Sunday, July 05, 2009

British doctors punished over appointment times by patient survey

This is British bureaucracy at its most moronic. Doctors will just reduce the number of patients they see if this goes through. Britons will end up having as much trouble finding a doctor as they already do in finding a dentist. In Britain, an NHS doctor has a "list" and you have to be on his list to be treated by him. If this goes through, doctors will close their lists and, as the elderly who take most of a doctor's time drop off the list through death, he will soon have a smaller list and be able to see all of them promptly. Nobody wants to work for nothing, which is what the new system imposes. Socialist bureaucracy will be as destructive as usual.

People with no doctor will then flood hospital emergency rooms and then what will become of the bureaucratic "targets" there? Will 4 hour waits transmogrify into 4 day waits? Bureaucracy will have made the problem worse instead of better -- as usual. Another possibility is that doctors will spend less time with each patient, thus causing things to be missed and allowing problems to develop -- with the patient ending up severely ill in hospital when that could have been avoided. Once again the strain on the already overburdened hospitals will be increased

Family doctors will lose millions of pounds in funding because of complaints from patients over the waiting times for appointments. Most general practices around the country are expected to suffer losses — some as much as £25,000 — when the results of a survey are released today.

The GP Patient Survey, the first to financially penalise doctors who receive negative responses, is expected to cost practitioners more than £10 million and in the worst cases could force cutbacks such as staff redundancies.

The estimated cost to surgeries in Birmingham has been calculated at more than £1 million, while those in Northern Ireland and Wales are likely to lose similar sums. In Greater Manchester, about half of GP practices have been told they will lose up to £10,000.

The system, designed to encourage a better service from GPs, has been widely criticised for punishing some practices that need more help. Doctors have also raised concerns about being judged on a small number of responses and queried why just two of the survey’s 49 questions — concerning access to a GP in 48 hours and more advanced appointments — carried all the financial penalties.

In Scotland, where patient responses were processed last month, some practices serving more than 10,000 patients were hit with five-figure penalties as a result of the responses of only 50 patients.

Laurence Buckman, chairman of the British Medical Association’s GPs’ committee, said that the lengthy survey did not encourage responses, and a few negative patients could skew the perception of a good practice. This was particularly likely in inner-city areas, where high numbers of patients could not be bothered to respond. “Some practices are going to be very badly hit with huge amounts of money on the say-so of very small numbers of patients,” Dr Buckman said. “We know in England that there are going to be similar results as there were in Scotland. “If you reduce money, you are reducing the services, not improving them. Because of the way payment is geared you can only have the money taken away. We will be looking at thousands of practices that will be adversely, and in some cases, unfairly hit.”

Describing the survey’s flawed methodology, Dr Buckman said that most questions were angled negatively to seek out underperformers while none covered simple issues such as “how good is your doctor?” He said that the process “was so long that most people would just get worn out and give up”.

Practices that receive less than 60 per cent of positive responses to the two key questions would sacrifice all the money available as part of the Quality and Outcomes Framework, which pays doctors for achieving service targets. The BMA predicted an average-sized practice could face losses of £7,500, while larger lists could lose more than £10,000. Hundreds of practices are expected to appeal.

In Glasgow, 170 of 270 practices will appeal. GPs’ leaders in Scotland said that few practices had escaped losses entirely.

David Stout, the Primary Care Trust network director at the NHS Confederation, said that money taken from GP budgets would be reinvested by trusts in other services. He said that PCTs had discretionary powers to reduce the penalties if they felt that a practice had been treated unfairly.

“If it’s over-zealous then [the Government] will want to look at that in the cold light of day and if it needs to be re-examined it will.”

A Department of Health spokesman denied that the survey was flawed, adding that it had been agreed by stakeholders and would be an accurate reflection of patient perceptions.


Alice in Healthcareland

Most political and media discussions of medical care have an air of unreality reminiscent of Alice in Wonderland. There is an abundance of catch-phrases but remarkably few coherent arguments. Let's start at square one. Why is there alarm about American medical care? The most usual reason given is because its cost is high and rising.

That is certainly true. We were not spending nearly as much on high-tech medical procedures in the past because there were not nearly as many of them, and we were not spending anything at all on some of the new pharmaceutical drugs because they didn't exist. This general pattern is not peculiar to medical care. Cars didn't cost nearly as much in the past, when they didn't have air-conditioning, power steering and high-tech safety features. Homes were cheaper when they were smaller, had fewer bathrooms and lacked such conveniences as built-in microwave ovens.

We would like to have all these things without the rising costs that come with them. But only with medical care is such wishful thinking taken seriously, with government regarded as a sort of fairy godmother who will give us the benefits without the costs.

A cynic is said to be someone who knows the price of everything and the value of nothing. If so, then it is political cynicism to point to other countries that spend less on medical care, including some countries where there is "universal health care" provided "free" by their governments. Just as medical care, houses and cars were all cheaper when they lacked things that they have today, so medical care in other countries is cheaper when they lack many things that are more readily available in the United States.

