implies a change in discharge criteria. One reason, he suggests, could be “poor medicine and rushing through the workload on the day” but there is no evidence for this in increased readmission rates. The numbers readmitted within 14 to 28 days are very similar to those discharged on any other day.

The increase in admission through A&E could have another explanation, apart from the four-hour target. To admit more patients is greatly in the financial interests of hospitals because under payment by results they get paid much more. Using the system in this way is called “gaming” within the NHS and is frowned upon. But trusts have been under such pressure to balance their books that some degree of gaming cannot be ruled out. Dr Robinson said: “There is the potential for that, but I wouldn’t see it as the main motivator.”

In a study published earlier this year by Cass Business School, City University, London, Les Mayhew and David Smith said that payment by results could have encouraged some trusts to “push patients through A&E even more quickly so benefiting from the higher inpatient tariff as compared to A&E tariffs. “The possibility of perverse incentives such as these was not the original aim behind the introduction of A&E targets, which were primarily a response to patients’ concerns, and may have encouraged the manipulation of data,” they said.


Tuesday, December 25, 2007

NHS patient data loss affects 168,000

The loss of patient records by the NHS affects 168,000 people, including at least 160,000 children, the Department of Health has said. Nine English NHS trusts have admitted losing confidential patient details in the latest public sector data lapse. The DoH says patients have been informed and there is no evidence data has fallen into the wrong hands.

The Tories condemned the government for its "failure to protect the personal information which we provide". It follows losses of millions of child benefit claimant and driver details.

The DoH confirmed that one of the breaches involved the loss of names and addresses of 160,000 children by City and Hackney Primary Care Trust, after a disc failed to arrive at its destination at St Leonards Hospital in east London. But it said the data had been encrypted to an "extremely high level of security".

A DoH spokesperson said: "We believe that an additional 8,000 patients in total may have been affected but even amongst these only a small proportion involves some clinical data, and there is no evidence that this has fallen into the wrong hands." It said investigations were under way and action would be taken against anyone who had failed to fulfil their responsibilities under data protection laws.

The other data trusts involved are Bolton Royal Hospital, Sutton and Merton PCT, Sefton Merseyside PCT, Mid-Essex Care Trust, and Norfolk and Norwich. The East and North Hertfordshire Trust reported a loss but has since found its missing data. A further disc, lost by Gloucester Partnership Foundation Trust, consisted of archive records relating to patients treated 40 years ago - none of whom is still alive. Maidstone and Tunbridge Wells NHS Trust has reported two breaches - meaning that 10 cases have occurred in total. The losses involved data stored on laptop computers and data sticks.

Roy Lilley, a former NHS trust chairman, said the losses were unacceptable: "The NHS has a very good encrypted secure system for sending data around the system and I can't see why sub-sets of data are being carted round on a memory stick." Mr Lansley said: "You have to wonder why on earth it took the Revenue and Customs to lose their discs and for government to institute an inquiry across government for these losses of data to come to light. "It does feel like there's a sense in government, all parts of government, that we're required to provide data and we are constantly told that it will be protected but in reality that level of protection simply isn't there."

Health minister Dawn Primarolo said: "What it is really important to stress is how important patient security and confidentiality is and how each of these trusts is moving to deal with this. "And given we have hundreds and hundreds of trusts I think that patients should be confident that their information is being held appropriately."

The DoH indicated the episode would not prevent the NHS's central computer database going ahead. A spokesperson said: "These breaches are in no way related to the National Programme for IT (NPfIT); indeed the NPfIT will help avoid such incidents, as it has particularly strong data protection rules and the highest standards of security control."

Police are still searching for two computer discs containing the names, addresses, dates of birth and bank account details of every child benefit claimant after it emerged they had been lost in the post by HM Revenue and Customs in November. Then on Monday it was revealed the details of three million learner drivers had also been lost after being sent to Iowa in America's mid-west.

Source Amusing that the BBC has changed this story since I downloaded it

Australia: Top public hospital doctors failed meningitis boy

They may have seen him but they did not look too hard

FOUR of the state's top doctors failed to give eight-year-old meningitis victim Isaraelu Pele the one test that could have saved his life. As a full investigation into Isaraelu's death was announced, the Children's Hospital at Westmead admitted the boy was not given a test for meningitis during his nine hours under its care. The revelation came as almost 300 mourners farewelled the talented rugby union player at a moving memorial service.

The Children's Hospital at Westmead CEO Tony Penna admitted four senior doctors failed to recognise the symptoms of meningitis that killed Isaraelu last Tuesday. He said the boy had been seen by "all the senior staff", including the resident registrar and consultant fellow, during his time at the hospital. But he revealed the battery of tests run on the Year 2 Punchbowl Public School student did not include a lumbar puncture - the one test that would have diagnosed his condition.

Less than 24 hours after doctors told Isaraelu's family he was merely dehydrated, the child was dead. [If he was dehydrated, he should have been put on a drip] Dr Penna announced a full investigation, headed by an external expert and with the input of Isaraelu's grief-stricken family, would be held. "This is a tragic event, we really do need to look into this objectively with a proper investigation," he said. "I stand by the competence and expertise of my staff." Dr Penna said it would be inefficient to test every child who presented at hospital for meningitis showing symptoms such as vomiting and headaches. The disease could progress rapidly from general symptoms to a serious condition, he said. All tests conducted on Isaraelu, including a blood count, came back normal.

But that was of little comfort to mourners who packed the Congregational Christian Church at Moorebank yesterday. In a moving tribute to his young brother, Andrew Pele, 19, joked that Isaraelu had been the favourite and that he was "a very good kid". Mourners included the schoolboy's parents Lila and Fai, who watched as Andrew played the guitar and was joined by other friends and relatives in a tribute song. Outside the chapel a family friend was scathing of the hospital staff, saying that, in his belief, if four senior doctors failed to even consider meningitis as a possibility "they should not be practising medicine".

"This is not a woman who came with her first newborn," the friend said. "She's a mother of six who knew something was really wrong with her child. The way this family has been treated is disgusting." Isaraelu's body was last night at the family's home where a vigil was held in his bedroom ahead of a funeral today.


