BRITAIN'S NHS IS SQUEEZING EVERY COST EXCEPT THE BUREAUCRACY
Tony Blair is to be told today that hospitals must make drastic cuts in spending on drugs and agency staff. Sir Ian Carruthers, the acting head of the NHS, will present his plan for reducing the estimated 750 million pound NHS deficit at a No 10 seminar. Sir Ian, who took over after Sir Nigel Crisp’s resignation, believes that there is considerable scope for cuts in the 10.3 billion pounds spent every year on drugs and the 1 billion on temporary staff. This will raise fears that some patients will not be given expensive treatments from which they could benefit.
Last year the Department of Health negotiated a cut of 7 per cent in the profits that drug companies can make from the NHS, but Sir Ian believes that too many hospitals still have a “misplaced brand loyalty”, which adds to costs. His review for the Prime Minister comes as a report predicts that NHS staff levels will fall by 100,000 as reforms bite. A smaller, more effective and flexible workforce should emerge, according to the market- orientated think-tank Reform. With young doctors emerging in ever greater numbers from medical schools, the report predicts “severe medical unemployment” and calls for a review of training plans. “There is little point in pulling more able young people into training with heavy costs when their employment chances are poor,” it says.
By 2004 the total NHS staff had risen to 1.33 million, an increase of 45,000 a year since 1999. As deficits hit hospitals, jobs are beginning to be shed — about 7,000 in the past few months — but new policies will accelerate the process, says the Reform team, led by Nick Bosanquet, Professor of Health Policy at Imperial College, London.
The costs of the expansion are one reason why the health service is being driven into deficit, the report says. Now the Government’s “highly welcome reform agenda” is likely to have widespread effects across the NHS. The reforms include payment by results, patient choice and the spread of foundation hospitals. The centralised “silo” mentality — pile up manpower regardless of cost or quality — will be replaced by more local initiatives. These could include an end to centralised contract negotiations, a key feature of recent NHS history.
Professor Bosanquet said yesterday that he expected the reforms to benefit staff as well as patients: they will gain from increased choice, higher morale and the satisfaction of working in smaller, more independent organisations; but he is concerned about job prospects for young doctors. Given the expansion in medical school places, the number of funded training posts needs to rise by 1,768 between 2004-05 and 2007-08. “Realistically this scenario is unlikely to be met as the funding situation worsens,” the report says. “New medical graduates are already facing serious obstacles to getting jobs. This pressure is likely to increase dramatically in the next few years as graduate numbers outweigh retirees massively and the financial situation of the NHS causes a dramatic slowing in recruitment and even a reduction in staffing numbers.”
So far most graduates do seem to be finding jobs. A survey for the General Medical Council found that only 2 per cent of those wanting to work as doctors were without jobs. There are still a few areas where the NHS is short of staff, including midwifery and radiography. Some parts of the country find it hard to recruit GPs, and mental health services find attracting staff of the right calibre difficult. The think-tank does not recommend that NHS staff should be paid off, but it says that this will inevitably happen if the Government’s current reforms are pursued.
Source
NHS: YOUR LUXURY CAR SUPPLIER (IF YOU ARE ON THE GRAVY TRAIN)
Senior health managers and consultants are being provided with luxury cars including Jaguars, Mercedes and even Porsches at a cost of millions to the National Health Service. As hospitals across Britain face job cuts, new figures show that executives are receiving subsidies of up to 6,600 pounds a year to lease cars that they can subsequently buy at a discount. All maintenance costs are included in the agreements, while some authorities and hospital trusts also cover the costs of insurance premiums. The bill for leasing the 35,000 cars for NHS staff is now close to 90 milion pounds, while the cost for new leases rose by more than 3.5% last year, according to government figures.
It coincides with a growing cash crisis in the NHS with total deficits estimated at more than 800 million and trusts cancelling operations and threatening more than 5,000 job cuts. Katherine Murphy, of the Patients Association, a charity campaigning for a better health service, said the issuing of luxury cars was "morally wrong". "Here we are with the health service in severe financial crisis with deficits everywhere, redundancies threatened and wards closing and these executives, who are on hugely inflated salaries anyway, are driving around in lovely top-of-the-range cars obtained with NHS money," she said. "It is morally wrong and gives completely the wrong message."
NHS officials say the "company car" perks enable the service to compete with the private sector. However, many health trusts eschew such schemes as an unnecessary expense. Last year the government tried to rein in the cost by paying outside consultants - at an estimated 2,000 pounds a day - to review the scheme nationally. Despite the exercise, the average annual cost of leasing each company car rose by 175 pounds.
The Department of Health admitted the extra expenditure following the consultants' exercise was because the vehicles now being bought by the NHS were of a "generally higher specification". In the 12 months until March this year, figures show that the NHS has started new lease-hires on 428 Audis, 260 BMWs, 101 Mercedes, 35 Jaguars, 28 Land Rovers, 88 Saabs, 10 Lexus and even a Porsche. Masterlease, one of nine lease-hire companies that have agreements with the NHS to supply vehicles over three-year contracts, is providing two Porsches to executives. A spokesman confirmed the company is leasing a Porsche Cayenne - a 4x4 model with prices ranging from 35,560 to 81,565 pounds - and a Boxster two-seater sports model, which retails at 32,640, to the NHS.
Because of the preferential rates negotiated centrally through the NHS's purchasing and supply agency, a Cayenne can be leased for about 6,000 pounds a year while a Boxster costs about 5,000 annually.
Most NHS staff who are entitled to company vehicles are given an allowance based either on their status and salary or the number of miles they drive. They are then entitled to choose any car they like. If their choice exceeds their allowance, they can top up the NHS subsidy with their own money. Other costs, such as road tax, are often paid by the driver, who is also sometimes expected to contribute towards the insurance. Petrol is paid for by staff and reimbursed through claims for mileage. Some trusts and health authorities are providing such generous allowances, however, that topping up is not necessary.
More here
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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.
***************************
Thursday, April 13, 2006
Wednesday, April 12, 2006
U.K.: EVEN THE NHS COMPUTER SYSTEM IS A BUDDING DISASTER
Leading academics called yesterday for a formal audit of the National Health Service’s 6.2 billion pound IT scheme over fears that it is behind schedule, over budget and not secure. In a letter to the Commons Health Select Committee, 23 professors raised questions about the system, its progress and whether it will work.
The concerns were brushed aside by the Department of Health but are an index of growing doubts about the system, called Connecting for Health, which is designed to allow instant access to patient records and for patients to make appointments with consultants online from GP surgeries. The letter, reported in Computer Weekly, amounts to the most heavyweight challenge yet to the programme, announced four years ago by the Prime Minister. Connecting for Health, previously known as the National Programme for Information Technology (NPfIT), will link more than 30,000 GPs in England to 300 hospitals by 2012. It involves an online booking system, a centralised medical records system for 50 million patients, e-prescriptions and fast computer network links between NHS organisations.
The academics’ letter, signed by professors from Oxford, Cambridge, the London School of Economics, Edinburgh, Birmingham, York and many other departments, says that the project has been managed in a secretive way. “Concrete, objective information about NPfIT’s progress is not available to external observers,” it says. “Reliable sources within NPfIT have raised concerns about the technology. We suggest an assessment should ask challenging questions and issue concrete recommendations.”
Concerns have been heightened by a delayed report from the National Audit Office, that was expected last summer and will not be published until this summer at the earliest. “My instinct is that had they had anything good to say about it it would not have been delayed so long,” said Martyn Thomas, a computer consultant and a visiting professor at Oxford University, who is one of the signatories. “In this case there has been a lot of pressure and a political timetable set by ministers from outside. There has not been enough scrutiny.” He said that the UK Computing Research Committee, an 80-strong expert group, had offered to help, but nobody from NPfIT had been interested in talking to them.
The Department of Health responded: “The National Programme for IT is under constant review, scrutiny and audit by Parliament and government bodies. We remain confident that the technical architecture is appropriate and will enable benefits to be delivered for patients, whilst ensuring value for money to the taxpayer.”
Source
MORE ON MASSACHUSETTS: FINANCING DOUBTS
Massachusetts politicians just built the healthcare McMansion of their dreams. Now, where do they get the money to underwrite the mortgage? Like many a thrilled new homeowner, they're not sure. Governor Mitt Romney, legislative leaders, and healthcare lobbyists are congratulating one another and basking in favorable media reaction. At the same time, they hope there is enough money to cover commitments made in this sweeping healthcare package -- especially the commitment to extend health insurance coverage to 95 percent of the population within three years.
But to some degree, the foundation for this plan is a mixture of euphoria and hope. And that's not enough. ''If Massachusetts is the national leader in setting up a new healthcare model, we have an extra-special responsibility to be sure that what we legislate will stand the test of financial scrutiny," said Ellen Lutch Bender, a longtime healthcare analyst.
Even some unabashed supporters of the package have their doubts: ''This is cutting-edge conceptual healthcare policy," said Democratic state Representative Harriett L. Stanley of West Newbury, a member of the legislative healthcare financing committee who voted for the measure. ''But we don't yet know what it's really going to cost us or where we're going to get the money from. To some extent you might call it a Hail Mary pass."
After a State House rally to celebrate passage of the legislation, John McDonough, a former state legislator who heads the advocacy group HealthCare For All, declared this package ''good enough for now." But, he, too, acknowledged, ''There are questions about the financial stability. The financing is plausible, but it could go awry." On his blog, which provides daily, informative analysis of the ups and downs of the healthcare bill, McDonough lists these concerns: ''The level of employer responsibility is minimal and does not come close to the cost borne by employers who do cover their workers; the bill leaves in place the unfair $160 million assessment on employers who do cover their workers; the individual mandate does not define clear affordability for when workers would be penalized. This will be a vitally important standard moving forward." As Judith Meredith, another healthcare advocate who celebrated passage of the legislation, said: ''The funding part worries us all."
The cost of extending health insurance coverage to an additional 515,000 people will be shared by business, individuals, and the government. Businesses with more than 10 workers that do not provide insurance will be assessed up to $295 per employee per year. Individuals who can afford insurance but don't have it are subject to state income tax penalties. And government subsidies will help poor families.
The state contribution -- coming from the Massachusetts General Fund -- is pegged at $58 million for the first year; it increases to $125 million for each of the next two years. Meanwhile, the so-called free-care pool stands to remain in the $500 million to $800 million range for at least the next three years -- and maybe longer, some healthcare specialists predict.
The expectation is that revenue generated from the business assessment and individual mandate compelling people who are uninsured to get insurance will reduce the cost of free care. But what if the projected cost-shifting doesn't play out as predicted? ''One of the stated goals was to decrease dependency on the free-care pool. Whether there will actually be a decrease in funding for the free-care pool has not been adequately answered," said Representative Jeffrey D. Perry of Barnstable, a Republican and one of only two House members who voted against the healthcare bill.
If the financing mechanism behind this conceptually-impressive legislation turns out to be inadequate, who will suffer? The hospitals and insurers will get their money. But, if the money runs out, the poor won't get the insurance coverage that makes this proposal worthy of so much excitement and media attention. ''The only redeeming part of the bill is that it says it will provide absolute coverage for the very poorest citizens. If there isn't enough money to meet those obligations, then what?" noted Secretary of State William Galvin, a critic of other aspects of this package.
This legislation pegs Massachusetts as a healthcare innovator. It may look like the most beautiful piece of property on the block. But, until the inspector declares the foundation sturdy, the acquisition may not be worth the purchase price.
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.
***************************
Leading academics called yesterday for a formal audit of the National Health Service’s 6.2 billion pound IT scheme over fears that it is behind schedule, over budget and not secure. In a letter to the Commons Health Select Committee, 23 professors raised questions about the system, its progress and whether it will work.
The concerns were brushed aside by the Department of Health but are an index of growing doubts about the system, called Connecting for Health, which is designed to allow instant access to patient records and for patients to make appointments with consultants online from GP surgeries. The letter, reported in Computer Weekly, amounts to the most heavyweight challenge yet to the programme, announced four years ago by the Prime Minister. Connecting for Health, previously known as the National Programme for Information Technology (NPfIT), will link more than 30,000 GPs in England to 300 hospitals by 2012. It involves an online booking system, a centralised medical records system for 50 million patients, e-prescriptions and fast computer network links between NHS organisations.
The academics’ letter, signed by professors from Oxford, Cambridge, the London School of Economics, Edinburgh, Birmingham, York and many other departments, says that the project has been managed in a secretive way. “Concrete, objective information about NPfIT’s progress is not available to external observers,” it says. “Reliable sources within NPfIT have raised concerns about the technology. We suggest an assessment should ask challenging questions and issue concrete recommendations.”
Concerns have been heightened by a delayed report from the National Audit Office, that was expected last summer and will not be published until this summer at the earliest. “My instinct is that had they had anything good to say about it it would not have been delayed so long,” said Martyn Thomas, a computer consultant and a visiting professor at Oxford University, who is one of the signatories. “In this case there has been a lot of pressure and a political timetable set by ministers from outside. There has not been enough scrutiny.” He said that the UK Computing Research Committee, an 80-strong expert group, had offered to help, but nobody from NPfIT had been interested in talking to them.
The Department of Health responded: “The National Programme for IT is under constant review, scrutiny and audit by Parliament and government bodies. We remain confident that the technical architecture is appropriate and will enable benefits to be delivered for patients, whilst ensuring value for money to the taxpayer.”
Source
MORE ON MASSACHUSETTS: FINANCING DOUBTS
Massachusetts politicians just built the healthcare McMansion of their dreams. Now, where do they get the money to underwrite the mortgage? Like many a thrilled new homeowner, they're not sure. Governor Mitt Romney, legislative leaders, and healthcare lobbyists are congratulating one another and basking in favorable media reaction. At the same time, they hope there is enough money to cover commitments made in this sweeping healthcare package -- especially the commitment to extend health insurance coverage to 95 percent of the population within three years.
But to some degree, the foundation for this plan is a mixture of euphoria and hope. And that's not enough. ''If Massachusetts is the national leader in setting up a new healthcare model, we have an extra-special responsibility to be sure that what we legislate will stand the test of financial scrutiny," said Ellen Lutch Bender, a longtime healthcare analyst.
Even some unabashed supporters of the package have their doubts: ''This is cutting-edge conceptual healthcare policy," said Democratic state Representative Harriett L. Stanley of West Newbury, a member of the legislative healthcare financing committee who voted for the measure. ''But we don't yet know what it's really going to cost us or where we're going to get the money from. To some extent you might call it a Hail Mary pass."
After a State House rally to celebrate passage of the legislation, John McDonough, a former state legislator who heads the advocacy group HealthCare For All, declared this package ''good enough for now." But, he, too, acknowledged, ''There are questions about the financial stability. The financing is plausible, but it could go awry." On his blog, which provides daily, informative analysis of the ups and downs of the healthcare bill, McDonough lists these concerns: ''The level of employer responsibility is minimal and does not come close to the cost borne by employers who do cover their workers; the bill leaves in place the unfair $160 million assessment on employers who do cover their workers; the individual mandate does not define clear affordability for when workers would be penalized. This will be a vitally important standard moving forward." As Judith Meredith, another healthcare advocate who celebrated passage of the legislation, said: ''The funding part worries us all."