There are more than four times as many Magnetic Resonance Imaging units (MRIs) per capita in the United States as in Britain or Canada, where there are government-run medical systems. There are more than twice as many CT scanners per capita in the United States as in Canada and more than four times as many per capita as in Britain. Is it surprising that such things cost money?

The cost of developing a new pharmaceutical drug is now about a billion dollars. Neither political rhetoric nor government bureaucracies will make those costs go away.

We can, of course, refuse to pay these and other medical costs, just as we can refuse to buy air-conditioned homes with built-in microwave ovens. But that just means we pay attention only to prices and not to the value of what we get for those prices. We can even refuse to pay for so many doctors. But that just means that we will have to wait longer to see a doctor— as people do in countries with government-run medical systems.

In Canada, 27 percent of the people who have surgery wait four months or more. In Britain, 38 percent wait that long. But only 5 percent of Americans wait that long for surgery. Surgery may well cost less in countries with government-run medical systems— if you count only the money cost, and not the time the patients have to endure the ailments that require surgery, or the fact that some conditions become worse, or even fatal, while waiting.

A recent report from the Fraser Institute in Canada shows that patients there wait an average of ten weeks to get an MRI, just to find out what is wrong with them. A lot of bad things can happen in 10 weeks, ranging from suffering to death.

Politicians may talk about "bringing down the cost of medical care," but they seldom even attempt to bring down the costs. What they bring down is the price— which is to say, they refuse to pay the costs. Anybody can refuse to pay any cost. But don't be surprised if you get less when you pay less. None of this is rocket science. But it does require us to stop and think before jumping on a bandwagon.

The great haste with which the latest government expansion into medical care is being rushed through Congress suggests that the politicians don't want us to stop and think. That makes sense, from their point of view, but not from ours.


Public medicine looks a lot like public school

With our son approaching school age, my wife and I are considering a variety of options: charter, private, homeschooling. Just about the only option not on the list, even though we're forced to pay for it anyway, are public schools. We're not only unimpressed with the results achieved by local public schools, but we also don't like their one-size-fits-all structure. As things stand, we're concerned that, a few years from now, we'll face a similar situation with health care, forcing us to pay for coverage that we don't want in addition to care that we actually choose.

That's the big problem with government-sponsored versions of anything. No matter the quality of the ultimate product, everybody has to pay for it, even if it doesn't suit their personal needs and preferences. Just imagine if dining out was a state-provided service. Given popular preferences, at best, we'd end up with reasonably decent steak and burger joints from sea to shining sea -- and that's it. Good luck to vegetarians and fanciers of exotic ethnic foods.

Of course, at worst, you'd be forced to pay for the food quality of a high school cafeteria mixed with the service you've come to love at the Department of Motor Vehicles.

That worst-case scenario came to pass in Canada, where the country's Supreme Court ruled in 2005 that the quality of medical care provided by the state system in Quebec was so terrible that the province's law against private health insurance couldn't be allowed to stand. While the ruling doesn't apply elsewhere, private -- and arguably illegal -- clinics are springing up around the country to provide care to people who'd rather pay for medicine twice than accept the government's prescription.

Private medicine is legal in the United Kingdom, where about 11.5% of Britons (up from 5% in 1980) carry private insurance in addition to the taxes they pay for the National Health Service. Government-provided dentistry is such a shambles that people have fled the system, and dentists now make more from private-pay patients than from the state system.

But if other country's medical systems have troubles, so does the American system. After all, The World Health Organization gave America's health care a miserable 37th-place ranking out of 191 countries, right?

Well ... not so much. Actually, when economist Glen Whitman looked at WHO's rankings, he concluded:
The WHO rankings depend crucially on a number of underlying assumptions—some of them logically incoherent, some characterized by substantial uncertainty, and some rooted in ideological beliefs and values that not everyone shares.

The analysts behind the WHO rankings express the hope that their framework "will lay the basis for a shift from ideological discourse on health policy to a more empirical one." Yet the WHO rankings themselves have a strong ideological component. They include factors that are arguably unrelated to actual health performance, some of which could even improve in response to worse health performance.

Basically, WHO front-loaded its ratings with criteria that guaranteed high rankings to tax-supported systems, and low rankings to systems where people pay for their own care. Said Whitman, "To use the existing WHO rankings to justify more government involvement in health care--such as via a single-payer health care system--is therefore to engage in circular reasoning because the rankings are designed in a manner that favors greater government involvement."

Plenty of people share WHO's biases -- many Canadians and Europeans are happy with what they get, and lots of Americans say they want the same thing. But plenty of people don't share WHO's biases. If you implement a state-sponsored health care system, everybody gets drafted into the one-size-fits-all scheme, without consideration for their personal preferences.

