THE DOWNWARD SPIRAL IN LOS ANGELES
The loonies in charge of California medical services think that just a new regulation will conjure unavailable doctors and nurses out of thin air
Busy county emergency rooms turned away ambulances 8 percent more often in 2005 than the year before, prompting officials to impose new limits on how long the facilities can remain shut. Some public hospitals closed their emergency rooms to ambulances an average of 20 hours a day while some private hospitals were shuttered for 12 hours or more, according to data from the county Emergency Medical Services Agency. At times, almost all of the emergency rooms in the county were closed to ambulances. Emergency room directors attributed the overload to population growth, a greater number of seriously ill patients, greater use of the facilities for routine care and the permanent closure of nine medical centers and emergency rooms during the past four years.
When emergency rooms force ambulances to divert to other locations, patient care is delayed and paramedics are prevented from responding to other calls. County officials responded to the problem by cutting the amount of time emergency rooms can remain shut. Current policy allows overwhelmed emergency rooms to close for two-hour periods. The new policy would allow diversions for one-hour periods, and require emergency rooms to remain open for at least 15 minutes before returning to diversion status, said Carol Meyer, director of the Emergency Medical Services Agency.
The guidelines will go into effect in a couple of weeks, she said. Some experts in emergency medicine, however, say the changes don't address the reasons for the closures. "It's window-dressing," said Dr. Marc Eckstein, medical director for the Los Angeles Fire Department. "I don't see how that's going to help anything." The county previously cut emergency room closure times from eight hours to four hours in 2001 and from four hours to two hours in 2002.
Source
SHUFFLING THE DECKCHAIRS ON THE NHS TITANIC
Even The Economist (article below) can suggest only that medical procedures in Britain's NHS be made more efficient. No mention of sacking the huge dead-weight of bureaucrats who are eating up most of the funds available. A British bureaucrat would keep his job through a nuclear winter
The Royal Free in north London and the Princess Alexandra in Harlow, a few miles away from Stansted airport in Essex, are two very different hospitals. One is a teaching hospital with a turnover of 350 million pounds ($615m) a year. The other is a much smaller district hospital with an annual turnover of 120m. But they have a common problem. Each will be in the red in the financial year ending this March. Across the National Health Service, a deficit of around 800m is now expected for 2005-06. This is far worse than the 250m shortfall in 2004-05, which followed a period of small surpluses (see chart). And it also marks a deterioration from the position in December, when a deficit of 620m was forecast for this year.
The inability of the NHS to balance its books despite unprecedented growth in its funding from taxpayers has caused trouble at the top. This week Sir Nigel Crisp, the 54-year-old chief executive of the NHS, said that he would be taking early retirement. Only a few months ago, his stock was so high that he had been in the running for the top job in the civil service. Sir Nigel may be going but the hot political questions remain. Why should there be any deficit at all after seven years in which the NHS budget has doubled? And how are its finances to be put right?
At both the Royal Free and the Princess Alexandra, generous pay awards conceded by the government are contributing to their financial difficulties. John Gilham, chief executive at the Princess Alexandra, says that the funding it received for “agenda for change”, the pay deal for nurses and non-medical staff, has not fully covered the extra cost. This shortfall is contributing about a third of the hospital's £4.8m deficit this year. This fits in with the overall picture in the NHS. According to the King's Fund, a health-policy think-tank, higher pay swallowed 50% of the cash increase for hospitals in 2005-06. The outlook for next year is not much better, with almost 40% of the planned boost to spending set to be absorbed by extra pay. The King's Fund also highlights other pressures on hospital budgets, such as greater spending on new drugs and compensation payments for clinical negligence.
Yet despite these big general cost pressures, the overall deficit is not spread uniformly across the health service. In December, when the deficit was forecast at 620m, a quarter of the 600 NHS organisations ran a gross deficit of 950m, with some offsetting surpluses elsewhere. In January, the government identified 62—the Royal Free and Princess Alexandra were not among them—which accounted for most of the gross deficit. Of these, 18 required urgent intervention, with managerial and financial “turnaround” teams sent in to help them. This suggests that the NHS's financial malaise reflects a set of local difficulties caused by poor managerial performers rather than a more general problem. Understandably, this is an explanation that the government has tended to stress. What has happened, arguably, is that stricter accounting rules have exposed underlying financial problems that should have been tackled long ago.
The main response of hospitals to these financial strains must be to raise efficiency. At the Royal Free, where the deficit was heading for £15m, savings of £10m have been made in this financial year to bring it back to 5m. According to Peter Commins, the trust's finance director, these have been achieved mainly by shortening the time patients stay in hospital and by increasing the rate of day-case surgery. At the Princess Alexandra, annual efficiency savings of 3% have been made in the past three years. Mr Gilham is introducing “lean management”—a technique that is common in industry—into the hospital. The main goal, he says, is to reduce waste by getting things right the first time. That requires standardisation of treatment procedures wherever possible.
The pressure for higher efficiency will increase next month for all hospitals, whether or not they are having to deal with deficits. A new payments system is being introduced to sharpen competition among hospitals. It sets a national tariff for treatments, which means that hospitals are paid according to how busy they are rather than receiving budgets based on previous funding levels. At present, the new system is limited for most hospitals to elective care, such as cataract removals, but in April it will be extended to emergency work and outpatient visits.
Mr Commins says that the payments change will have a big effect, leading hospitals to shed services when they cannot provide them competitively. With so much riding on the new payments system, it was thus a grave embarrassment to the government when the tariff for 2006-07 had to be withdrawn for amendments towards the end of February. That should prove a temporary setback, but it was an unfortunate prelude to what will be a turbulent and crucial financial year.
The NHS is running out of excuses and time. The big boost to spending is due to end in spring 2008, when the NHS will have to adapt to much tighter budgets. Quite simply, the health service has got to work harder for its money. In some places, there will have to be closures of excess capacity. The deficits spell out in red ink the case for reform
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, March 11, 2006
Friday, March 10, 2006
Canadianizing the Golden State: California marches backward on health care
A plan to outlaw private health insurance in California has been proposed by state Sen. Sheila Kuehl (D-Los Angeles). Senator Kuehl's bill, SB840, proposes to create the California Health Insurance Agency, a state government run single payer system for financing the health care of all Californians. Her bill, if enacted, would abolish all private health insurance in the Golden State. Her legislation essentially aims to replicate the system of socialized medicine in Canada which, until a recent court ruling in Quebec, made all private health care illegal. Her health care proposal is more authoritarian than the health care systems in the United Kingdom or Germany in which citizens can buy private insurance if they so choose.
Remarkably, Kuehl's proposal to socialize California's health care is being made just at the time when the Canadian system it resembles is falling apart at the seams. For instance, Canada's single payer system is projected to absorb more than half the budgets of most Canadian provinces. In addition, the amount of time a Canadian patient must wait before receiving medical care is notorious. "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years," said Dr. Brian Day in a recent New York Times article on Canada's health care crisis.
Kuehl flatly denies that her plan is "government-run health care." She prefers to style it as "a publicly administered finance system." Of course, as the old saying goes: "He who pays the piper, calls the tune." In this case, the new California Health Insurance Agency (CHIA) will be paying, and thus every health care provider and patient in the state would have to dance to its tune.
Kuehl maintains that her government single payer health insurance system will cover all Californians including the one-fifth who are uninsured now and be cheaper at the same time. How? In order to control rising health care costs, Kuehl's plan pegs annual growth in health spending to growth in California's economy. But is that the right amount of spending? In fact, we know that as people earn more, they generally choose to spend higher percentages of their incomes on health care. For instance, economic studies show that for every one percent increase income, families generally prefer to increase their spending on health care by 1.6 percent.
Let's consider a simplified example of how Kuehl's plan would lead to less spending on health care than most Californians would like. Take the California median household income of $50,000 and assume that each household spends an average of 20 percent, or $10,000, on health insurance and out-of-pocket medical expenses each year. Then let's assume that California's economy continues to grow and that median family income climbs to $80,000.
If economists are right, this means that California families on average would prefer to spend $19,600 annually on health care. In other words, people would rather buy health care than the biggest houses or fastest cars that they could afford with a higher income. However, under Kuehl's proposal to fix health care spending at the growth rate of the economy, California health insurance bureaucrats would allocate only an average of $16,000 per year to each family. And since it would be illegal for California families to buy supplemental private insurance, they would be getting much less access to doctors and modern treatments than they would prefer.
Like all politicians Kuehl promises voters all good things. For example, she vows that under CHIA, "You will choose your own doctor and you and your provider, not insurance agents, will decide your care. All needed services, drugs, hospital stays, therapies, and medical equipment will be covered."
Looking at the fine print, you find that Kuehl's government-run single payer system will be cheaper because it will actually ration health care. In other words, decisions about what treatments will be available to Californians and when they will become available will be in the hands of government health care bureaucrats. Just like the Canadian socialized health care system, the new California Health Insurance Agency will determine how much it will pay pharmaceutical companies for new more effective medicines. This means that Californians, like Canadians today, will wait a long time, possibly forever, to get access to modern therapies. In 2002, Sally Pipes, head of the Pacific Research Institute, a free-market think tank in San Francisco noted,, "One hundred new drugs were launched in the United States from 1997 through 1999. Only 43 made it to market in Canada in that same period. Canadians are still waiting for many of them."
California health bureaucrats will also set doctors' fees. Kuehl likens her plan to the Federal government's Medicare system for seniors. She overlooks the fact that physicians are fleeing Medicare in droves because the program doesn't adequately reimburse them. Doctors are like anybody else; they work less when they get paid less. If Kuehl's system is adopted, you will eventually see waiting lines lengthening and doctors treating fewer and fewer patients. California doctors and other health care workers will leave for other states where they are better compensated, and few new doctors, nurses and other personnel will be attracted to California. Another side effect will be that many of California's innovative biotech companies will relocate to friendlier business environments.
Kuehl plans to finance the California Health Insurance Agency through a dedicated payroll tax in which employers would pay 8.2 percent and workers would pay 3.8 percent. And when the system runs short of money, as it inevitably will, the new health bureaucracy will impose cost control measures that include the "postponement of introduction of new benefits or benefit improvements; a temporary decrease in benefits; a postponement of planned capital expenditures, and limitations on aggregate reimbursements to manufacturers of pharmaceutical and durable and nondurable medical equipment." Translation: California health care bureaucrats, not doctors or patients, will be deciding what new treatments will be offered; what new hospitals and laboratories will be built; and what new drugs and new biomedical technologies will be permitted in the state.
Today, as the Canadian health care system implodes, more and more Canadians are seeking private medical care across the border in the United States. Within a decade after Kuehl's single payer system has been adopted, I predict that many Californians will similarly be fleeing across the border into Arizona and Nevada looking for modern private medical care in state-of-the-art hospitals and clinics.
Source
A NOW FAMILIAR STORY IN SOCIALIZED MEDICINE SYSTEMS
As in Australian States, Britain is closing public hospital wards
Two NHS trusts announced ward closures and job losses yesterday as Tony Blair defended the Government’s handling of the health service. Royal Cornwall Hospitals NHS Trust, which faces an 8.1 million pounds shortfall this year, said that it would cut 300 jobs because of the financial pressures. Trafford NHS Trust in Greater Manchester, which is 9 million pounds in debt, said that it closing two in-patient wards at Altrincham General Hospital because it was unable to provide 24-hour care.
The cutbacks came as Mr Blair faced a barrage of questions in the Commons about the circumstances surrounding the departure of Sir Nigel Crisp, who announced on Tuesday that he was leaving his post early. Referring to comments made by Sir Nigel in an interview with The Times, David Cameron, the Tory leader, accused Mr Blair of sacking the chief executive and urged ministers to take responsibility for failures in the NHS. Despite five years of unprecedented funding, the annual deficits of the NHS are now expected to approach 900 million pounds, with hospitals already being forced to cut back on services.
Last week doctors and nurses in Surrey and Sussex Strategic Health Authority, one of England’s biggest authorities, covering 2.5 million people, were told to block all “new investment” unless it produced savings elsewhere. Its shortfall is now close to 100 million pounds. Health experts say that up to a quarter of hospitals are in serious financial difficulty, but targets have been met since 2000 as a result of annual funding doubling to almost 80 million pounds.
The pressure group Reform estimates that the NHS will have about 600 million pounds for new programmes next year after cost pressures of 3.8 billion pounds and the deficit of close to 1 billion pounds are subtracted from an additional spending allocation of 5.4 billion pounds. It called on the NHS to suspend hospital building programmes under the Private Finance Initiative (PFI) yesterday. The Department of Health says that funds will come from efficiency savings.
Citing Sir Nigel’s admission to The Times that the NHS was in a “bad patch”, including some worsening structural and managerial problems, Mr Cameron called on Mr Blair to face up to Labour’s failings and admit to sacking the chief executive.
Mr Blair defended his reform programme and said that the deficit was less than 1 per cent of the annual cost of the NHS. He added that 50 per cent of the debt was in only 6 per cent of trusts. “It’s true that in your area there is a substantial financial deficit, but there’s also been massive real-term increase in the amount of money going in — money you voted against,” he told Mr Cameron. “What we have to have is a proper system of financial transparency.” Mr Blair also paid tribute to Sir Nigel as “a superb public servant who in the past few years has overseen a transformation of the health service”. He denied that he had been pressured to step down. Sir Ian Carruthers, a highly regarded NHS manager, and Hugh Taylor, a career civil servant, have been brought in as short-term replacements for Sir Nigel, 54. The search for a longer-term successor is expected to take up to five months
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
A plan to outlaw private health insurance in California has been proposed by state Sen. Sheila Kuehl (D-Los Angeles). Senator Kuehl's bill, SB840, proposes to create the California Health Insurance Agency, a state government run single payer system for financing the health care of all Californians. Her bill, if enacted, would abolish all private health insurance in the Golden State. Her legislation essentially aims to replicate the system of socialized medicine in Canada which, until a recent court ruling in Quebec, made all private health care illegal. Her health care proposal is more authoritarian than the health care systems in the United Kingdom or Germany in which citizens can buy private insurance if they so choose.
Remarkably, Kuehl's proposal to socialize California's health care is being made just at the time when the Canadian system it resembles is falling apart at the seams. For instance, Canada's single payer system is projected to absorb more than half the budgets of most Canadian provinces. In addition, the amount of time a Canadian patient must wait before receiving medical care is notorious. "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years," said Dr. Brian Day in a recent New York Times article on Canada's health care crisis.
Kuehl flatly denies that her plan is "government-run health care." She prefers to style it as "a publicly administered finance system." Of course, as the old saying goes: "He who pays the piper, calls the tune." In this case, the new California Health Insurance Agency (CHIA) will be paying, and thus every health care provider and patient in the state would have to dance to its tune.
Kuehl maintains that her government single payer health insurance system will cover all Californians including the one-fifth who are uninsured now and be cheaper at the same time. How? In order to control rising health care costs, Kuehl's plan pegs annual growth in health spending to growth in California's economy. But is that the right amount of spending? In fact, we know that as people earn more, they generally choose to spend higher percentages of their incomes on health care. For instance, economic studies show that for every one percent increase income, families generally prefer to increase their spending on health care by 1.6 percent.
Let's consider a simplified example of how Kuehl's plan would lead to less spending on health care than most Californians would like. Take the California median household income of $50,000 and assume that each household spends an average of 20 percent, or $10,000, on health insurance and out-of-pocket medical expenses each year. Then let's assume that California's economy continues to grow and that median family income climbs to $80,000.
If economists are right, this means that California families on average would prefer to spend $19,600 annually on health care. In other words, people would rather buy health care than the biggest houses or fastest cars that they could afford with a higher income. However, under Kuehl's proposal to fix health care spending at the growth rate of the economy, California health insurance bureaucrats would allocate only an average of $16,000 per year to each family. And since it would be illegal for California families to buy supplemental private insurance, they would be getting much less access to doctors and modern treatments than they would prefer.
Like all politicians Kuehl promises voters all good things. For example, she vows that under CHIA, "You will choose your own doctor and you and your provider, not insurance agents, will decide your care. All needed services, drugs, hospital stays, therapies, and medical equipment will be covered."
Looking at the fine print, you find that Kuehl's government-run single payer system will be cheaper because it will actually ration health care. In other words, decisions about what treatments will be available to Californians and when they will become available will be in the hands of government health care bureaucrats. Just like the Canadian socialized health care system, the new California Health Insurance Agency will determine how much it will pay pharmaceutical companies for new more effective medicines. This means that Californians, like Canadians today, will wait a long time, possibly forever, to get access to modern therapies. In 2002, Sally Pipes, head of the Pacific Research Institute, a free-market think tank in San Francisco noted,, "One hundred new drugs were launched in the United States from 1997 through 1999. Only 43 made it to market in Canada in that same period. Canadians are still waiting for many of them."
California health bureaucrats will also set doctors' fees. Kuehl likens her plan to the Federal government's Medicare system for seniors. She overlooks the fact that physicians are fleeing Medicare in droves because the program doesn't adequately reimburse them. Doctors are like anybody else; they work less when they get paid less. If Kuehl's system is adopted, you will eventually see waiting lines lengthening and doctors treating fewer and fewer patients. California doctors and other health care workers will leave for other states where they are better compensated, and few new doctors, nurses and other personnel will be attracted to California. Another side effect will be that many of California's innovative biotech companies will relocate to friendlier business environments.