The cost of extending health insurance coverage to an additional 515,000 people will be shared by business, individuals, and the government. Businesses with more than 10 workers that do not provide insurance will be assessed up to $295 per employee per year. Individuals who can afford insurance but don't have it are subject to state income tax penalties. And government subsidies will help poor families.
The state contribution -- coming from the Massachusetts General Fund -- is pegged at $58 million for the first year; it increases to $125 million for each of the next two years. Meanwhile, the so-called free-care pool stands to remain in the $500 million to $800 million range for at least the next three years -- and maybe longer, some healthcare specialists predict.
The expectation is that revenue generated from the business assessment and individual mandate compelling people who are uninsured to get insurance will reduce the cost of free care. But what if the projected cost-shifting doesn't play out as predicted? ''One of the stated goals was to decrease dependency on the free-care pool. Whether there will actually be a decrease in funding for the free-care pool has not been adequately answered," said Representative Jeffrey D. Perry of Barnstable, a Republican and one of only two House members who voted against the healthcare bill.
If the financing mechanism behind this conceptually-impressive legislation turns out to be inadequate, who will suffer? The hospitals and insurers will get their money. But, if the money runs out, the poor won't get the insurance coverage that makes this proposal worthy of so much excitement and media attention. ''The only redeeming part of the bill is that it says it will provide absolute coverage for the very poorest citizens. If there isn't enough money to meet those obligations, then what?" noted Secretary of State William Galvin, a critic of other aspects of this package.
This legislation pegs Massachusetts as a healthcare innovator. It may look like the most beautiful piece of property on the block. But, until the inspector declares the foundation sturdy, the acquisition may not be worth the purchase price.
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.
***************************
Tuesday, April 11, 2006
AN INTERESTING CRITIQUE OF THE MASSACHUSETTS BRAINWAVE FROM THE LEFT
It's a stirring scene. The Governor, legislative leaders and leaders of Health Care For All standing in the State House Rotunda declaring victory in the fight for universal health coverage. Unfortunately, this week's tableau merely repeats one from 20 years ago when Governor Dukakis was celebrating passage of his universal healthcare bill. That plan imploded within two years, and today about 250,000 more people are uninsured in Massachusetts than the day it was signed. Unfortunately, Massachusetts' new health reform legislation looks set to repeat that disaster.
What's in the New Bill? The new bill includes three key provisions meant to expand coverage. First, it would modestly expand Medicaid eligibility. Second, it would offer subsidies for the purchase of private coverage to low-income individuals and families, though the size of the subsidies has yet to be determined. Finally, those making more than three times the poverty income (about $30,000 for a single person) would have to buy their own coverage or pay a fine.
To help make coverage more affordable, a new state agency will connect people with the private insurance plans that sell the coverage, and allow people to use pre-tax dollars to purchase coverage (a tax break that mostly helps affluent tax payers who are in high tax brackets). This new agency is also supposed to help design affordable plans.
Businesses that employ more than 10 people and fail to provide health insurance will be assessed a fee (not more than $295) to help subsidize care. Additionally, hospitals won a rate hike assuring them better payments from state programs, and several provisions were included that are meant to attract additional Federal funding to help pay for the Medicaid expansion.
What's Wrong With This Picture? First, the politicians assumed that only about 500,000 people in Massachusetts are uninsured. The Census Bureau says that 748,000 are uninsured. Why the difference? The 500,000 figure comes from a phone survey conducted in English and Spanish. Anyone without a phone or who speaks another language is counted as insured. The 748,000 figure comes from a door-to-door survey carried out in many languages (including Portuguese and Haitian Creole, common languages in Massachusetts). In sum, the reform plan wishes away 248,000 uninsured people who don't have phones or don't speak English or Spanish. It provides no funding or means to get them coverage.
Second, the linchpin of the plan is the false assumption that uninsured people will be able to find affordable health plans. A typical group policy in Massachusetts costs about $4500 annually for an individual and more than $11,000 for family coverage. A wealthy uninsured person could afford that - but few of the uninsured are wealthy. A 25 year old fitness instructor can find a cheaper plan. But few of the uninsured are young and healthy. According to Census Bureau figures, only 12.4% of the 748,000 uninsured in Massachusetts are both young enough to qualify for low-premium plans (under age 35) and affluent enough (incomes greater than 499% of poverty) to readily afford them. Yet even this 12.4% figure may be too high if insurers are allowed to charge higher premiums for persons with health problems; only half of uninsured persons in those age and income categories report that they are in "excellent health".
The legislation promises that the uninsured will be offered comprehensive, affordable private health plans. But that's like promising chocolate chip cookies with no fat, sugar or calories. The only way to get cheaper plans is to strip down the coverage - boost copayments, deductibles, uncovered services etc.
Hence, the requirement that most of the uninsured purchase coverage will either require them to pay money they don't have, or buy nearly worthless stripped down policies that represent coverage in name only.
Third, the legislation will do nothing to contain the skyrocketing costs of care in Massachusetts - already the highest in the world. Indeed, it gives new infusions of cash to hospitals and private insurers. Predictably, rising costs will force more and more employers to drop coverage, while state coffers will be drained by the continuing cost increases in Medicaid. Moreover, when the next recession hits, tax revenues will fall just as a flood of newly unemployed people join the Medicaid program or apply for the insurance subsidies promised in the reform legislation. The program is simply not sustainable over the long - or even medium - term.
More here
The solution these authors propose for the problems they identify is to bring in a single-payer health insurance system. And their grounds for arguing that? They argue that having the government take over would REDUCE bureaucracy. I kid you not: They actually do argue that having the government do something would reduce bureaucracy. What an incredible poverty of ideas they suffer from to propose something that goes against all human experience!
U.K.: Discharge NHS patients sooner and save cash, says Hewitt
Some hospitals are keeping patients up to four times longer than others for simple operations, draining resources and adding to the financial pressures on the NHS, the Health Secretary said yesterday. Patricia Hewitt called on all trusts to become more efficient at discharging patients and to reduce the substantial discrepancies in hospital stays. She spoke as two more trusts announced more than 500 job losses to try to tackle spiralling debts. A total NHS deficit of more than 800 million pounds has led organisations across England to rein in spending in recent weeks and announce more than 5,000 job cuts.
Surrey and Sussex Healthcare NHS Trust yesterday became the latest organisation to confirm that it will lose staff, with 400 jobs expected to go to help to reduce a monthly 2 million pound overspend. The trust, which manages Crawley Hospital and East Surrey Hospital, has a long history of financial problems and estimates its total debt for this financial year at 41.2 million pounds. The trust said that though 400 posts would go, permanent staff numbers would drop by only about 100. On Monday the Medway NHS Trust said that up to 160 jobs would go at the Medway Maritime Hospital in Gillingham, Kent. The trust needs to cut its spending by up to 11 million in 2006-07 and claw back a 1 million overspend from 2005.
Ms Hewitt, who has faced sustained pressure recently to explain the mounting debts on the back of six years of unprecedented NHS funding, said that money could be saved and care improved by reducing some patient stays. According to analysis by the NHS Institute for Innovation and Improvement, the best trusts treat a broken hip in less than 11 days, while the slowest performers take 45 days. Many of the longer stays targeted in the report were not offering more thorough care but, rather, were being less efficient and failing to prepare for the departure of patients from hospital.
Hip replacements varied between 7.4 days in the top 10 trusts to 29 days in the lowest-performing trusts, while stays for acute strokes ranged from 13 to 55 days. Knee replacements varied from 6.4 to 20 days. "The NHS is treating more people more quickly than ever before, but there are still parts of the system that can and should be far more efficient in speeding up the patient journey," Ms Hewitt said. "Cutting the variation between hospitals in patients' length of stay means patients can leave when they are clinically ready, freeing up capacity and time to deal with new patients coming in. This firstly improves services for patients, but will also help the NHS to save thousands of bed days a year." Ms Hewitt made her comments when visiting a number of hospitals in the North West yesterday.
More here
This is the sort of "care" you get from socialized medicine
Three times Pamela Dale has prepared herself for potentially hazardous brain surgery, only to have it cancelled minutes before her operation because of bed shortages. Her surgery was scheduled at the Royal Brisbane and Women's Hospital. The mother-of-three has a brain tumour which is causing her blackouts. It was first diagnosed in August 2004, and in early March she was scheduled for surgery to remove the tumour. "That was cancelled half an hour before we were due to leave home due to a lack of beds," Mrs Dale, 34, said.
"The next time I was scheduled was March 27. I was told it was cancelled because there was not enough time to complete the operation." An RBWH spokeswoman said: "Hospital staff can plan to a certain point, but cannot predict when patients requiring high-dependency or intensive care will come through the emergency department, or if patients already in wards in the hospital will deteriorate and need such care."
Medical groups have claimed that Queenslanders requiring urgent surgery are continuing to be turned away by the state's public hospital system because of a bed shortage crisis and it is unlikely to be fixed soon. Besides turning away patients requiring surgery, the bed shortage often leaves public hospital emergency departments overcrowded and patients needing to be transferred to hospital wards. In his report in September last year, State Government consultant Peter Forster estimated Queensland Health would require an additional 170 beds each year for the next 20 years just to meet future demand. A Queensland Health spokeswoman said an additional 99 beds had so far been opened this year. The Government also had identified scope to open a further 170 beds in 10 public hospitals around Queensland at a cost of $36.6 million a year, the spokeswoman said.
But Australian Medical Association Queensland president Dr Steve Hambleton said overcrowding continued to be a big problem. "I have just come back from Mackay and Cairns where they are suffering from bed block - Mount Isa is the same," Dr Hambleton said. "We need 200 beds on the Gold Coast urgently. It is going to take five years to bring enough bed numbers online."
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.
***************************
It's a stirring scene. The Governor, legislative leaders and leaders of Health Care For All standing in the State House Rotunda declaring victory in the fight for universal health coverage. Unfortunately, this week's tableau merely repeats one from 20 years ago when Governor Dukakis was celebrating passage of his universal healthcare bill. That plan imploded within two years, and today about 250,000 more people are uninsured in Massachusetts than the day it was signed. Unfortunately, Massachusetts' new health reform legislation looks set to repeat that disaster.
What's in the New Bill? The new bill includes three key provisions meant to expand coverage. First, it would modestly expand Medicaid eligibility. Second, it would offer subsidies for the purchase of private coverage to low-income individuals and families, though the size of the subsidies has yet to be determined. Finally, those making more than three times the poverty income (about $30,000 for a single person) would have to buy their own coverage or pay a fine.
To help make coverage more affordable, a new state agency will connect people with the private insurance plans that sell the coverage, and allow people to use pre-tax dollars to purchase coverage (a tax break that mostly helps affluent tax payers who are in high tax brackets). This new agency is also supposed to help design affordable plans.
Businesses that employ more than 10 people and fail to provide health insurance will be assessed a fee (not more than $295) to help subsidize care. Additionally, hospitals won a rate hike assuring them better payments from state programs, and several provisions were included that are meant to attract additional Federal funding to help pay for the Medicaid expansion.
What's Wrong With This Picture? First, the politicians assumed that only about 500,000 people in Massachusetts are uninsured. The Census Bureau says that 748,000 are uninsured. Why the difference? The 500,000 figure comes from a phone survey conducted in English and Spanish. Anyone without a phone or who speaks another language is counted as insured. The 748,000 figure comes from a door-to-door survey carried out in many languages (including Portuguese and Haitian Creole, common languages in Massachusetts). In sum, the reform plan wishes away 248,000 uninsured people who don't have phones or don't speak English or Spanish. It provides no funding or means to get them coverage.
Second, the linchpin of the plan is the false assumption that uninsured people will be able to find affordable health plans. A typical group policy in Massachusetts costs about $4500 annually for an individual and more than $11,000 for family coverage. A wealthy uninsured person could afford that - but few of the uninsured are wealthy. A 25 year old fitness instructor can find a cheaper plan. But few of the uninsured are young and healthy. According to Census Bureau figures, only 12.4% of the 748,000 uninsured in Massachusetts are both young enough to qualify for low-premium plans (under age 35) and affluent enough (incomes greater than 499% of poverty) to readily afford them. Yet even this 12.4% figure may be too high if insurers are allowed to charge higher premiums for persons with health problems; only half of uninsured persons in those age and income categories report that they are in "excellent health".
The legislation promises that the uninsured will be offered comprehensive, affordable private health plans. But that's like promising chocolate chip cookies with no fat, sugar or calories. The only way to get cheaper plans is to strip down the coverage - boost copayments, deductibles, uncovered services etc.
Hence, the requirement that most of the uninsured purchase coverage will either require them to pay money they don't have, or buy nearly worthless stripped down policies that represent coverage in name only.
Third, the legislation will do nothing to contain the skyrocketing costs of care in Massachusetts - already the highest in the world. Indeed, it gives new infusions of cash to hospitals and private insurers. Predictably, rising costs will force more and more employers to drop coverage, while state coffers will be drained by the continuing cost increases in Medicaid. Moreover, when the next recession hits, tax revenues will fall just as a flood of newly unemployed people join the Medicaid program or apply for the insurance subsidies promised in the reform legislation. The program is simply not sustainable over the long - or even medium - term.
More here
The solution these authors propose for the problems they identify is to bring in a single-payer health insurance system. And their grounds for arguing that? They argue that having the government take over would REDUCE bureaucracy. I kid you not: They actually do argue that having the government do something would reduce bureaucracy. What an incredible poverty of ideas they suffer from to propose something that goes against all human experience!
U.K.: Discharge NHS patients sooner and save cash, says Hewitt
Some hospitals are keeping patients up to four times longer than others for simple operations, draining resources and adding to the financial pressures on the NHS, the Health Secretary said yesterday. Patricia Hewitt called on all trusts to become more efficient at discharging patients and to reduce the substantial discrepancies in hospital stays. She spoke as two more trusts announced more than 500 job losses to try to tackle spiralling debts. A total NHS deficit of more than 800 million pounds has led organisations across England to rein in spending in recent weeks and announce more than 5,000 job cuts.
Surrey and Sussex Healthcare NHS Trust yesterday became the latest organisation to confirm that it will lose staff, with 400 jobs expected to go to help to reduce a monthly 2 million pound overspend. The trust, which manages Crawley Hospital and East Surrey Hospital, has a long history of financial problems and estimates its total debt for this financial year at 41.2 million pounds. The trust said that though 400 posts would go, permanent staff numbers would drop by only about 100. On Monday the Medway NHS Trust said that up to 160 jobs would go at the Medway Maritime Hospital in Gillingham, Kent. The trust needs to cut its spending by up to 11 million in 2006-07 and claw back a 1 million overspend from 2005.