Monday, December 24, 2007

Australia: Boy dies after repeated public hospital misdiagnosis

Ignoring grave symptoms and failing to do any tests is just incomprehensible. And what was wrong with giving precautionary antibiotics in such grave circumstances?

AN eight-year-old boy was sent home by two Sydney hospitals before dying of meningitis a week before Christmas. Isaraelu Pele, a year two student at Punchbowl Public School, was told by medical staff at Bankstown and Westmead Children's Hospital he needed only to take painkillers and drink lemonade, despite pleas for help from his family. Now, instead of watching him in his church's Christmas Eve musical tomorrow, his parents will bury the gentle young boy they call Elu.

He became the latest victim of the NSW hospital crisis after falling ill on December 13 and then being passed from one medical professional to the next without a correct diagnosis. When he first became ill, complaining of nausea, headaches and vomiting, his mother took him to Bankstown Medical Centre. "The doctor told us to give him Gatorade and he prescribed him anti-nausea medication," his mother, Fai Pele said. When her son was still sick last Saturday, suffering severe head and neck pain, Mrs Pele took him to their family general practitioner, who prescribed him Panamax.

On Sunday afternoon, the family were attending carols at Wiley Park when Elu started vomiting blood and Mr Pele immediately rushed him to Bankstown Hospital around 6pm. "He was vomiting in front of the van and the blood came up from his mouth," Mrs Pele said. Elu recorded a temperature of 39 degrees and was initially placed in a hospital bed for tests, but asked to vacate for another patient at 8pm. He lay on his mother's lap in the waiting room from 8pm until 11pm when doctors discharged him, telling Mrs Pele there was nothing wrong with her son.

"He was still complaining of neck and back pain, he couldn't keep his head up," Mrs Pele said. "We were sitting there from 8 to 11. They discharged us from the waiting area, they said to give him Panamax and lemonade." However, Elu's condition worsened overnight. He could not eat, continued to vomit blood and complained of extreme pain in his head and neck. He stopped being able to walk.

On Monday at 10am, his parents took him to Westmead Children's Hospital, where they remained for 12 hours. "His head was rolling around, he was vomiting blood, his fever was 38 degrees. he couldn't even look at us," Mrs Pele said. But at 10.30pm, doctors told Mrs Pele, who works as an aged-care nurse, to take her son home. "The registered nurse came up to me and said, 'You are free to go home'," Mrs Pele said. "They said they couldn't find anything wrong with him.

"Telling us to go home was not fair. He was still sick, he wasn't eating, it was really painful for us. "I said 'Look at him, he's still sick.' They tried to force him to walk and sit up, but he couldn't. He kept falling on me. They said give him Panamax."

On the following evening, Mrs Pele panicked when Elu's forehead grew cold while he was sleeping about 6pm. The family rushed him to Bankstown Hospital. Little Elu still had a pulse when he arrived at the hospital. However, about 40 minutes later, doctors told Mrs Pele her son had died. "The doctors came in and said, 'Your son is dead'," Mr Pele said. "They showed no respect for the family. They didn't even say it in a polite manner."

The family said a coroner had phoned them the next day to tell them Elu had died from meningitis, a serious illness that is curable if treated promptly. Elu lived with his five brothers and sisters, aged five to 19, at his family home in Bankstown.

Health Minister Reba Meagher said the child's death has been referred to the Coroner for investigation. "The death of a child at any time is extremely tragic and our thoughts and sympathies are with the child's family, particularly so close to Christmas," she said. Mrs Pele said she was considering legal action against the hospital. "I feel so angry, I want to sue them, It's the loss of my little boy," she said.


Mike Pechar has just agreed to blog occasionally here so that should increase the variety of the posts. Mike has just put up on his own blog a post about Huckabee that gave me a belly-laugh.

There is such a lot going on in the world of healthcare that I would probably be receptive if there were someone else with a libertarian/conservative perspective who wanted to become a co-blogger here too. I get about 150 hits a day here so that is far from top-line but still pretty good as blogs in general go

Sunday, December 23, 2007

‘World News’ Uses Scare Tactics to Push Socialized Medicine Agenda

Last week, ABC's "World News with Charles Gibson" made the case for socialized medicine when it suggested the VA hospital system is a successful example of government-run medicine. This time the December 20 "World News" played on the emotions of one of its core audiences - senior citizens. "Millions of older Americans are facing an important decision right now," anchor Charles Gibson said. "And some hard sell insurance agents see them as easy targets. Every December, seniors choose between Medicare or any of dozens of private plans that compete with the government. This year, almost 9 million opted for the private plans. And as ABC's David Muir reports, some now have serious regrets."

"World News" used one piece of anecdotal evidence where private insurance allegedly didn't work. A 76-year-old man from Chickasha, Okla., named Bobby Box ran up a $45,000 in medical bills but didn't realize his Medicare Advantage plan didn't cover some expenses when he signed up for it. Box told "World News" he was tricked. "He had Medicare but says an insurance agent told him he could do better and enrolled him in a private plan, a so-called Medicare Advantage Plan," Muir said. "Hundreds of companies now sell these plans to seniors, and sometimes these plans can work to their advantage. But the problem is in many cases, seniors are pushed to sign up, not realizing what they're getting, or as Bobby learned, what they're not getting."

But, at the end of the story it was revealed the plan had indeed covered his needs.

The story had no voice from private insurance providers, but did offer comment from Robert Hayes, president of the Medicare Rights Center - a non-profit organization that advocates expanding the role of Medicare and calls for more regulation in the Medicare private health plan marketplace. "There are millions of people who are being tricked," Hayes said.

As for the other side, the only offering was a small comment from Muir. "The insurance industry says it's cracking down on bad agents who give these plans a bad name," Muir said. "As for Bobby, he fought for months and got that hospital bill paid. He's now back on Medicare, where he believes he should have stayed in the first place."

This is the latest round of ABC favoring government health care over private options. On December 10-12, "World News" ran a three-part series about socialized medicine and even suggested the VA Hospital system was evidence government-ran health care works.