Kuehl plans to finance the California Health Insurance Agency through a dedicated payroll tax in which employers would pay 8.2 percent and workers would pay 3.8 percent. And when the system runs short of money, as it inevitably will, the new health bureaucracy will impose cost control measures that include the "postponement of introduction of new benefits or benefit improvements; a temporary decrease in benefits; a postponement of planned capital expenditures, and limitations on aggregate reimbursements to manufacturers of pharmaceutical and durable and nondurable medical equipment." Translation: California health care bureaucrats, not doctors or patients, will be deciding what new treatments will be offered; what new hospitals and laboratories will be built; and what new drugs and new biomedical technologies will be permitted in the state.
Today, as the Canadian health care system implodes, more and more Canadians are seeking private medical care across the border in the United States. Within a decade after Kuehl's single payer system has been adopted, I predict that many Californians will similarly be fleeing across the border into Arizona and Nevada looking for modern private medical care in state-of-the-art hospitals and clinics.
Source
A NOW FAMILIAR STORY IN SOCIALIZED MEDICINE SYSTEMS
As in Australian States, Britain is closing public hospital wards
Two NHS trusts announced ward closures and job losses yesterday as Tony Blair defended the Government’s handling of the health service. Royal Cornwall Hospitals NHS Trust, which faces an 8.1 million pounds shortfall this year, said that it would cut 300 jobs because of the financial pressures. Trafford NHS Trust in Greater Manchester, which is 9 million pounds in debt, said that it closing two in-patient wards at Altrincham General Hospital because it was unable to provide 24-hour care.
The cutbacks came as Mr Blair faced a barrage of questions in the Commons about the circumstances surrounding the departure of Sir Nigel Crisp, who announced on Tuesday that he was leaving his post early. Referring to comments made by Sir Nigel in an interview with The Times, David Cameron, the Tory leader, accused Mr Blair of sacking the chief executive and urged ministers to take responsibility for failures in the NHS. Despite five years of unprecedented funding, the annual deficits of the NHS are now expected to approach 900 million pounds, with hospitals already being forced to cut back on services.
Last week doctors and nurses in Surrey and Sussex Strategic Health Authority, one of England’s biggest authorities, covering 2.5 million people, were told to block all “new investment” unless it produced savings elsewhere. Its shortfall is now close to 100 million pounds. Health experts say that up to a quarter of hospitals are in serious financial difficulty, but targets have been met since 2000 as a result of annual funding doubling to almost 80 million pounds.
The pressure group Reform estimates that the NHS will have about 600 million pounds for new programmes next year after cost pressures of 3.8 billion pounds and the deficit of close to 1 billion pounds are subtracted from an additional spending allocation of 5.4 billion pounds. It called on the NHS to suspend hospital building programmes under the Private Finance Initiative (PFI) yesterday. The Department of Health says that funds will come from efficiency savings.
Citing Sir Nigel’s admission to The Times that the NHS was in a “bad patch”, including some worsening structural and managerial problems, Mr Cameron called on Mr Blair to face up to Labour’s failings and admit to sacking the chief executive.
Mr Blair defended his reform programme and said that the deficit was less than 1 per cent of the annual cost of the NHS. He added that 50 per cent of the debt was in only 6 per cent of trusts. “It’s true that in your area there is a substantial financial deficit, but there’s also been massive real-term increase in the amount of money going in — money you voted against,” he told Mr Cameron. “What we have to have is a proper system of financial transparency.” Mr Blair also paid tribute to Sir Nigel as “a superb public servant who in the past few years has overseen a transformation of the health service”. He denied that he had been pressured to step down. Sir Ian Carruthers, a highly regarded NHS manager, and Hugh Taylor, a career civil servant, have been brought in as short-term replacements for Sir Nigel, 54. The search for a longer-term successor is expected to take up to five months
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, March 09, 2006
KAISER GOES HI-TECH
Joyce Bonner has relied on Kaiser Permanente for her health care the past 40 years. Except for the birth of her third son, at the Morse Avenue hospital 36 years ago, most of her doctor's visits have been routine - the kind of preventive maintenance for which the health care giant is best known. In the view of Bonner and other Sacramento-area members, that image of Kaiser is evolving, growing wider with the addition of the kind of high-tech medical care typically associated with university teaching hospitals and speciality medical groups. Bonner, 64, was among the first in the region to benefit from one of those sophisticated medical advances: a cochlear implant to restore her hearing.
Other highly specialized services also are finding a home at Kaiser centers in the Sacramento area. With the recent addition of two radiation oncology centers in Roseville and Rancho Cordova, cancer patients can now stay inside the Kaiser system for radiation therapy. And patients who need complex vascular surgeries are no longer sent to Stanford. Autistic children will have a special center for their care in Rancho Cordova beginning in June. And starting next month, infertile couples can opt for in vitro fertilization at Kaiser's Point West offices.
While patients have to pay out of pocket for some of the new offerings, many are part of the overall benefits packages. Driving the change over the past few years are membership growth, increased demand for broader services and a shift in the way Kaiser has positioned itself in the health care marketplace. "There has been an explicit effort to focus on the quality of care, becoming more of a quality leader rather than the low-cost leader," said Jill Yegian, director of health insurance at the California Healthcare Foundation, a health policy group. "Kaiser is trying to adjust to the fact that managed care as we knew it has undergone significant setbacks," said Walter Zelman, director of the California Policy Institute at the University of Southern California who worked on the Clinton health care reform proposal in the early 1990s. "People are concerned about quality, about having choice."
But that can be more costly. Jerry Fleming, a Kaiser senior vice president and health plan manager, acknowledged that Kaiser premiums on average have jumped about 10 percent per year the past two years, emphasizing that actual increases vary depending on the buyer's use of services. "We are in a competitive marketplace, so we have to bring in a premium that allows us to be effective," he said. Regardless, local Kaiser leaders say they are in a good position to offer increasingly specialized medical services.
Kaiser Permanente's market share has grown steadily in the Sacramento region; with nearly 647,000 members, it owns 34 percent of the market, up from 26 percent a decade ago. Kaiser's is a unique system in which its Permanente Medical Group works under contract with the Kaiser Foundation Health Plan, but the doctors are responsible for all medical decisions and drive the direction of care. "Our focus here is to do the right thing," said Dr. Richard Isaacs, an ear, nose and throat specialist and physician-in-chief at Kaiser's South Sacramento and Elk Grove facilities. "That's one of the powers of the system. There is no administrator telling me what to do." Mostly, Kaiser doctors are paid an annual salary that does not depend on the number of patients they see or on the cost of the procedures they do.
While many perceive Kaiser's approach as miserly, the doctors' lack of financial incentive pleases Bonner, who is glad her $50,000 cochlear implant surgery was done only after careful medical evaluation. Kaiser covered the entire cost of the procedure, which involves implantation of the device into the skull. The retired state analyst had been losing her hearing for decades because of otosclerosis, a condition that produces abnormal bone growth in the middle ear. Completely deaf in one ear and with just 10 percent of her hearing left in the other, doctors two years ago deemed her eligible for the implant, which processes sounds from the environment into electrical signals then sends them into electrodes implanted in the patient's cochlea.
Beyond the surgical risks, Bonner was initially reluctant to take the plunge because she would have had to make numerous four-hour trips to Oakland from her home in Volcano, in Amador County. She changed her mind last October, when doctors at Kaiser's South Sacramento facility began offering the surgery. Although the sounds she hears are different from how she remembers them, every one has been thrilling: "I can hear so many sounds I hadn't heard in years and years, like birds chirping, the car keys dropping, the water running," she said.
Kaiser patients unable to get pregnant will also have additional options soon. Dr. Jack Rosanz, Kaiser's physician in chief in Sacramento, said the new in-vitro fertilization program addresses demand, and physician recruitment problems. He said the medical group lost two top-notch reproductive endocrinologists because it lacked an IVF program. Dr. Kenneth Vu, a reproductive endocrinologist from the University of Hawaii, will run the program for couples who have exhausted other infertility treatments. "This is the next step for treatment," he said. "We have to do something to meet these women halfway. When we have to go outside the system, the sense is that the system failed." He said about 150 to 180 women have sought IVF treatment outside of Kaiser over the past couple of years. Kaiser has invested about $2.8 million to develop the program. Patients will pay out of pocket an estimated $8,000 fee for services, which includes the medications.
In some cases, Kaiser has looked very attractive to highly specialized doctors, who see opportunity in bringing their expertise into the large system with strong support systems in place. Kaiser now boasts the largest neurosurgery department in the Sacramento region, for example, with nine surgeons and two interventional neuroradiologists. Dr. Edie Zusman, director of adult neurosurgery at Sutter Neuroscience Institute, who began her career at Kaiser, has noticed the growth since her departure. "The emphasis in Kaiser at the time was on generalized neurosurgery rather than specialty programs," she said. "(Now) they are making important steps to meeting their members' needs."
It was a factor that attracted Dr. Victor Rodriguez, a highly sought after vascular surgeon specially trained to repair massive and complex aneurysms. "I've had offers elsewhere, but I like this place," he said. "I like the freedom to expand and grow. If you have the training, you want to be able to do these things."
Kaiser still has its limitations. It sends its heart surgery patients to Mercy hospitals. Some of the most complex neurosurgeries are done at UC Davis. And patients needing organ transplants are sent to the Bay Area. Still, there are more expansion plans on tap. Highest on the list: a move to establish the Sacramento area's fourth trauma center.
Source
USELESS BRITISH HEALTH BOSS REWARDED WITH A PEERAGE
The head of the NHS was forced out of his job yesterday after secret government forecasts revealed that hospital deficits were likely to spiral to œ900 million this year. Sir Nigel Crisp was given a peerage to ease his early departure after Tony Blair was said to have become anxious that the NHS had "taken its foot off the pedal". Sir Nigel had survived a reshuffle of senior executives in January after forecasts that hospitals were heading for debts of 623 million pounds. But days later he is understood to have learnt that pre-dicted deficits were running at more than 800 million pounds and he realised that he could not carry on.
One source said that pressure from Downing Street had been "intense" over the past six months after Sir Nigel was told that Mr Blair wanted to see results by April 2007 from all the effort and extra funding put into reform. Senior departmental officials were left in no doubt that success in transforming the NHS was a key part of Mr Blair's plans to leave a lasting legacy in transforming the public services. The source said: "The PM accepts it will be tricky financially but wants to see something to show for it at the end of that period [2006-07]." Downing Street said that Mr Blair had ten peerages to give out during the Parliament. Mr Blair's spokesman said: "The esteem in which the Prime Minister held Sir Nigel was illustrated by the fact he had recommended him for a life peerage."
Sir Nigel told The Times that he had walked, not been pushed. But he acknowledged that he had planned to stay for at least another year, and would have preferred to go when the service was "on the up". He denied any breakdown in relations with Patricia Hewitt, the Health Secretary, but there had been whispers for some time that ministers had lost confidence in him. More significant was a growing feeling in the senior echelons of the NHS that Sir Nigel, 54, could not pull it round. With many strategic health authority chief executives due to lose their jobs in the latest merger plans, loyalty to him ceased to have much value.
Insiders linked the fresh urgency from Downing Street to the appointment in December of Professor Paul Corrigan as Mr Blair's health adviser. Professor Corrigan is said to have believed that a shake-up of executives at the very top was necessary. Sir Nigel is to be replaced by two older men: Sir Ian Carruthers, 55, will become acting chief executive of the NHS, and Hugh Taylor, also 55, will become acting permanent secretary, two jobs combined by Sir Nigel.
The Conservatives said that Sir Nigel was the scapegoat for ministers' errors. Andrew Lansley, the Shadow Health Secretary, said: "Sir Nigel's rushed departure is a clear admission that the NHS centrally is in a crisis. Ministers can try to blame Sir Nigel but they are responsible. The NHS is plunging into the red because ministers raised costs and pushed targets without regard to the overall impact on services."
Since Sir Nigel took office in 2000, he has been responsible for spending more than 30 billion pounds in extra funding from the Chancellor. Yet he will leave office at the end of the month with the NHS facing its largest deficit since 1999. He said yesterday: "The deficits are clearly going to be too big, and I'm sorry we are going through a bad patch. There are three reasons for it. In some areas there are structural problems, which are getting worse. "The changes being made in the primary care trusts meant that there was less psychological pressure on managers to get the finances right. And we now have more transparency - financial problems that were disguised are now revealed."
Sir Nigel's fate was sealed after a panicky memo sent to the heads of strategic health authorities in February ordered them to stop within 72 hours all discretionary spending that did not affect clinical priorities. NHS finances had failed to show signs of recovery between December 2005 and January 2006, a time of year when deficits traditionally shrink. This year they grew, indicating a loss of control.This also came as a shock to Sir Nigel and made him question whether the SHAs were reporting accurately to him any longer. No 10 denied that Sir Nigel was "carrying the can" for the cash problems, saying taking responsibility was part of leadership. Traditionally ministers, not civil servants, carry the can
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Joyce Bonner has relied on Kaiser Permanente for her health care the past 40 years. Except for the birth of her third son, at the Morse Avenue hospital 36 years ago, most of her doctor's visits have been routine - the kind of preventive maintenance for which the health care giant is best known. In the view of Bonner and other Sacramento-area members, that image of Kaiser is evolving, growing wider with the addition of the kind of high-tech medical care typically associated with university teaching hospitals and speciality medical groups. Bonner, 64, was among the first in the region to benefit from one of those sophisticated medical advances: a cochlear implant to restore her hearing.
Other highly specialized services also are finding a home at Kaiser centers in the Sacramento area. With the recent addition of two radiation oncology centers in Roseville and Rancho Cordova, cancer patients can now stay inside the Kaiser system for radiation therapy. And patients who need complex vascular surgeries are no longer sent to Stanford. Autistic children will have a special center for their care in Rancho Cordova beginning in June. And starting next month, infertile couples can opt for in vitro fertilization at Kaiser's Point West offices.
While patients have to pay out of pocket for some of the new offerings, many are part of the overall benefits packages. Driving the change over the past few years are membership growth, increased demand for broader services and a shift in the way Kaiser has positioned itself in the health care marketplace. "There has been an explicit effort to focus on the quality of care, becoming more of a quality leader rather than the low-cost leader," said Jill Yegian, director of health insurance at the California Healthcare Foundation, a health policy group. "Kaiser is trying to adjust to the fact that managed care as we knew it has undergone significant setbacks," said Walter Zelman, director of the California Policy Institute at the University of Southern California who worked on the Clinton health care reform proposal in the early 1990s. "People are concerned about quality, about having choice."
But that can be more costly. Jerry Fleming, a Kaiser senior vice president and health plan manager, acknowledged that Kaiser premiums on average have jumped about 10 percent per year the past two years, emphasizing that actual increases vary depending on the buyer's use of services. "We are in a competitive marketplace, so we have to bring in a premium that allows us to be effective," he said. Regardless, local Kaiser leaders say they are in a good position to offer increasingly specialized medical services.
Kaiser Permanente's market share has grown steadily in the Sacramento region; with nearly 647,000 members, it owns 34 percent of the market, up from 26 percent a decade ago. Kaiser's is a unique system in which its Permanente Medical Group works under contract with the Kaiser Foundation Health Plan, but the doctors are responsible for all medical decisions and drive the direction of care. "Our focus here is to do the right thing," said Dr. Richard Isaacs, an ear, nose and throat specialist and physician-in-chief at Kaiser's South Sacramento and Elk Grove facilities. "That's one of the powers of the system. There is no administrator telling me what to do." Mostly, Kaiser doctors are paid an annual salary that does not depend on the number of patients they see or on the cost of the procedures they do.
While many perceive Kaiser's approach as miserly, the doctors' lack of financial incentive pleases Bonner, who is glad her $50,000 cochlear implant surgery was done only after careful medical evaluation. Kaiser covered the entire cost of the procedure, which involves implantation of the device into the skull. The retired state analyst had been losing her hearing for decades because of otosclerosis, a condition that produces abnormal bone growth in the middle ear. Completely deaf in one ear and with just 10 percent of her hearing left in the other, doctors two years ago deemed her eligible for the implant, which processes sounds from the environment into electrical signals then sends them into electrodes implanted in the patient's cochlea.
Beyond the surgical risks, Bonner was initially reluctant to take the plunge because she would have had to make numerous four-hour trips to Oakland from her home in Volcano, in Amador County. She changed her mind last October, when doctors at Kaiser's South Sacramento facility began offering the surgery. Although the sounds she hears are different from how she remembers them, every one has been thrilling: "I can hear so many sounds I hadn't heard in years and years, like birds chirping, the car keys dropping, the water running," she said.
