Friday, September 18, 2009

Lucky Brits: The government is at long last thinking of giving them a choice of doctor

Patients will be able to register with a GP anywhere in the country in a radical move to abolish restrictive catchment areas, Andy Burnham, the Health Secretary, will announce. GP practices often run very tight boundaries and refuse to take patients who live even 100 yards too far away or on the wrong side of the road and people who move house are forced to change their surgery. But within the next year patients will be able to choose to remain with a favoured doctor when they move house or register with one near work or school if they choose.

Under new plans to be announced in a keynote speech in London Mr Burnham will say GPs will not be able to refuse to take patients because they live too far away. The changes aim to drive up quality of care by prompting more competition between doctors to attract patients with the most successful practices being able to expand. Meanwhile patients will have more choice and control over their own healthcare.

The idea was proposed in the review of the NHS led by Sir Ara Darzi, a surgeon and until recently a junior health minister. It is envisaged that most patients will still want to register with a GP near home for convenience, especially those with long-term illnesses, but some will want to see a doctor near work or family and others may want to remain with a favoured family doctor even when they move house.

Mr Burnham will say: "In this day and age I can see no reason why patients should not be able to choose the GP practice they want. "Many of us lead hectic lives and health services should be there to make things easier. A busy mum needs flexibility – she may want to register at a practice near her children’s school. "Equally, a commuter may want to register near to work. I want to them to be able to do this whilst ensuring that access to home visits won't be affected, wherever someone ends up registering."

The details are still being finalised but it is thought patients who want to register with a surgery a long way from their home may have to accept some services such as home visits are not practical.

A large proportion of practice income is based on the number of patients on its list so funding will increase with the number of patients but new patients are worth less to surgeries than existing ones. Some popular surgeries will be unable to expand for logistical reasons and will have to close their lists to new patients.

In his first major speech as Health Secretary, Mr Burnham will set out his vision for the future of the health service at the King's Fund think tank, saying although it is now unrecognisable from the "poor state it was in 12 years ago" more reform is needed to ensure patients have greater choice and improved quality of care.

As well as changes to primary care, Mr Burnham wants to see hospital trusts rewarded for providing good care and penalised financially for poor treatment. Trusts that provide a high quality patient experience from the way patients are spoken to by NHS staff, to clinical quality, to compassion and respect will be reflected in payments made for treatment. But it means that budgets will suffer at hospitals that receive low ratings and where patients report poor care.

Mr Burnham will add: "In the last decade, the NHS has gone from poor to good. In the next, I want to help it go from good to great. "That will mean a relentless focus on quality and people-centred care. I also want to use financial incentives to change the way care is provided – for example it can often be cost effective and better quality to provide dialysis or chemotherapy in people's homes."

Dr Laurence Buckman, chairman of the General Practice Committee at the British Medical Association said GPs will support the moves but added that the law, the National Health Service Act, will have to be changed to allow the people to have a GP who would not be able to visit them at home. He said: “The idea of getting rid of practice boundaries altogether has been discussed many times in the past, and we are happy to discuss it again. “However, major logistical barriers would need to be overcome. “Home visits with a GP a long way away would become difficult, and costly for the NHS to fund. “Practices in rural and suburban areas could lose significant numbers of young, healthy, patients, destabilising their funding and threatening their viability. "Meanwhile, city centre practices would be inundated with requests for appointments at lunchtime and evenings, which would effectively limit patient choice."

He said other services like district nursing still have defined boundaries. “These problems are not insurmountable but will need a lot of careful thinking if they are to be solved,” he said.

The plans were welcomed by patients groups but there was a call for more information to help patients choose their surgery more effectively. A spokesman for the Patients Association said: "This idea was proposed years ago so we need a clear timetable for introduction-it can't fall by the wayside again. "Action speaks louder than words. Patients do not have easy access to meaningful information so choice at the moment is relatively meaningless as it focuses on things like convenience and location. "We welcome the proposal but there needs to be real progress on information to support genuine patient choice."