Actually, "draft" is the right word. Since state-supported schemes are supported by taxes picked from all our pockets, they're basically conscription with limited -- or expensive -- opportunities for conscientious objectors (and sayonara to voluntary alternatives). That's true of public schools, and it may soon be true of health care.

Right now, President Obama and his allies in Congress say they have no plans to displace private medicine, only to create a public plan that would compete with and "discipline" private insurers.

Right. What do you think would happen to Burger King if McDonald's not only ran its own restaurants, but also had the power to charge everybody for Big Macs whether they ate under the golden arches or not, and could regulate all fast-food joints? That's the sort of "discipline" you get from a government plan.

I expect that, in years to come, my wife and I will be looking at our options for escaping not just public education, but also public medicine. And, as it already is for Britons and Canadians, that choice will be expensive and limited by a government that doesn't put a lot of value on personal choice.


Obama healthcare poison pill

In his crusade to bring health care - one-sixth of the country's economy - under government control, President Obama is asking Americans to swallow a huge and potentially poisonous policy pill.

Just as many Canadian politicians and their families have, hypocritically, come to the U.S. when they prefer our advanced, private health care over their own socialized system, President Obama got caught last night in a "do as I say not as I do" moment. In a special broadcast on ABC, the president refused to pledge that he'd limit his own family to the tests and treatments that the general public would have to confine themselves to under his proposed health care "public option" restrictions.

Obama dismisses as "fear tactics" charges that his program amounts to "socialized medicine" similar to Canada, the United Kingdom and Sweden. Yet, ironically, Canada, the United Kingdom and Sweden are all beginning to open their socialized systems to private care due to citizen protests that critical treatments are delayed or denied. The past president of the Canadian Medical Association says that in Canada, "¦a dog can get a hip replaced in under a week but a human may wait two to three years."

None of this deters Obama from his insistence on government-run health care. And while he bases the need for reform on cost savings and universal coverage, the Congressional Budget Office recently estimated that Obamacare would increase the federal deficit by more than $1.6-trillion over ten years even while leaving 30 million people uninsured.

This week, Obama is leading a charge to use Democrats to ram through draft health reform legislation in the Senate, excluding Republican input. Obama's rush to pass health care reform by August 1 is the centerpiece of his plan to do a "community reorganization" of America by putting more of the private sector under government control and tying the middle class to government with the major entitlement of health insurance.

But according to Michael Cannon, writing in National Review, "there aren't enough Americans earning more than $250,000 to finance [Obamacare] reform would mean higher taxes for the middle class, violating another promise Obama made during the presidential campaign." Further, "if Congress used Medicare's payment rates and opened the new program to everyone, it could pull 120 million Americans out of private insurance more than half of the private market" and boost the government rolls by an even larger number. Two-thirds of Americans would depend on government for their health care, compared with just over one-quarter today. That would strike a historic blow against even the possibility of limited government."

The public's worries are growing about Obama's overreach. A new Washington Post-ABC News poll finds that "Most respondents are 'very concerned' that health-care reform would lead to higher costs, lower quality, fewer choices, a bigger deficit, diminished insurance coverage and more government bureaucracy." When those polled find out that government-funded health care could put many private insurers out of business because of an inability to compete with Uncle Sam, support for government control sinks to 37 percent.

Medicare and Medicaid illustrate the potential for Obamacare to bankrupt individual states en route to bankrupting the nation and transforming the country into a welfare continent like Europe. Medicare and Medicaid waste, fraud, mismanagement and runaway costs threaten the financial viability of many states, including California and New York. Just as with Obamacare, Medicare and Medicaid use ostensible cost controls mandated by Big Government. But the result has been that patients, hospitals, doctors, pharmaceutical companies and the government itself game the crazy incentives of the system to overuse and overprescribe medicine while stifling more cost efficiency and innovation in medical care.

Obama is selling his health care plan as a way to reform all that. But what he's not telling you is that the price you'll pay (when you're not paying it in higher taxes) includes rationing: of medical procedures, patient-doctor choices, and access to cutting edge new drug" which will all be restricted by government bureaucrats.

Contrary to Obama (and his echo chamber in the mainstream news media), there are alternative health care plans that can be emulated -- using the private economy. In the June 19 Wall Street Journal, Kimberly Strassel wrote about tens of thousands of Safeway employees enjoying quality, cost-effective health care in a program championed by CEO Steve Burd who "blew up the company's existing health care structure and replaced it with one that embodied market principles -- choice, responsibility, competition and price."

The FOX Forum and others, including the Center for Medicine in the Public Interest, are providing outlets for citizens to debate what kind of health care they prefer.

The antidote of public scrutiny is needed. Otherwise, Obama's health care poison pill could kill the private system that makes American medicine the world's best.


1 comment:

Hamster said...

Here's a Harris poll of what various people around the world think of their own healthcare system.
Americans have the worst opinion of their system

Canadians seem to like their healthcare system. Americans seem to hate theirs. The Dutch really liked theirs