Ms Hewitt, who has faced sustained pressure recently to explain the mounting debts on the back of six years of unprecedented NHS funding, said that money could be saved and care improved by reducing some patient stays. According to analysis by the NHS Institute for Innovation and Improvement, the best trusts treat a broken hip in less than 11 days, while the slowest performers take 45 days. Many of the longer stays targeted in the report were not offering more thorough care but, rather, were being less efficient and failing to prepare for the departure of patients from hospital.
Hip replacements varied between 7.4 days in the top 10 trusts to 29 days in the lowest-performing trusts, while stays for acute strokes ranged from 13 to 55 days. Knee replacements varied from 6.4 to 20 days. "The NHS is treating more people more quickly than ever before, but there are still parts of the system that can and should be far more efficient in speeding up the patient journey," Ms Hewitt said. "Cutting the variation between hospitals in patients' length of stay means patients can leave when they are clinically ready, freeing up capacity and time to deal with new patients coming in. This firstly improves services for patients, but will also help the NHS to save thousands of bed days a year." Ms Hewitt made her comments when visiting a number of hospitals in the North West yesterday.
More here
This is the sort of "care" you get from socialized medicine
Three times Pamela Dale has prepared herself for potentially hazardous brain surgery, only to have it cancelled minutes before her operation because of bed shortages. Her surgery was scheduled at the Royal Brisbane and Women's Hospital. The mother-of-three has a brain tumour which is causing her blackouts. It was first diagnosed in August 2004, and in early March she was scheduled for surgery to remove the tumour. "That was cancelled half an hour before we were due to leave home due to a lack of beds," Mrs Dale, 34, said.
"The next time I was scheduled was March 27. I was told it was cancelled because there was not enough time to complete the operation." An RBWH spokeswoman said: "Hospital staff can plan to a certain point, but cannot predict when patients requiring high-dependency or intensive care will come through the emergency department, or if patients already in wards in the hospital will deteriorate and need such care."
Medical groups have claimed that Queenslanders requiring urgent surgery are continuing to be turned away by the state's public hospital system because of a bed shortage crisis and it is unlikely to be fixed soon. Besides turning away patients requiring surgery, the bed shortage often leaves public hospital emergency departments overcrowded and patients needing to be transferred to hospital wards. In his report in September last year, State Government consultant Peter Forster estimated Queensland Health would require an additional 170 beds each year for the next 20 years just to meet future demand. A Queensland Health spokeswoman said an additional 99 beds had so far been opened this year. The Government also had identified scope to open a further 170 beds in 10 public hospitals around Queensland at a cost of $36.6 million a year, the spokeswoman said.
But Australian Medical Association Queensland president Dr Steve Hambleton said overcrowding continued to be a big problem. "I have just come back from Mackay and Cairns where they are suffering from bed block - Mount Isa is the same," Dr Hambleton said. "We need 200 beds on the Gold Coast urgently. It is going to take five years to bring enough bed numbers online."
More here
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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.
***************************
Monday, April 10, 2006
There's always plenty of money for bureaucrats
Taxpayers have forked out an extra $94 million for pen-pushers in WA's beleaguered health system since Labor came to power. While thousands of patients are waiting for surgery and Treasurer Eric Ripper has threatened tax rises because of a health spending blow-out, the Government has employed an extra 604 administration staff. There are now nearly three times as many health bureaucrats earning $80,000 or more - 435 in 2005 compared with 148 in 2001.
Opposition health spokesman Kim Hames said it was disgraceful that the extra funding, which could have employed 1700 nurses or provided more doctors and hospital beds, had gone to bureaucrats. "It's an administration out of control caused by mismanagement and the blame lies at (Health Minister) Jim McGinty's feet," he said. There are now 6297 health bureaucrats compared with 5693 in 2001, despite former premier Geoff Gallop's promise of a leaner public sector. Their wages cost $299 million of the $3.6 billion health budget. Dr Hames said he was amazed that in the past financial year there was $20 million extra spent on bureaucrats and $17 million of that had gone to 190 additional staff earning $80,000 or more. "How many hip replacements and knee replacements would that fund?" he said. There was a desperate need for more nurses, but Mr McGinty had rejected his repeated calls for a nursing summit to address the issue. The Government claimed it had reduced surgery waiting lists down from about 18,000 two years ago to about 15,000, but he believed figures had been manipulated. He estimated another 31,000 were waiting to see specialists, with a view to being put on a waiting list for surgery.
Australian Medical Association WA president Paul Skerritt said priority had been put on the Government's long-term overhaul of the health system, but day-to-day management was being neglected. Acting Health Department director-general John de Campo took the heat for Mr McGinty, who is overseas, saying the number of public clinical staff employed between 2001 and 2005 far outweighed the increase in administrative staff. He said in June, 2005, there were 22,094 doctors, nurses and health staff in the public health system compared with 18,508 in June 2001.
Source
The Queensland public health system shows it arrogance and incompetence once again
Two paramedics who said they were unable to treat a youth because he was so drunk and obnoxious have been punished by their Queensland Ambulance Service bosses. Sources told The Sunday Mail that frontline staff were furious at the disciplinary measures taken by management. Ambulance staff said that they believed the officers were "in the right". One of the officers recently quit in disgust, accusing the QAS internal investigators of "intimidation and standover tactics."
The incident happened on the Sunshine Coast early this year after a young man who had been drinking was punched in the head during a brawl. The paramedics said the drunken man refused a proper assessment of his injury and would not let them take him to hospital. They say the man's sober girlfriend agreed to keep watch on him and take him to a doctor. But the man later complained to Emergency Services that he had been "refused" proper treatment. He said officers simply put a butterfly clip on a badly cut lip and sent him home, and he needed to get hospital treatment for a head wound the next day.
The paramedics were condemned by the QAS probe and given three-month "diminished performance" reports, which reduced their responsibilities. "One experienced paramedic has been forced to resign . . . they were subjected to a completely intimidating investigation that was protracted over many weeks," a source said. He said that investigators had overlooked evidence about the man's drunken behaviour. "All of these facts were reported in the patient report form," the source said.
The Sunday Mail reported a similar case late last year, which resulted in a paramedic being investigated by the Crime and Misconduct Commission after a doctor, who was arrested for drunken behaviour, claimed the ambo refused to treat him. The paramedic was disciplined by QAS bosses and could face criminal charges. Angry ambulance colleagues rallied to his support. "A professional doctor behaves like a drunken hooligan, gets arrested for assault, refuses to be assessed and puts a paramedic through all this," said one ambo. The CMC is still investigating the doctor's complaint.
Ambulance Employees Australia union secretary Steve Crow said paramedics were advised not to put themselves in danger. They had "zero tolerance" to violence from intoxicated patients. "At the end of the day, if people do not want to be treated, you cannot chase them up the road forever," he said. A spokeswoman for Ambulance Commissioner Jim Higgins said the Sunshine Coast matter had been investigated and "internally managed." [So that's what you call bullying!] She declined to comment further.
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.
***************************
Taxpayers have forked out an extra $94 million for pen-pushers in WA's beleaguered health system since Labor came to power. While thousands of patients are waiting for surgery and Treasurer Eric Ripper has threatened tax rises because of a health spending blow-out, the Government has employed an extra 604 administration staff. There are now nearly three times as many health bureaucrats earning $80,000 or more - 435 in 2005 compared with 148 in 2001.
Opposition health spokesman Kim Hames said it was disgraceful that the extra funding, which could have employed 1700 nurses or provided more doctors and hospital beds, had gone to bureaucrats. "It's an administration out of control caused by mismanagement and the blame lies at (Health Minister) Jim McGinty's feet," he said. There are now 6297 health bureaucrats compared with 5693 in 2001, despite former premier Geoff Gallop's promise of a leaner public sector. Their wages cost $299 million of the $3.6 billion health budget. Dr Hames said he was amazed that in the past financial year there was $20 million extra spent on bureaucrats and $17 million of that had gone to 190 additional staff earning $80,000 or more. "How many hip replacements and knee replacements would that fund?" he said. There was a desperate need for more nurses, but Mr McGinty had rejected his repeated calls for a nursing summit to address the issue. The Government claimed it had reduced surgery waiting lists down from about 18,000 two years ago to about 15,000, but he believed figures had been manipulated. He estimated another 31,000 were waiting to see specialists, with a view to being put on a waiting list for surgery.
Australian Medical Association WA president Paul Skerritt said priority had been put on the Government's long-term overhaul of the health system, but day-to-day management was being neglected. Acting Health Department director-general John de Campo took the heat for Mr McGinty, who is overseas, saying the number of public clinical staff employed between 2001 and 2005 far outweighed the increase in administrative staff. He said in June, 2005, there were 22,094 doctors, nurses and health staff in the public health system compared with 18,508 in June 2001.
Source
The Queensland public health system shows it arrogance and incompetence once again
Two paramedics who said they were unable to treat a youth because he was so drunk and obnoxious have been punished by their Queensland Ambulance Service bosses. Sources told The Sunday Mail that frontline staff were furious at the disciplinary measures taken by management. Ambulance staff said that they believed the officers were "in the right". One of the officers recently quit in disgust, accusing the QAS internal investigators of "intimidation and standover tactics."
The incident happened on the Sunshine Coast early this year after a young man who had been drinking was punched in the head during a brawl. The paramedics said the drunken man refused a proper assessment of his injury and would not let them take him to hospital. They say the man's sober girlfriend agreed to keep watch on him and take him to a doctor. But the man later complained to Emergency Services that he had been "refused" proper treatment. He said officers simply put a butterfly clip on a badly cut lip and sent him home, and he needed to get hospital treatment for a head wound the next day.
The paramedics were condemned by the QAS probe and given three-month "diminished performance" reports, which reduced their responsibilities. "One experienced paramedic has been forced to resign . . . they were subjected to a completely intimidating investigation that was protracted over many weeks," a source said. He said that investigators had overlooked evidence about the man's drunken behaviour. "All of these facts were reported in the patient report form," the source said.
The Sunday Mail reported a similar case late last year, which resulted in a paramedic being investigated by the Crime and Misconduct Commission after a doctor, who was arrested for drunken behaviour, claimed the ambo refused to treat him. The paramedic was disciplined by QAS bosses and could face criminal charges. Angry ambulance colleagues rallied to his support. "A professional doctor behaves like a drunken hooligan, gets arrested for assault, refuses to be assessed and puts a paramedic through all this," said one ambo. The CMC is still investigating the doctor's complaint.
Ambulance Employees Australia union secretary Steve Crow said paramedics were advised not to put themselves in danger. They had "zero tolerance" to violence from intoxicated patients. "At the end of the day, if people do not want to be treated, you cannot chase them up the road forever," he said. A spokeswoman for Ambulance Commissioner Jim Higgins said the Sunshine Coast matter had been investigated and "internally managed." [So that's what you call bullying!] She declined to comment further.
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, April 09, 2006
GERMAN INSANITY
This week in Berlin, the government will be advocating a series of health care reforms similar to Gordon Brown's unsuccessful and over-bureaucratic attempts to reform the UK National Health Service. One of the more draconian proposals is a "bonus malus" penalty system for doctors who prescribe too many expensive drugs to German patients. This new system is designed cut public expenditures for prescription drugs by making physicians personally liable if they exceed their quarterly budgets. For instance, physicians will have to cover 50% of the excess spending out of their own pocket if they exceed their budgets by more than 30%.
At first glance, making anyone stick to a budget may sound like sound financial policy. The problem is that in this case the budget does not necessarily reflect real world demand. The allocation of funds for medicine is not driven by patients and doctors but by politicians – much like the production targets for Soviet tractor factories were set by bureaucrats in Moscow with little regard to the needs of Russian and Ukrainian farmers.
Germany will be on its way to a shortage of medicine if the government gets its way. The government's goal is to reduce the annual pharmaceutical costs by 400 million euros starting in 2007, and German patients are already receiving too little medicine. For example, only 30% of Germans with osteoporosis receive treatment, and the German sick funds do not cover preventive medicine for osteoporosis patients. This means that middle aged and elderly women with osteoporosis often have to experience a debilitating hip or other bone fracture before they receive the medicine they need.
A shortage of medicine means that patients will no longer be able to trust doctors to prescribe them the medicine they need. The medical needs of the individual patient will take second place to the budgetary considerations of the doctor. One possible consequence is that patients will be inclined to exaggerate the symptoms they have in order to move up on the doctor's list of priorities; and doctors will tend to dismiss more patients as hypochondriacs. These diverging interests will lead to distrust between patients and their doctors and undermine the open doctor-patient dialogue that is required for early detection of health problems and successful treatment.
The lower use of drugs and the worsened doctor-patient relationship could end up costing the German economy more than the 400 million euros the government hopes to save. Without the right medicine, patients are more likely to spend time in expensive hospital care and to be absent from work due to health problems. Add the time and resources that will be wasted on legal expenses and handling objections from doctors and patients, and it becomes evident that managing German health care like a Soviet tractor factory is not very cost-efficient.
In addition, there are long-term costs to consider. Germany has more medical students per capita than any other European country. What will these future doctors think about working in a system that penalizes them for doing the job they have been trained for, namely curing patients? Providing second class care to patients and being denied access to the latest advances in medical research is hardly a very encouraging prospect. Chances are that the best and brightest of Germany's future physicians will add to the brain drain and join the 400,000 European researchers that currently live in the United States. When the brains leave, so do the prospects for investments in research and development. Without such investments, Germany will have to rely on old economy products based on heavy industry. Again, the Soviet tractor factory comes to mind.
More here
At long last: Australia recognizes the only solution to substandard foreign doctors from India and elsewhere
The Commonwealth Government is to spend $250 million to train more doctors and nurses over the next four years. Prime Minister John Howard said today that extra funding will pay for 400 new medical school places a year, with some starting in 2007 and the full 400 in 2008. Mr Howard said 120 places would go a new medical school at Deakin University in Victoria with Monash University's new Gippsland branch receiving 40 additional places. The remaining 240 places will be distributed among all the states and territories, including Victoria.
Mr Howard told the Victorian Liberal Party's state council he expected the state governments to match the funding and pay for the training of new nurses, care assistants and Aboriginal health workers. "I make this announcement today so that universities can prepare to introduce these places without delay," Mr Howard 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.
***************************
This week in Berlin, the government will be advocating a series of health care reforms similar to Gordon Brown's unsuccessful and over-bureaucratic attempts to reform the UK National Health Service. One of the more draconian proposals is a "bonus malus" penalty system for doctors who prescribe too many expensive drugs to German patients. This new system is designed cut public expenditures for prescription drugs by making physicians personally liable if they exceed their quarterly budgets. For instance, physicians will have to cover 50% of the excess spending out of their own pocket if they exceed their budgets by more than 30%.
At first glance, making anyone stick to a budget may sound like sound financial policy. The problem is that in this case the budget does not necessarily reflect real world demand. The allocation of funds for medicine is not driven by patients and doctors but by politicians – much like the production targets for Soviet tractor factories were set by bureaucrats in Moscow with little regard to the needs of Russian and Ukrainian farmers.