Andrew Lansley, the shadow health secretary, said the Tories have already announced similar plans. He said: “We’ve always argued that it was ludicrous for the Government to talk about giving people a choice of GP when they restricted that choice based on their postcode. That is why we announced plans to abolish practice boundaries two years ago. “So this is a step in the right direction, but just a small one. It is only a small part of the much bigger package of reform that we need to make to our system of family doctors.

"We need to remove the perverse disincentives that currently exist which dissuade doctors from taking on new patients. We also need to give GPs much greater responsibility for managing their patients’ care when they refer them on for hospital treatment, including control of the money that funds that treatment."

Norman Lamb, the Liberal Democrat health spokesman, also supported the changes. He said: "The current system breeds complacency, there isn't any effective competition which can potentially drive up standards and ultimately it gives the patient no choice. "There is a certain reality that in rural areas, in particular, the extent to which patients have a real choice is inevitably limited by geography, for the elderly especially and there are limits on how far you can expect GPS to go on home visits. "But in general it must be right that individuals should be able to choose which practice they want to register with and the money should follow the patient."


That compassionate, sensitive British socialist system again

'I only wanted to change the appointment': Dementia patient's wife asked to see doctor nearer home ... hospital wrote back asking for his brain for research

The wife of a television comedy writer now suffering from dementia was shocked to receive a letter from his consultant asking if they'd donate his brain for research after he died. Mike Craig, who worked with the likes of Morecambe and Wise and Ken Dodd during a long showbusiness career, needs to be looked after around the clock after developing a rare condition called Pick's disease.

But when the 74-year-old's devoted wife Susan called the hospital he attends to say he was too ill to travel there, she was shocked to receive a reply asking her to consider brain donation.

Yesterday she said that while she understood the need to carry out research on sufferers' brains, the letter was deeply insensitive as all she had wanted to do was find a doctor closer to their home.

Mr Craig worked as a producer or writer on more than 1,000 classic episodes, helping to script such much-loved moments as Angela Rippon's 1976 appearance with Morecambe and Wise. He also worked with Des O'Connor and Roy Castle and went on to become a popular after-dinner speaker, making appearances on cruise ships talking about his experiences in the 'golden age of comedy'.

However around seven years ago his family became worried that his behaviour was becoming rambling and obsessive. He was eventually diagnosed with Pick's disease, a rare and terminal form of dementia which initially targets the personality more than the memory. There is no medical treatment available, and Mr Craig has to be watched around the clock by his wife as he his liable to turn the gas on or leave taps running.

He continued making once-a-year trips to a consultant at the brain unit at Salford Royal Hospital, six miles from his home in Timperley, Greater Manchester. But when his wife was notified of an appointment there next January, she rang to say he had deteriorated and was too ill to travel there. However she was shocked to receive a letter which said they had changed hospital records to note that he 'will no longer be coming here' in future.

The consultant went on: 'Having perused Mr Craig's notes I don't think that we ever discussed the brain donation research programme with you and your family. 'I wonder whether it would be in order for us to contact you to discuss this issue?'

Yesterday Mrs Craig said she was horrified to have the question of donation raised so baldly and without any offer of alternative medical support or monitoring. 'I am all for research and I would be happy to discuss tissue donation with Mike's children because I would support anything which might help find a treatment for this awful disease, but I was shocked to get this letter,' she said. 'I thought the doctors might make alternative arrangements to see Mike. We were surprised they would write to us about tissue donation rather than speaking about it in person or on the phone. 'I would have thought if they want him to be part of a research study it would be important for them to see him regularly, to chart how the condition affects him.'

Last night the hospital apologised, saying the letter had been sent by mistake and that the sensitive issue of brain tissue donation always ought to be raised face-to-face. A spokeswoman said: 'We are very sorry to have caused Mrs Craig any distress through our recent communication, we acknowledge that this was insensitive and we would like to offer assurance that this will never happen again.'

Medical campaigners say new guidelines are needed on how to encourage the families of people with dementia and similar conditions to agree to donate their brains after their death without making the trauma they face even worse.