Saturday, December 22, 2007

Hillary slams health insurers

"How many of you know somebody who doesn't have health insurance?" White House hopeful Hillary Clinton asked a thousand cheering supporters at the downtown Hyatt Regency on Tuesday night. At least half of the hands went up. "How many of you have health insurance but you had to fight with the health insurance company to get it to pay for what you needed?" she asked. About a third of the hands went up. "When you really need it, they won't pay," Clinton said. "What point is it to have health insurance if you're diabetic if they won't cover diabetes?"

Despite her failure to solve the health insurance issue during her husband's presidency, Clinton said she is resolved to solve it as president. "We're going to tell the insurance companies that they're going to have to change the way they do business," Clinton said. "You know, we regulate banks. We regulate utilities. Well, we're going to regulate the insurance companies."


Comment by Jammie wearer

One of the many things socialists such as Clinton never seem to grasp is that you cannot force a company to provide a product/service against their will. Guess what the insurance companies will do the government starts telling them how to run their business? They will either raise their rates to pass on the extra costs or just will not write the coverage.

If you understand elementary economics, what Clinton is proposing doing here will shift the supply curve of health insurance inwards and thus reduce supply, not increase it. Reducing the supply of health coverage is the opposite of what she claims to want to do. Clinton also has been advertised as the smartest woman in the world, so you have to figure that she took Econ 101 along the way somewhere and should therefore understand the laws of supply and demand. So, what we have here is a situation where Hillary Clinton is either stupid or lying to you. It's one or the other.

Patients to beat NHS queues in EU plan for open health market

And the British government is fighting it. Can't have competition, can we?

Patients will find it easier to escape NHS queues and head across the Channel for treatment under an EU blueprint for European health tourism to be published tomorrow. It will guarantee that, in most cases, treatment within the European Union will be funded by the taxpayer. The move will open up competiton between the NHS and European health services and is being hailed as a big step towards an open market for public healthcare.

Until now, patients who have paid for more efficient treatment in France or Germany without securing prior funding approval have faced court battles to get the NHS to reimburse them. A draft of the EU directive on cross-border healthcare, seen by The Times, obliges the NHS to fund outpatient treatments in Europe, such as scans and minor operations, provided that the patient has been referred by a medical professional and is suffering delays. The EU wants the same system for major hospital procedures such as joint replacements and serious dental work. But Brussels will allow countries to refuse to fund such operations abroad if they can argue that domestic services will suffer as a result. Such opt-outs would be negotiated procedure by procedure.

Ministers are concerned that the changes could lead to too much cash flowing out of the NHS -- potentially a significant loss of control for Whitehall. The Government plans to fight the proposals as it tries to retain control of the purse strings. It does not expect a great influx of European patients to travel to British hospitals. [I wonder why?] Keith Pollard, director of Treatment Abroad, a British company that places patients overseas, said: "The whole idea is to make an open market for healthcare throughout the EU. The NHS faces the prospect of losing revenue to hospitals overseas.

"But to get the NHS to a position where it is providing the same level of healthcare available in many European countries, something needs to shake it up. Otherwise we will carry on with this healthcare system which we worship but does not deliver."

The draft directive states: "If the appropriate care for the patient's condition cannot be provided in their own country without undue delay, then they will be authorised to go abroad, and any additional costs of treatment will be covered by public funds."

The definition of "undue delay" is likely to be based on the assessment of a medical professional rather than a funding body. The directive was drawn up after several patients took the NHS to the European Court of Justice to try to recover the costs of treatments in the EU. This has left the refunding of treatment abroad governed by a confusing series of court rulings.

Yvonne Watts, 76, who went to France for a hip replacement in 2002, confirmed the right of patients to seek treatment abroad if they suffered undue delay in a legal battle decided by the European court last year. Her local health funder, Bedford Primary Care Trust, had refused to pay her 4,000 pound bill. Edwina Currie, the former Health Minister and spokeswoman for the Patients' Association, said: "This is not about individual countries giving up their health services to Brussels. This will affect a number of people like Mrs Watts who have had to wait too long for routine surgery."

Any patients seeking to come to Britain from EU countries would have to join the queue. NHS centres of excellence, such as Great Ormond Street Hospital for Children and the Royal Marsden cancer hospital, both in London, are seen as potential draws.

The Government plans to fight the proposals, however, to retain control over funding and, therefore, whether patients are allowed to travel. The Department of Health said: "We are committed to ensuring that the right legislative framework is developed which ensures that, where patients choose to travel abroad, the NHS retains the ability to decide what care it will fund to meet the clinical needs of people it looks after. What people want is good services close to home and that is what we are committed to providing."


Friday, December 21, 2007

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."


Thursday, December 20, 2007

Australian GP fights bureaucracy to get emergency help

A Queensland rural doctor, voted Australia's best GP for this year, was refused an emergency helicopter for a patient who suffered a heart attack. Dr Rachel Yarvey of Glenden, a mining town 180km west of Mackay, was 'told to ring around hospitals herself to find a bed for her patient on December 4 before the helicopter would be dispatched.

"It's just outrageous, an absolute disgrace ... that's not the doctor's job ... it could have been the difference between life and death," said Dr Harvey, 39. She said she spent about 35 minutes arguing on the telephone with Queensland Health and Queensland Ambulance Service. She then called a senior Queensland Health officer at Townsville Hospital and was again given the run-around but eventually got the helicopter and her cardiac patient was transferred to Mackay hospital and her life saved.

"It was all about politics - not patient care," she said. Dr Harvey said the first priority should be getting the patient to hospital before asking questions.

The article above is by Darrell Giles and appeared in the Brisbane "Sunday Mail" on December 16, 2007

"Haphazard" treatment at Australian public hospital leads to toddler's painful death

SYSTEMIC failures in the treatment of Ryan Saunders at the Rockhampton Base Hospital were likely to have contributed to the toddler's tragic death. The Courier-Mail has learnt an internal investigation by Queensland Health heavily criticised the hospital's haphazard approach to the two-year-old's care. It found necessary blood tests were not undertaken and Ryan should have been in intensive care but was sent to a ward because the unit lacked pediatric staff.

Ryan died after a harrowing and painful ordeal in Rockhampton when a Group A streptococcal infection went undetected and he developed toxic shock syndrome. The circumstances of Ryan's death, first revealed in The Courier-Mail last month, have outraged the community in his hometown of Emerald and horrified people throughout the state.