Germany will be on its way to a shortage of medicine if the government gets its way. The government's goal is to reduce the annual pharmaceutical costs by 400 million euros starting in 2007, and German patients are already receiving too little medicine. For example, only 30% of Germans with osteoporosis receive treatment, and the German sick funds do not cover preventive medicine for osteoporosis patients. This means that middle aged and elderly women with osteoporosis often have to experience a debilitating hip or other bone fracture before they receive the medicine they need.
A shortage of medicine means that patients will no longer be able to trust doctors to prescribe them the medicine they need. The medical needs of the individual patient will take second place to the budgetary considerations of the doctor. One possible consequence is that patients will be inclined to exaggerate the symptoms they have in order to move up on the doctor's list of priorities; and doctors will tend to dismiss more patients as hypochondriacs. These diverging interests will lead to distrust between patients and their doctors and undermine the open doctor-patient dialogue that is required for early detection of health problems and successful treatment.
The lower use of drugs and the worsened doctor-patient relationship could end up costing the German economy more than the 400 million euros the government hopes to save. Without the right medicine, patients are more likely to spend time in expensive hospital care and to be absent from work due to health problems. Add the time and resources that will be wasted on legal expenses and handling objections from doctors and patients, and it becomes evident that managing German health care like a Soviet tractor factory is not very cost-efficient.
In addition, there are long-term costs to consider. Germany has more medical students per capita than any other European country. What will these future doctors think about working in a system that penalizes them for doing the job they have been trained for, namely curing patients? Providing second class care to patients and being denied access to the latest advances in medical research is hardly a very encouraging prospect. Chances are that the best and brightest of Germany's future physicians will add to the brain drain and join the 400,000 European researchers that currently live in the United States. When the brains leave, so do the prospects for investments in research and development. Without such investments, Germany will have to rely on old economy products based on heavy industry. Again, the Soviet tractor factory comes to mind.
More here
At long last: Australia recognizes the only solution to substandard foreign doctors from India and elsewhere
The Commonwealth Government is to spend $250 million to train more doctors and nurses over the next four years. Prime Minister John Howard said today that extra funding will pay for 400 new medical school places a year, with some starting in 2007 and the full 400 in 2008. Mr Howard said 120 places would go a new medical school at Deakin University in Victoria with Monash University's new Gippsland branch receiving 40 additional places. The remaining 240 places will be distributed among all the states and territories, including Victoria.
Mr Howard told the Victorian Liberal Party's state council he expected the state governments to match the funding and pay for the training of new nurses, care assistants and Aboriginal health workers. "I make this announcement today so that universities can prepare to introduce these places without delay," Mr Howard 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, April 08, 2006
NASTY SECRET PLAN BY THE NHS
Patients are being denied appointments with consultants in a systematic attempt to ration care and save the NHS money, The Times has learnt. Leaked documents passed to The Times show that while ministers promise patients choice, a series of barriers are being erected limiting GPs’ rights to refer people to consultants. The documents reveal that health trusts across London have drawn up plans to establish panels that will “monitor” how many patients are referred to hospital by GPs. Local health trusts have been told that they must cut GP referral rates to those of the lowest 10 per cent nationally. This, the document claims, would save 25 million pounds a year in the capital. Consultant-to-consultant referrals are also being limited, in many cases denying patients a second opinion.
Patients who use hospital accident and emergency units to obtain care that could be provided by GPs are also targeted. Emergency care practitioners in A&E departments will “redirect” 40-70 per cent of patients back to GPs or walk-in centres. Hospitals that treat people who ought to have been sent to their GPs will not be paid.
It is not known how many similar schemes are in existence, but the British Medical Association has confirmed it has found examples in Kent, Oxfordshire, Dorset, Wiltshire, Surrey, Sussex, Cornwall, Shropshire, Suffolk, Lancashire and Yorkshire, as well as London. The draft paper, headed Pan London Demand Management Arrangements 06-07, says that Hammersmith and Fulham has found that a fifth of consultant-to-consultant referrals are “clinically not necessary”. Matching that across London would save another 7 million pounds, the paper says. But the bureacracy needed to screen all the referrals will itself cost 1.6 million. The London paper says that primary care trusts (PCTs) which cannot demonstrate that their referrals match the lowest 10 per cent nationally will be required to help to set up “review panels” in dermatology, ear, nose and throat, gynaecology, ophthalmology, rheumatology, trauma and orthopaedics.
These panels will review referrals by GPs, and cut them back. What this means is that patients will be denied appointments that their GPs believe they need. The language of the document makes no pretence that this will improve care, and emphasises cost savings throughout. “It is imperative that London balances its books overall,” the first paragraph says. It also indicates that the measures proposed are “the bare minimum that we expect all PCTs to be doing”. Urgent consultant-to-consultant referrals will be audited. “All urgent clinical referrals found to be clinically inappropriate will not be paid for by the PCT,” the document says.
The BMA yesterday condemned such schemes. Hamish Meldrum, the chairman of the association’s GP committee, said that they left patients in limbo, with no one clear where the responsibility lay if the condition worsened or the patient died. Jonathan Fielden, deputy chairman of the BMA consultants committee, said: “It’s clear that clinicians don’t know how these referral management systems aid improvements in clinical care. To them they are purely cost-saving. “The way they work is not transparent or clear. If clinicians don’t know, patients cannot know either. That certainly flies in the face of the Government’s Patient Choice agenda.”
Hospitals will also be penalised for the common practice of admitting people who have waited almost four hours in accident and emergency departments without being dealt with — thus avoiding the four-hour A&E target being breached.
More here
DOUBTS ABOUT THE MASSACHUSETTS BRAINWAVE
Post lifted from Claremont
The New York Times reports that Massachusetts Governor (and 2008 presidential hopeful) Mitt Romney is set to sign a bill that would make his state the first in the nation to offer universal health care. “The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.” Fortunately, we are assured by a Brandeis professor quoted in the piece that “‘It is not a typical Massachusetts-Taxachusetts, oh-just-crazy-liberal plan.’” What is the new mechanism, then? “Individuals who can afford private insurance will be penalized on their state income taxes if they do not purchase it.”
But that’s not all. “The Massachusetts bill creates a sliding scale of affordability ranging from people who can afford insurance outright to those who cannot afford it at all.” So, Massachusetts residents will be forced to buy insurance, the price of which will be set for them, based on what the experts think they should be able to afford, with government subsidies to cover the rest. In short, another bureaucratic scheme just waiting to be taken advantage of.
And what about the hospitals and drug companies? Will they be re-staffed with saintly folk devoted to public charity? Certainly a lot of people go into the health care system out of a sense of good will to care for people. (Well, that and the God-complex, the money, and the women, but let’s stick with the good will for now). In the end, it's a business like any other. It may be crass, but if there are no incentives in that business, the quality of care will go down, the research for cures will decrease, and ultimately, more people will suffer.
The larger question is: when did it become government’s responsibility -- or for that matter, my employer’s -- to see that I have health insurance? Why not home-owner’s insurance? I have a “right” to shelter as much as health, don’t I? And how about some car owner’s insurance? Heck, why not a car? I mean, how else am I going to get to work? In fact, why doesn’t my employer or his government-appointed representative come over in the morning to make me some breakfast (Brian: I like to start the day with some cottage cheese and fruit). After all, it is the most important meal of the day. Should I be taxed if I jeopardize my health by skipping breakfast? Only time will tell.
***************************
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.
***************************
Patients are being denied appointments with consultants in a systematic attempt to ration care and save the NHS money, The Times has learnt. Leaked documents passed to The Times show that while ministers promise patients choice, a series of barriers are being erected limiting GPs’ rights to refer people to consultants. The documents reveal that health trusts across London have drawn up plans to establish panels that will “monitor” how many patients are referred to hospital by GPs. Local health trusts have been told that they must cut GP referral rates to those of the lowest 10 per cent nationally. This, the document claims, would save 25 million pounds a year in the capital. Consultant-to-consultant referrals are also being limited, in many cases denying patients a second opinion.
Patients who use hospital accident and emergency units to obtain care that could be provided by GPs are also targeted. Emergency care practitioners in A&E departments will “redirect” 40-70 per cent of patients back to GPs or walk-in centres. Hospitals that treat people who ought to have been sent to their GPs will not be paid.
It is not known how many similar schemes are in existence, but the British Medical Association has confirmed it has found examples in Kent, Oxfordshire, Dorset, Wiltshire, Surrey, Sussex, Cornwall, Shropshire, Suffolk, Lancashire and Yorkshire, as well as London. The draft paper, headed Pan London Demand Management Arrangements 06-07, says that Hammersmith and Fulham has found that a fifth of consultant-to-consultant referrals are “clinically not necessary”. Matching that across London would save another 7 million pounds, the paper says. But the bureacracy needed to screen all the referrals will itself cost 1.6 million. The London paper says that primary care trusts (PCTs) which cannot demonstrate that their referrals match the lowest 10 per cent nationally will be required to help to set up “review panels” in dermatology, ear, nose and throat, gynaecology, ophthalmology, rheumatology, trauma and orthopaedics.
These panels will review referrals by GPs, and cut them back. What this means is that patients will be denied appointments that their GPs believe they need. The language of the document makes no pretence that this will improve care, and emphasises cost savings throughout. “It is imperative that London balances its books overall,” the first paragraph says. It also indicates that the measures proposed are “the bare minimum that we expect all PCTs to be doing”. Urgent consultant-to-consultant referrals will be audited. “All urgent clinical referrals found to be clinically inappropriate will not be paid for by the PCT,” the document says.
The BMA yesterday condemned such schemes. Hamish Meldrum, the chairman of the association’s GP committee, said that they left patients in limbo, with no one clear where the responsibility lay if the condition worsened or the patient died. Jonathan Fielden, deputy chairman of the BMA consultants committee, said: “It’s clear that clinicians don’t know how these referral management systems aid improvements in clinical care. To them they are purely cost-saving. “The way they work is not transparent or clear. If clinicians don’t know, patients cannot know either. That certainly flies in the face of the Government’s Patient Choice agenda.”
Hospitals will also be penalised for the common practice of admitting people who have waited almost four hours in accident and emergency departments without being dealt with — thus avoiding the four-hour A&E target being breached.
More here
DOUBTS ABOUT THE MASSACHUSETTS BRAINWAVE
Post lifted from Claremont
The New York Times reports that Massachusetts Governor (and 2008 presidential hopeful) Mitt Romney is set to sign a bill that would make his state the first in the nation to offer universal health care. “The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.” Fortunately, we are assured by a Brandeis professor quoted in the piece that “‘It is not a typical Massachusetts-Taxachusetts, oh-just-crazy-liberal plan.’” What is the new mechanism, then? “Individuals who can afford private insurance will be penalized on their state income taxes if they do not purchase it.”
But that’s not all. “The Massachusetts bill creates a sliding scale of affordability ranging from people who can afford insurance outright to those who cannot afford it at all.” So, Massachusetts residents will be forced to buy insurance, the price of which will be set for them, based on what the experts think they should be able to afford, with government subsidies to cover the rest. In short, another bureaucratic scheme just waiting to be taken advantage of.
And what about the hospitals and drug companies? Will they be re-staffed with saintly folk devoted to public charity? Certainly a lot of people go into the health care system out of a sense of good will to care for people. (Well, that and the God-complex, the money, and the women, but let’s stick with the good will for now). In the end, it's a business like any other. It may be crass, but if there are no incentives in that business, the quality of care will go down, the research for cures will decrease, and ultimately, more people will suffer.
The larger question is: when did it become government’s responsibility -- or for that matter, my employer’s -- to see that I have health insurance? Why not home-owner’s insurance? I have a “right” to shelter as much as health, don’t I? And how about some car owner’s insurance? Heck, why not a car? I mean, how else am I going to get to work? In fact, why doesn’t my employer or his government-appointed representative come over in the morning to make me some breakfast (Brian: I like to start the day with some cottage cheese and fruit). After all, it is the most important meal of the day. Should I be taxed if I jeopardize my health by skipping breakfast? Only time will tell.
***************************
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, April 07, 2006
MASSACHUSETTS TRIES MANDATORY PRIVATE INSURANCE
See here for the case AGAINST mandatory health insurance
Massachusetts is poised to become the first state to provide nearly universal health care coverage with a bill passed overwhelmingly by the legislature Tuesday that Gov. Mitt Romney says he will sign. The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance. It accomplishes that in a way that experts say combines methods and proposals from across the political spectrum, apportioning the cost among businesses, individuals and the government. "This is probably about as close as you can get to universal," said Paul B. Ginsburg, president of the nonpartisan Center for Studying Health System Change in Washington. "It's definitely going to be inspiring to other states about how there was this compromise. They found a way to get to a major expansion of coverage that people could agree on. For a conservative Republican, this is individual responsibility. For a Democrat, this is government helping those that need help."
The bill, the product of months of wrangling between legislators and the governor, requires all Massachusetts residents to obtain health coverage by July 1, 2007. Individuals who can afford private insurance will be penalized on their state income taxes if they do not purchase it. Government subsidies to private insurance plans will allow more of the working poor to buy insurance and will expand the number of children who are eligible for free coverage. Businesses with more than 10 workers that do not provide insurance will be assessed up to $295 per employee per year. All told, the plan is expected to cover 515,000 uninsured people within three years, about 95 percent of the state's uninsured population, legislators said, leaving less than 1 percent of the population unprotected. "It is not a typical Massachusetts-Taxachusetts, oh-just-crazy-liberal plan," said Stuart H. Altman, a professor of health policy at Brandeis University. "It isn't that at all. It is a pretty moderate approach, and that's what's impressive about it. It tried to borrow and blend a lot of different pieces."
Many states, including Massachusetts, have been wrestling for years with how to cover the uninsured, and several states have come close, according to the National Conference of State Legislatures. Hawaii passed a universal access law in 1974 requiring employers to offer health care coverage for employees working 20 hours or more a week, but nearly 10 percent of people remain uncovered. Efforts to cover all citizens in Minnesota and Vermont in 1992 and in Massachusetts in 1988 fell flat in the mid-1990s when the language in the bills concerning universal coverage was repealed.
In 2003, Maine enacted a law that significantly broadened insurance coverage and combined employer payments with expanded government programs. That year, California enacted a law that required employer contributions, but it was repealed in a referendum in 2004. Massachusetts would be the first state to require its citizens to have health insurance.
The Massachusetts bill creates a sliding scale of affordability ranging from people who can afford insurance outright to those who cannot afford it at all. About 215,000 people will be covered by allowing individuals and businesses with 50 or fewer employees to buy insurance with pretax dollars, and by giving insurance companies incentives to offer stripped-down plans at lower cost. Lower-cost basic plans will be available to people ages 19 to 26.