Australia: Incredible NSW hospitals bureaucracy again

More than 130 doctors at one of the state's most dilapidated hospitals have threatened to walk off the job after being told the Health Department is impotent to change their ''slum-like conditions'' but is demanding they slash up to $9 million from their budget and cull staff.

Doctors at Hornsby Ku-ring-gai Hospital went public in the Herald last month, upset that wards were stained with possum urine, dangerous cabling snaked across floors and operating theatres were too small for modern equipment and lacked emergency arrest buttons, putting staff and patients at risk. Possums had also been found living among open boxes of medical supplies in the intensive care unit.

But, after a visit by the then health minister John Della Bosca, hospital management was this week told to slash up to $9 million from its budget, lose 23 staff and close a ward. Doctors had planned to discuss the proposed cuts with the chief of the Northern Sydney Area Health Service, Matthew Daly, yesterday but the meeting was cancelled at short notice, leaving staff fearing they have been sidelined.

''Is this punishment for bringing the Hornsby debacle to the public?'' the chairman of the medical staff council, Richard Harris, asked yesterday. ''They are all hoping this will blow over, but we are … determined to make sure it doesn't blow over,'' he said.

The hospital's clinical director of surgery and anaesthetics, Pip Middleton, said doctors would give the Government six weeks to agree to a rebuild before considering withdrawing their services. ''In less than two years this hospital will become unsafe and unworkable so it is fast getting to the point where the only thing we can do is walk out. It's not something we'd do lightly but it may be the only thing they understand.''

Dr Middleton, who has previously labelled conditions at the hospital as medieval and offensive, said a recent offer by the area health service to renovate a ward was ''Chinese finance''. ''Sticky tape and a lick of paint does nothing to improve the conditions for anyone here. If they can't rebuild completely, they are throwing good money after bad. We need some firm evidence they are doing something rather than stalling, or we're out,'' he said.

A cardiologist, Jason Sharp, said staff were tired of dealing with '' a dysfunctional bureaucracy that can't achieve anything''. He said the recent resignation of the hospital's general manager had left staff feeling more demoralised. ''Administration is in disarray at a hospital level, an area health service level and a state level. They are immobilised and it leaves us disappointed.''

The hospital's executive clinical director, Sue Kurrle, said staff were perplexed at being told to cut the budget. ''This is one of the most cost-efficient hospitals in the state. There's nothing to cut.''

Dr Harris has called for a meeting with the new Health Minister, Carmel Tebbutt, and wants representatives from the Australian Medical Association and the Royal Australasian College of Surgeons to tour the hospital.


The follies of job-based health insurance

A small note: In Australia, ALL health insurance is bought directly by individuals, I have a very high level of cover for myself and my son but pay only $241 a month. It's about what the average smoker would spend on cigarettes

The other day, I was trying to figure out why the paycheck deduction for my health insurance was higher than I had expected. When I called my insurer to ask what the total premium was, the customer service representative said it was none of my business.

Three-fifths of Americans, the share with employer-provided health insurance, are in the same situation: Since someone else buys insurance for them, using money they would otherwise receive as wages, they are in no position to shop around and typically do not even know the true cost of their coverage. This disconnect between payment and consumption is one of the central problems with the current health care system, contributing to rapidly escalating costs, insecurity, and the general lack of choice and competition. Yet both Democrats and Republicans insist upon preserving it.

Outlining his health care reforms last week, President Obama was at pains to reassure the public that "nothing in this plan will require you or your employer to change the coverage or the doctor you have." In fact, he said employers should be forced to provide health insurance (or, alternatively, contribute to a fund that subsidizes premiums).

Obama presented himself as the protector of job-based medical coverage against those "on the right" who "argue that we should end employer-based systems and leave individuals to buy health insurance on their own." That approach, he warned, represents "a radical shift that would disrupt the health care most people currently have."

Meanwhile, the Republicans, whose last president and last presidential candidate both proposed eliminating the tax incentives that encourage employers to offer health insurance in lieu of higher pay, seem to have abandoned that idea. One of their main complaints about Obama's plan is that it would reduce the number of Americans covered through their jobs.