Kaiser patients unable to get pregnant will also have additional options soon. Dr. Jack Rosanz, Kaiser's physician in chief in Sacramento, said the new in-vitro fertilization program addresses demand, and physician recruitment problems. He said the medical group lost two top-notch reproductive endocrinologists because it lacked an IVF program. Dr. Kenneth Vu, a reproductive endocrinologist from the University of Hawaii, will run the program for couples who have exhausted other infertility treatments. "This is the next step for treatment," he said. "We have to do something to meet these women halfway. When we have to go outside the system, the sense is that the system failed." He said about 150 to 180 women have sought IVF treatment outside of Kaiser over the past couple of years. Kaiser has invested about $2.8 million to develop the program. Patients will pay out of pocket an estimated $8,000 fee for services, which includes the medications.
In some cases, Kaiser has looked very attractive to highly specialized doctors, who see opportunity in bringing their expertise into the large system with strong support systems in place. Kaiser now boasts the largest neurosurgery department in the Sacramento region, for example, with nine surgeons and two interventional neuroradiologists. Dr. Edie Zusman, director of adult neurosurgery at Sutter Neuroscience Institute, who began her career at Kaiser, has noticed the growth since her departure. "The emphasis in Kaiser at the time was on generalized neurosurgery rather than specialty programs," she said. "(Now) they are making important steps to meeting their members' needs."
It was a factor that attracted Dr. Victor Rodriguez, a highly sought after vascular surgeon specially trained to repair massive and complex aneurysms. "I've had offers elsewhere, but I like this place," he said. "I like the freedom to expand and grow. If you have the training, you want to be able to do these things."
Kaiser still has its limitations. It sends its heart surgery patients to Mercy hospitals. Some of the most complex neurosurgeries are done at UC Davis. And patients needing organ transplants are sent to the Bay Area. Still, there are more expansion plans on tap. Highest on the list: a move to establish the Sacramento area's fourth trauma center.
Source
USELESS BRITISH HEALTH BOSS REWARDED WITH A PEERAGE
The head of the NHS was forced out of his job yesterday after secret government forecasts revealed that hospital deficits were likely to spiral to œ900 million this year. Sir Nigel Crisp was given a peerage to ease his early departure after Tony Blair was said to have become anxious that the NHS had "taken its foot off the pedal". Sir Nigel had survived a reshuffle of senior executives in January after forecasts that hospitals were heading for debts of 623 million pounds. But days later he is understood to have learnt that pre-dicted deficits were running at more than 800 million pounds and he realised that he could not carry on.
One source said that pressure from Downing Street had been "intense" over the past six months after Sir Nigel was told that Mr Blair wanted to see results by April 2007 from all the effort and extra funding put into reform. Senior departmental officials were left in no doubt that success in transforming the NHS was a key part of Mr Blair's plans to leave a lasting legacy in transforming the public services. The source said: "The PM accepts it will be tricky financially but wants to see something to show for it at the end of that period [2006-07]." Downing Street said that Mr Blair had ten peerages to give out during the Parliament. Mr Blair's spokesman said: "The esteem in which the Prime Minister held Sir Nigel was illustrated by the fact he had recommended him for a life peerage."
Sir Nigel told The Times that he had walked, not been pushed. But he acknowledged that he had planned to stay for at least another year, and would have preferred to go when the service was "on the up". He denied any breakdown in relations with Patricia Hewitt, the Health Secretary, but there had been whispers for some time that ministers had lost confidence in him. More significant was a growing feeling in the senior echelons of the NHS that Sir Nigel, 54, could not pull it round. With many strategic health authority chief executives due to lose their jobs in the latest merger plans, loyalty to him ceased to have much value.
Insiders linked the fresh urgency from Downing Street to the appointment in December of Professor Paul Corrigan as Mr Blair's health adviser. Professor Corrigan is said to have believed that a shake-up of executives at the very top was necessary. Sir Nigel is to be replaced by two older men: Sir Ian Carruthers, 55, will become acting chief executive of the NHS, and Hugh Taylor, also 55, will become acting permanent secretary, two jobs combined by Sir Nigel.
The Conservatives said that Sir Nigel was the scapegoat for ministers' errors. Andrew Lansley, the Shadow Health Secretary, said: "Sir Nigel's rushed departure is a clear admission that the NHS centrally is in a crisis. Ministers can try to blame Sir Nigel but they are responsible. The NHS is plunging into the red because ministers raised costs and pushed targets without regard to the overall impact on services."
Since Sir Nigel took office in 2000, he has been responsible for spending more than 30 billion pounds in extra funding from the Chancellor. Yet he will leave office at the end of the month with the NHS facing its largest deficit since 1999. He said yesterday: "The deficits are clearly going to be too big, and I'm sorry we are going through a bad patch. There are three reasons for it. In some areas there are structural problems, which are getting worse. "The changes being made in the primary care trusts meant that there was less psychological pressure on managers to get the finances right. And we now have more transparency - financial problems that were disguised are now revealed."
Sir Nigel's fate was sealed after a panicky memo sent to the heads of strategic health authorities in February ordered them to stop within 72 hours all discretionary spending that did not affect clinical priorities. NHS finances had failed to show signs of recovery between December 2005 and January 2006, a time of year when deficits traditionally shrink. This year they grew, indicating a loss of control.This also came as a shock to Sir Nigel and made him question whether the SHAs were reporting accurately to him any longer. No 10 denied that Sir Nigel was "carrying the can" for the cash problems, saying taking responsibility was part of leadership. Traditionally ministers, not civil servants, carry the can
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, March 08, 2006
DRUG SCARES HURT PATIENTS
In the wake of last year's Vioxx panic, it would be easy to imagine that unexpected news about new drugs will be mostly bad. But two stories last week remind us why that's not the case, and that an excess of caution--whether due to regulation, litigation or fear--can itself be harmful to public health.
The first story concerns Erbitux, the ImClone cancer drug that became infamous after its initial rejection by the Food and Drug Administration in December 2001 led to an insider trading scandal that counted Martha Stewart as a victim. We said from the start that the FDA had made a bad call, and Erbitux was eventually approved to treat colon cancer.
Well, it turns out Erbitux works for other cancers too. Last Wednesday the FDA approved the drug for a new indication--head and neck cancer--based on data showing a whopping 20-month survival advantage over traditional chemotherapy alone. In fact, Erbitux represents the first significant advance for head and neck tumors since the 1950s.
That Erbitux worked in head and neck tumors was fairly obvious from early trial results even at the time it was first rejected for colon cancer. Dr. Mark Thornton, one of the FDA medical reviewers who finally helped push Erbitux through in 2004, tells us there was "extremely compelling" data on Erbitux for head and neck cancer as early as 2000. He adds that "it was hard to argue against providing it to patients" at the time it was first rejected.
Another man for whom the latest news on Erbitux is bittersweet is Frank Burroughs, who founded the Abigail Alliance for Better Access to Developmental Drugs in honor of his daughter, who died of head and neck cancer while trying to obtain Erbitux and other treatments. "This news serves as yet another reminder that the biggest 'ImClone scandal' of 2001 had nothing to do with Martha Stewart, but instead resulted from the FDA's failure to approve a drug that had been proven safe and effective for thousands of patients," the Alliance said in a statement.
In short, Erbitux is a perfect example of why it's important to get active drugs with reasonable safety profiles out before all the efficacy data is refined to the 10th decimal place, as the FDA always tries to insist. Such data are never going to be complete anyway. Think of all the new benefits that still keep being discovered for humble aspirin.
The second good-news story last week concerns Tysabri, the multiple sclerosis treatment that was voluntarily withdrawn last year (read: lawsuit panic) after three patients on the drug developed a rare neurological infection. This possible side effect wasn't entirely surprising, given that MS is a degenerative neurological disorder caused by immune system dysfunction and Tysabri works by depressing parts of the immune system. But it was also clear, as we editorialized at the time, that the patients in question had been treated with other immuno-suppressive drugs too, and that the risks of untreated or poorly treated MS probably outweighed the risks of taking Tysabri.
Well, now several new studies reported in the New England Journal of Medicine appear to support the point that Tysabri's risks are small and its potential benefits big. Tysabri appears to cut the rate of clinical relapses by 68%, and reduce by a whopping 83% the number of new or expanding brain lesions found in MS patients.
And remember that since MS is a degenerative disease there's no way to undo the damage in patients denied the right to weigh Tysabri's risks and benefits for themselves. This week an FDA panel will meet to consider Tysabri's re-introduction to the market and MS patients are expected to be there in force. "This drug worked for me, and I want to be able to have the choice to make an informed decision," said Cheryl Bloom, who also told Bloomberg news service she will be paying her own travel expenses from Idaho to have her voice heard.
A common theme in the story of these two different drugs is the issue of informed consent. Our philosophy is that patients and doctors dealing with fatal or degenerative diseases ought to have the maximum possible autonomy in treatment decisions. We now know that the FDA could have extended a lot of lives had it followed that principle with Erbitux from the start. And it has an opportunity to extend and improve many more if it decides to help facilitate Tysabri's return to the market.
Source
THE "GREEN" FDA
In yet another GOP contribution to limited government, an advisory committee at the Food and Drug Administration has recommended a ban on Primatene Mist, an over-the-counter asthma spray. This menace to society is propelled by chlorofluorocarbons. CFCs are considered injurious to the ozone layer.
The ozone-friendly FDA suggests that people use CFC-free prescription asthma nebulizers. That’s swell, unless you lack health insurance, pharmaceutical coverage, or the time to see a doctor — or if you need asthma relief right now.
Primatene is perfect for emergencies. I once suffered an asthma attack while visiting friends in lovely but secluded Bucks County, Pennsylvania. That weekend, I happened to forget my prescription inhaler. Rather than visit a pricey hospital emergency room or locate and awaken a doctor to write a prescription at 11:00 P.M., I had my friends drive me to a drug store where I bought some Primatene for about $12. Yes, I did inhale. And I felt much better.
Now, the Bush administration wants to deny asthmatics that freedom, choice, and comfort. If Primatene’s three million customers routinely emptied their atomizers into the air, this restriction might be ecologically sound. However, as Heritage Foundation senior policy analyst Ben Lieberman says: “The amounts of CFCs used in these inhalers is so small, it makes sense to exempt them for several more years until comparable alternatives are available.”
“To put people at risk from asthma, in order to address these inconsequential or even imaginary risks to planetary ozone, takes the precautionary principle to unconscionably absurd new levels,” says Paul Driessen, my Atlas Foundation colleague. “This is a good issue for anyone who favors equal access to affordable health care. This asinine rule would hit poor people hardest, resulting in more frequent, serious, and fatal attacks for them than for upper-crust people, like those who walk the halls of the FDA.”....
On deregulation, the GOP can redeem itself somewhat by revisiting an issue it dropped in 2001. Mandated under the 1992 Energy Policy Act signed by the elder President Bush, 1.6-gallon low-flow toilets have annoyed Americans who prefer the one-flush power of 3.5-gallon traditional toilets. Despite their superior performance, the old toilets are illegal. Amazingly, America now boasts a black market in classic commodes.
Despite ample histrionics during the so-called “Republican Revolution,” Rep. Joe Knollenberg’s (R., Mich.) bill to repeal the low-flow law languished in committee. This election year, roll-call votes to repeal this regulation should tell Americans whether their senators and representatives favor toilet freedom or toilet socialism.
Here’s an idea: Uncle Sam should retreat from asthmatics’ lungs, viewers’ cable boxes, and everyone’s toilets. That should give public servants in Washington more time to track and kill terrorists.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
In the wake of last year's Vioxx panic, it would be easy to imagine that unexpected news about new drugs will be mostly bad. But two stories last week remind us why that's not the case, and that an excess of caution--whether due to regulation, litigation or fear--can itself be harmful to public health.
The first story concerns Erbitux, the ImClone cancer drug that became infamous after its initial rejection by the Food and Drug Administration in December 2001 led to an insider trading scandal that counted Martha Stewart as a victim. We said from the start that the FDA had made a bad call, and Erbitux was eventually approved to treat colon cancer.
Well, it turns out Erbitux works for other cancers too. Last Wednesday the FDA approved the drug for a new indication--head and neck cancer--based on data showing a whopping 20-month survival advantage over traditional chemotherapy alone. In fact, Erbitux represents the first significant advance for head and neck tumors since the 1950s.
That Erbitux worked in head and neck tumors was fairly obvious from early trial results even at the time it was first rejected for colon cancer. Dr. Mark Thornton, one of the FDA medical reviewers who finally helped push Erbitux through in 2004, tells us there was "extremely compelling" data on Erbitux for head and neck cancer as early as 2000. He adds that "it was hard to argue against providing it to patients" at the time it was first rejected.
Another man for whom the latest news on Erbitux is bittersweet is Frank Burroughs, who founded the Abigail Alliance for Better Access to Developmental Drugs in honor of his daughter, who died of head and neck cancer while trying to obtain Erbitux and other treatments. "This news serves as yet another reminder that the biggest 'ImClone scandal' of 2001 had nothing to do with Martha Stewart, but instead resulted from the FDA's failure to approve a drug that had been proven safe and effective for thousands of patients," the Alliance said in a statement.
In short, Erbitux is a perfect example of why it's important to get active drugs with reasonable safety profiles out before all the efficacy data is refined to the 10th decimal place, as the FDA always tries to insist. Such data are never going to be complete anyway. Think of all the new benefits that still keep being discovered for humble aspirin.
The second good-news story last week concerns Tysabri, the multiple sclerosis treatment that was voluntarily withdrawn last year (read: lawsuit panic) after three patients on the drug developed a rare neurological infection. This possible side effect wasn't entirely surprising, given that MS is a degenerative neurological disorder caused by immune system dysfunction and Tysabri works by depressing parts of the immune system. But it was also clear, as we editorialized at the time, that the patients in question had been treated with other immuno-suppressive drugs too, and that the risks of untreated or poorly treated MS probably outweighed the risks of taking Tysabri.
Well, now several new studies reported in the New England Journal of Medicine appear to support the point that Tysabri's risks are small and its potential benefits big. Tysabri appears to cut the rate of clinical relapses by 68%, and reduce by a whopping 83% the number of new or expanding brain lesions found in MS patients.
And remember that since MS is a degenerative disease there's no way to undo the damage in patients denied the right to weigh Tysabri's risks and benefits for themselves. This week an FDA panel will meet to consider Tysabri's re-introduction to the market and MS patients are expected to be there in force. "This drug worked for me, and I want to be able to have the choice to make an informed decision," said Cheryl Bloom, who also told Bloomberg news service she will be paying her own travel expenses from Idaho to have her voice heard.
A common theme in the story of these two different drugs is the issue of informed consent. Our philosophy is that patients and doctors dealing with fatal or degenerative diseases ought to have the maximum possible autonomy in treatment decisions. We now know that the FDA could have extended a lot of lives had it followed that principle with Erbitux from the start. And it has an opportunity to extend and improve many more if it decides to help facilitate Tysabri's return to the market.
Source
THE "GREEN" FDA
In yet another GOP contribution to limited government, an advisory committee at the Food and Drug Administration has recommended a ban on Primatene Mist, an over-the-counter asthma spray. This menace to society is propelled by chlorofluorocarbons. CFCs are considered injurious to the ozone layer.
The ozone-friendly FDA suggests that people use CFC-free prescription asthma nebulizers. That’s swell, unless you lack health insurance, pharmaceutical coverage, or the time to see a doctor — or if you need asthma relief right now.
Primatene is perfect for emergencies. I once suffered an asthma attack while visiting friends in lovely but secluded Bucks County, Pennsylvania. That weekend, I happened to forget my prescription inhaler. Rather than visit a pricey hospital emergency room or locate and awaken a doctor to write a prescription at 11:00 P.M., I had my friends drive me to a drug store where I bought some Primatene for about $12. Yes, I did inhale. And I felt much better.
Now, the Bush administration wants to deny asthmatics that freedom, choice, and comfort. If Primatene’s three million customers routinely emptied their atomizers into the air, this restriction might be ecologically sound. However, as Heritage Foundation senior policy analyst Ben Lieberman says: “The amounts of CFCs used in these inhalers is so small, it makes sense to exempt them for several more years until comparable alternatives are available.”
“To put people at risk from asthma, in order to address these inconsequential or even imaginary risks to planetary ozone, takes the precautionary principle to unconscionably absurd new levels,” says Paul Driessen, my Atlas Foundation colleague. “This is a good issue for anyone who favors equal access to affordable health care. This asinine rule would hit poor people hardest, resulting in more frequent, serious, and fatal attacks for them than for upper-crust people, like those who walk the halls of the FDA.”....
On deregulation, the GOP can redeem itself somewhat by revisiting an issue it dropped in 2001. Mandated under the 1992 Energy Policy Act signed by the elder President Bush, 1.6-gallon low-flow toilets have annoyed Americans who prefer the one-flush power of 3.5-gallon traditional toilets. Despite their superior performance, the old toilets are illegal. Amazingly, America now boasts a black market in classic commodes.
Despite ample histrionics during the so-called “Republican Revolution,” Rep. Joe Knollenberg’s (R., Mich.) bill to repeal the low-flow law languished in committee. This election year, roll-call votes to repeal this regulation should tell Americans whether their senators and representatives favor toilet freedom or toilet socialism.