Subsidies for other private plans will be available for people with incomes at or below 300 percent of the poverty level. Children in those families will be eligible for free coverage through Medicaid, an expansion of the current system. The Massachusetts bill was hammered out with proposals and input from state Democratic legislators; Mr. Romney, a Republican; Senator Edward M. Kennedy, a Democrat; insurers; academics; businesses; hospitals; and advocates for the poor, including religious leaders. They were motivated in part by a threat by the federal government to eliminate $385 million in federal Medicaid money unless the state reduced the number of uninsured people. The state was supposed to have the bill completed by January, but state officials said they were confident that the federal government would approve of Tuesday's bill. "Whenever you can have the medical community, the business community and the advocates all applauding our efforts, I think that's indicative of a successful exercise," said State Senator Robert E. Travaglini, the majority leader.
Mr. Romney, who is considering running for president in 2008, said in an interview Tuesday that the bill, passed by a legislature that is 85 percent Democratic, was "95 percent of what I proposed." He said, "This is really a landmark for our state because this proves at this stage that we can get health insurance for all our citizens without raising taxes and without a government takeover. The old single-payer canard is gone." Mr. Romney pushed the idea of the "individual mandate," requiring people who can afford insurance to buy it. The bill makes it possible for employers to enable many of those people to use pretax dollars, saving them 25 percent or more. Individuals who fail to get health insurance by July 2007 will first lose their personal exemption on their state taxes. In subsequent years, they would have to pay a penalty that could be as high as half of what an affordable health care premium would cost.
Eric Fehrnstrom, the governor's communications director, said that for those people with incomes above 300 percent of poverty, "our assumption was that these would be mostly single mothers who just did not have the wherewithal to get insurance. It turned out it was mostly young males. In some cases they are making very attractive salaries. These are people who just don't imagine themselves needing care, but of course when they break a leg when they're out bungee jumping they go to the hospital and we end up paying for their care anyway."
One element that Mr. Romney and some legislators did not want was the fee for employers who do not provide health insurance. For several months the bill seemed stalled because the House and Senate leaders could not agree on the issue of charging businesses. One proposal of an $800-per-employee charge was reduced to a maximum of $295 that would go toward paying costs for the uninsured and would be reduced as more people became insured, Mr. Travaglini said.
Because the bill is part of a budget bill, Mr. Romney has line-item veto power. He said Tuesday that he would likely change the business fee provision in some way or veto it before signing the bill. Still, he did not seem that worried about it, saying he had been most concerned that the fee not be a payroll tax, as had been originally proposed. Mr. Travaglini said that if Mr. Romney vetoed the business fee, the legislature would override it. Bob Baker, president of the Smaller Business Association of New England, said his members seemed to accept the idea of the fee. "The notion of the level playing field, I think from an element of fairness and equity, people are O.K. with it, unless it impinges on their ability to pay for it," Mr. Baker said. "There hasn't been a hue and cry among our members."
Mr. Romney said that with more people insured, everyone would "get better health care" and that premiums for people who already had insurance might drop because "providers won't be pushing the cost of the uninsured onto the people who have insurance." James Roosevelt Jr., president and chief executive of Tufts Health Plan, agreed. "I think that will help both improve the quality of health care and lower the cost," Mr. Roosevelt said, but he added, "We would have liked more flexibility in the design of health plans to permit lower premiums that are affordable for all people."
The program, which was approved 154 to 2 in the House and 37 to 0 in the Senate, will cost $1.2 billion over three years, but only $125 million of that will be new state money. The rest will come from federal money and existing state money. After three years, lawmakers say, no new state money will be required. A new agency will administer the system.
Advocates for the uninsured held a victory rally at the Statehouse. "We're thrilled that this truly represents a commitment to the poor and the working poor," said Rabbi Jonah Pesner, a leader of the Greater Boston Interfaith Organization. Joseph Landais, 64, could use insurance for himself, his wife and three children. Mr. Landais, a retired hospital custodian, said his wife, a nurse's aide, makes too much for the family to be eligible for Medicaid but not enough to afford insurance. He had a hernia operation four months ago that he did not have to pay for under the free-care pool, but he had not been able to see a doctor since then, even though he is still not feeling well. "After years that you've been working that hard," Mr. Landais said, "I think you deserve something back."
Source
THE NHS CONCEPT OF PREVENTIVE MEDICINE
From Eamonn Butler
Sorry to keep going on about health, but the subject has been high in my mind recently. Because last week I had my annual check-up with BUPA, the independent healthcare insurer and provider.
It was just routine, and apparently I am fit as a flea - albeit a rather decrepit flea. I got an impressive battery of tests including heart and lung function, hearing, eyesight, and about 101 other things you can discover from the scrutiny of blood and various other samples you do not want to know about it.
The state-run National Health Service, bless it, did some public opinion polls a while back and discovered that the idea of a regular check-up was really popular among its patients and potential patients. People did not just want to fall sick and let the NHS look after them - they thought the NHS should be helping them to stay healthy.
So politicians a few months ago announced their next great policy. Regular check-ups on the NHS. Better late than never, you might think, and what an excellent use for the extra billions (about 35 extra billions, in fact) that the government has pumped into the Service.
Er, no. The much-vaunted `regular check-up' does not involve seeing a doctor for two hours, like I did on my BUPA examination. It does not actually involve seeing a doctor at all. No, their idea of a check-up is to send people a questionnaire form at four stages in their lives - after childbirth, at retirement, that sort of thing.
For some years, a number of us have been saying that we have a National Sickness Service and really we want a National Wellness Service. If a bit of form-filling is what they regard as a regular check-up, this vision remains a very long way off.
***************************
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.
***************************
See here for the case AGAINST mandatory health insurance
Massachusetts is poised to become the first state to provide nearly universal health care coverage with a bill passed overwhelmingly by the legislature Tuesday that Gov. Mitt Romney says he will sign. The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance. It accomplishes that in a way that experts say combines methods and proposals from across the political spectrum, apportioning the cost among businesses, individuals and the government. "This is probably about as close as you can get to universal," said Paul B. Ginsburg, president of the nonpartisan Center for Studying Health System Change in Washington. "It's definitely going to be inspiring to other states about how there was this compromise. They found a way to get to a major expansion of coverage that people could agree on. For a conservative Republican, this is individual responsibility. For a Democrat, this is government helping those that need help."
The bill, the product of months of wrangling between legislators and the governor, requires all Massachusetts residents to obtain health coverage by July 1, 2007. Individuals who can afford private insurance will be penalized on their state income taxes if they do not purchase it. Government subsidies to private insurance plans will allow more of the working poor to buy insurance and will expand the number of children who are eligible for free coverage. Businesses with more than 10 workers that do not provide insurance will be assessed up to $295 per employee per year. All told, the plan is expected to cover 515,000 uninsured people within three years, about 95 percent of the state's uninsured population, legislators said, leaving less than 1 percent of the population unprotected. "It is not a typical Massachusetts-Taxachusetts, oh-just-crazy-liberal plan," said Stuart H. Altman, a professor of health policy at Brandeis University. "It isn't that at all. It is a pretty moderate approach, and that's what's impressive about it. It tried to borrow and blend a lot of different pieces."
Many states, including Massachusetts, have been wrestling for years with how to cover the uninsured, and several states have come close, according to the National Conference of State Legislatures. Hawaii passed a universal access law in 1974 requiring employers to offer health care coverage for employees working 20 hours or more a week, but nearly 10 percent of people remain uncovered. Efforts to cover all citizens in Minnesota and Vermont in 1992 and in Massachusetts in 1988 fell flat in the mid-1990s when the language in the bills concerning universal coverage was repealed.
In 2003, Maine enacted a law that significantly broadened insurance coverage and combined employer payments with expanded government programs. That year, California enacted a law that required employer contributions, but it was repealed in a referendum in 2004. Massachusetts would be the first state to require its citizens to have health insurance.
The Massachusetts bill creates a sliding scale of affordability ranging from people who can afford insurance outright to those who cannot afford it at all. About 215,000 people will be covered by allowing individuals and businesses with 50 or fewer employees to buy insurance with pretax dollars, and by giving insurance companies incentives to offer stripped-down plans at lower cost. Lower-cost basic plans will be available to people ages 19 to 26.
Subsidies for other private plans will be available for people with incomes at or below 300 percent of the poverty level. Children in those families will be eligible for free coverage through Medicaid, an expansion of the current system. The Massachusetts bill was hammered out with proposals and input from state Democratic legislators; Mr. Romney, a Republican; Senator Edward M. Kennedy, a Democrat; insurers; academics; businesses; hospitals; and advocates for the poor, including religious leaders. They were motivated in part by a threat by the federal government to eliminate $385 million in federal Medicaid money unless the state reduced the number of uninsured people. The state was supposed to have the bill completed by January, but state officials said they were confident that the federal government would approve of Tuesday's bill. "Whenever you can have the medical community, the business community and the advocates all applauding our efforts, I think that's indicative of a successful exercise," said State Senator Robert E. Travaglini, the majority leader.
Mr. Romney, who is considering running for president in 2008, said in an interview Tuesday that the bill, passed by a legislature that is 85 percent Democratic, was "95 percent of what I proposed." He said, "This is really a landmark for our state because this proves at this stage that we can get health insurance for all our citizens without raising taxes and without a government takeover. The old single-payer canard is gone." Mr. Romney pushed the idea of the "individual mandate," requiring people who can afford insurance to buy it. The bill makes it possible for employers to enable many of those people to use pretax dollars, saving them 25 percent or more. Individuals who fail to get health insurance by July 2007 will first lose their personal exemption on their state taxes. In subsequent years, they would have to pay a penalty that could be as high as half of what an affordable health care premium would cost.
Eric Fehrnstrom, the governor's communications director, said that for those people with incomes above 300 percent of poverty, "our assumption was that these would be mostly single mothers who just did not have the wherewithal to get insurance. It turned out it was mostly young males. In some cases they are making very attractive salaries. These are people who just don't imagine themselves needing care, but of course when they break a leg when they're out bungee jumping they go to the hospital and we end up paying for their care anyway."
One element that Mr. Romney and some legislators did not want was the fee for employers who do not provide health insurance. For several months the bill seemed stalled because the House and Senate leaders could not agree on the issue of charging businesses. One proposal of an $800-per-employee charge was reduced to a maximum of $295 that would go toward paying costs for the uninsured and would be reduced as more people became insured, Mr. Travaglini said.
Because the bill is part of a budget bill, Mr. Romney has line-item veto power. He said Tuesday that he would likely change the business fee provision in some way or veto it before signing the bill. Still, he did not seem that worried about it, saying he had been most concerned that the fee not be a payroll tax, as had been originally proposed. Mr. Travaglini said that if Mr. Romney vetoed the business fee, the legislature would override it. Bob Baker, president of the Smaller Business Association of New England, said his members seemed to accept the idea of the fee. "The notion of the level playing field, I think from an element of fairness and equity, people are O.K. with it, unless it impinges on their ability to pay for it," Mr. Baker said. "There hasn't been a hue and cry among our members."
Mr. Romney said that with more people insured, everyone would "get better health care" and that premiums for people who already had insurance might drop because "providers won't be pushing the cost of the uninsured onto the people who have insurance." James Roosevelt Jr., president and chief executive of Tufts Health Plan, agreed. "I think that will help both improve the quality of health care and lower the cost," Mr. Roosevelt said, but he added, "We would have liked more flexibility in the design of health plans to permit lower premiums that are affordable for all people."
The program, which was approved 154 to 2 in the House and 37 to 0 in the Senate, will cost $1.2 billion over three years, but only $125 million of that will be new state money. The rest will come from federal money and existing state money. After three years, lawmakers say, no new state money will be required. A new agency will administer the system.
Advocates for the uninsured held a victory rally at the Statehouse. "We're thrilled that this truly represents a commitment to the poor and the working poor," said Rabbi Jonah Pesner, a leader of the Greater Boston Interfaith Organization. Joseph Landais, 64, could use insurance for himself, his wife and three children. Mr. Landais, a retired hospital custodian, said his wife, a nurse's aide, makes too much for the family to be eligible for Medicaid but not enough to afford insurance. He had a hernia operation four months ago that he did not have to pay for under the free-care pool, but he had not been able to see a doctor since then, even though he is still not feeling well. "After years that you've been working that hard," Mr. Landais said, "I think you deserve something back."
Source
THE NHS CONCEPT OF PREVENTIVE MEDICINE
From Eamonn Butler
Sorry to keep going on about health, but the subject has been high in my mind recently. Because last week I had my annual check-up with BUPA, the independent healthcare insurer and provider.
It was just routine, and apparently I am fit as a flea - albeit a rather decrepit flea. I got an impressive battery of tests including heart and lung function, hearing, eyesight, and about 101 other things you can discover from the scrutiny of blood and various other samples you do not want to know about it.
The state-run National Health Service, bless it, did some public opinion polls a while back and discovered that the idea of a regular check-up was really popular among its patients and potential patients. People did not just want to fall sick and let the NHS look after them - they thought the NHS should be helping them to stay healthy.
So politicians a few months ago announced their next great policy. Regular check-ups on the NHS. Better late than never, you might think, and what an excellent use for the extra billions (about 35 extra billions, in fact) that the government has pumped into the Service.
Er, no. The much-vaunted `regular check-up' does not involve seeing a doctor for two hours, like I did on my BUPA examination. It does not actually involve seeing a doctor at all. No, their idea of a check-up is to send people a questionnaire form at four stages in their lives - after childbirth, at retirement, that sort of thing.
For some years, a number of us have been saying that we have a National Sickness Service and really we want a National Wellness Service. If a bit of form-filling is what they regard as a regular check-up, this vision remains a very long way off.
***************************
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, April 06, 2006
Stop, think, rebuild; a prescription for the NHS
Two years ago few would have predicted that the centre of gravity of the health debate would move so quickly towards reform and value for money and away from higher spending. Yet on Sunday Sir Derek Wanless, the author of the landmark report on NHS financing used to justify higher spending, cautioned that all the extra money (in fact "slightly more" than all the money) has already been spent. Yesterday Aidan Halligan, the former Deputy Chief Medical Officer, commented: "We have learnt that throwing money at the problem only allows us to do more of what we have always done." The service has lurched from a deficit of 200 million pounds before Christmas to 800 million now, losing a chief executive and a head of human resources along the way.
The scale of the extra resources is not in doubt. After inflation, annual spending has increased by four-fifths since 1999-2000, taking spending beyond the European average. The increased spending per year amounts to an extra 120 billion pounds in total. But it is equally clear that the extra resources have not created a service of the standard of continental countries. Certainly some areas of the service have improved. The longest waiting times have been reduced, but improvements have tended to fall in areas of narrowly focused political pressure or where reforms, such as patient choice, have been implemented. Other areas of the service have been neglected.
The public is clear that spending has risen sharply but expectations have risen just as quickly. But the majority of extra resources has been absorbed in higher costs rather than being used to expand access or develop new services. As a result there is a widening gap between supply and demand. The reduction in the rate of spending increases after 2008, already announced by the Government, will only make the situation worse.
This raises the prospect of much greater rationing and longer waiting times that will come as a very unpleasant surprise to patients. It will also increase suffering, as a high proportion of patients' conditions deteriorate further while on waiting lists.