Senate Minority Leader Mitch McConnell, R-Ky., warns that one Democratic health care bill "would cause 10 million people with employer-based insurance to lose the coverage they have." The Republican National Committee claims "over 88 million people" who are covered through work "would lose current insurance under government-run health care."

It's no mystery why each party portrays the other as bent on destroying employment-based medical coverage. Surveys find that a large majority of people who have such insurance are happy with it. According to a recent Zogby poll, 77 percent of Americans oppose "taxing employer-provided health care benefits."

Yet it's the tax-free status of those benefits that favors them over cash compensation, maintaining a bizarre system in which most Americans get their health insurance -- unlike their car, life or homeowner's insurance -- through their employers. As a result, they are insulated from the actual price of their insurance and are more likely to have plans with low deductibles that cover routine medical expenses as well as large, unpredictable costs. In choosing among providers, drugs and courses of treatment, they have little incentive to economize and usually do not even know the relative costs of the various options.

The artificial dominance of job-based plans, along with misguided restrictions on where insurers can sell policies and what types of coverage they can offer, has stunted the development of alternatives. Even so, the large price difference between the job-based and individual insurance markets (some of which may be due to differences in the age and health of policy holders) suggests the savings that are possible when people decide how to spend their own money: In 2007 the average annual premium for nongroup health insurance was about $2,600 for single-person coverage and $5,800 for family coverage, compared to $4,500 and $12,100, respectively, for job-based plans.

In addition to enhancing competition and controlling costs, cutting the link between employment and health insurance would relieve the insecurity that many Americans feel about going without coverage when they lose or leave their jobs. Obama is right that it would be "a radical shift" -- radical in the sense that it goes to the root of the current health care mess.


Rx for money woes: Doctors quit medicine

Some physicians, fed up with the costs of their practice, are ready to hang up their stethoscopes and shift careers. How is Obama going to fix this? How is he going to provide more health care with fewer doctors? Republicans are pushing for tort reform but are getting nowhere and Obama actually wants to REDUCE the pittance that doctors get from Medicare

Some 5,000 patients suddenly found themselves without an ob/gyn last November when Dr. Tara Wah closed her practice in Tallahassee, Fla. Wah, 55, informed her patients in a letter that she could "no longer afford to make ends meet." After 24 years, "I'm working longer hours than ever," she wrote. "Insurance payments for patient care have stayed virtually the same for the last 15 years, while the cost of doing business, including health insurance, staff salaries and supplies have risen."

The rising cost of malpractice insurance, particularly for her specialty, was the straw that broke the camel's back. "My malpractice insurance was $125,000 a year, and going up," said Wah. "The only way to get the extra money was to cut back on my salary."

But it wasn't always like that. Being a doctor was once thought to be a path to a cushy lifestyle. Six years after she started practicing, Wah hit her "peak" income year in 1990. Then she took a pay cut every year from 1993 onward, to eventually take no salary for two months prior to permanently shutting her office.

Wah no longer practices medicine. Instead, she designs and repairs jewelry. "I feel guilty. I dream about [medicine]," she said. "[But] I am so angry. I think, 'What a waste of my training.' "

Wah's situation sheds light on a troubling trend of physicians leaving medicine for a career outside of health care, said Kurt Mosley, a staffing expert with Merritt Hawkins & Associates, a physician search and consulting firm. A first-ever survey of 12,000 primary care physicians conducted last October by Merritt Hawkins and the Physicians' Foundation, an organization that represent the interests of physicians, showed that 10.1% of respondents planned to seek a job outside of health care in the next one to three years. "That is a big number. It's just very sad," said Mosley, especially in light of the shortage of primary care doctors in the United States today.

The American Medical Association said it is aware of this trend, citing the survey, but said it does not have data to show how many doctors have already prematurely exited the profession.

Regardless, Mosley said it's a waste of training, skill, talent and money when a doctor leaves the profession in mid-career. It takes a minimum of 10 to 12 years of training to become a doctor. In Wah's case, she underwent 10 years of training, including medical school and residency, before she entered the workforce.