The findings, which were not released at the request of Ryan's family, have prompted a significant overhaul of procedures in every Queensland public hospital. The case also has been referred to the Health Quality and Complaints Commission for further investigation.

Health Minister Stephen Robertson met with Ryan's father Terry in Rockhampton yesterday to express his sympathies. "Terry Saunders is just one of the most decent people I have met in my life and for this to happen to his family, your heart goes out to them," Mr Robertson said. Mr Robertson said he felt an obligation on behalf of the family to prevent a repeat of the tragic circumstances. The Saunders family declined to comment.

Ryan, who would have celebrated his third birthday earlier this month, was originally thought to have died on September 26 from a twisted bowel. He was sent from Emerald Hospital to Rockhampton for an ultrasound but instead spent the night in severe pain in a ward bed. His infection was not discovered until 24 hours after Ryan arrived at Rockhampton but it was too late.

There have been 32 cases of Group A streptococcal infections in children aged under five years in Queensland over the past two years but it is unknown how many of these developed toxic shock. The team investigating the tragedy recommended more extensive blood tests for all children in Queensland hospitals and a review of Rockhampton's intensive care unit roster. It also called for the introduction of new observation rules for children and toxic shock education for pediatric staff at all hospitals.


Wednesday, December 19, 2007

100,000 patients on hold in South Australian government hospitals

MORE than 100,000 patients were not seen on time in the state's emergency departments last year, the latest Health Department figures show. Almost 18,000 more people sought emergency treatment last financial year compared to the year before, putting pressure on overloaded staff. Only about two in three people were seen within the ideal waiting times. While almost all patients requiring resuscitation were seen to immediately, emergency departments are still failing to meet targets for other urgent cases.

Health Minister John Hill said waiting times were improving despite the "enormous extra workload". "The most significant insight from these figures is that despite the massive increase in the number of people going to EDs, our hospitals are improving in terms of waiting times - not going backwards," he said. "But we know there is more work to do and that's why the Government launched SA's $2.2 billion Health Care Plan this year, designed to reform the health system and make it work better for patients and expand capacity at our hospitals."

Opposition health spokeswoman Michelle Lensink said the health care reforms were the "worst decision" the Government had made. "The fact they want to centralise everything into the new Marjorie Jackson-Nelson Hospital will make things much worse for people who live in areas like the west or the north-east because there's an increase in ambulance transit times," she said.

Mr Hill, who wrote to his federal counterpart, Nicola Roxon, yesterday with proposals to increase elective surgery numbers, said besides opening 250 beds and expanding emergency departments in the hospital system, the Government was working to keep people out of hospital through its GP Plus Health Care Centres and hospital at home programs. "Importantly people should be reassured that if they are suffering a life-threatening condition they will get immediate treatment in our hospitals," he said.


$2.5 million for unnecessary HIV treatments at Massachusetts university hospital

A jury awarded $2.5 million in damages Wednesday to a woman who received HIV treatments for almost nine years before discovering she never actually had the virus that causes AIDS. In her lawsuit against a doctor who treated her, Audrey Serrano said the powerful combination of drugs she took triggered a string of ailments, including depression, chronic fatigue, loss of weight and appetite and inflammation of the intestine.

Serrano, 45, said she cried after hearing the verdict in Worcester Superior Court and was gratified that the jury believed her. "I'm going to finish my school and I am going to continue to help others," Serrano said in a telephone interview from her Fitchburg home. "I am going to find another doctor that will help me."

Serrano's attorney, David Angueira, said Dr. Kwan Lai, who treated his client at the University of Massachusetts Medical Center in Worcester's HIV clinic, repeatedly failed to order definitive tests even after monitoring of Serrano's treatment did not show the presence of HIV in her blood. "It is one of the clearest cases of misdiagnosis that I have ever seen and it's based in part on a presumption that people who engage in certain types of conduct are more likely to have HIV and AIDS than other people without really listening to the patient," Angueira said after the verdict.

Lai testified last week that Serrano told her she had worked as a prostitute, her partner had AIDS, and that she had suffered three bouts of a type of pneumonia typically associated with those infected by the virus. Serrano has denied she had ever been a prostitute. She confirmed that her former boyfriend tested positive for HIV/AIDS, but disputed the claim that she told the doctor that she had suffered bouts of Pneumocystis pneumonia.

Lai's attorney, Joannie Gulliford Hoban, did not return a call for comment Wednesday night. Lai testified that she had no reason to question Serrano's original diagnosis at another clinic because Serrano convinced her she had HIV when she took her personal history, and her blood had abnormal amounts of cells used to fight infections. Hoban argued during the trial that Lai had provided standard care to Serrano.

"Audrey's case clearly demonstrates how inadequate that procedure was," Angueira said. He said his client "is responsible for changing thousands of lives in the future." The medical center, which was not named in the lawsuit, did not immediately return a message for comment Wednesday night. The institution has denied wrongdoing in the case. The jury reached its verdict after two days of deliberations, Serrano's attorney said. He said the damages could total about $3.7 million including prejudgment interest.

Serrano filed the lawsuit in 2003 after she became suspicious of her diagnosis and had herself tested at another hospital.


Tuesday, December 18, 2007

How Congress Is Killing Competition: The Future of Specialty Hospitals

Specialty hospitals provide the only real competition to traditional hospitals, and they offer a real opportunity to improve quality and cost control in the highly protective health care sector. However, Congress is once again considering measures to block or hinder specialty hospitals from effectively competing with traditional hospitals. During the current session of Congress, the House of Representatives has already included and enacted such restrictions in the Children's Health and Medicare Protection Act of 2007 (H.R. 3162). There is discussion of reviving these kinds of restrictions in draft Medicare legislation.

Under Section 651 of H.R. 3162, Congress would impose a permanent ban on physician referrals of Medicare patients to new specialty hospitals in which they have an ownership interest; require existing hospitals to limit physician ownership to 40 percent; and limit individual physician ownership to 2 percent. It would also prohibit the addition of new inpatient beds and operating rooms in existing specialty hospitals that get Medicare reimbursement. This policy would essentially kill any new specialty hospitals, including those under construction. Moreover, it would fundamentally change the way that existing specialty hospitals are managed.