All the political parties need to undertake an urgent review of NHS aspirations in the future. We need a debate to identify which services should remain in a taxpayer-funded core and which areas are appropriate for a new partnership between the individual and the State. The latter areas will include the services where the NHS has failed to deliver on its guarantee of care. Despite the highest possible funding increases, the service as currently constructed does not deliver on its guarantee of universal care. For example, the British Society of Hearing Aid Audiologists showed last year that waiting lists for NHS hearing aids can reach up to three years. The National Audit Office has reported that only half of stroke patients receive proper rehabilitation in the crucial months after suffering a stroke.
Worse, the fiction that the NHS covers these areas of illness prevents new forms of funding and new providers from emerging. Where the NHS has recognised the limits of its coverage, such as in ophthalmology, a successful market has been allowed to develop. Standards of eye care have risen and - with several opticians on every high street - choice and access for patients have been transformed.
As well as supply and demand, the other fundamental divide is between consumer demand and society's need. As medicine advances and the population ages, consumers will inevitably want to spend more than society wishes to fund. In coming years numbers of young taxpayers will fall relative to the older generations. Will the young taxpayers of 2016 or 2026 wish to fund the health wishes of a much greater number of non-taxpayers? The days of an exclusively tax-funded health service are numbered.
The great prize of a reformed and balanced funding system is that the gaps in today's service could be filled and a modern, truly comprehensive service could emerge. People could be freed to put additional resources of their own into healthcare, as they increasingly will wish to do.
This new system will look and feel different. Alongside a new funding model will come new forms of provision based on out-of-hospital care much closer to people's homes. Pluralism - with private and voluntary sector providers delivering care on equal terms with the NHS - will be taken for granted. The gains to innovation will be immense. Co-payments and health insurance will be the new vocabulary of healthcare financing.
The review of NHS aspirations should be undertaken without political prejudices in any direction. We must certainly guarantee equitable access for healthcare for all in society. Healthcare free at the point of use is a cornerstone of the British system. But, as the Prime Minister himself said in 2003, the 1945 model of healthcare has never delivered equal access for people on low incomes. Equity is the first thing to go when healthcare is rationed by waiting lists because the better-off can push their way to the queue or jump it altogether by going private. If rationing does start to bite and waiting lists lengthen after 2008, equity and fairness will suffer.
Despite admitting the need for reform, politicians remain unwilling to face up to the debate on financing. The medical profession and their patients are all too aware of the need. Two thirds of the electorate agree that the NHS is unlikely to meet patient expectations, no matter how much is spent on it. The parties will find considerable support for some boldness.
(Article above by Dr. Karol Sikora of "Doctors for Reform")
MORE ON NHS REFORM
Doctors for Reform has a point. The NHS, as elegantly argued by Professor Karol Sikora, a leading Doctor for Reform, on this page yesterday, is going to face a widening gap between supply and demand and will have to choose which services to provide and which to leave to the open market, ie, for the rich.
Look at the pressures that will be wrought by an ageing population: in 1950, with the NHS barely a year old, there were more than five people of working age for every pensioner. By 2050 there will be just two. Then look at the potential (and cost) of new genetic technology. If a genetic test, for instance, could show that I have a 4 per cent higher than average chance of developing Columnist Repetitive Argument Pharyngitis, and should therefore, for my health, avoid opinionating in newspapers regularly, ought I to be allowed to have the tests to discover that on the NHS?
Say that a test, for which you may have to pay yourself, shows that you have a 15 per cent chance of developing a particular cancer, where the norm would be 3 per cent - should the NHS give you preventive treatment that would reduce your probability of contracting the disease to the 3 per cent average? Even if it costs tens of thousands of pounds?
When David Cameron declared in January that the Conservative Party now believes in a taxpayer-funded NHS free at the point of need, he embraced the cost of new genetic treatments as well as new cancer drugs. "The NHS can no longer ration these treatments as it used to," he declared. Really? Who is going to pay for them? With both main parties playing politics for idiots - you ask, we give - there is no check on consumer demand for the NHS. And consumer demand is limitless: it started with basic healthcare, grew to embrace mental health and fertility and now slimness, and would, given half a chance, stretch to beauty and energy as well. Permanent blondeness? Why not? Look at the expensive things people are prepared to pay for privately with only a slim chance that they might make a difference to their health - from reflexology to cutting-edge cancer drugs - and then ask yourself whether you want to fund all this on the NHS.
So, yes, Professor Sikora is right: the days of an exclusively tax-funded health service are numbered. But then they always were. What the NHS provides was limited from Day 1, and demand has always outstripped expectations. In its first year of operation, 1949, Bevan estimated that the NHS would cost 176 million pounds; it actually cost 437 million. A year after its launch, a shilling prescription charge was introduced, both to raise money and to reduce the "cascades of medicine pouring down British throats", in Bevan's words. Two years later, dental and optical charges had to be introduced. The rich always have and always will be able to buy a more expensive range of healthcare.
What Doctors for Reform seem to be demanding (it isn't entirely clear) is a completely different European-style funding system for the NHS, and it isn't necessary. What we do need is greater realism from politicians about the limits of the system, less encouragement from populist ministers to act like children demanding more sweets from the sweetie shop, and a serious attempt instead to decide where the lines should be drawn in future.
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.
***************************
Two years ago few would have predicted that the centre of gravity of the health debate would move so quickly towards reform and value for money and away from higher spending. Yet on Sunday Sir Derek Wanless, the author of the landmark report on NHS financing used to justify higher spending, cautioned that all the extra money (in fact "slightly more" than all the money) has already been spent. Yesterday Aidan Halligan, the former Deputy Chief Medical Officer, commented: "We have learnt that throwing money at the problem only allows us to do more of what we have always done." The service has lurched from a deficit of 200 million pounds before Christmas to 800 million now, losing a chief executive and a head of human resources along the way.
The scale of the extra resources is not in doubt. After inflation, annual spending has increased by four-fifths since 1999-2000, taking spending beyond the European average. The increased spending per year amounts to an extra 120 billion pounds in total. But it is equally clear that the extra resources have not created a service of the standard of continental countries. Certainly some areas of the service have improved. The longest waiting times have been reduced, but improvements have tended to fall in areas of narrowly focused political pressure or where reforms, such as patient choice, have been implemented. Other areas of the service have been neglected.
The public is clear that spending has risen sharply but expectations have risen just as quickly. But the majority of extra resources has been absorbed in higher costs rather than being used to expand access or develop new services. As a result there is a widening gap between supply and demand. The reduction in the rate of spending increases after 2008, already announced by the Government, will only make the situation worse.
This raises the prospect of much greater rationing and longer waiting times that will come as a very unpleasant surprise to patients. It will also increase suffering, as a high proportion of patients' conditions deteriorate further while on waiting lists.
All the political parties need to undertake an urgent review of NHS aspirations in the future. We need a debate to identify which services should remain in a taxpayer-funded core and which areas are appropriate for a new partnership between the individual and the State. The latter areas will include the services where the NHS has failed to deliver on its guarantee of care. Despite the highest possible funding increases, the service as currently constructed does not deliver on its guarantee of universal care. For example, the British Society of Hearing Aid Audiologists showed last year that waiting lists for NHS hearing aids can reach up to three years. The National Audit Office has reported that only half of stroke patients receive proper rehabilitation in the crucial months after suffering a stroke.
Worse, the fiction that the NHS covers these areas of illness prevents new forms of funding and new providers from emerging. Where the NHS has recognised the limits of its coverage, such as in ophthalmology, a successful market has been allowed to develop. Standards of eye care have risen and - with several opticians on every high street - choice and access for patients have been transformed.
As well as supply and demand, the other fundamental divide is between consumer demand and society's need. As medicine advances and the population ages, consumers will inevitably want to spend more than society wishes to fund. In coming years numbers of young taxpayers will fall relative to the older generations. Will the young taxpayers of 2016 or 2026 wish to fund the health wishes of a much greater number of non-taxpayers? The days of an exclusively tax-funded health service are numbered.
The great prize of a reformed and balanced funding system is that the gaps in today's service could be filled and a modern, truly comprehensive service could emerge. People could be freed to put additional resources of their own into healthcare, as they increasingly will wish to do.
This new system will look and feel different. Alongside a new funding model will come new forms of provision based on out-of-hospital care much closer to people's homes. Pluralism - with private and voluntary sector providers delivering care on equal terms with the NHS - will be taken for granted. The gains to innovation will be immense. Co-payments and health insurance will be the new vocabulary of healthcare financing.
The review of NHS aspirations should be undertaken without political prejudices in any direction. We must certainly guarantee equitable access for healthcare for all in society. Healthcare free at the point of use is a cornerstone of the British system. But, as the Prime Minister himself said in 2003, the 1945 model of healthcare has never delivered equal access for people on low incomes. Equity is the first thing to go when healthcare is rationed by waiting lists because the better-off can push their way to the queue or jump it altogether by going private. If rationing does start to bite and waiting lists lengthen after 2008, equity and fairness will suffer.
Despite admitting the need for reform, politicians remain unwilling to face up to the debate on financing. The medical profession and their patients are all too aware of the need. Two thirds of the electorate agree that the NHS is unlikely to meet patient expectations, no matter how much is spent on it. The parties will find considerable support for some boldness.
(Article above by Dr. Karol Sikora of "Doctors for Reform")
MORE ON NHS REFORM
Doctors for Reform has a point. The NHS, as elegantly argued by Professor Karol Sikora, a leading Doctor for Reform, on this page yesterday, is going to face a widening gap between supply and demand and will have to choose which services to provide and which to leave to the open market, ie, for the rich.
Look at the pressures that will be wrought by an ageing population: in 1950, with the NHS barely a year old, there were more than five people of working age for every pensioner. By 2050 there will be just two. Then look at the potential (and cost) of new genetic technology. If a genetic test, for instance, could show that I have a 4 per cent higher than average chance of developing Columnist Repetitive Argument Pharyngitis, and should therefore, for my health, avoid opinionating in newspapers regularly, ought I to be allowed to have the tests to discover that on the NHS?
Say that a test, for which you may have to pay yourself, shows that you have a 15 per cent chance of developing a particular cancer, where the norm would be 3 per cent - should the NHS give you preventive treatment that would reduce your probability of contracting the disease to the 3 per cent average? Even if it costs tens of thousands of pounds?
When David Cameron declared in January that the Conservative Party now believes in a taxpayer-funded NHS free at the point of need, he embraced the cost of new genetic treatments as well as new cancer drugs. "The NHS can no longer ration these treatments as it used to," he declared. Really? Who is going to pay for them? With both main parties playing politics for idiots - you ask, we give - there is no check on consumer demand for the NHS. And consumer demand is limitless: it started with basic healthcare, grew to embrace mental health and fertility and now slimness, and would, given half a chance, stretch to beauty and energy as well. Permanent blondeness? Why not? Look at the expensive things people are prepared to pay for privately with only a slim chance that they might make a difference to their health - from reflexology to cutting-edge cancer drugs - and then ask yourself whether you want to fund all this on the NHS.
So, yes, Professor Sikora is right: the days of an exclusively tax-funded health service are numbered. But then they always were. What the NHS provides was limited from Day 1, and demand has always outstripped expectations. In its first year of operation, 1949, Bevan estimated that the NHS would cost 176 million pounds; it actually cost 437 million. A year after its launch, a shilling prescription charge was introduced, both to raise money and to reduce the "cascades of medicine pouring down British throats", in Bevan's words. Two years later, dental and optical charges had to be introduced. The rich always have and always will be able to buy a more expensive range of healthcare.
What Doctors for Reform seem to be demanding (it isn't entirely clear) is a completely different European-style funding system for the NHS, and it isn't necessary. What we do need is greater realism from politicians about the limits of the system, less encouragement from populist ministers to act like children demanding more sweets from the sweetie shop, and a serious attempt instead to decide where the lines should be drawn in future.
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.
***************************
Wednesday, April 05, 2006
Millions wasted as Australian public hospital waiting lists grow
Patients are waiting longer than ever for elective surgery, even though state governments have collectively wasted an additional $200 million a year on trying to fix the problem. Waiting times increased most significantly in NSW, Victoria and the ACT, while Queensland and South Australia showed some improvement. Figures obtained by The Australian from state and territory governments reveal that there were 143,000 patients across Australia needing elective surgery. And on average they waited longer for common procedures such as cataract removals and knee and hip replacements in 2004-05 than they did in the previous year.
The average wait for a cataract extraction jumped from 168 days to 218 days in NSW and from 152 to 176 days in Victoria. A third of patients in NSW and the Northern Territory waited for more than a year for a knee replacement. Ten per cent of patients in NSW and the ACT waited more than 600 days to have knee surgery and more than 400 days for a hip replacement. Tasmania, which had the longest waiting times last year, was the only state that would not release figures for 2004-05.
Australian Society of Orthopaedic Surgeons national chairman Gary Speck said state governments were wasting millions of dollars every year on non-essential services and paperwork. "Spending the money more appropriately would be a good start," Dr Speck said. "A lot of money is spent putting up new buildings and on administration, rather than being spent at the coalface." He said many patients suffered for years before they were placed on the official waiting lists. "There is a waiting list to get an appointment to see a specialist and, in some parts of Victoria, that could take 15 months," Dr Speck told The Australian. "Once they finally get to see a specialist, patients then wait another nine to 12 months before they have the surgery, so people needing hip and knee replacements often wait more than two years."
The executive director of the Health Services Association of NSW, James McGillicuddy, said that state governments were reluctant to invest in long-term strategies to restructure the public health system. Mr McGillicuddy said elective surgery should be removed, or dramatically reduced, from public hospitals that ran busy emergency departments, and relocated to designated public health organisations dedicated to elective surgery. "The current situation, where elective surgery is done in existing public hospitals, is unworkable and will lead to longer waiting lists as the population becomes older and demand for elective surgery increases," he said. "This proposal would involve increased investment in public health infrastructure, but in the long run it would pay dividends to both the Government and reduce waiting times for elective surgery."
Mr McGillicuddy said private hospitals were also struggling to meet elective surgery demand. Forty-three per cent of Australians have private health insurance, but the 33 per cent increase in premiums during the past five years has forced many younger members to dump their health cover.
A spokesman for Victorian Health Minister Bronwyn Pike said an elective surgery centre would be opened on the grounds of Melbourne's The Alfred hospital in November to reduce pressure on the public hospital. "The $90 million centre, which is still part of the public hospitals, will have staff and beds dedicated to elective surgery only," she said. "It was designed to deal with the problem of elective surgery having to be prioritised in amongst the emergency demands."
A spokeswoman for NSW Health Minister John Hatzistergos said the Government was focusing on reducing the number of patients waiting longer than a year. "The long wait list has dropped from over 10,500 in February 2005 to 3400 in February 2006," she said.