Here’s an idea: Uncle Sam should retreat from asthmatics’ lungs, viewers’ cable boxes, and everyone’s toilets. That should give public servants in Washington more time to track and kill terrorists.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, March 07, 2006
THE AUSTRALIAN PUBLIC HEALTH DEBACLE
I have three brief news items below about shortcomings in the Australian public health system and also below are two longer articles. It all does help to explain why nearly half of Australians have health insurance that enables them to go to our many excellent private hospitals rather than the overstretched public facilities. The trouble is that lots of Australians still believe the lie that the politicians have been telling them for years -- that everybody will be given as much "free" medical care as they want or need
Why did the Australian taxpayer EVER fund this stuff?: "Patients seeking facelifts, breast and penile enlargements, tattoo removals and liposuction have been banished from the waiting lists at NSW public hospitals. Instead, the 2000 patients awaiting nip'n'tuck cosmetic procedures will be forced to shop around private health facilities to have their operations. "Unless there is a legitimate medical reason, I don't see why NSW taxpayers should be funding these types of surgery," Health Minister John Hatzistergos said. "Most cosmetic surgery should ideally be undertaken within specialist private health facilities. "By reducing clinically unnecessary procedures, doctors will be ensuring more surgery time for people with real health needs," Mr Hatzistergos said. The new elective surgery policy will be announced today by Mr Hatzistergos in a dramatic move to streamline waiting lists and give priority to patients queueing for procedures such as hip and knee replacements, cataract removal and gallstone surgery".
Who cares about the patient in a public hospital? "Vital tests to check for bowel cancer in at-risk Victorians are being secretly cancelled and cut back, surgeons and specialists claim. Investigative colonoscopies were postponed indefinitely by some hospitals last month and scaled back by others, worried doctors said this week. The surveillance procedures are done on Victorians who have a family history of bowel cancer or are considered high risk for other reasons. Surgeons said the procedures were postponed indefinitely at Box Hill, Maroondah and Angliss hospitals in mid-February and scaled back at several others. A specialist said: "People are being left in purgatory -- their procedures are being postponed indefinitely." The surgeons' claims have been backed by the Cancer Council Victoria, with director Prof David Hill saying he had received similar reports. "We are hearing at the coal face that this is happening," Prof Hill said. It is believed cash-strapped hospitals have chosen to drop colonoscopies because it allows them to save money while also appearing to have maintained their care standards".
Roadside births soar as wards close: "The number of roadside births in Queensland has soared as maternity wards shut their doors across the state. Thirty-six of Queensland's 84 public maternity wards have closed over the past decade - coinciding with a 70 per cent increase in roadside births since 2001. Latest Queensland Health figures obtained by The Sunday Mail reveal 277 babies were born on the roadside in 2004, up from 162 three years earlier. Lobby group Maternity Coalition state president Bruce Teakle said women were having to travel up to 1000km to have a baby. "It's a huge concern - it's not good enough that on average five women a week give birth on the side of a road," he said. "Women are travelling further in labour, and that means more roadside births. "It's something that can be very distressing, and it's just not a good start to family life".
Up to 1300 Australians per year die waiting for public hospital help
Up to 1300 Australians die each year waiting to be treated in or admitted to public hospitals. A review of deaths at four public hospitals found patients forced to wait more than eight hours for treatment were 30 per cent more likely to die than those admitted when the hospital was not overcrowded. "Overcrowding is endemic in all large tertiary hospitals in Australia," said Peter Sprivulis, associate professor of emergency medicine at the University of Western Australia. "The situation has been deteriorating for about 15 years."
The two studies of more than 60,000 admissions at Canberra Hospital, Royal Perth Hospital, Fremantle Hospital and the Sir Charles Gairdiner in Perth found delays in treatment caused more than 130 deaths a year. "It's probably five to 10 times that amount nationally," Professor Sprivulis told The Australian. "It is well known that people who experience delays in getting treatment do worse. "For example, if a patient has a very serious infection they are more likely to die if they don't get the antibiotics on time."
Professor Sprivulis said medical errors were also more likely to occur when hospital resources were stretched. "Overcrowding is often associated with placing inpatients on an incorrect ward -- such as medical patients placed in emergency department corridors, which can cause potential adverse events."
The West Australian study, published in the Medical Journal of Australia, analysed hospital admissions via emergency departments in the three years to June 2003. It found 120 deaths a year were linked with overcrowding in the West Australian hospitals. The Canberra Hospital study looked at how many patients died within 10 days of presenting to the emergency department in 2002, 2003 and 2004. It attributed 13 deaths a year to overcrowding in the emergency department.
Drew Richardson, chair of road trauma and emergency medicine at Canberra Hospital, said further studies were needed to determine the extent of the problem. "The magnitude of the association of overcrowding and mortality in the ACT is around 13 additional in-hospital deaths annually. "That's similar to the number of people killed on the roads in the ACT each year, and if replicated in other studies, this association would represent a significant health issue," Professor Richardson said.
Peter Cameron, head of Monash University's pre-hospital and emergency trauma group, said increasing the number of hospital beds would not ease pressure on public hospitals. "Increasing the number of hospital beds temporarily alleviates access block, but does not solve the problem -- the beds quickly fill and the problems recurs." Professor Cameron said hospitals needed to find a better way to balance the dual demands of managing critically ill patients while still providing elective surgery. "Moving patients quickly from acute hospitals to more appropriate facilities increases hospital bed availability. "Access to rehabilitation, residential aged care and community outreach programs is an essential component of an efficient and well managed health system," Professor Cameron said.
He also called for better disease prevention strategies. Research had shown increasing flu vaccination uptake in the over-65s to greater than 90 per cent would reduce the need for acute hospitalisation in that age group by up to 40 per cent.
Source
Bureaucrats bleeding the NSW public health system
The Labor Government keeps the shackles on our doctors and nurses and our whole health system is crumbling.... Where does it start? It starts with the Government accepting federal health funding and banking it straight into consolidated revenue and then failing to forward the entirety of that money on to our state healthcare system. They get away with this because long ago the Wran Labor government started voting doctors off hospital boards and kicking them out of hospital administration, working through every hospital in Sydney, and then replacing them all with bureaucrats. Then doctors in the Health Department were also replaced by bureaucrats.
This is dangerous: A bureaucrat's first rule is to look after his own, a creed which begins to explain why today there are 1.8 hospital administrators for every patient. It's why the old nurses' quarters at Royal Prince Alfred, a building that used to be full with 1400 nurses all prepared to tend to our sick, is now wall-to-wall with administrators making economic decisions about our health care. Not a nurse to be seen.
Wran's illusion of care, which has been copied by following state governments, happened so long ago that we have been conditioned to accept it. Much of what truly happens inside hospitals is never discovered because the Government covers its tracks by gagging doctors and leaning over nurses, threatening them with their jobs. "The money is not going where it is needed," a doctor whispered in this ear. "We keep telling the Government this and they keep telling us to get stuffed."
He would speak only under condition of anonymity. Why? Because doctors are gagged by the Government. Any doctor that speaks out is in danger of losing their job. Now some - just some - of the truth can be told. He said patients were being discharged from hospital three and four days after receiving a coronary artery bypass graft. Why? Because the bureaucrats need the beds to meet their bottom line. Who cares if patients still dangerously ill are being told they are ready to go home and are discharged. He said no elective surgery was booked for the days leading up to public holidays like the Easter break. Why? Because penalty rates are too severe. The only theatres kept open are for emergency and casualty patients.
Then he said 30 per cent of beds across Sydney hospitals were closed. Why? Because every bed requires three different nursing shifts and two different doctors, working 12-hour shifts each day. Along with that comes cooks, cleaners, laundry and other ancillary staff. Close one bed down for a day and the bureaucrats save around $1000. lose 50 beds down and they get a call from head office and a recommendation for the next promotion. That is the reward of the loyal bureaucrat, whose god is numbers. They close down as many beds as possible to save money while at the same time discharging patients as soon as possible to increase the turnover . . . and therefore the cash.
And throughout we suffer the great insult - a Federal Government snipping from us a portion of our salaries for the Medicare levy, to support that health system. Money, remember, that goes straight into consolidated revenue and then fails to get redistributed, in its entirety, into state health care. This is the bureaucracy we deal with in government - and it is time for it to stop.
Doctors are tired of sending sick people home early or turning them away. Recently a leading surgeon quit a major public hospital frustrated at being unable to get his patients booked in for operations. "What's relevant is that the Government will not put the money into the system," the doctor whispered.
These are grounds that the next state election should be fought on. No doubt there will be some who will consider it unrealistic, others will say the problems are too deeply entrenched to ever be satisfactorily repaired. But if you can't hope for a better, more humane way you might as well throw it all away.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
I have three brief news items below about shortcomings in the Australian public health system and also below are two longer articles. It all does help to explain why nearly half of Australians have health insurance that enables them to go to our many excellent private hospitals rather than the overstretched public facilities. The trouble is that lots of Australians still believe the lie that the politicians have been telling them for years -- that everybody will be given as much "free" medical care as they want or need
Why did the Australian taxpayer EVER fund this stuff?: "Patients seeking facelifts, breast and penile enlargements, tattoo removals and liposuction have been banished from the waiting lists at NSW public hospitals. Instead, the 2000 patients awaiting nip'n'tuck cosmetic procedures will be forced to shop around private health facilities to have their operations. "Unless there is a legitimate medical reason, I don't see why NSW taxpayers should be funding these types of surgery," Health Minister John Hatzistergos said. "Most cosmetic surgery should ideally be undertaken within specialist private health facilities. "By reducing clinically unnecessary procedures, doctors will be ensuring more surgery time for people with real health needs," Mr Hatzistergos said. The new elective surgery policy will be announced today by Mr Hatzistergos in a dramatic move to streamline waiting lists and give priority to patients queueing for procedures such as hip and knee replacements, cataract removal and gallstone surgery".
Who cares about the patient in a public hospital? "Vital tests to check for bowel cancer in at-risk Victorians are being secretly cancelled and cut back, surgeons and specialists claim. Investigative colonoscopies were postponed indefinitely by some hospitals last month and scaled back by others, worried doctors said this week. The surveillance procedures are done on Victorians who have a family history of bowel cancer or are considered high risk for other reasons. Surgeons said the procedures were postponed indefinitely at Box Hill, Maroondah and Angliss hospitals in mid-February and scaled back at several others. A specialist said: "People are being left in purgatory -- their procedures are being postponed indefinitely." The surgeons' claims have been backed by the Cancer Council Victoria, with director Prof David Hill saying he had received similar reports. "We are hearing at the coal face that this is happening," Prof Hill said. It is believed cash-strapped hospitals have chosen to drop colonoscopies because it allows them to save money while also appearing to have maintained their care standards".
Roadside births soar as wards close: "The number of roadside births in Queensland has soared as maternity wards shut their doors across the state. Thirty-six of Queensland's 84 public maternity wards have closed over the past decade - coinciding with a 70 per cent increase in roadside births since 2001. Latest Queensland Health figures obtained by The Sunday Mail reveal 277 babies were born on the roadside in 2004, up from 162 three years earlier. Lobby group Maternity Coalition state president Bruce Teakle said women were having to travel up to 1000km to have a baby. "It's a huge concern - it's not good enough that on average five women a week give birth on the side of a road," he said. "Women are travelling further in labour, and that means more roadside births. "It's something that can be very distressing, and it's just not a good start to family life".
Up to 1300 Australians per year die waiting for public hospital help
Up to 1300 Australians die each year waiting to be treated in or admitted to public hospitals. A review of deaths at four public hospitals found patients forced to wait more than eight hours for treatment were 30 per cent more likely to die than those admitted when the hospital was not overcrowded. "Overcrowding is endemic in all large tertiary hospitals in Australia," said Peter Sprivulis, associate professor of emergency medicine at the University of Western Australia. "The situation has been deteriorating for about 15 years."
The two studies of more than 60,000 admissions at Canberra Hospital, Royal Perth Hospital, Fremantle Hospital and the Sir Charles Gairdiner in Perth found delays in treatment caused more than 130 deaths a year. "It's probably five to 10 times that amount nationally," Professor Sprivulis told The Australian. "It is well known that people who experience delays in getting treatment do worse. "For example, if a patient has a very serious infection they are more likely to die if they don't get the antibiotics on time."
Professor Sprivulis said medical errors were also more likely to occur when hospital resources were stretched. "Overcrowding is often associated with placing inpatients on an incorrect ward -- such as medical patients placed in emergency department corridors, which can cause potential adverse events."
The West Australian study, published in the Medical Journal of Australia, analysed hospital admissions via emergency departments in the three years to June 2003. It found 120 deaths a year were linked with overcrowding in the West Australian hospitals. The Canberra Hospital study looked at how many patients died within 10 days of presenting to the emergency department in 2002, 2003 and 2004. It attributed 13 deaths a year to overcrowding in the emergency department.
Drew Richardson, chair of road trauma and emergency medicine at Canberra Hospital, said further studies were needed to determine the extent of the problem. "The magnitude of the association of overcrowding and mortality in the ACT is around 13 additional in-hospital deaths annually. "That's similar to the number of people killed on the roads in the ACT each year, and if replicated in other studies, this association would represent a significant health issue," Professor Richardson said.
Peter Cameron, head of Monash University's pre-hospital and emergency trauma group, said increasing the number of hospital beds would not ease pressure on public hospitals. "Increasing the number of hospital beds temporarily alleviates access block, but does not solve the problem -- the beds quickly fill and the problems recurs." Professor Cameron said hospitals needed to find a better way to balance the dual demands of managing critically ill patients while still providing elective surgery. "Moving patients quickly from acute hospitals to more appropriate facilities increases hospital bed availability. "Access to rehabilitation, residential aged care and community outreach programs is an essential component of an efficient and well managed health system," Professor Cameron said.
He also called for better disease prevention strategies. Research had shown increasing flu vaccination uptake in the over-65s to greater than 90 per cent would reduce the need for acute hospitalisation in that age group by up to 40 per cent.
Source
Bureaucrats bleeding the NSW public health system
The Labor Government keeps the shackles on our doctors and nurses and our whole health system is crumbling.... Where does it start? It starts with the Government accepting federal health funding and banking it straight into consolidated revenue and then failing to forward the entirety of that money on to our state healthcare system. They get away with this because long ago the Wran Labor government started voting doctors off hospital boards and kicking them out of hospital administration, working through every hospital in Sydney, and then replacing them all with bureaucrats. Then doctors in the Health Department were also replaced by bureaucrats.
This is dangerous: A bureaucrat's first rule is to look after his own, a creed which begins to explain why today there are 1.8 hospital administrators for every patient. It's why the old nurses' quarters at Royal Prince Alfred, a building that used to be full with 1400 nurses all prepared to tend to our sick, is now wall-to-wall with administrators making economic decisions about our health care. Not a nurse to be seen.
Wran's illusion of care, which has been copied by following state governments, happened so long ago that we have been conditioned to accept it. Much of what truly happens inside hospitals is never discovered because the Government covers its tracks by gagging doctors and leaning over nurses, threatening them with their jobs. "The money is not going where it is needed," a doctor whispered in this ear. "We keep telling the Government this and they keep telling us to get stuffed."
He would speak only under condition of anonymity. Why? Because doctors are gagged by the Government. Any doctor that speaks out is in danger of losing their job. Now some - just some - of the truth can be told. He said patients were being discharged from hospital three and four days after receiving a coronary artery bypass graft. Why? Because the bureaucrats need the beds to meet their bottom line. Who cares if patients still dangerously ill are being told they are ready to go home and are discharged. He said no elective surgery was booked for the days leading up to public holidays like the Easter break. Why? Because penalty rates are too severe. The only theatres kept open are for emergency and casualty patients.
Then he said 30 per cent of beds across Sydney hospitals were closed. Why? Because every bed requires three different nursing shifts and two different doctors, working 12-hour shifts each day. Along with that comes cooks, cleaners, laundry and other ancillary staff. Close one bed down for a day and the bureaucrats save around $1000. lose 50 beds down and they get a call from head office and a recommendation for the next promotion. That is the reward of the loyal bureaucrat, whose god is numbers. They close down as many beds as possible to save money while at the same time discharging patients as soon as possible to increase the turnover . . . and therefore the cash.
And throughout we suffer the great insult - a Federal Government snipping from us a portion of our salaries for the Medicare levy, to support that health system. Money, remember, that goes straight into consolidated revenue and then fails to get redistributed, in its entirety, into state health care. This is the bureaucracy we deal with in government - and it is time for it to stop.
Doctors are tired of sending sick people home early or turning them away. Recently a leading surgeon quit a major public hospital frustrated at being unable to get his patients booked in for operations. "What's relevant is that the Government will not put the money into the system," the doctor whispered.
These are grounds that the next state election should be fought on. No doubt there will be some who will consider it unrealistic, others will say the problems are too deeply entrenched to ever be satisfactorily repaired. But if you can't hope for a better, more humane way you might as well throw it all away.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, March 06, 2006
BRITAIN'S NHS GOES WACKY
Cherie's magic magnets cure
NHS accountants are so impressed by the cost-effectiveness of a "magnetic leg wrap" called 4UlcerCare that from Wednesday doctors will be allowed to prescribe it to patients.