This legislation, which is strongly supported by traditional hospitals, is the most recent in a series of attempts to terminate the growth of specialty hospitals. As Professor Regina Herzlinger, Nancy McPherson Professor of Business Administration at the Harvard Business School, has observed, this congressional attempt to suppress competition was not advanced in the interest of patient care: "... no one alleged that the specialty hospitals were bad for the consumers' health. No, instead, the general hospitals alleged that the specialty hospitals were bad for their health."[1]

Hospital Specialization

A specialty hospital is defined by the U.S. Government Accountability Office (GAO) as "a hospital in which two-thirds or more of its inpatient claims were in one or two major diagnosis categories, or two-thirds or more of its inpatient claims were for surgical diagnosis-related groups.[2]" There are currently more than 125 specialty hospitals in the U.S., focused on providing specialized services in cardiac, orthopedic, or general surgery. Specialty hospitals, which are predominately physician-owned, provide patients with a more consistent hospital experience due to their focus on a limited range of patient services.

Government Research Findings

Due to the rapid increase in the number of specialty hospitals, and accusations of unfair competition from traditional hospitals, Congress in 2003 commissioned a study on the impact of specialty hospitals on traditional hospitals. Congress assigned the Medicare Payment Advisory Commission (MedPAC)--a special federal panel that makes recommendations on Medicare payment to medical professionals and institutions--the task of examining the financial impact of specialty hospitals. Meanwhile, the Center for Medicare and Medicaid Services (CMS) was assigned to study the impact of specialty hospitals on the quality of patient care. During the18-month duration of these studies, Congress restricted any Medicare reimbursements to specialty hospitals established after November 18, 2003.

In the spring of 2005, both MedPAC and HHS reported their findings. The key revelations were as follows:

Specialty hospitals had no significant negative impact on the financial condition of traditional hospitals. The studies revealed no conclusive data showing any financial harm to traditional hospitals as a result of the operation of specialty hospitals; in particular, there was little impact on community hospital profitability during the time period studied.[3] Moreover, there was no difference in the ratio of more profitable, low-severity surgeries to less profitable, high-severity surgeries between the two hospital groups.

Specialty hospitals could promote innovation in patient care. MedPAC analystscited specialty hospitals as a possible and important competitive force to promote innovations in the health care field.[4]

Specialty hospitals provide predictable scheduling and patient care. CMS analysts determined that the specialty hospitals provide a more uniform set of services and have fewer competing pressures than community hospitals, leading to more predictable scheduling and patient care. Moreover, cardiac specialty hospitals had fewer complications and lower mortality rates than those at full service hospitals, although the duration of patient stays at these cardiac hospitals was not significantly different. Also, patient satisfaction was high at the specialty institutions.[5]

The Medicare reimbursement system needs to change. Medicare payments should be reevaluated to eliminate disparities and equalize payments to all inpatient hospitals. This would require an overhaul of the current system of diagnosis related groups (DRG), in which hospitals receive a predetermined amount per patient based on diagnosis. Under current arrangements, according to the researchers, the DRGs would encourage the cherry-picking of patients.

Since MedPAC recommended reimbursement reforms, CMS has initiated changes to the DRG system to reflect the severity of the patients' cases and the true cost of the hospital services.

Even though the results of a second set of government reports were consistent with the first, Congress is considering a permanent ban on new specialty hospitals, citing figures from the Congressional Budget Office (CBO) that indicate the ban will save the government $700 million over five years and $2.9 billion over 10 years.[6] However, these savings are based on the assumption of increased utilization of ambulatory surgery centers if specialty hospitals are restricted. Most of the traffic from specialty hospitals would likely go to traditional hospitals, rendering the estimates by the CBO significant overestimations.

Improving Patient Care

Specialty hospitals offer patients a viable option to obtain high-quality, reliable health care. They have consistent operations and results while incorporating desirable features that increase quality, such as a low patient-to-nurse ratio, high procedure volume, electronic physician ordering, and the latest medical equipment and technology. Compared to traditional hospitals, it is not surprising that specialty hospitals have higher patient satisfaction, lower mortality rates, and lower costs.[7] Some key findings on studies about specialty hospitals are listed below:

Specialty hospitals have higher rates of patient satisfaction. Numerous focus groups have compared patients' experiences in specialty versus traditional hospitals. Most panels conclude that patient satisfaction is very high in specialty hospitals. In an effort to continue to improve their performance, 92 percent of specialty hospitals tend to collect patient satisfaction data to improve the patient care experience.[8] Customer-based services, with routine patient feedback, will continue to drive innovation in these institutions.

Specialty hospitals have lower mortality rates. Risk-adjusted, 30-day mortality rates were significantly lower for specialty hospitals than for community hospitals.[9] This finding has been documented in both cardiac and orthopedic hospitals, including the report from the HHS commissioned by Congress.[10]The main force behind this notable achievement is that the streamlined procedures of specialty hospitals allow for shorter hospital stays, which decreases the chance of patients acquiring preventable, hospital-based infections.

Specialty hospitals have comparable costs to traditional hospitals. MedPAC reported that, currently, costs are not lower at specialty hospitals, despite fewer complications and shorter hospital stays. This discrepancy, however, is most likely due to the initially high, fixed costs of the specialty hospitals; with time, it is expected that "overhead costs may decrease from having operations performed in the specialty hospitals [rather] than in community hospitals."[11]

Specialty hospitals focus on a select number of services. Specialty hospitals focus on a smaller number of procedures, which tend to be the higher reimbursement procedures. Of course, this is also the best strategy for getting superior results in those types of procedures. Moreover, despite the assumption that specialty hospitals are solely focused on profits, recent research shows that "...specialty hospitals incurred a greater net community benefit burden than their not-for-profit competitors did."[12]

Physician referrals to specialty hospitals are not self-serving. The fear that physicians are mainly self-referring to specialty hospitals in which they have a part ownership is exaggerated. According to an analysis published in Health Affairs, a prominent health policy journal, there is "...little difference in referral patterns between owners and non-owners, which suggests that specialization of the hospital is potentially a primary issue, not ownership alone."[13] Moreover, those physicians who have less than a 1 percent share in a specialty hospital refer, at most, 10 percent of their patients to that specialty hospital; the referral rate, however, does increase as the percentage of ownership increases.[14]

Specialty hospitals have higher procedural volume. Specialty hospitals do have higher procedural volume than traditional hospitals for those procedures performed at specialty hospitals.[15] However, most of the studies draw inferences from utilization rates, which do not take into account the specific factors driving demand. According to one recent analysis, " with specialty POHs [physician owned hospitals] tend to be associated with lower expenditures, and general hospitals in markets with specialty POHs tend to be more efficient."[16]

The Right Policy

Congress should encourage competition and consumer choice in the health care system. Specialty hospitals have demonstrated that they can offer a higher quality, lower cost alternative to traditional hospitals. By imposing artificial statutory or regulatory restrictions on specialty hospitals, Congress is killing a catalyst for improvement and for bringing innovations to the health care sector.