However, Elizabeth Feeney, chairwoman of the Australian Medical Association's hospital practice committee (NSW), said the continued closure of operating theatres during public holidays would hamper efforts to reduce waiting times. "Ten years ago, hospitals used to close for a week between Christmas and New Year, but now some close for up to eight weeks over Christmas and three weeks over Easter to cut costs," Dr Feeney said. "To have all that money invested in equipment and instruments and only use it for three-quarters of a year is not what a business would do. "If BHP shut for a few months a year that would seem pretty odd."
Source
ANOTHER BRILLIANT SUCCESS FOR BRITAIN'S NHS
Hospital cleaning products may actually help a diarrhoea-causing bug to survive and spread, researchers claim. Some strains of Clostridium difficile became more resistant when exposed to two cleaning agents used in hospitals. Elderly patients are most at risk from Clostridium difficile, the major cause of hospital-acquired diarrhoea, with tens of thousands contracting it each year.
Researchers from Leeds General Infirmary and the University of Leeds treated the strains with five cleaning products. All the strains produced more spores when exposed to two chemicals that did not contain bleach. If a bug has more spores it means it may be able to survive for longer periods in hospitals. Professor Wilcox said: "These bacteria can form spores which survive for months or even years in the environment, in spite of hospital cleaning regimens. "We have shown that some commonly used hospital cleaning and disinfectant agents not only fail to kill bacteria, they actually promote spore formation."
In 2004, Department of Health figures showed there were 44,488 cases of the bug in those aged over-65. Clostridium difficile is not as deadly as the superbug MRSA but it has led to several deaths. Careful use of antibiotics and being able to isolate infected patients are two of the things that help to stop it spreading.
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.
***************************
Patients are waiting longer than ever for elective surgery, even though state governments have collectively wasted an additional $200 million a year on trying to fix the problem. Waiting times increased most significantly in NSW, Victoria and the ACT, while Queensland and South Australia showed some improvement. Figures obtained by The Australian from state and territory governments reveal that there were 143,000 patients across Australia needing elective surgery. And on average they waited longer for common procedures such as cataract removals and knee and hip replacements in 2004-05 than they did in the previous year.
The average wait for a cataract extraction jumped from 168 days to 218 days in NSW and from 152 to 176 days in Victoria. A third of patients in NSW and the Northern Territory waited for more than a year for a knee replacement. Ten per cent of patients in NSW and the ACT waited more than 600 days to have knee surgery and more than 400 days for a hip replacement. Tasmania, which had the longest waiting times last year, was the only state that would not release figures for 2004-05.
Australian Society of Orthopaedic Surgeons national chairman Gary Speck said state governments were wasting millions of dollars every year on non-essential services and paperwork. "Spending the money more appropriately would be a good start," Dr Speck said. "A lot of money is spent putting up new buildings and on administration, rather than being spent at the coalface." He said many patients suffered for years before they were placed on the official waiting lists. "There is a waiting list to get an appointment to see a specialist and, in some parts of Victoria, that could take 15 months," Dr Speck told The Australian. "Once they finally get to see a specialist, patients then wait another nine to 12 months before they have the surgery, so people needing hip and knee replacements often wait more than two years."
The executive director of the Health Services Association of NSW, James McGillicuddy, said that state governments were reluctant to invest in long-term strategies to restructure the public health system. Mr McGillicuddy said elective surgery should be removed, or dramatically reduced, from public hospitals that ran busy emergency departments, and relocated to designated public health organisations dedicated to elective surgery. "The current situation, where elective surgery is done in existing public hospitals, is unworkable and will lead to longer waiting lists as the population becomes older and demand for elective surgery increases," he said. "This proposal would involve increased investment in public health infrastructure, but in the long run it would pay dividends to both the Government and reduce waiting times for elective surgery."
Mr McGillicuddy said private hospitals were also struggling to meet elective surgery demand. Forty-three per cent of Australians have private health insurance, but the 33 per cent increase in premiums during the past five years has forced many younger members to dump their health cover.
A spokesman for Victorian Health Minister Bronwyn Pike said an elective surgery centre would be opened on the grounds of Melbourne's The Alfred hospital in November to reduce pressure on the public hospital. "The $90 million centre, which is still part of the public hospitals, will have staff and beds dedicated to elective surgery only," she said. "It was designed to deal with the problem of elective surgery having to be prioritised in amongst the emergency demands."
A spokeswoman for NSW Health Minister John Hatzistergos said the Government was focusing on reducing the number of patients waiting longer than a year. "The long wait list has dropped from over 10,500 in February 2005 to 3400 in February 2006," she said.
However, Elizabeth Feeney, chairwoman of the Australian Medical Association's hospital practice committee (NSW), said the continued closure of operating theatres during public holidays would hamper efforts to reduce waiting times. "Ten years ago, hospitals used to close for a week between Christmas and New Year, but now some close for up to eight weeks over Christmas and three weeks over Easter to cut costs," Dr Feeney said. "To have all that money invested in equipment and instruments and only use it for three-quarters of a year is not what a business would do. "If BHP shut for a few months a year that would seem pretty odd."
Source
ANOTHER BRILLIANT SUCCESS FOR BRITAIN'S NHS
Hospital cleaning products may actually help a diarrhoea-causing bug to survive and spread, researchers claim. Some strains of Clostridium difficile became more resistant when exposed to two cleaning agents used in hospitals. Elderly patients are most at risk from Clostridium difficile, the major cause of hospital-acquired diarrhoea, with tens of thousands contracting it each year.
Researchers from Leeds General Infirmary and the University of Leeds treated the strains with five cleaning products. All the strains produced more spores when exposed to two chemicals that did not contain bleach. If a bug has more spores it means it may be able to survive for longer periods in hospitals. Professor Wilcox said: "These bacteria can form spores which survive for months or even years in the environment, in spite of hospital cleaning regimens. "We have shown that some commonly used hospital cleaning and disinfectant agents not only fail to kill bacteria, they actually promote spore formation."
In 2004, Department of Health figures showed there were 44,488 cases of the bug in those aged over-65. Clostridium difficile is not as deadly as the superbug MRSA but it has led to several deaths. Careful use of antibiotics and being able to isolate infected patients are two of the things that help to stop it spreading.
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.
***************************
Tuesday, April 04, 2006
U.K.: We must rethink NHS, plead senior doctors
The National Health Service is doomed to fail without radical changes in funding and approach, a group of almost 800 senior doctors says today
Doctors for Reform has written to the three main party leaders urging a fresh look at the NHS, pointing out that Britain has European levels of spending on health but still falls short of European standards. The doctors' letter is backed by an opinion poll showing that two thirds of voters believe that in its present form the NHS will never meet public demand, however much is spent on it. More than half of those questioned do not believe that the extra spending has resulted in real improvements to the NHS.
The initiative by Doctors for Reform comes at a critical moment. After huge spending and patchy improvement, large parts of the NHS are in deficit and laying off staff. Andrew Holdenby, director of Reform, the free-market think-tank that backs Doctors for Reform, said: "Now that the big spending increases are coming to an end, the NHS . . . still doesn't fulfil patients' rising expectations. We want to start a serious debate about where to go."
Since its launch two years ago, Doctors for Reform has grown from 500 doctors to almost 800. They come from all three political parties, disproving government claims that they are simply a stalking-horse for Conservative ideas. Professor Karol Sikora, one of the letter's signatories, a cancer specialist, said: "Doctors are apathetic, politically. Few belong to political parties, but they are getting to the end of their tether. The problem for the future is going to be matching the consumerist demand from patients, especially the young, with the social equity of the NHS. The system we have today is heavy on bureaucracy and poor on delivery. "It is doomed to fail, because with a single monolithic employer it cannot adapt to either technical or societal change. Compared to that, what we see in Europe are far more flexible systems that cost no more and deliver much better care."
Christoph Lees, a consultant in obstetrics and a co-signatory, said: "Centrally dictated targets do produce some results but they distort priorities. Those specialties outside the target areas become Cinderellas - mental health and maternity services are examples. The attempts to save money are undermining clinical relationships in an outrageous way. It's a doctor's obligation to act in the patient's best interests, but often we can no longer do that."
David Wrede, a consultant obstetrician and gynaecologist and a former Liberal Democrat parliamentary candidate, said: "Ministers talk the language of choice, but there is less choice now than there was years ago, when we could refer patients to anywhere we wanted," he said.
Doctors for Reform believes that only by opening up the NHS to different sources of financing will it be liberated, allowing "a modern, truly comprehensive system" to emerge. Andrew Holdenby believed that political leaders were reluctant to tamper with the NHS because they were convinced the public was devoted to it, but the Reform poll, carried out at the end of March by ICM, suggests that this is a myth.
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.
***************************
The National Health Service is doomed to fail without radical changes in funding and approach, a group of almost 800 senior doctors says today
Doctors for Reform has written to the three main party leaders urging a fresh look at the NHS, pointing out that Britain has European levels of spending on health but still falls short of European standards. The doctors' letter is backed by an opinion poll showing that two thirds of voters believe that in its present form the NHS will never meet public demand, however much is spent on it. More than half of those questioned do not believe that the extra spending has resulted in real improvements to the NHS.
The initiative by Doctors for Reform comes at a critical moment. After huge spending and patchy improvement, large parts of the NHS are in deficit and laying off staff. Andrew Holdenby, director of Reform, the free-market think-tank that backs Doctors for Reform, said: "Now that the big spending increases are coming to an end, the NHS . . . still doesn't fulfil patients' rising expectations. We want to start a serious debate about where to go."
Since its launch two years ago, Doctors for Reform has grown from 500 doctors to almost 800. They come from all three political parties, disproving government claims that they are simply a stalking-horse for Conservative ideas. Professor Karol Sikora, one of the letter's signatories, a cancer specialist, said: "Doctors are apathetic, politically. Few belong to political parties, but they are getting to the end of their tether. The problem for the future is going to be matching the consumerist demand from patients, especially the young, with the social equity of the NHS. The system we have today is heavy on bureaucracy and poor on delivery. "It is doomed to fail, because with a single monolithic employer it cannot adapt to either technical or societal change. Compared to that, what we see in Europe are far more flexible systems that cost no more and deliver much better care."
Christoph Lees, a consultant in obstetrics and a co-signatory, said: "Centrally dictated targets do produce some results but they distort priorities. Those specialties outside the target areas become Cinderellas - mental health and maternity services are examples. The attempts to save money are undermining clinical relationships in an outrageous way. It's a doctor's obligation to act in the patient's best interests, but often we can no longer do that."
David Wrede, a consultant obstetrician and gynaecologist and a former Liberal Democrat parliamentary candidate, said: "Ministers talk the language of choice, but there is less choice now than there was years ago, when we could refer patients to anywhere we wanted," he said.
Doctors for Reform believes that only by opening up the NHS to different sources of financing will it be liberated, allowing "a modern, truly comprehensive system" to emerge. Andrew Holdenby believed that political leaders were reluctant to tamper with the NHS because they were convinced the public was devoted to it, but the Reform poll, carried out at the end of March by ICM, suggests that this is a myth.
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, April 03, 2006
How to Get What We Want -- Better Health Care
By Arnold Kling (Arnold Kling is an economist and author of the forthcoming health-policy book "Crisis of Abundance")
In recent years, the approach to major policy issues has been for wonks to design proposals and for politicians to stage confrontations over those proposals. Sometimes, such legislation stalls, as with the Clinton health plan and the Bush Social Security plan. At other times it passes, as with Bush's Medicare drug benefit. Either way, the result can be considered a failure. The mistake has been to focus public attention on solutions without providing adequate background on the problem. An issue as challenging as health care requires a conversation, not a confrontation.
More people, both in Washington and in the country at large, need to be better educated concerning the trends, constraints and trade-offs involved in health policy. Some well-established facts are rarely brought up in the public debate, while myths, half-truths and rash promises are widely circulated. Here are some issues that Americans, liberals and conservatives alike, should consider: Our health-care system is pulled in different directions by competing objectives. For example, individual consumers would prefer to have health-care expenses covered for them, rather than worry about paying for health care. This is the objective of Insulation. However, we are concerned with the rising share of resources devoted to health care. This is the objective of Affordability. Finally, we do not like the idea of being denied health care because of a bureaucrat's decision. This is the objective of Accessibility, because we want to be able to access whatever our doctor recommends. These objectives conflict with one another. For example, managed care was an attempt to move toward Affordability, but it reduced Accessibility.
We cannot slow the growth of health-care spending in this country without changing health-care practices. Experts agree that new technologies make medical care more expensive. In addition, the rapid rise of physician specialization accounts for a large share of our health-care expenditure growth. Reining in health-care spending would require wrenching cultural changes. A market-based approach would be to reduce Insulation and instead steer people toward catastrophic health insurance, requiring them to pay more out of pocket for routine care. A government-based approach would be to set a national budget for health care and provide only the services that fall within that budget. The consequences of either approach are not well understood by policy-makers or the general public. The better plan would be to experiment with different approaches at the state level instead of suddenly lurching in one direction for the country. Perhaps California could be one of the states that attempts to experiment with a single-payer system. As a non-Californian, I would like to see that. My guess is that single-payer will require enormous tax increases and ruin the state's economy. Better that should happen in California than in Maryland, where I live.
We lack information about the effectiveness of health-care protocols. Critics complain about "information asymmetries," in which doctors know more than patients. But that problem pales in comparison to the information gaps shared by doctors and patients alike. For example, after a heart operation, no one knows how often a patient should be seen by a cardiologist. Is it cost-effective to be followed up once a month, once every six months or once a year? Researchers at Dartmouth University found that the main factor in determining follow-up visits was cardiologist availability. Cardiologists with a lot of room in their calendars will see a given patient more often than those with more crowded schedules. Overall, the researchers documented a shockingly broad pattern of differences in health-care practices that appeared to have no relationship to medical outcomes.
Those of us who propose market-oriented health-care reform need to spell out what this will mean for consumers -- how it will increase their responsibility to study the costs and benefits of alternative treatments. Those who favor universal government-provided health insurance also have an obligation to describe how health-care decisions will be made. If we cannot afford all the health-care services that everyone might want, then we are going to need policies for rationing health care.
Before electing to undergo surgery, we want the diagnosis explained, the alternatives described, the risks outlined and our responsibilities for contributing to a successful recovery made clear. By the same token, surgery on our health-care system requires a more thoughtful conversation than this country has had so far.
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.
***************************
By Arnold Kling (Arnold Kling is an economist and author of the forthcoming health-policy book "Crisis of Abundance")
In recent years, the approach to major policy issues has been for wonks to design proposals and for politicians to stage confrontations over those proposals. Sometimes, such legislation stalls, as with the Clinton health plan and the Bush Social Security plan. At other times it passes, as with Bush's Medicare drug benefit. Either way, the result can be considered a failure. The mistake has been to focus public attention on solutions without providing adequate background on the problem. An issue as challenging as health care requires a conversation, not a confrontation.