Magnetic therapy, which was pioneered in ancient Egypt, has become one of the pillars of modern alternative medicine. Its adherents include Cherie Blair, Bill Clinton and Sir Anthony Hopkins, the actor. Although its merits are challenged by traditional medics, it is used to treat joint pains, sports injuries, backache, muscle soreness and period pain. It is also used on animals - 4UlcerCare was inspired by a dog named Kiri, which developed severe arthritis. Conventional treatments did not help and, after researching the use of magnets, Kiri's owner, Derek Price, made a magnetic collar. The dog made a remarkable recovery, which led Price to start manufacturing magnetic treatments for animals and people. Magnopulse, of which he is managing director, has sold more than 1m therapeutic magnets since 1997 to treat arthritis, swollen ankles, period pains and varicose veins.
The NHS Prescription Pricing Authority has ruled that 4UlcerCare is not just good for patients but also a good use of NHS cash. It believes the magnets will save money on bandages and nurses' time by healing the wounds. It has included magnets on the official list of items that can be prescribed on the NHS. The NHS has even done a cut-price deal with the manufacturers, buying treatments at 13.80 pounds instead of the normal price of 29 pounds.
Critics of magnetic therapy say it is no more effective than a placebo, however. Only last month a paper in the British Medical Journal by Professor Leonard Finegold, from Drexel University in Philadelphia, and Professor Bruce Flamm, from Kaiser Permanente Medical Center in Riverside, California, cast doubt on the treatment. "Patients should be advised that magnet therapy has no proven benefits. If they insist on using a magnetic device, they could be advised to buy the cheapest - this will alleviate the pain in their wallet," they wrote.
It is not known exactly how magnets work. Adherents believe they improve circulation because they attract the iron in blood towards them and, in doing so, increase the supply of oxygen to the wound. They may also reduce painful acidity in tissue.
More here
BUT NO FUNDING FOR SOME TREATMENTS THAT DO work
I guess Brits might have to wait until Cherie Blair backs it
The patient with a cerebral tumour may well complain of a headache. Classically, such headaches are worse in the mornings after the patient has been lying flat all night. They are usually across the forehead, affect both sides of the head and are made worse by coughing, straining or vomiting. Over time they tend to last longer and longer into the day and are increasingly likely to be associated with dizziness, nausea, clumsiness and a disturbed gait. Other people often notice subtle changes in the personality of their friend or relative. In one case in four, it is these observed changes that first draw attention to the possibility of a brain tumour. The patient may become difficult, obstinate or aggressive. Their behaviour and language may change and they may begin to show a Jekyll-and-Hyde side to their nature.
Seizures can also be an early symptom. If the tumour is pressing on some precise spot in the brain, it may give rise to related symptoms - for example, pressure on nerves leading to the eye may cause double vision. Although only a few headaches are related to cerebral tumours, these cancers are not as rare as people like to think - 10 per cent of solid cancers are within the brain, and these account for 1 per cent of all deaths in the UK. Unfortunately, treatment of the common brain cancers has not improved dramatically in the past 30 years, although modern surgery and radiotherapy are giving patients a longer survival time....
In this distressing field of medicine there has recently been a glimmer of hope - not a huge breakthrough but a significant one. Treatment has been introduced that can prolong survival time by 20 per cent in those suffering from a glioma. Gliomas account for 60 per cent of brain tumours. A licence was recently granted for the insertion of a chemotherapeutic, biodegradable disc or wafer, the size of a 5p piece, into the tumour site at surgery, with the intention of destroying the glioma tentacles that have escaped the surgeon's knife.
Unfortunately the National Institute for Clinical Excellence (Nice) is reluctant to recommend that the NHS pays for it and is equally reluctant to pay for temozolomide, another advance in the treatment of gliomas: 26 per cent of patients taking temozolomide were alive two years after treatment, compared with only 10 per cent who had radiotherapy alone. These latest treatments have been widely adopted by countries much poorer than Britain.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Cherie's magic magnets cure
NHS accountants are so impressed by the cost-effectiveness of a "magnetic leg wrap" called 4UlcerCare that from Wednesday doctors will be allowed to prescribe it to patients.
Magnetic therapy, which was pioneered in ancient Egypt, has become one of the pillars of modern alternative medicine. Its adherents include Cherie Blair, Bill Clinton and Sir Anthony Hopkins, the actor. Although its merits are challenged by traditional medics, it is used to treat joint pains, sports injuries, backache, muscle soreness and period pain. It is also used on animals - 4UlcerCare was inspired by a dog named Kiri, which developed severe arthritis. Conventional treatments did not help and, after researching the use of magnets, Kiri's owner, Derek Price, made a magnetic collar. The dog made a remarkable recovery, which led Price to start manufacturing magnetic treatments for animals and people. Magnopulse, of which he is managing director, has sold more than 1m therapeutic magnets since 1997 to treat arthritis, swollen ankles, period pains and varicose veins.
The NHS Prescription Pricing Authority has ruled that 4UlcerCare is not just good for patients but also a good use of NHS cash. It believes the magnets will save money on bandages and nurses' time by healing the wounds. It has included magnets on the official list of items that can be prescribed on the NHS. The NHS has even done a cut-price deal with the manufacturers, buying treatments at 13.80 pounds instead of the normal price of 29 pounds.
Critics of magnetic therapy say it is no more effective than a placebo, however. Only last month a paper in the British Medical Journal by Professor Leonard Finegold, from Drexel University in Philadelphia, and Professor Bruce Flamm, from Kaiser Permanente Medical Center in Riverside, California, cast doubt on the treatment. "Patients should be advised that magnet therapy has no proven benefits. If they insist on using a magnetic device, they could be advised to buy the cheapest - this will alleviate the pain in their wallet," they wrote.
It is not known exactly how magnets work. Adherents believe they improve circulation because they attract the iron in blood towards them and, in doing so, increase the supply of oxygen to the wound. They may also reduce painful acidity in tissue.
More here
BUT NO FUNDING FOR SOME TREATMENTS THAT DO work
I guess Brits might have to wait until Cherie Blair backs it
The patient with a cerebral tumour may well complain of a headache. Classically, such headaches are worse in the mornings after the patient has been lying flat all night. They are usually across the forehead, affect both sides of the head and are made worse by coughing, straining or vomiting. Over time they tend to last longer and longer into the day and are increasingly likely to be associated with dizziness, nausea, clumsiness and a disturbed gait. Other people often notice subtle changes in the personality of their friend or relative. In one case in four, it is these observed changes that first draw attention to the possibility of a brain tumour. The patient may become difficult, obstinate or aggressive. Their behaviour and language may change and they may begin to show a Jekyll-and-Hyde side to their nature.
Seizures can also be an early symptom. If the tumour is pressing on some precise spot in the brain, it may give rise to related symptoms - for example, pressure on nerves leading to the eye may cause double vision. Although only a few headaches are related to cerebral tumours, these cancers are not as rare as people like to think - 10 per cent of solid cancers are within the brain, and these account for 1 per cent of all deaths in the UK. Unfortunately, treatment of the common brain cancers has not improved dramatically in the past 30 years, although modern surgery and radiotherapy are giving patients a longer survival time....
In this distressing field of medicine there has recently been a glimmer of hope - not a huge breakthrough but a significant one. Treatment has been introduced that can prolong survival time by 20 per cent in those suffering from a glioma. Gliomas account for 60 per cent of brain tumours. A licence was recently granted for the insertion of a chemotherapeutic, biodegradable disc or wafer, the size of a 5p piece, into the tumour site at surgery, with the intention of destroying the glioma tentacles that have escaped the surgeon's knife.
Unfortunately the National Institute for Clinical Excellence (Nice) is reluctant to recommend that the NHS pays for it and is equally reluctant to pay for temozolomide, another advance in the treatment of gliomas: 26 per cent of patients taking temozolomide were alive two years after treatment, compared with only 10 per cent who had radiotherapy alone. These latest treatments have been widely adopted by countries much poorer than Britain.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, March 05, 2006
SCREWY U.S. REGULATIONS
Two years ago, the University of Washington School of Medicine paid the government $62 million to settle a Medicare billing dispute. In addition to its legal expenses, the medical school paid more than $750,000 for a high-powered, outside committee to review what happened and write up a report. Obviously, the medical school learned an expensive lesson. But will the lesson help improve patient care? We doubt it.
The title of the 111-page report summarizes the emphasis: "Achieving Excellence in Compliance." The document uses the word "compliance" 620 times, and recommends a new objective for the school: achieving "a culture of compliance" in addition to the more traditional medical school goals of research, teaching and patient care. To implement the recommendations of the report, the school is spending money for more lawyers, more layers of staffing, re-educating physicians and more oversight of who bills for what and how.
Unfortunately, the process is eerily like that for many businesses where the Sarbanes-Oxley law has resulted in complicated, expensive and difficult-to-comply-with rules. Once upon a time, an organization could be successful by ethically providing goods and services to customers and clients. The ethical guidelines for this behavior were ultimately based on underlying and universal moral rules, such as those prohibiting stealing or cheating. Understandable and enforceable laws and contracts often reflected those ethics. Over time, many lost sight of the underlying moral code but still followed the ethical codes set up by business or professional organizations.
More recently, complicated laws governing business and professional behavior are causing increased emphasis on compliance to the often arbitrary rules, sometimes leaving common sense and ethics behind. Judges agreeing with new ideas put forth by trial lawyers or government prosecutors often defeat rather than fulfill justice. Many enterprises, probably now including the UW medical school, visualize these exceedingly complicated rules as an impenetrable briar patch. It's easy to understand why they now concentrate their compliance resources in the areas targeted by government enforcers. Because it's impossible to consistently comply with all the myriad rules, the goal becomes damage control; the modus operandi becomes risk management. Instead of being a uniform and solidifying bedrock underpinning civilization, law enforcement has become an unmarked minefield destroying lives and enterprises almost willy-nilly.
In medicine, Congress is now considering "pay for performance" and "best practices" incentives that would reward doctors for following government guidelines (i.e., rules) on how to treat patients with particular conditions or diseases. One difficulty with this government micromanagement is that the scientific studies used to establish the "best practice" rules typically include patients with a given condition, such as congestive heart failure and a narrow range of possibly complicating factors. Researchers do not further analyze patients with a significant complicating factor because it would take too many such patients to generate a statistically significant result. For these patients, there's no "best practice" science to unerringly guide the doctor in treatment. For example, a patient with heart failure might have a past history of a previous stroke and also come down with pneumonia on top of the heart failure. It would be rare for an up-to-date scientific study to account for even this relatively simple set of complicating factors. And, medical advances quickly outdate these studies.
In addition, research funds for promising but politically-incorrect treatment methods, such as chelation therapy and hyperbaric oxygen therapy, is cut off by the medical-political complex controlling almost all research grants.
Most people want doctors with experience in treating their condition rather than a technician treating them based on a printout from the best-practices computer.
There's a huge disconnect between the goals of compliance and excellent patient care. "Compliance" implies there's something to comply with, such as government billing and practice rules. But successful patient care often depends on creative insight. The practice of medicine is as much an art as a science. If it were only science and technique, we'd have high-school-graduate best-practices technicians following computer printouts rather than medical doctors taking care of patients. Why waste all that time and money for college plus five to ten years of medical training?
We agree that doctors should be moral, honest and ethical. But "compliant" as a primary motivation? Ethical should cover that base. The more energy and costs expended on compliance, the less is left over for patient care. The alternative is for increased costs of medical care, without any added patient benefit. Ironically, although the government insists that Medicare recipients get first class medical care at the same time it clamps down on medical costs, the result of more compliance efforts will be decreased access and higher costs.
If the University of Washington succeeds in "achieving excellence in compliance," it may avoid further government penalties, but patients will ultimately pay the price, both in the quality of care and dollars.
Source
Queensland hospital bed crisis continues despite political hot air
There seems to be NOTHING they can do to make their public medicine system work properly
As Premier Peter Beattie announced on Thursday that Queensland's health system had "turned the corner", 49 Queenslanders were on hospital gurneys in emergency departments statewide, waiting for proper beds. This was in spite of Queensland Health data showing that during the last six months of 2005 the five Brisbane public hospitals admitted fewer patients than in the same period in 2004. Admissions to the Mater General, for example, were down almost 20 per cent. The data shows all five hospitals have been operating at peak capacity for most of the past week. Statewide, this has contributed to dozens of patients every day being forced to wait in hospital emergency departments while staff struggle to find beds for them. Yesterday 64 people were waiting for beds; on Wednesday (the day before Mr Beattie's declaration) 72 were in limbo across the state.
So urgent has the demand for beds become that management at Queensland's largest hospital, the Royal Brisbane and Women's, has told staff to move discharged patients into a transit lounge to free beds, and that beds are not to stay vacant longer than 30 minutes. The situation is not confined to Brisbane, with most regional hospitals also forced to accommodate people in emergency departments while staff look for beds.
The number of public hospital beds in Queensland dropped from 10,115 in 1994-95 to 9340 in 2004-05. In this time Queensland's population grew by 25 per cent. The bed shortage is likely to hit the politically sensitive issue of elective-surgery waiting lists harder. Two new studies to appear tomorrow in The Medical Journal of Australia have found hospital and emergency department overcrowding to be associated with increased mortality; and show the hospital bed closures have resulted in hospital occupancies over 95 per cent.
Mr Beattie yesterday continued to defend his proclamation that the state's health system had "turned the corner". He said securing new pay deals for doctors and nurses was "absolutely fundamental" to turning the corner to improve health. "If you haven't got doctors and nurses it doesn't matter how many beds you've got you'll never reduce waiting times," he said. "The core issue here was to get a pay package that satisfied our doctors and satisfied our nurses. They were the two big challenges - and to make sure, we trained more doctors for the future." Mr Beattie said hospital bed numbers and waiting lists were among the "longterm, systemic" issues that would take time to resolve because of Queensland's population growth. "That's why we had a five-year plan," he said.
Queensland Opposition health spokesman Bruce Flegg said all of Queensland's major hospitals "are suffering serious bed shortages that is causing a critical situation of access-block in emergency departments". "Clearly Queensland Health has not turned the corner, and Mr Beattie should be ashamed of himself for trying to pull the wool over the eyes of Queenslanders," Dr Flegg said. Australian Medical Association Queensland president Steve Hambleton said yesterday that "the health system is nowhere near fixed yet". He said the $1 billion pay rise over the next three years, given to nurses this week, was "recognition of their value to the system, but the money was not a solution alone". "Fixing Queensland's health system will depend on the co-operation of all those in the health profession," Dr Hambleton said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Two years ago, the University of Washington School of Medicine paid the government $62 million to settle a Medicare billing dispute. In addition to its legal expenses, the medical school paid more than $750,000 for a high-powered, outside committee to review what happened and write up a report. Obviously, the medical school learned an expensive lesson. But will the lesson help improve patient care? We doubt it.
The title of the 111-page report summarizes the emphasis: "Achieving Excellence in Compliance." The document uses the word "compliance" 620 times, and recommends a new objective for the school: achieving "a culture of compliance" in addition to the more traditional medical school goals of research, teaching and patient care. To implement the recommendations of the report, the school is spending money for more lawyers, more layers of staffing, re-educating physicians and more oversight of who bills for what and how.
Unfortunately, the process is eerily like that for many businesses where the Sarbanes-Oxley law has resulted in complicated, expensive and difficult-to-comply-with rules. Once upon a time, an organization could be successful by ethically providing goods and services to customers and clients. The ethical guidelines for this behavior were ultimately based on underlying and universal moral rules, such as those prohibiting stealing or cheating. Understandable and enforceable laws and contracts often reflected those ethics. Over time, many lost sight of the underlying moral code but still followed the ethical codes set up by business or professional organizations.
More recently, complicated laws governing business and professional behavior are causing increased emphasis on compliance to the often arbitrary rules, sometimes leaving common sense and ethics behind. Judges agreeing with new ideas put forth by trial lawyers or government prosecutors often defeat rather than fulfill justice. Many enterprises, probably now including the UW medical school, visualize these exceedingly complicated rules as an impenetrable briar patch. It's easy to understand why they now concentrate their compliance resources in the areas targeted by government enforcers. Because it's impossible to consistently comply with all the myriad rules, the goal becomes damage control; the modus operandi becomes risk management. Instead of being a uniform and solidifying bedrock underpinning civilization, law enforcement has become an unmarked minefield destroying lives and enterprises almost willy-nilly.
In medicine, Congress is now considering "pay for performance" and "best practices" incentives that would reward doctors for following government guidelines (i.e., rules) on how to treat patients with particular conditions or diseases. One difficulty with this government micromanagement is that the scientific studies used to establish the "best practice" rules typically include patients with a given condition, such as congestive heart failure and a narrow range of possibly complicating factors. Researchers do not further analyze patients with a significant complicating factor because it would take too many such patients to generate a statistically significant result. For these patients, there's no "best practice" science to unerringly guide the doctor in treatment. For example, a patient with heart failure might have a past history of a previous stroke and also come down with pneumonia on top of the heart failure. It would be rare for an up-to-date scientific study to account for even this relatively simple set of complicating factors. And, medical advances quickly outdate these studies.