Monday, December 17, 2007


A few years ago, the subscription-based Queensland ambulance service was taken over by the Leftist State government and made "free" to all. The resulting steep decline in standards of service accompanied by an explosion of bureaucracy was of course predictable. See three articles from just one day below. The first two articles below are by Darrell Giles and appeared in the Brisbane "Sunday Mail" on December 16, 2007

Ambulances "too busy" for heart attack victim

Family members say they have been let down by the Queensland Ambulance Service after paramedics did not arrive before their rugby league legend father died of a heart attack. John and Leanne Fleming, of Beaudesert, south of Brisbane, called Triple-0 after John Fleming Sr, 70, a former Kangaroos league manager, suffered a cardiac arrest late on Friday, December 7. No ambulances were available and firefighters were sent to his home instead. The fire crew gave oxygen and tried to resuscitate Mr Fleming Sr, but he died before paramedics arrived about 23 minutes after the initial emergency call. "It was such a long time ... he was gone before they got there," his son said yesterday. "The firemen, the ambu- lance officers, they were all great. But it was the system which was at fault. The system let us down."

It was at least the third such death in southeast Queensland this year. An exclusive Sunday Mail report in June revealed that a 28-year-old Sunshine Coast man died from a heart attack after firefighters had to go to an emergency call. Peter Crane, 76, died at his Bribie Island home in similar circumstances in February.

Mrs Leanne Fleming called Triple-0 at 11.54pm about her father-in-law. She was told the closest ambulance was about. 20km away. "When you call and ask for an ambulance you expect an ambulance, not the fire service," Mr Fleming said. "They said upfront they couldn't get there quickly." Mr Fleming said even when the paramedics arrived at 12.17am, they said they could only stay a matter of moments because they were so busy. "l don't know whether they could have saved his life, but he might have had a better chance," he said.

A QAS spokesman said "at the time of the call there was a high demand for ambulance services in the region".... The Department of Emergency Services has set a 10-minute benchmark for ambulances to arrive in life- threatening cases. Recent Queensland Ambulance Service figures showed paramedics met the mark in about 60 percent of cases - well below the 68 per cent expected by the Government [What about 100%?]. The latest death is likely to speed up the installation of defibrillators on fire appliances so crews can try to save the life of heart attack victims. It is planned to have hundreds of defibrillators on fire trucks next year.

Attempted ambulance service coverup

The Queensland Ambulance Service withheld a damning accident investigation report despite repeated attempts by a crash victim to obtain a copy under freedom of information laws. The QAS twice sent Keith Murr incomplete versions of the report -- although the paperwork had long been completed and placed the blame for the accident on an ambulance driver.

Mr Murr, 72, and his wife Yvonne, 68, were in their car when it was hit by an ambulance responding to an emergency in Toowoomba on March 17, 2005. Mrs Murr, who was driving, suffered severe head and upper body injuries and now has permanent impairment. The QAS initially blamed her for the crash but the ambulance driver was at fault -- he was found to have ignored the QAS driving code and went through a red light at a busy intersection on the wrong side of the road about 40 km/h too fast, according to the report.

The conclusion was missing from copies of the report sent to Mr Murr in 2006 and 2007. The truth finally emerged when he asked the State Ombudsman to investigate. The completed accident investigation report, obtained by the Ombudsman in October, said the ambulance officer failed to meet the requirements of QAS policy.

Mr Murr said the release of the report was too late, since they had not been properly compensated from personal injury claims and the officer could no longer be charged. "The crash was bad enough but the administrative nightmare and bureaucratic bungling which followed just added to our personal injuries," he said. He said it had been a frustrating process: "We are just trying to find the truth, trying to untangle it all. We will keep going until we do."

The department's executive manager of ethical standards, Craig Rosenthal, said in a letter it was "regrettable" the complete version was not released for the original FOI requests. The ambulance officer was placed on a one-year driving performance plan.

Amulance bureaucracy to be cut?

Believe it when you see it

PREMIER Anna Bligh has given the crisis-hit Queensland Ambulance Service a massive shake-up, with bureaucrats to be axed and more people sent to the front line. Ms Bligh, whose first decision when she took over from former premier Peter Beattie in September was to order an audit of the service, yesterday vowed to "cut the fat" and make emergency staff a priority. She promised 100 more paramedics would be employed as soon as possible, on top of the extra 250 ambulance officers already allocated in the June State Budget. Ms Bligh said non-essential services - such as some patient transfers and first-aid courses - would be scrapped, with the resulting $12 million savings redirected to the front line.

Details of the internal review - released exclusively to The Sunday Mail yesterday - revealed a top-heavy bureaucracy that had not used record funding properly. Ms Bligh said more than 100 senior public servants would be retrained, redeployed or lost through natural attrition. A tough-talking Premier said she wanted fewer "bums on seats" at QAS headquarters at Kedron in Brisbane and more paramedics out on the road saving lives. "We need the QAS to get back to the basics - less people at head office and more on the front line," Ms Bligh said.

She also signalled an end to QAS bosses taking numerous overseas and interstate trips at taxpayers' expense. A Sunday Mail report last month revealed Ambulance Commissioner Jim Higgins and his deputy Neil Kirby had enjoyed four years of jet-setting, costing the public more than $150,000. Ms Bligh dumped emergency services' then-director-general Fiona McKersie in September, and effectively put Mr Higgins on notice with the hard-hitting audit.