While some enter medicine because they believe it pays well, most choose it as a career because they feel it's their calling. "For many it's not about the money. They have a passion for it, to take care of people," said Mosley. "It's not easy to feel that passionately for another career after medicine."

It's also a waste of taxpayer money when a physician opts out. "We are all paying out of our pockets to produce doctors," said Mosley. That's because medical residency programs are mostly funded by Medicare to the tune of $9 billion to train about 100,000 residents annually, according to the Medicare Payment Advisory Commission. "It's Medicare that funds hospital costs to house residency programs, pay salaries of residents and sometimes pay faculties' salaries," said Mosley.

Dr. Patricia Perry, 44, a dermatologist based in Burbank, Calif., operates a solo practice. She mostly performs medical procedures such as skin biopsies. Perry said she's "seeking to get out" of her profession because she's fed up with insurance reimbursement challenges while struggling to cover other costs associated with being a doctor. "When you get to a point where you feel unappreciated and you're arguing with people about being paid, it takes away the passion for what you do," Perry said.

Daryl Richard, a spokesman for insurer UnitedHealthcare (UHC), said his company is taking steps to address some of providers' concerns. "We agree 100% that there is too much paperwork" tied to reimbursement claims, he said. Richard said UnitedHealthcare offers a Web-based application to all of its providers that will enable the company to adjudicate claims to determine a reimbursement and a patient's out-of-pocket expense "by the time the patient makes it to the (doctor's) front desk." "This takes away some of the unknown for both providers and consumers," he added.

Perry pays $2,500 a year in malpractice insurance. "I am licensed in three states. To maintain my license I have to pay a fee every one to two years in each state," she said. She also pays a considerable amount of money every year to attend annual trade conferences required by her specialty to update and hone her skills. She said many physicians are scared to speak out about their money woes because they don't want to be perceived as "greedy." "I have news for you. You are already being perceived that way," she said.

Dr. Kenneth Cohn, a general surgeon with an MBA who tours the country advising doctors on non-clinical job options, says there's a high-level of angst among U.S. physicians. "There's absolutely a greater number who are looking for other job opportunities," he said. It's a reality that we have to deal with, Cohn said. The implication of it on the health care system, he said, is that doctors may have to increasingly use nurse practitioners and physicians assistants to fill in the gaps. They may also need to look to newer delivery concepts such as medical homes, in which doctor take more of a managerial role in a patient's health care.

More here

Doctors Threaten to Go Galt if ObamaCare Passes

It would be a miracle of biblical proportions if Big Government’s minions could decrease costs while increasing coverage, as Democrats have been promising to do when they seize control of the healthcare industry. What will make cost savings even more improbable is that they will have to do it with a radically reduced supply — because doctors unwilling to labor as government slaves have promised to go Galt:
Four of nine doctors, or 45%, said they “would consider leaving their practice or taking an early retirement” if Congress passes the plan the Democratic majority and White House have in mind. More than 800,000 doctors were practicing in 2006, the government says. Projecting the poll’s finding onto that population, 360,000 doctors would consider quitting.

The IBD/TIPP poll also found that 2/3 of doctors oppose ObamaCare, despite the lies being spewed on your dime by NPR.
The poll contradicts the claims of not only the White House, but also doctors’ own lobby — the powerful American Medical Association — both of which suggest the medical profession is behind the proposed overhaul. …

It also differs with findings of a poll released Monday by National Public Radio that suggests a “majority of physicians want public and private insurance options,” and clashes with media reports such as Tuesday’s front-page story in the Los Angeles Times with the headline “Doctors Go For Obama’s Reform.”

Surprisingly, only 71% of doctors answered “no” when asked whether they could swallow that “the government can cover 47 million more people and that it will cost less money and the quality of care will be better.” The rest must be Democrats, like they all will be after ObamaCare passes and hospitals turn into the DMV.

Becoming a doctor isn’t easy. Who is going to do it in the future, when our socialist rulers have destroyed every incentive? It will make more sense just to apply for a job at the post office than endure the rigors of medical school and residency. This is yet another reason that socialism simply does not work. But at least we’ll have no shortage of useless bureauweenies telling us how to live and when to die.


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