In addition, research funds for promising but politically-incorrect treatment methods, such as chelation therapy and hyperbaric oxygen therapy, is cut off by the medical-political complex controlling almost all research grants.
Most people want doctors with experience in treating their condition rather than a technician treating them based on a printout from the best-practices computer.
There's a huge disconnect between the goals of compliance and excellent patient care. "Compliance" implies there's something to comply with, such as government billing and practice rules. But successful patient care often depends on creative insight. The practice of medicine is as much an art as a science. If it were only science and technique, we'd have high-school-graduate best-practices technicians following computer printouts rather than medical doctors taking care of patients. Why waste all that time and money for college plus five to ten years of medical training?
We agree that doctors should be moral, honest and ethical. But "compliant" as a primary motivation? Ethical should cover that base. The more energy and costs expended on compliance, the less is left over for patient care. The alternative is for increased costs of medical care, without any added patient benefit. Ironically, although the government insists that Medicare recipients get first class medical care at the same time it clamps down on medical costs, the result of more compliance efforts will be decreased access and higher costs.
If the University of Washington succeeds in "achieving excellence in compliance," it may avoid further government penalties, but patients will ultimately pay the price, both in the quality of care and dollars.
Source
Queensland hospital bed crisis continues despite political hot air
There seems to be NOTHING they can do to make their public medicine system work properly
As Premier Peter Beattie announced on Thursday that Queensland's health system had "turned the corner", 49 Queenslanders were on hospital gurneys in emergency departments statewide, waiting for proper beds. This was in spite of Queensland Health data showing that during the last six months of 2005 the five Brisbane public hospitals admitted fewer patients than in the same period in 2004. Admissions to the Mater General, for example, were down almost 20 per cent. The data shows all five hospitals have been operating at peak capacity for most of the past week. Statewide, this has contributed to dozens of patients every day being forced to wait in hospital emergency departments while staff struggle to find beds for them. Yesterday 64 people were waiting for beds; on Wednesday (the day before Mr Beattie's declaration) 72 were in limbo across the state.
So urgent has the demand for beds become that management at Queensland's largest hospital, the Royal Brisbane and Women's, has told staff to move discharged patients into a transit lounge to free beds, and that beds are not to stay vacant longer than 30 minutes. The situation is not confined to Brisbane, with most regional hospitals also forced to accommodate people in emergency departments while staff look for beds.
The number of public hospital beds in Queensland dropped from 10,115 in 1994-95 to 9340 in 2004-05. In this time Queensland's population grew by 25 per cent. The bed shortage is likely to hit the politically sensitive issue of elective-surgery waiting lists harder. Two new studies to appear tomorrow in The Medical Journal of Australia have found hospital and emergency department overcrowding to be associated with increased mortality; and show the hospital bed closures have resulted in hospital occupancies over 95 per cent.
Mr Beattie yesterday continued to defend his proclamation that the state's health system had "turned the corner". He said securing new pay deals for doctors and nurses was "absolutely fundamental" to turning the corner to improve health. "If you haven't got doctors and nurses it doesn't matter how many beds you've got you'll never reduce waiting times," he said. "The core issue here was to get a pay package that satisfied our doctors and satisfied our nurses. They were the two big challenges - and to make sure, we trained more doctors for the future." Mr Beattie said hospital bed numbers and waiting lists were among the "longterm, systemic" issues that would take time to resolve because of Queensland's population growth. "That's why we had a five-year plan," he said.
Queensland Opposition health spokesman Bruce Flegg said all of Queensland's major hospitals "are suffering serious bed shortages that is causing a critical situation of access-block in emergency departments". "Clearly Queensland Health has not turned the corner, and Mr Beattie should be ashamed of himself for trying to pull the wool over the eyes of Queenslanders," Dr Flegg said. Australian Medical Association Queensland president Steve Hambleton said yesterday that "the health system is nowhere near fixed yet". He said the $1 billion pay rise over the next three years, given to nurses this week, was "recognition of their value to the system, but the money was not a solution alone". "Fixing Queensland's health system will depend on the co-operation of all those in the health profession," Dr Hambleton said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, March 04, 2006
WAL-MART IS THE HAM IN THE SOCIALIZED MEDICINE SANDWICH
With the war on Wal-Mart now heating up in nearly three dozen state legislatures, I put a call in to someone who was in on the ground floor in pushing to force the retailer to spend more on health care for its employees. What Maryland's Delegate James Hubbard, a Democrat from Prince George's County, had to say was revealing of both why he backed his state's "Wal-Mart bill" and what this fight is really about: expanding Medicaid and other taxpayer-funded health-care entitlements.
Let's first understand that the drive to enact anti-Wal-Mart legislation has very little to do with the retail giant except in two respects: dipping into its very deep pockets, and using the controversy surrounding the company to mask the larger agenda of expanding already-bankrupt entitlement programs. Of course, in this war legislators have a ready made ally in the AFL-CIO, which has its own reasons for going after the nonunionized company.
With that, let's turn to Mr. Hubbard. He began our conversation by pointing out that the Wal-Mart bill--which forces companies with more than 10,000 employees to spend at least 8% of their payroll on health care or pay the state the difference--was always intended to be just the first step. Four years ago, he made his intentions clear by introducing legislation to increase cigarette taxes and to use the tax code to compel employers to provide health insurance. Under his legislation the revenue from these taxes would be dumped into a new state fund that would then be used to expand Medicaid eligibility to families with incomes up to 300% of the poverty line (up from 200% now). But even in a legislature with large Democratic majorities, his bill stalled.
So Mr. Hubbard and others settled on a new approach--pushing through smaller, bite-sized pieces. The first piece was the Wal-Mart bill. It passed last year and was enacted last month, when the Legislature overrode Gov. Robert Ehrlich's veto. Two weeks ago Mr. Hubbard was at it again, this time introducing a new bill to mandate that companies with at least 1,000 employees spend 4.5% of their payroll on health care or pay the state the difference. Once this piece is in place, Mr. Hubbard told me, the next step will be to create a similar mandate--perhaps 2% or 3%--for companies with fewer than 1,000 employees. Each year, Mr. Hubbard hopes to expand the mandate to include ever smaller companies with the ultimate goal of "health coverage for all Marylanders."
Mr. Hubbard noted how effective splitting the difference can be in moving legislation toward a larger goal. "If you give up 80% of what you want to get 20%," he said, "after five years you will have nothing left to give up." Mr. Hubbard also noted a quirk in the system that made raising taxes and expanding the Medicaid rolls attractive. With the federal government paying half or more of every dollar spent on Medicaid, states were essentially leaving federal dollars on the table by not expanding the program.
It is within this context that we should view the National Governors Association's meeting in Washington this week. Like all interest groups, the states' chief executives are determined not to leave town empty-handed; and every year a top agenda item for them is getting more federal dollars to cover the ever-expanding cost of Medicaid. And who could blame them? After all, the federal government created Medicaid as a tiny program in the 1960s. Today it eats up, on average, about a quarter of each state's budget and grows every year at a rate that outstrips inflation and threatens to gobble up dollars needed for education and other priorities.
Yet Mr. Hubbard isn't the only state lawmaker who has figured out that he can leverage the federal Treasury to his advantage by expanding Medicaid eligibility. New York is well ahead on this learning curve. According to a recent study published by State Policy Reports, the Empire State receives more federal dollars per capita than any other state and more than twice the national average.
What's now dawning on Wal-Mart CEO Lee Scott is that his company is a middleman in this exchange. So on Sunday he spoke directly to the governors and said there was "too much politics" in state bills taking aim at his company. Of course, that's exactly why more states will target Wal-Mart and other employers in order to raise revenue to expand Medicaid, unless someone in Washington puts a stop to it.
Source
Foreigners get free surgery on Medicare in Australia too
Sick foreigners are using the Medicare cards of Australian citizens to get free medical treatment in our hospitals. The Medicare fraud, which is costing taxpayers millions of dollars a year, is possible because our outdated Medicare [ID] cards carry no proof of identity. A Daily Telegraph investigation has found a Victorian man was convicted and fined for allowing his father, a foreigner, to use his Medicare card to claim benefits for laser eye treatments and medical consultations worth more than $3300. He told investigators he had committed the fraud because he could not afford to pay for his father's treatment when he came to visit Australia.
A Sydney woman discovered last year that someone received a free kidney operation using her Medicare card after it was stolen. She only discovered the fraud when she visited her specialist for a routine appointment and he asked her how she was feeling after the surgery.
In 2003-04 Medicare Australia investigated 137 reports of members of the public defrauding Medicare. A recent Auditor General's report found 500,000 Medicare cards were still registered to patients who had died. Some citizens have two Medicare cards - one which lists them as a male, the other as a female.
It is not just foreigners who are using stolen Medicare cards to defraud taxpayers. In Western Australia a man has been jailed for 12 months on 80 counts of fraud when he was found to have used another person's Medicare card to get taxpayers to pay for medical services and narcotics. A deregistered Queensland doctor used 21 stolen identities involving Medicare cards to get hold of 19,650 morphine tablets. The fraud cost the Pharmaceutical Benefits Scheme $50,000 and the tablets had a street value of $2 million. Police in Western Australia have uncovered an organised crime syndicate that was using multiple identities and Medicare cards to get taxpayers to pay for medical services. The fraud is estimated to have been worth more than $19,000. These are just some of the fraud cases that have been uncovered by Medicare Australia but the full scale of the problem could be much larger.
Medicare says less than 1 per cent of the $9 billion worth of claims a year it pays out are fraudulent but that still means fraud could be costing taxpayers up to $90 million a year. Human Services Minister Joe Hockey will soon take to Cabinet plans for a new Medicare smartcard that would carry a person's photograph and other identification and help combat Medicare fraud. The enhanced identity safeguards would make it difficult for an imposter or a non-taxpaying foreigner to use another person's Medicare card to claim rebates or get free public hospital treatment.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
With the war on Wal-Mart now heating up in nearly three dozen state legislatures, I put a call in to someone who was in on the ground floor in pushing to force the retailer to spend more on health care for its employees. What Maryland's Delegate James Hubbard, a Democrat from Prince George's County, had to say was revealing of both why he backed his state's "Wal-Mart bill" and what this fight is really about: expanding Medicaid and other taxpayer-funded health-care entitlements.
Let's first understand that the drive to enact anti-Wal-Mart legislation has very little to do with the retail giant except in two respects: dipping into its very deep pockets, and using the controversy surrounding the company to mask the larger agenda of expanding already-bankrupt entitlement programs. Of course, in this war legislators have a ready made ally in the AFL-CIO, which has its own reasons for going after the nonunionized company.
With that, let's turn to Mr. Hubbard. He began our conversation by pointing out that the Wal-Mart bill--which forces companies with more than 10,000 employees to spend at least 8% of their payroll on health care or pay the state the difference--was always intended to be just the first step. Four years ago, he made his intentions clear by introducing legislation to increase cigarette taxes and to use the tax code to compel employers to provide health insurance. Under his legislation the revenue from these taxes would be dumped into a new state fund that would then be used to expand Medicaid eligibility to families with incomes up to 300% of the poverty line (up from 200% now). But even in a legislature with large Democratic majorities, his bill stalled.
So Mr. Hubbard and others settled on a new approach--pushing through smaller, bite-sized pieces. The first piece was the Wal-Mart bill. It passed last year and was enacted last month, when the Legislature overrode Gov. Robert Ehrlich's veto. Two weeks ago Mr. Hubbard was at it again, this time introducing a new bill to mandate that companies with at least 1,000 employees spend 4.5% of their payroll on health care or pay the state the difference. Once this piece is in place, Mr. Hubbard told me, the next step will be to create a similar mandate--perhaps 2% or 3%--for companies with fewer than 1,000 employees. Each year, Mr. Hubbard hopes to expand the mandate to include ever smaller companies with the ultimate goal of "health coverage for all Marylanders."
Mr. Hubbard noted how effective splitting the difference can be in moving legislation toward a larger goal. "If you give up 80% of what you want to get 20%," he said, "after five years you will have nothing left to give up." Mr. Hubbard also noted a quirk in the system that made raising taxes and expanding the Medicaid rolls attractive. With the federal government paying half or more of every dollar spent on Medicaid, states were essentially leaving federal dollars on the table by not expanding the program.
It is within this context that we should view the National Governors Association's meeting in Washington this week. Like all interest groups, the states' chief executives are determined not to leave town empty-handed; and every year a top agenda item for them is getting more federal dollars to cover the ever-expanding cost of Medicaid. And who could blame them? After all, the federal government created Medicaid as a tiny program in the 1960s. Today it eats up, on average, about a quarter of each state's budget and grows every year at a rate that outstrips inflation and threatens to gobble up dollars needed for education and other priorities.
Yet Mr. Hubbard isn't the only state lawmaker who has figured out that he can leverage the federal Treasury to his advantage by expanding Medicaid eligibility. New York is well ahead on this learning curve. According to a recent study published by State Policy Reports, the Empire State receives more federal dollars per capita than any other state and more than twice the national average.
What's now dawning on Wal-Mart CEO Lee Scott is that his company is a middleman in this exchange. So on Sunday he spoke directly to the governors and said there was "too much politics" in state bills taking aim at his company. Of course, that's exactly why more states will target Wal-Mart and other employers in order to raise revenue to expand Medicaid, unless someone in Washington puts a stop to it.
Source
Foreigners get free surgery on Medicare in Australia too
Sick foreigners are using the Medicare cards of Australian citizens to get free medical treatment in our hospitals. The Medicare fraud, which is costing taxpayers millions of dollars a year, is possible because our outdated Medicare [ID] cards carry no proof of identity. A Daily Telegraph investigation has found a Victorian man was convicted and fined for allowing his father, a foreigner, to use his Medicare card to claim benefits for laser eye treatments and medical consultations worth more than $3300. He told investigators he had committed the fraud because he could not afford to pay for his father's treatment when he came to visit Australia.
A Sydney woman discovered last year that someone received a free kidney operation using her Medicare card after it was stolen. She only discovered the fraud when she visited her specialist for a routine appointment and he asked her how she was feeling after the surgery.
In 2003-04 Medicare Australia investigated 137 reports of members of the public defrauding Medicare. A recent Auditor General's report found 500,000 Medicare cards were still registered to patients who had died. Some citizens have two Medicare cards - one which lists them as a male, the other as a female.
It is not just foreigners who are using stolen Medicare cards to defraud taxpayers. In Western Australia a man has been jailed for 12 months on 80 counts of fraud when he was found to have used another person's Medicare card to get taxpayers to pay for medical services and narcotics. A deregistered Queensland doctor used 21 stolen identities involving Medicare cards to get hold of 19,650 morphine tablets. The fraud cost the Pharmaceutical Benefits Scheme $50,000 and the tablets had a street value of $2 million. Police in Western Australia have uncovered an organised crime syndicate that was using multiple identities and Medicare cards to get taxpayers to pay for medical services. The fraud is estimated to have been worth more than $19,000. These are just some of the fraud cases that have been uncovered by Medicare Australia but the full scale of the problem could be much larger.
Medicare says less than 1 per cent of the $9 billion worth of claims a year it pays out are fraudulent but that still means fraud could be costing taxpayers up to $90 million a year. Human Services Minister Joe Hockey will soon take to Cabinet plans for a new Medicare smartcard that would carry a person's photograph and other identification and help combat Medicare fraud. The enhanced identity safeguards would make it difficult for an imposter or a non-taxpaying foreigner to use another person's Medicare card to claim rebates or get free public hospital treatment.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, March 03, 2006
THE HEARTLESS CANADIAN SYSTEM AGAIN
Two stories below about what "caring" Leftists create:
No mercy for man waiting for surgery:
A mentally disabled Elliot Lake man will have to live with a painful stomach condition for a few more months because Sudbury Regional Hospital (SRH) has a limit on the surgery he needs. The middle-aged man, who was born with his stomach in the wrong place, suffers from severe and painful dry heaves. His condition can be cured by a procedure called laparoscopic anti-reflux surgery, which would change the position of his stomach. However, the hospital has limited Sudbury's two thoracic surgeons to doing just 25 of these surgeries in a fiscal year, and they have already surpassed their limit.
The man was originally scheduled for surgery at Sudbury Regional Hospital in December, but the procedure was cancelled twice, says Heather Tasse, a home support worker for Community Living Algoma who helps to care for the man. The man's surgeon, who has asked not to be named, told Tasse the hospital isn't allowing him to perform any laparoscopic anti-reflux surgeries from the beginning of February until the end of March, when the fiscal year ends.
Demand for his services has been increasing over the past few years. He is one of only a few doctors in the province able to perform anti-reflux surgery in a minimally invasive fashion. Tasse says her client is near the top of the surgeon's 14-month waiting list, because he is in so much pain. "How can you put a cap on people's health?" asks Tass‚. "Maybe more people should ask why (the surgeon) is being limited in the number of these procedures he does. I mean, that's ludicrous."