Mr Higgins was given an extra $50 million in June, taking his annual budget to $405 million. But announcing the audit, Ms Bligh questioned whether additional funds were flowing to front-line officers. There was also widespread public concern about where $450 million raised from the controversial ambulance levy had been spent. "I expect, with the added resources from the Budget and the audit, to see a much better performance," Ms Bligh said. She rejected a recommendation by the audit panel to abolish the levy and introduce a user-pays system. "Access to emergency services is a basic right, and I will not see Queenslanders priced out of getting an ambulance," she said. She was concerned that Queensland spent more per person on ambulance services than any other state - $81.50 annually, compared to a national average of $68.75.

The audit found the QAS corporate support staff of 453 was double the number of the next highest state, New South Wales, which had the largest ambulance service in Australia. It recommended more than 100 head office positions be slashed.

Private and community groups would be used to provide first aid training. Ms Bligh said fines of up to $3750 would be implemented to clamp down on "shocking waste" caused by nuisance calls. "One in six Triple-0 call-outs for emergencies don't even result in a patient having to be taken to hospital," she said. "Our paramedics are working their guts out, and it's plain to see why they are getting frustrated. "Queenslanders have to realise that ambulances are a last-resort emergency transport. We call on the ambos 30 per cent more than the national average, and demand for emergency call-outs is increasing at six times the rate of population growth. "Under the present system, paramedics in a fully-equipped ambulance can respond to an emergency call only to find out someone has a minor cut they are quite capable of treating, but they are often required to take them to hospital."

Emergency Services Minister Neil Roberts said staff, union and ambulance committees would be consulted on potential savings: "There will be no forced redundancies in achieving these savings. Staff will be redeployed, retrained or lost through natural attrition." The besieged Minister said $4.3 million would be redirected from non-essential services and $7.9 million saved through cuts in bureaucracy and discretionary spending such as supplies, service, travel and consultants.

The audit revealed there were "no signs of improvement" in ambulances getting to life-threatening emergencies in under 10 minutes. It said the QAS had the highest level of absenteeism and sick leave in the Queensland public sector, and one of the worst rates of staff retention.


Sunday, December 16, 2007

Australia: More high quality government medical care

A BLEEDING pregnant woman was twice told by a doctor in a Sydney hospital that her baby was healthy when the fetus had been dead for a month. It is the second botched handling of a miscarriage to rock the NSW hospital system after a woman miscarried in a toilet at Royal North Shore Hospital earlier this year, prompting a parliamentary inquiry.

In the latest case, Amy Bennett was rushed to Campbelltown Hospital in Sydney's southwest on Sunday after she started bleeding. Ms Bennett told Network Ten a doctor at the hospital had told her in heavily accented English that the bleeding was normal before sending her home. She said she returned to the hospital the next day when the bleeding worsened, but the same doctor diagnosed dehydration and sent her home again. "I woke up the next morning, there was blood everywhere," a distraught Ms Bennett said. "I didn't want to go back to Campbelltown Hospital and have them tell me nothing was wrong when I knew something was wrong. "I've never miscarried before, how was I meant to know?"

Ms Bennett instead went to her GP, who immediately diagnosed a miscarriage. Scans later revealed the baby had been dead for a month. Sydney South West Area Health Service said it had reviewed Ms Bennett's records and found no evidence of inappropriate treatment. [???!!!!]


Are U.S. Health Care Costs 'Too High'?

By Steven M. Warshawsky

In 2005, Americans spent roughly $2 trillion on health care, or an average of $6,700 per person. This amounted to 16 percent of the gross domestic product. In other words, nearly one-sixth of the total output of goods and services produced by our economy in 2005 was devoted to health care (including both public and private expenditures). Many analysts expect total spending on health care to rise to $4 trillion and 20 percent of GDP by 2015.

The question is: Is this a good thing, a bad thing, or just a fact of life in an advanced technological society with an aging population? The answer is that it is all three.

On the one hand, high levels of health care spending is a good thing because it means that millions of Americans are receiving the highest quality medical care that is available anywhere in the world. Compared to citizens of other western countries, the average American has more access to the best doctors, the best facilities, the best medicines, and the best diagnostic and treatment technologies. This is why people from Canada and Britain and Europe, indeed from all over the world, come to the United States to obtain needed medical care that is not available to them in their home countries. This even includes Canadian mothers who are sent to the United States to give birth because their local public hospitals lack bed space and the ability to handle high-risk pregnancies. So much for the alleged superiority of "single-payer" health care systems.

Yet the highest quality medical care in the world comes at a steep price. This price has nothing to do with "greedy" doctors, HMOs, and drug companies. Rather, as with any other good or service, the price of medical care fundamentally is determined by the value of the resources required to produce it. And the resources required to produce, say, a world-class cardiologist or orthopedic surgeon or oncologist are extremely valuable.

For starters, only the smartest people in our society (roughly the top 10 percent) have the innate ability to become competent, modern doctors. Then these people must go through 10 to 15 years (post-high school) of very demanding, and very expensive, education and training. Then they must be equipped with the most advanced tools and drugs and machines, all of which cost many more millions (sometimes billions) of dollars to develop and produce. Only at this point can these doctors start providing us with the high-quality medical care that we expect in this country.

To expect that this medical care can come cheap is to indulge in wishful thinking. Such wishful thinking lies at the heart of the health care plans being offered by the leading Democratic presidential candidates. They all claim to be able to provide more Americans with better health care at a lower cost. For example, according to Hillary Clinton, her plan "covers all Americans and improves health care by lowering costs and improving quality." John Edwards likewise promises "universal health care reform that covers everyone, cuts costs, and provides better care." Barack Obama at least acknowledges that "the best medical technology and scientific research in the world" come at a heavy price, but he too believes it is possible to provide "affordable, comprehensive, and portable health coverage for all Americans."

This is pure fantasy. True, we can provide more Americans with lower cost health care -- by reducing the quality of the health care they receive. For example, by prescribing trusses for hernias instead of repairing them surgically, as often happens in Britain. Or we can provide more Americans with higher-quality health care -- by increasing the total amount of health care spending. But we cannot provide every American with the best medical care money can buy, while at the same time reducing the amount of our gross domestic product devoted to health care. This is an economic impossibility.