SRH chief of staff Dr. Chris McKibbon says the hospital has many surgical priorities, and must decide how to allocate funding within their tight budget. The hospital puts a cap on many types of surgeries, not just laparoscopic anti-reflux surgery, he says. "One of the things that you need to understand is that we're funded for particular volumes of all kinds of things. We project how many cardiac surgeries, knee replacements and cataracts we're going to do," says the doctor. "The struggle is try to do the best we can to get it right and actually deliver on our commitments. So is this (capping numbers of surgeries) unique? Not at all."
Couple face long, painful wait for care. Man, wife need knee, hip surgeries:
Incapacitated by joint damage, Joan and Don Brigden have squeezed their lives into two rooms by installing their bed and a shower downstairs. She is 70 and was slated for hip replacement since May; he is 68 and was to get a new knee in September. But then their files and referrals got lost between two Gatineau hospitals. The couple from Bowman, 70 kilometres north of Ottawa, had to start from scratch, facing an eight-month wait for a consultation.
"She's gone from using a cane to a walker to a wheelchair in four months," Don Brigden said of his wife. "We are literally living in two rooms. It's terrible. We shouldn't have to suffer this way."
Montreal orthopedic surgeon Ethan Lichtblau "inherited" the two cases in December after a referral from a family doctor in Hawkesbury, Ont. The Brigdens had expected their suffering would end shortly. They were looking forward to doing their grocery shopping together once again. But this week, they found themselves on yet another waiting list. Lichtblau's hospital, Santa Cabrini, has shut its operating room to knee and hip replacements because of budget restrictions.
When is Quebec's plan of guaranteed wait times going to kick in?, Don Brigden demanded. The Brigdens say they understand surgery delays aren't the hospital's or the surgeon's fault. "But from where I'm sitting, it doesn't seem fair," Joan Brigden said. "You can't blame the doctors - it's the friggin' system," her husband added. "We paid taxes all our lives for this and now they tell us they don't have the money to do it right away."
Tired of waiting for the pain to abate, other Gatineau-area patients have paid $15,000 for hip surgery, done in a private clinic in Laval. The Brigdens are going to wait until Santa Cabrini opens again to knee and hip surgeries in April. "It's just a shame we have to wait that long. She should be walking around being functional," Don Brigden said of his wife. "It's just not right."
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Two stories below about what "caring" Leftists create:
No mercy for man waiting for surgery:
A mentally disabled Elliot Lake man will have to live with a painful stomach condition for a few more months because Sudbury Regional Hospital (SRH) has a limit on the surgery he needs. The middle-aged man, who was born with his stomach in the wrong place, suffers from severe and painful dry heaves. His condition can be cured by a procedure called laparoscopic anti-reflux surgery, which would change the position of his stomach. However, the hospital has limited Sudbury's two thoracic surgeons to doing just 25 of these surgeries in a fiscal year, and they have already surpassed their limit.
The man was originally scheduled for surgery at Sudbury Regional Hospital in December, but the procedure was cancelled twice, says Heather Tasse, a home support worker for Community Living Algoma who helps to care for the man. The man's surgeon, who has asked not to be named, told Tasse the hospital isn't allowing him to perform any laparoscopic anti-reflux surgeries from the beginning of February until the end of March, when the fiscal year ends.
Demand for his services has been increasing over the past few years. He is one of only a few doctors in the province able to perform anti-reflux surgery in a minimally invasive fashion. Tasse says her client is near the top of the surgeon's 14-month waiting list, because he is in so much pain. "How can you put a cap on people's health?" asks Tass‚. "Maybe more people should ask why (the surgeon) is being limited in the number of these procedures he does. I mean, that's ludicrous."
SRH chief of staff Dr. Chris McKibbon says the hospital has many surgical priorities, and must decide how to allocate funding within their tight budget. The hospital puts a cap on many types of surgeries, not just laparoscopic anti-reflux surgery, he says. "One of the things that you need to understand is that we're funded for particular volumes of all kinds of things. We project how many cardiac surgeries, knee replacements and cataracts we're going to do," says the doctor. "The struggle is try to do the best we can to get it right and actually deliver on our commitments. So is this (capping numbers of surgeries) unique? Not at all."
Couple face long, painful wait for care. Man, wife need knee, hip surgeries:
Incapacitated by joint damage, Joan and Don Brigden have squeezed their lives into two rooms by installing their bed and a shower downstairs. She is 70 and was slated for hip replacement since May; he is 68 and was to get a new knee in September. But then their files and referrals got lost between two Gatineau hospitals. The couple from Bowman, 70 kilometres north of Ottawa, had to start from scratch, facing an eight-month wait for a consultation.
"She's gone from using a cane to a walker to a wheelchair in four months," Don Brigden said of his wife. "We are literally living in two rooms. It's terrible. We shouldn't have to suffer this way."
Montreal orthopedic surgeon Ethan Lichtblau "inherited" the two cases in December after a referral from a family doctor in Hawkesbury, Ont. The Brigdens had expected their suffering would end shortly. They were looking forward to doing their grocery shopping together once again. But this week, they found themselves on yet another waiting list. Lichtblau's hospital, Santa Cabrini, has shut its operating room to knee and hip replacements because of budget restrictions.
When is Quebec's plan of guaranteed wait times going to kick in?, Don Brigden demanded. The Brigdens say they understand surgery delays aren't the hospital's or the surgeon's fault. "But from where I'm sitting, it doesn't seem fair," Joan Brigden said. "You can't blame the doctors - it's the friggin' system," her husband added. "We paid taxes all our lives for this and now they tell us they don't have the money to do it right away."
Tired of waiting for the pain to abate, other Gatineau-area patients have paid $15,000 for hip surgery, done in a private clinic in Laval. The Brigdens are going to wait until Santa Cabrini opens again to knee and hip surgeries in April. "It's just a shame we have to wait that long. She should be walking around being functional," Don Brigden said of his wife. "It's just not right."
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, March 02, 2006
NOW READ HOW IT IS IN 2006 CANADA:
Since the year 2000 article I put up yesterday, the Canadian government has still not changed its stance. It is only defiant private entrepreneurs who are, with the help of the courts, beginning to alleviate the Canadian health service shortages
The Cambie Surgery Center, Canada's most prominent private hospital, may be considered a rogue enterprise. Accepting money from patients for operations they would otherwise receive free of charge in a public hospital is technically prohibited in this country, even in cases where patients would wait months or even years in discomfort before receiving treatment. But no one is about to arrest Dr. Brian Day, who is president and medical director of the center, or any of the 120 doctors who work there. Public hospitals are sending him growing numbers of patients they are too busy to treat, and his center is advertising that patients do not have to wait to replace their aching knees.
The country's publicly financed health insurance system - frequently described as the third rail of its political system and a core value of its national identity - is gradually breaking down. Private clinics are opening around the country by an estimated one a week, and private insurance companies are about to find a gold mine. Dr. Day, for instance, is planning to open more private hospitals, first in Toronto and Ottawa, then in Montreal, Calgary and Edmonton. Ontario provincial officials are already threatening stiff fines. Dr. Day says he is eager to see them in court. "We've taken the position that the law is illegal," Dr. Day, 59, says. "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years."
Dr. Day may be a rebel (he keeps a photograph of himself with Fidel Castro behind his desk), but he appears to be on top of a new wave in Canada's health care future. He is poised to become the president of the Canadian Medical Association next year, and his profitable Vancouver hospital is serving as a model for medical entrepreneurs in several provinces.
Canada remains the only industrialized country that outlaws privately financed purchases of core medical services. Prime Minister Stephen Harper and other politicians remain reluctant to openly propose sweeping changes even though costs for the national and provincial governments are exploding and some cancer patients are waiting months for diagnostic tests and treatment.
But a Supreme Court ruling last June - it found that a Quebec provincial ban on private health insurance was unconstitutional when patients were suffering and even dying on waiting lists - appears to have become a turning point for the entire country. "The prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services," the court ruled.
In response, the Quebec premier, Jean Charest, proposed this month to allow private hospitals to subcontract hip, knee and cataract surgery to private clinics when patients are unable to be treated quickly enough under the public system. The premiers of British Columbia and Alberta have suggested they will go much further to encourage private health services and insurance in legislation they plan to propose in the next few months.
Private doctors across the country are not waiting for changes in the law, figuring provincial governments will not try to stop them only to face more test cases in the Supreme Court. One Vancouver-based company launched a large for-profit family medical clinic specializing in screening and preventive medicine here last November. It is planning to set up three similar clinics - in Toronto, Ottawa and London, Ontario - next summer and nine more in several other cities by the end of 2007. Private diagnostic clinics offering MRI tests are opening around the country.
Canadian leaders continue to reject the largely market-driven American system, with its powerful private insurance companies and 40 million people left uninsured, as they look to European mixed public-private health insurance and delivery systems. "Why are we so afraid to look at mixed health care delivery models when other states in Europe and around the world have used them to produce better results for patients at a lower cost to taxpayers?" the premier of British Columbia, Gordon Campbell, asked in a speech two weeks ago.
While proponents of private clinics say they will shorten waiting lists and quicken service at public institutions, critics warn that they will drain the public system of doctors and nurses. Canada has a national doctor shortage already, with 1.4 million people in the province of Ontario alone without the services of a family doctor. "If anesthetists go to work in a private clinic," Manitoba's health minister, Tim Sale, argued recently, "the work that they were doing in the public sector is spread among fewer and fewer people."
But most Canadians agree that current wait times are not acceptable. The median wait time between a referral by a family doctor and an appointment with a specialist has increased to 8.3 weeks last year from 3.7 weeks in 1993, according to a recent study by The Fraser Institute, a conservative research group. Meanwhile the median wait between appointment with a specialist and treatment has increased to 9.4 weeks from 5.6 weeks over the same period. Average wait times between referral by a family doctor and treatment range from 5.5 weeks for oncology to 40 weeks for orthopedic surgery, according to the study. Last December, provincial health ministers unveiled new targets for cutting wait times, including four weeks for radiation therapy for cancer patients beginning when doctors consider them ready for treatment and 26 weeks for hip replacements. But few experts think that will stop the trend toward privatization.
Dr. Day's hospital here opened in 1996 with 30 doctors and three operating rooms, treating mostly police officers, members of the military and worker's compensation clients, who are still allowed to seek treatment outside the public insurance system. It took several years to turn a profit. Today the center is twice its original size and has yearly revenue of more than $8 million, mostly from perfectly legal procedures. Over the last 18 months, the hospital has been under contract by overburdened local hospitals to perform knee, spine and gynecological operations on more than 1,000 patients. Since the Supreme Court ruling in June, it began treating patients unwilling to wait on waiting lists and willing to pay their own money.
Now Dr. Day says he is considering building a full-service private hospital somewhere in Canada with a private medical school attached to it. "In a free and democratic society where you can spend money on gambling and alcohol and tobacco," Dr. Day said, "the state has no business preventing you and me from spending our own money on health care."
Source
Another hole in an Australian government health service: "A paramedic shortage has forced the Queensland government to search interstate and overseas for ambulance staff. The Department of Emergency Services today launched a major advertising campaign in newspapers throughout Australia and New Zealand to fill 144 paramedic positions. However, Queensland Emergency Services Minister Pat Purcell said he was not concerned by the staff shortage and the need to search beyond the state. "Paramedics are not coming here at the moment so that is why we are going elsewhere with the advertising," Mr Purcell said. "I don't know why they wouldn't want to come and work here as it's the most professional (paramedic) service in Australia." [Pay?] The positions needed to be filled throughout Queensland by September next year, he said".
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Since the year 2000 article I put up yesterday, the Canadian government has still not changed its stance. It is only defiant private entrepreneurs who are, with the help of the courts, beginning to alleviate the Canadian health service shortages
The Cambie Surgery Center, Canada's most prominent private hospital, may be considered a rogue enterprise. Accepting money from patients for operations they would otherwise receive free of charge in a public hospital is technically prohibited in this country, even in cases where patients would wait months or even years in discomfort before receiving treatment. But no one is about to arrest Dr. Brian Day, who is president and medical director of the center, or any of the 120 doctors who work there. Public hospitals are sending him growing numbers of patients they are too busy to treat, and his center is advertising that patients do not have to wait to replace their aching knees.
The country's publicly financed health insurance system - frequently described as the third rail of its political system and a core value of its national identity - is gradually breaking down. Private clinics are opening around the country by an estimated one a week, and private insurance companies are about to find a gold mine. Dr. Day, for instance, is planning to open more private hospitals, first in Toronto and Ottawa, then in Montreal, Calgary and Edmonton. Ontario provincial officials are already threatening stiff fines. Dr. Day says he is eager to see them in court. "We've taken the position that the law is illegal," Dr. Day, 59, says. "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years."
Dr. Day may be a rebel (he keeps a photograph of himself with Fidel Castro behind his desk), but he appears to be on top of a new wave in Canada's health care future. He is poised to become the president of the Canadian Medical Association next year, and his profitable Vancouver hospital is serving as a model for medical entrepreneurs in several provinces.
Canada remains the only industrialized country that outlaws privately financed purchases of core medical services. Prime Minister Stephen Harper and other politicians remain reluctant to openly propose sweeping changes even though costs for the national and provincial governments are exploding and some cancer patients are waiting months for diagnostic tests and treatment.
But a Supreme Court ruling last June - it found that a Quebec provincial ban on private health insurance was unconstitutional when patients were suffering and even dying on waiting lists - appears to have become a turning point for the entire country. "The prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services," the court ruled.
In response, the Quebec premier, Jean Charest, proposed this month to allow private hospitals to subcontract hip, knee and cataract surgery to private clinics when patients are unable to be treated quickly enough under the public system. The premiers of British Columbia and Alberta have suggested they will go much further to encourage private health services and insurance in legislation they plan to propose in the next few months.
Private doctors across the country are not waiting for changes in the law, figuring provincial governments will not try to stop them only to face more test cases in the Supreme Court. One Vancouver-based company launched a large for-profit family medical clinic specializing in screening and preventive medicine here last November. It is planning to set up three similar clinics - in Toronto, Ottawa and London, Ontario - next summer and nine more in several other cities by the end of 2007. Private diagnostic clinics offering MRI tests are opening around the country.
Canadian leaders continue to reject the largely market-driven American system, with its powerful private insurance companies and 40 million people left uninsured, as they look to European mixed public-private health insurance and delivery systems. "Why are we so afraid to look at mixed health care delivery models when other states in Europe and around the world have used them to produce better results for patients at a lower cost to taxpayers?" the premier of British Columbia, Gordon Campbell, asked in a speech two weeks ago.
While proponents of private clinics say they will shorten waiting lists and quicken service at public institutions, critics warn that they will drain the public system of doctors and nurses. Canada has a national doctor shortage already, with 1.4 million people in the province of Ontario alone without the services of a family doctor. "If anesthetists go to work in a private clinic," Manitoba's health minister, Tim Sale, argued recently, "the work that they were doing in the public sector is spread among fewer and fewer people."
But most Canadians agree that current wait times are not acceptable. The median wait time between a referral by a family doctor and an appointment with a specialist has increased to 8.3 weeks last year from 3.7 weeks in 1993, according to a recent study by The Fraser Institute, a conservative research group. Meanwhile the median wait between appointment with a specialist and treatment has increased to 9.4 weeks from 5.6 weeks over the same period. Average wait times between referral by a family doctor and treatment range from 5.5 weeks for oncology to 40 weeks for orthopedic surgery, according to the study. Last December, provincial health ministers unveiled new targets for cutting wait times, including four weeks for radiation therapy for cancer patients beginning when doctors consider them ready for treatment and 26 weeks for hip replacements. But few experts think that will stop the trend toward privatization.
Dr. Day's hospital here opened in 1996 with 30 doctors and three operating rooms, treating mostly police officers, members of the military and worker's compensation clients, who are still allowed to seek treatment outside the public insurance system. It took several years to turn a profit. Today the center is twice its original size and has yearly revenue of more than $8 million, mostly from perfectly legal procedures. Over the last 18 months, the hospital has been under contract by overburdened local hospitals to perform knee, spine and gynecological operations on more than 1,000 patients. Since the Supreme Court ruling in June, it began treating patients unwilling to wait on waiting lists and willing to pay their own money.
Now Dr. Day says he is considering building a full-service private hospital somewhere in Canada with a private medical school attached to it. "In a free and democratic society where you can spend money on gambling and alcohol and tobacco," Dr. Day said, "the state has no business preventing you and me from spending our own money on health care."
Source
Another hole in an Australian government health service: "A paramedic shortage has forced the Queensland government to search interstate and overseas for ambulance staff. The Department of Emergency Services today launched a major advertising campaign in newspapers throughout Australia and New Zealand to fill 144 paramedic positions. However, Queensland Emergency Services Minister Pat Purcell said he was not concerned by the staff shortage and the need to search beyond the state. "Paramedics are not coming here at the moment so that is why we are going elsewhere with the advertising," Mr Purcell said. "I don't know why they wouldn't want to come and work here as it's the most professional (paramedic) service in Australia." [Pay?] The positions needed to be filled throughout Queensland by September next year, he said".
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, March 01, 2006
CANADIANS ARE SLOW LEARNERS
The article below is from the year 2000!