But what about the argument -- which has become commonplace in public policy circles since the days of Hillarycare -- that the main reason health care costs are so high in this country is because we pay for our medical care through third-party payment plans, i.e., insurance (both public and private)? Washington Post and Newsweek columnist Robert Samuelson makes this argument in his most recent column.

The gist of this argument is that if consumers had to pay more for their health care out-of-pocket, instead of through insurance, they would make wiser and more efficient health care decisions. For example, if a doctor's visit cost $100, instead of only a $10 co-pay, consumers would be less likely to go to the doctor for minor illnesses and injuries, like common colds and sprained ankles, and instead would save their visits for more serious conditions. However, as Samuelson argues, because "[m]ost Americans think that someone else pays for their care," they have no incentive to "control spending." Although Samuelson does not say so explicitly, what he and others who subscribe to this argument really are saying is that health care costs are so high in this country because Americans use too much health care.

But what does "too much" mean in this context? And who is to decide how much is enough? Certainly, if Americans were to consume less and lower-quality health care, total health care spending would decrease. This is precisely why health care spending in countries like Canada and Britain is lower than in the United States. Their citizens are provided by their governments with less and lower-quality health care than the vast majority of Americans currently enjoy under our mixed system. If we adopt one of the health care plans being peddled by the Democrats, in the future Americans, too, will consume less and lower-quality health care. This may reduce the portion of our gross domestic product that is devoted to health care, but will this make us better off, individually and as a nation? For some Americans, yes. Overall, no.

Moreover, there is a hidden fallacy in Samuelson's analysis. The problem with health care spending is not the reliance on insurance arrangements, per se. In a free market, insurance arrangements are economically efficient. Insurance works by pooling resources and rationally distributing risks and costs among large numbers of people. This enables more people to enjoy the benefits of various goods and services at a lower cost per person. Indeed, insurance arrangements are a vital feature of any modern commercial economy.

Importantly, the critical feature that underlies the economic efficiency of insurance arrangements is that individual premiums are based on each consumer's risk-cost profile. That is, riskier consumers, i.e., those who are more likely to need the insurance, must pay a higher price for their coverage. For example, people who have speeding tickets are charged more for car insurance than those who have clean driving records. Similarly, consumers who want a larger amount of coverage must pay a higher price. For example, people who drive Cadillacs are charged more for collision coverage than people who drive Hyundais. Where insurance companies are allowed to charge each consumer a premium commensurate with the consumer's level of risk and amount of coverage desired, then insurance arrangements are economically efficient. This also comports with our basic moral intuition that people who need or want more coverage should pay for it.

There is no question that the American health care market is inefficient. But this inefficiency does not stem from the use of third-party payment plans. Rather, it is the inevitable result of government tax-and-spend programs and regulatory mandates that interfere with the free market by eliminating the vital link between insurance premiums and each consumer's risk-cost profile.

Consider Medicare and Medicaid, which in 2005 had combined expenditures of approximately $500 billion. Significantly, the premiums for these programs are not based on a rational assessment of each beneficiary's risk-cost profile. Instead, these programs require only small co-pays based on income level. Moreover, these payments do not come close to paying the full cost of the medical care provided. On the contrary, the cost of this medical care is primarily paid for by payroll taxes and income taxes on all Americans. In other words, Medicare and Medicaid are not insurance arrangements in the correct sense of the term. They are entitlement programs. And like all entitlement programs, they are woefully inefficient.

What about private health insurance? Here, too, government regulations have transformed these policies into pseudo-entitlements by mandating that employers and insurance companies provide a panoply of benefits without taking into account each consumer's risk-cost profile. Not surprisingly, such mandated benefits are a key component of the health care plans being offered by the Democratic candidates. For example, Hillary's health care plan prohibits insurance companies from charging "excessive insurance company premiums" and denying coverage to any person based on pre-existing conditions. Obama's plan requires insurance companies "to provide comprehensive benefits, issue every applicant a policy, and charge fair and stable premiums." And Edwards' plan requires insurance companies "to keep plans open to everyone and charge fair premiums, regardless of preexisting conditions, medical history, age, job, and other characteristics."

In other words, under the Democratic plans, insurance companies will be strictly limited in their ability to calculate premiums based on the nature of the risks and costs to be covered for each consumer. As is already happening, this will raise the cost of insurance, unjustly shift costs from some consumers to others (by requiring consumers with more favorable risk-cost profiles to subsidize the premiums of those with less favorable risk-cost profiles), and create an increasingly untenable situation for all but the largest and most diversified insurance companies.

The bottom line is that there is only one truly efficient solution to the high cost of health care in this country: expanding the free market by eliminating mandates and phasing out entitlement programs. Socialized medicine is not the answer. Either it will lead to even more health care spending, and therefore higher taxes, because the government will mandate that all Americans receive top quality medical care; or it will lead to shortages, rationing, and lower-quality medical care for most Americans, as a way to reduce total spending. Neither scenario is desirable. Indeed, the first scenario inevitably will lead to the second. Plus, unless the government tyrannically prohibits wealthier citizens from paying separately for private medical care - effectively eliminating property rights - we still will have a mixed system that inefficiently adds to total costs.

Under greater free market conditions, Americans will be required to pay more individually for the health care they receive. Whether these payments are made out-of-pocket or through rationally priced insurance premiums, this will create the financial incentives to control spending that Samuelson stresses in his article. Yes, this also will mean that many Americans will not be able to afford the same level of health care that they currently enjoy as a result of government subsidies. However, the moral and financial responsibility for providing medical care should rest with each individual citizen and his or her family, not the business community or general public. Where an individual's resources are not enough, private charity, not the government's taxing authority, should fill the gap.

Nevertheless, even in a free market, total health care spending in this country still will be very high. As noted previously, high-quality health care is extremely expensive, and Americans have enormous demand for the best medical care money can buy. There is nothing inherently "bad" about this. The United States is an extremely rich country, and we have enough wealth to expend a large percentage of our gross domestic product on health care, while still providing for our other vital needs, e.g., national defense.

However, we do not have enough money for the government to "promise" every American, regardless of age or condition, that he or she will receive the best available medical care. We are not that rich, and never will be.