Full Hospitals Make Canadians Wait and Look South
MONTREAL: Dressed in her orchid pink bathrobe and blue velour slippers, Edouardine Boucher perched on her bed at Notre Dame Hospital here on Friday and recounted the story of her night: electric doors constantly opening and closing by her feet, cold drafts blowing across her head each time an ambulance arrived in the subzero weather, and a drug addict who started shouting at 2:30 a.m., ''Untie me, untie me.'' But as nurses hurried by on Friday morning, no one thought it remarkable that Ms. Boucher, a 58-year-old grandmother awaiting open heart surgery, had spent a rough night on a gurney in an emergency room hallway. After all, other hallways of this 3-year-old hospital were lined with 66 other patients lying quietly on temporary beds.
To explain overflowing hospitals here and across the nation, Canadian health officials are blaming the annual winter flu epidemic. But, at the mention of flu, Daniel Brochu, the veteran head nurse here, gave a smirk and ran his pen down the patient list today: ''Heart problem, infection problem, hypertension, dialysis, brain tumor, two cerebral hemorrhages.'' On Thursday, he said, crowding was so bad that he was able to admit one patient only after the ambulance crew agreed to leave its stretcher.
When Canada's state-run health system was in its first bloom, in the 1970's, Americans regularly trooped up here on inspection tours, attracted by Canada's promise of universal ''free'' health care. Today, however, few Canadians would recommend their system as a model for export. Improving health care should be the federal government's top priority, said 93 percent of 3,000 Canadians interviewed last month by Ekos Research Associates. In another poll last month, conducted by Pollara, 74 percent of respondents supported the idea of user fees, which have been outlawed since 1984. ''There is not a day when the newspapers do not talk of the health crisis,'' said Pierre Gauthier, president of the Federation of Specialist Doctors of Quebec. ''It has become the No. 1 problem for Quebecois and for Canadians.''
In Toronto, Canada's largest city, overcrowding prompted emergency rooms in 23 of the city's 25 hospitals to turn away ambulances one day last week. Two weeks ago, in what one newspaper later called an ''ominous foreshadowing,'' police officers shot to death a distraught father who had taken a doctor hostage in a Toronto emergency room in an attempt to speed treatment for his sick baby. Further west, in Winnipeg, ''hallway medicine'' has become so routine that hallway stretcher locations have permanent numbers. Patients recuperate more slowly in the drafty, noisy hallways, doctors report. On the Pacific Coast, ambulances filled with ill patients have repeatedly stacked up this winter in the parking lot of Vancouver General Hospital. Maureen Whyte, a hospital vice president, estimates that 20 percent of heart attack patients who should have treatment within 15 minutes now wait an hour or more.
The shortage is a case of supply not keeping up with demand. During the 1990's, after government deficits ballooned, partly because of rising health costs, the government in Ottawa cut revenue-sharing payments to provinces -- by half, by some accounts. Today, the federal budget is balanced, but 7 hospitals in Montreal have been closed, and 44 hospitals in Ontario have been closed or merged.
Ottawa also largely closed the door to the immigration of foreign doctors and cut the number of spaces in Canadian medical schools by 20 percent. Today, Canada has one medical school slot for every 20,000 people, compared with one for 13,000 in the United States and Britain. With a buyout program, Quebec induced 3,600 nurses and 1,200 doctors to take early retirement. And across the nation, 6,000 nurses and at least 1,000 doctors have moved to the United States in recent years. At the same time, demands on Canada's health system grow every year. Within 30 years, the population over 65 is expected to double, to 25 percent.
Unable to meet the demand, hospitals now have operation waiting lists stretching for months or longer -- five years in the case of Ms. Boucher.
As a result, Canada has moved informally to a two-tier, public-private system. Although private practice is limited to dentists and veterinarians, 90 percent of Canadians live within 100 miles of the United States, and many people are crossing the border for private care. Last summer, as waiting lists for chemotherapy treatments for breast and prostate cancer stretched to four months, Montreal doctors started to send patients 45 minutes down the highway to Champlain Valley Physicians' Hospital in Plattsburgh, N.Y. There, scores have undergone radiation treatment, some being treated by bilingual doctors who left Montreal. Business has been so good that the Plattsburgh hospital, which was on the verge of closing its cancer unit, has invested half a million dollars in new equipment. And on the Quebec side, the program has allowed health authorities to boast that they have cut the list of cancer patients who have to wait two months or more, to 368 today from 516 last summer.
In Toronto, waiting lists have become so long at the Princess Margaret Hospital, the nation's largest and most prestigious cancer hospital, that hospital lawyers drew up a waiver last week for patients to sign, showing that they fully understood the danger of delaying radiation treatment.
With the chemotherapy waiting list in British Columbia at 670 people, hospitals in Washington have started marketing their services to Canadians in Vancouver, a 45-minute drive. A two-tier system is also being used for other kinds of operations. ''I would like to buy mother a plastic hip for Christmas, so she doesn't have to limp through the year 2000 in excruciating pain,'' Margaret Wente, a newspaper columnist for The Globe and Mail in Toronto, wrote last month. ''I could just drive her to Cleveland, which is fast becoming the de facto hip-replacement capital of Southern Ontario.''
Allan Rock, Canada's health minister, disapproves of such attitudes. In an essay in the same newspaper, he wrote sarcastically: ''Forget about equal access. Let people buy their way to the front of the line.'' In defense of Canada's state health system, he wrote, ''Its social equity reflects our Canadian values.'' Mr. Rock, who hopes to become prime minister one day, said that health delivery could be improved through better, computerized planning. He attacked a proposal in Alberta to allow private hospitals, warning readers, ''The precedent may be set for American for-profit health-care providers looking to set up shop in Canada.''
But the idea that there may be room in Canada's future for private medicine is gaining ground. ''We have no significant crises in care for our teeth or our animals, largely because dentists and veterinarians operate in the private sector,'' Michael Bliss, a medical historian, wrote on Wednesday in The National Post, a conservative newspaper. ''So we have the absurdity in Canada that you can get faster care for your gum disease than your cancer, and probably more attentive care for your dog than your grandmother.'' In Ontario, Canada's wealthiest province, the waiting list for magnetic resonance imaging tests is so long that one man recently reserved a session for himself at a private animal hospital that had a machine. He registered under the name Fido.
To Ms. Boucher, who jealously guarded her 15 square feet of corridor space today, such cocktail circuit anecdotes were not amusing. Glumly eating her cold breakfast toast, she said, ''It scares us to get sick.''
ANOTHER AUSTRALIAN PUBLIC HOSPITAL SYSTEM IN REVERSE GEAR
I have posted a lot on the meltdown in the State of Queensland but it seems that the State of Victoria has big problems too. In both States, the number of hospital beds provided has declined while demand has increased!
Dozens of beds have closed in the face of soaring patient numbers as Victoria's public hospital system struggles to meet demand. More than 180 beds have dropped out of the public hospital system in the eight years to 2003-04, while patient numbers have increased 30 per cent. At the same time the number of people languishing on hospital waiting lists has jumped more than 40 per cent. Despite the drop in bed numbers, stressed staff are dealing with hundreds of thousands more patients each year.
Australian Medical Association state president Dr Mark Yates said Victorian hospitals were running at nearly 95 per capacity and struggling to cope. "What we need to see is an increase in the number of beds in Victoria so that our hospitals can run more efficiently," Dr Yates said. He said the biggest loss of beds was across intensive care departments.
Ben Hart, spokesman for acting Health Minister Gavin Jennings, said a worldwide shortage of intensive care nurses was responsible for the lack of intensive care beds in Victoria. According to figures from the Australian Institute of Health and Welfare, the number of public hospital beds dropped 184 from 1996-97 to 2003-04.
Opposition health spokeswoman Helen Shardey said the drastic shortage of beds was putting patients at risk. "Where are these beds? What's happened to them, why aren't they available to patients who need them? The Government needs to fess up," Ms Shardey said. "The Bracks Government promised an extra 900 hospital beds and not only have they not delivered on that promise, but bed numbers are still going down. "That causes enormous problems and huge blockages in the system: elective surgery is cancelled, the emergency department is under pressure, ambulances are put on bypass. "No excuses should be accepted by the public."
In the eight years to 2003-04 there was a 31.9 per cent increase in the number of patients admitted to hospital. In 2003-04, 1,187,529 patients were admitted to hospital in Victoria. While the number of people admitted for at least one night rose just 3.5 per cent to 510,713 patients in the latest figures, the number of patients admitted for day procedures rose more than 60 per cent to 652,364 in 2003-04. According to the State Government's Hospital Services Report, elective surgery waiting lists blew out 40 per cent.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The article below is from the year 2000!
Full Hospitals Make Canadians Wait and Look South
MONTREAL: Dressed in her orchid pink bathrobe and blue velour slippers, Edouardine Boucher perched on her bed at Notre Dame Hospital here on Friday and recounted the story of her night: electric doors constantly opening and closing by her feet, cold drafts blowing across her head each time an ambulance arrived in the subzero weather, and a drug addict who started shouting at 2:30 a.m., ''Untie me, untie me.'' But as nurses hurried by on Friday morning, no one thought it remarkable that Ms. Boucher, a 58-year-old grandmother awaiting open heart surgery, had spent a rough night on a gurney in an emergency room hallway. After all, other hallways of this 3-year-old hospital were lined with 66 other patients lying quietly on temporary beds.
To explain overflowing hospitals here and across the nation, Canadian health officials are blaming the annual winter flu epidemic. But, at the mention of flu, Daniel Brochu, the veteran head nurse here, gave a smirk and ran his pen down the patient list today: ''Heart problem, infection problem, hypertension, dialysis, brain tumor, two cerebral hemorrhages.'' On Thursday, he said, crowding was so bad that he was able to admit one patient only after the ambulance crew agreed to leave its stretcher.
When Canada's state-run health system was in its first bloom, in the 1970's, Americans regularly trooped up here on inspection tours, attracted by Canada's promise of universal ''free'' health care. Today, however, few Canadians would recommend their system as a model for export. Improving health care should be the federal government's top priority, said 93 percent of 3,000 Canadians interviewed last month by Ekos Research Associates. In another poll last month, conducted by Pollara, 74 percent of respondents supported the idea of user fees, which have been outlawed since 1984. ''There is not a day when the newspapers do not talk of the health crisis,'' said Pierre Gauthier, president of the Federation of Specialist Doctors of Quebec. ''It has become the No. 1 problem for Quebecois and for Canadians.''
In Toronto, Canada's largest city, overcrowding prompted emergency rooms in 23 of the city's 25 hospitals to turn away ambulances one day last week. Two weeks ago, in what one newspaper later called an ''ominous foreshadowing,'' police officers shot to death a distraught father who had taken a doctor hostage in a Toronto emergency room in an attempt to speed treatment for his sick baby. Further west, in Winnipeg, ''hallway medicine'' has become so routine that hallway stretcher locations have permanent numbers. Patients recuperate more slowly in the drafty, noisy hallways, doctors report. On the Pacific Coast, ambulances filled with ill patients have repeatedly stacked up this winter in the parking lot of Vancouver General Hospital. Maureen Whyte, a hospital vice president, estimates that 20 percent of heart attack patients who should have treatment within 15 minutes now wait an hour or more.
The shortage is a case of supply not keeping up with demand. During the 1990's, after government deficits ballooned, partly because of rising health costs, the government in Ottawa cut revenue-sharing payments to provinces -- by half, by some accounts. Today, the federal budget is balanced, but 7 hospitals in Montreal have been closed, and 44 hospitals in Ontario have been closed or merged.
Ottawa also largely closed the door to the immigration of foreign doctors and cut the number of spaces in Canadian medical schools by 20 percent. Today, Canada has one medical school slot for every 20,000 people, compared with one for 13,000 in the United States and Britain. With a buyout program, Quebec induced 3,600 nurses and 1,200 doctors to take early retirement. And across the nation, 6,000 nurses and at least 1,000 doctors have moved to the United States in recent years. At the same time, demands on Canada's health system grow every year. Within 30 years, the population over 65 is expected to double, to 25 percent.
Unable to meet the demand, hospitals now have operation waiting lists stretching for months or longer -- five years in the case of Ms. Boucher.
As a result, Canada has moved informally to a two-tier, public-private system. Although private practice is limited to dentists and veterinarians, 90 percent of Canadians live within 100 miles of the United States, and many people are crossing the border for private care. Last summer, as waiting lists for chemotherapy treatments for breast and prostate cancer stretched to four months, Montreal doctors started to send patients 45 minutes down the highway to Champlain Valley Physicians' Hospital in Plattsburgh, N.Y. There, scores have undergone radiation treatment, some being treated by bilingual doctors who left Montreal. Business has been so good that the Plattsburgh hospital, which was on the verge of closing its cancer unit, has invested half a million dollars in new equipment. And on the Quebec side, the program has allowed health authorities to boast that they have cut the list of cancer patients who have to wait two months or more, to 368 today from 516 last summer.
In Toronto, waiting lists have become so long at the Princess Margaret Hospital, the nation's largest and most prestigious cancer hospital, that hospital lawyers drew up a waiver last week for patients to sign, showing that they fully understood the danger of delaying radiation treatment.
With the chemotherapy waiting list in British Columbia at 670 people, hospitals in Washington have started marketing their services to Canadians in Vancouver, a 45-minute drive. A two-tier system is also being used for other kinds of operations. ''I would like to buy mother a plastic hip for Christmas, so she doesn't have to limp through the year 2000 in excruciating pain,'' Margaret Wente, a newspaper columnist for The Globe and Mail in Toronto, wrote last month. ''I could just drive her to Cleveland, which is fast becoming the de facto hip-replacement capital of Southern Ontario.''
Allan Rock, Canada's health minister, disapproves of such attitudes. In an essay in the same newspaper, he wrote sarcastically: ''Forget about equal access. Let people buy their way to the front of the line.'' In defense of Canada's state health system, he wrote, ''Its social equity reflects our Canadian values.'' Mr. Rock, who hopes to become prime minister one day, said that health delivery could be improved through better, computerized planning. He attacked a proposal in Alberta to allow private hospitals, warning readers, ''The precedent may be set for American for-profit health-care providers looking to set up shop in Canada.''
But the idea that there may be room in Canada's future for private medicine is gaining ground. ''We have no significant crises in care for our teeth or our animals, largely because dentists and veterinarians operate in the private sector,'' Michael Bliss, a medical historian, wrote on Wednesday in The National Post, a conservative newspaper. ''So we have the absurdity in Canada that you can get faster care for your gum disease than your cancer, and probably more attentive care for your dog than your grandmother.'' In Ontario, Canada's wealthiest province, the waiting list for magnetic resonance imaging tests is so long that one man recently reserved a session for himself at a private animal hospital that had a machine. He registered under the name Fido.
To Ms. Boucher, who jealously guarded her 15 square feet of corridor space today, such cocktail circuit anecdotes were not amusing. Glumly eating her cold breakfast toast, she said, ''It scares us to get sick.''
ANOTHER AUSTRALIAN PUBLIC HOSPITAL SYSTEM IN REVERSE GEAR
I have posted a lot on the meltdown in the State of Queensland but it seems that the State of Victoria has big problems too. In both States, the number of hospital beds provided has declined while demand has increased!
Dozens of beds have closed in the face of soaring patient numbers as Victoria's public hospital system struggles to meet demand. More than 180 beds have dropped out of the public hospital system in the eight years to 2003-04, while patient numbers have increased 30 per cent. At the same time the number of people languishing on hospital waiting lists has jumped more than 40 per cent. Despite the drop in bed numbers, stressed staff are dealing with hundreds of thousands more patients each year.
Australian Medical Association state president Dr Mark Yates said Victorian hospitals were running at nearly 95 per capacity and struggling to cope. "What we need to see is an increase in the number of beds in Victoria so that our hospitals can run more efficiently," Dr Yates said. He said the biggest loss of beds was across intensive care departments.
Ben Hart, spokesman for acting Health Minister Gavin Jennings, said a worldwide shortage of intensive care nurses was responsible for the lack of intensive care beds in Victoria. According to figures from the Australian Institute of Health and Welfare, the number of public hospital beds dropped 184 from 1996-97 to 2003-04.
Opposition health spokeswoman Helen Shardey said the drastic shortage of beds was putting patients at risk. "Where are these beds? What's happened to them, why aren't they available to patients who need them? The Government needs to fess up," Ms Shardey said. "The Bracks Government promised an extra 900 hospital beds and not only have they not delivered on that promise, but bed numbers are still going down. "That causes enormous problems and huge blockages in the system: elective surgery is cancelled, the emergency department is under pressure, ambulances are put on bypass. "No excuses should be accepted by the public."
In the eight years to 2003-04 there was a 31.9 per cent increase in the number of patients admitted to hospital. In 2003-04, 1,187,529 patients were admitted to hospital in Victoria. While the number of people admitted for at least one night rose just 3.5 per cent to 510,713 patients in the latest figures, the number of patients admitted for day procedures rose more than 60 per cent to 652,364 in 2003-04. According to the State Government's Hospital Services Report, elective surgery waiting lists blew out 40 per cent.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
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