More people, both in Washington and in the country at large, need to be better educated concerning the trends, constraints and trade-offs involved in health policy. Some well-established facts are rarely brought up in the public debate, while myths, half-truths and rash promises are widely circulated. Here are some issues that Americans, liberals and conservatives alike, should consider: Our health-care system is pulled in different directions by competing objectives. For example, individual consumers would prefer to have health-care expenses covered for them, rather than worry about paying for health care. This is the objective of Insulation. However, we are concerned with the rising share of resources devoted to health care. This is the objective of Affordability. Finally, we do not like the idea of being denied health care because of a bureaucrat's decision. This is the objective of Accessibility, because we want to be able to access whatever our doctor recommends. These objectives conflict with one another. For example, managed care was an attempt to move toward Affordability, but it reduced Accessibility.
We cannot slow the growth of health-care spending in this country without changing health-care practices. Experts agree that new technologies make medical care more expensive. In addition, the rapid rise of physician specialization accounts for a large share of our health-care expenditure growth. Reining in health-care spending would require wrenching cultural changes. A market-based approach would be to reduce Insulation and instead steer people toward catastrophic health insurance, requiring them to pay more out of pocket for routine care. A government-based approach would be to set a national budget for health care and provide only the services that fall within that budget. The consequences of either approach are not well understood by policy-makers or the general public. The better plan would be to experiment with different approaches at the state level instead of suddenly lurching in one direction for the country. Perhaps California could be one of the states that attempts to experiment with a single-payer system. As a non-Californian, I would like to see that. My guess is that single-payer will require enormous tax increases and ruin the state's economy. Better that should happen in California than in Maryland, where I live.
We lack information about the effectiveness of health-care protocols. Critics complain about "information asymmetries," in which doctors know more than patients. But that problem pales in comparison to the information gaps shared by doctors and patients alike. For example, after a heart operation, no one knows how often a patient should be seen by a cardiologist. Is it cost-effective to be followed up once a month, once every six months or once a year? Researchers at Dartmouth University found that the main factor in determining follow-up visits was cardiologist availability. Cardiologists with a lot of room in their calendars will see a given patient more often than those with more crowded schedules. Overall, the researchers documented a shockingly broad pattern of differences in health-care practices that appeared to have no relationship to medical outcomes.
Those of us who propose market-oriented health-care reform need to spell out what this will mean for consumers -- how it will increase their responsibility to study the costs and benefits of alternative treatments. Those who favor universal government-provided health insurance also have an obligation to describe how health-care decisions will be made. If we cannot afford all the health-care services that everyone might want, then we are going to need policies for rationing health care.
Before electing to undergo surgery, we want the diagnosis explained, the alternatives described, the risks outlined and our responsibilities for contributing to a successful recovery made clear. By the same token, surgery on our health-care system requires a more thoughtful conversation than this country has had so far.
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, April 02, 2006
Dangerous druggie doctors not stopped by regulators
Which shows how much use the regulators are.
Stephen Rabone was a known drug addict back in the early 1990s when he infected 11 patients with the viral disease hepatitis C at a South Australian country hospital. A South Australian inquiry into the Medical Board heard evidence that nursing staff alleged the doctor would order pethidine and other narcotic drugs, inject himself with them out of sight, return, and then inject the patient with the same syringe. Victims negotiated a confidential settlement in 2004. But today Rabone lives in Sydney's leafy, well-to-do suburb of Lane Cove, has full registration to practise medicine in NSW, and is a Fellow of the Faculty of Occupational Medicine with the Royal Australasian College of Physicians.
"Our hands are tied," says college chief executive Craig Patterson about the Rabone case, even though issues of drug addiction are "absolutely germane" in deciding whether to grant a doctor a fellowship. If these matters are proven, they are very serious indeed. (But) before we can strike or remove someone as a fellow . . . you need a properly constituted judicial or medical board hearing to have problems aired, facts need to be properly obtained and determinations properly obtained . . . that didn't happen in the Rabone case."
Just how South Australia's medical board handled the Rabone case was highlighted by a scathing inquiry ordered by the state's parliament, which released its report earlier this month. The report cited a handful of cases to illustrate how the Medical Board of South Australia failed to protect the health and safety of the public. "Deeply disturbed" inquiry members recommended the board be stripped of its powers to handle complaints, investigations and disciplinary proceedings. Such lack of confidence in the conduct of a bastion of the medical establishment comes on top of further scandals over how state-based medical boards deal with dodgy doctors.
Medical boards are statutory bodies responsible for registering doctors, monitoring their conduct and fitness to practise and when needed, handling disciplinary proceedings. But now the competency of doctors to manage their own is under fire. Queensland's medical board failed to identify problems with the paperwork provided by the rogue surgeon Jayant Patel, dubbed Dr Death. And in South Australia evidence revealed a litany of concerns. The board took as long as 10 years to deal with complaints, lacked transparency, and has provided two doctors alleged to have drug problems with certificates of good standing, one being Rabone, allowing them to work in NSW. These exposures are placing further pressure on the health sector to better control and manage the flow of doctors across state borders and from overseas.
In January a Productivity Commission report on the health workforce came out in favour of what many within the medical profession regard as an extreme solution: merging Australia's 90 existing registration boards for health professionals into one national entity, possibly swallowing up the eight state and territory medical boards. The report conceded that some functions, such as monitoring codes of practice and discipline "might best be handled on a profession-specific basis or possibly a regional basis". But the report made clear that medical boards should at least have their powers clipped. The radical proposals were discussed by state premiers at the February meeting of the Council of Australian Governments (COAG). Commonwealth and state governments are now considering the Productivity Commission's conclusions and recommendations, with a health working group due to report back mid-year.
Bob Sneath, the plain-speaking Legislative Councillor who chaired the upper house inquiry in South Australia, says it is "bloody dreadful" that shortcomings more than a decade ago allowed Rabone to move to NSW and continue his career with little disruption. Sneath says anything that ensures all information about a doctor's fitness to practise is known by any registering body would have his support. "I would not want to rock up there (in Sydney, to be treated by Rabone)," he says. "His patients would not have a clue."
South Australia's acting board president Mark Coleman also gave evidence that the board may have made a mistake in treating mentally ill, drug-addicted doctor Stuart Mauro, who admitted to a 10-cones-a-day cannabis habit. A coronial inquiry last year found Mauro provided "seriously inadequate" care to a public hospital patient who later died. Back in 2002 a medical board committee, headed up by some of Adelaide's most prominent and senior doctors, investigated patient complaints that Mauro had appeared to be under the influence of drugs while working as a locum. But as the parliamentary inquiry noted, the coroner found the committee "accepted Dr Mauro's denials without further inquiry". Mauro was also cleared to work in NSW, attracting complaints there. He then headed back to South Australia, and wasn't struck off until after the damaging coronial report was released and his case became public.
Dix is limited about what he can say about individual doctors practising in NSW who have addiction issues. In the case of Rabone, laws forbid disclosure of anything but the doctor's address and registration status. "I'm not sure if he's practising," Dix says. If any member of the public contacts the board to get information about Rabone, or any other doctor alleged to have had, or used to have, a drug-related impairment, state laws exclude these problems from being revealed. "We believe in giving a doctor rehabilitation rather than throwing him on the scrap heap," Dix says.
President of the Medical Practitioners Board of Victoria Joanna Flynn says procedures ought to allow effective transfer of information between the state medical boards. Flynn, also president of the Australian Medical Council, says "no doubt there are slip-ups from time to time". She believes a single national database for doctors would address that. But Flynn opposes a single national registration board for all health professionals. "I don't think that's a very good idea at all," she says, pointing the medical profession's "proud record of self-regulation".
But whether self-regulation has failed the public, as well as the medical profession, is open to debate. Those like Craig Patterson from the Royal Australasian College of Physicians believe that the transfer of data between medical boards is "variable". He says South Australia's medical board has been "cagey" with its information, and that the college, which admitted Rabone as a Fellow, needs to rely on medical boards, rather than media reports, to make decisions about their membership. The problems arising from the Rabone case are "the sort of issue that the medical boards need to be able to get on top of. What I can say is that national registration, a national database, is one of the things we have to start getting right . . . we call upon the medical boards to get it right, and it hasn't happened yet".
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.
***************************
Which shows how much use the regulators are.
Stephen Rabone was a known drug addict back in the early 1990s when he infected 11 patients with the viral disease hepatitis C at a South Australian country hospital. A South Australian inquiry into the Medical Board heard evidence that nursing staff alleged the doctor would order pethidine and other narcotic drugs, inject himself with them out of sight, return, and then inject the patient with the same syringe. Victims negotiated a confidential settlement in 2004. But today Rabone lives in Sydney's leafy, well-to-do suburb of Lane Cove, has full registration to practise medicine in NSW, and is a Fellow of the Faculty of Occupational Medicine with the Royal Australasian College of Physicians.
"Our hands are tied," says college chief executive Craig Patterson about the Rabone case, even though issues of drug addiction are "absolutely germane" in deciding whether to grant a doctor a fellowship. If these matters are proven, they are very serious indeed. (But) before we can strike or remove someone as a fellow . . . you need a properly constituted judicial or medical board hearing to have problems aired, facts need to be properly obtained and determinations properly obtained . . . that didn't happen in the Rabone case."
Just how South Australia's medical board handled the Rabone case was highlighted by a scathing inquiry ordered by the state's parliament, which released its report earlier this month. The report cited a handful of cases to illustrate how the Medical Board of South Australia failed to protect the health and safety of the public. "Deeply disturbed" inquiry members recommended the board be stripped of its powers to handle complaints, investigations and disciplinary proceedings. Such lack of confidence in the conduct of a bastion of the medical establishment comes on top of further scandals over how state-based medical boards deal with dodgy doctors.
Medical boards are statutory bodies responsible for registering doctors, monitoring their conduct and fitness to practise and when needed, handling disciplinary proceedings. But now the competency of doctors to manage their own is under fire. Queensland's medical board failed to identify problems with the paperwork provided by the rogue surgeon Jayant Patel, dubbed Dr Death. And in South Australia evidence revealed a litany of concerns. The board took as long as 10 years to deal with complaints, lacked transparency, and has provided two doctors alleged to have drug problems with certificates of good standing, one being Rabone, allowing them to work in NSW. These exposures are placing further pressure on the health sector to better control and manage the flow of doctors across state borders and from overseas.
In January a Productivity Commission report on the health workforce came out in favour of what many within the medical profession regard as an extreme solution: merging Australia's 90 existing registration boards for health professionals into one national entity, possibly swallowing up the eight state and territory medical boards. The report conceded that some functions, such as monitoring codes of practice and discipline "might best be handled on a profession-specific basis or possibly a regional basis". But the report made clear that medical boards should at least have their powers clipped. The radical proposals were discussed by state premiers at the February meeting of the Council of Australian Governments (COAG). Commonwealth and state governments are now considering the Productivity Commission's conclusions and recommendations, with a health working group due to report back mid-year.
Bob Sneath, the plain-speaking Legislative Councillor who chaired the upper house inquiry in South Australia, says it is "bloody dreadful" that shortcomings more than a decade ago allowed Rabone to move to NSW and continue his career with little disruption. Sneath says anything that ensures all information about a doctor's fitness to practise is known by any registering body would have his support. "I would not want to rock up there (in Sydney, to be treated by Rabone)," he says. "His patients would not have a clue."
South Australia's acting board president Mark Coleman also gave evidence that the board may have made a mistake in treating mentally ill, drug-addicted doctor Stuart Mauro, who admitted to a 10-cones-a-day cannabis habit. A coronial inquiry last year found Mauro provided "seriously inadequate" care to a public hospital patient who later died. Back in 2002 a medical board committee, headed up by some of Adelaide's most prominent and senior doctors, investigated patient complaints that Mauro had appeared to be under the influence of drugs while working as a locum. But as the parliamentary inquiry noted, the coroner found the committee "accepted Dr Mauro's denials without further inquiry". Mauro was also cleared to work in NSW, attracting complaints there. He then headed back to South Australia, and wasn't struck off until after the damaging coronial report was released and his case became public.
Dix is limited about what he can say about individual doctors practising in NSW who have addiction issues. In the case of Rabone, laws forbid disclosure of anything but the doctor's address and registration status. "I'm not sure if he's practising," Dix says. If any member of the public contacts the board to get information about Rabone, or any other doctor alleged to have had, or used to have, a drug-related impairment, state laws exclude these problems from being revealed. "We believe in giving a doctor rehabilitation rather than throwing him on the scrap heap," Dix says.
President of the Medical Practitioners Board of Victoria Joanna Flynn says procedures ought to allow effective transfer of information between the state medical boards. Flynn, also president of the Australian Medical Council, says "no doubt there are slip-ups from time to time". She believes a single national database for doctors would address that. But Flynn opposes a single national registration board for all health professionals. "I don't think that's a very good idea at all," she says, pointing the medical profession's "proud record of self-regulation".
But whether self-regulation has failed the public, as well as the medical profession, is open to debate. Those like Craig Patterson from the Royal Australasian College of Physicians believe that the transfer of data between medical boards is "variable". He says South Australia's medical board has been "cagey" with its information, and that the college, which admitted Rabone as a Fellow, needs to rely on medical boards, rather than media reports, to make decisions about their membership. The problems arising from the Rabone case are "the sort of issue that the medical boards need to be able to get on top of. What I can say is that national registration, a national database, is one of the things we have to start getting right . . . we call upon the medical boards to get it right, and it hasn't happened yet".
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.
***************************
Saturday, April 01, 2006
TOO BAD FOR YOU IF A SOCIALIZED MEDICINE SYSTEM CANNOT AFFORD YOU
With private insurance you have enforceable rights. But this kid was told to go away and die until publicity got the politicians involved
Fifteen-year-old diabetic Cruze Poupouare has been told there's no place for him at Queensland's largest clinic for teenage sufferers of the disease because of a funding crisis. His mother, Doreen Poupouare, was fuming yesterday that money had been put ahead of her son's welfare. But Queensland Health pledged last night to help Cruze. Southern area health services general manager Terry Mehan told The Courier-Mail: "We will deal with this."
Mrs Poupouare was told on March 15 by the Mater Hospital's Adolescents with Diabetes Clinic that it was unable to take on Cruze – even though he had been referred there by his GP. The young man has battled Type 1 diabetes since he was a baby, and needs twice-daily injections of insulin. The Mater's child diabetes clinics were "booked beyond a level we consider critical in order to offer you safe and effective care", Mrs Poupouare was told. The letter to her continued: "Until we can obtain further government funding to improve our significantly diminished staffing levels, we are unable to accept any new patient referrals. "I do appreciate the significance of this dilemma and that it leaves you and your child without specialist care."
An angry Ms Poupouare, a credit manager from Camira, west of Brisbane, said last night that she was "gutted" by the rejection. "I have never had treatment like this before . . . to be told you can't be seen at a hospital because of funding issues," she said. Recently arrived from New Zealand with Cruze and his sister, Alycia, 12, Ms Poupouare, 44, said she would have to consider returning there with her family. Their private health fund in New Zealand would not cover her son in Australia, and no insurer here would cover his existing condition , she said.
Mater Health Services said a doubling in four years of Type 1 diabetes patients, combined with the rising incidence of the lifestyle-related Type 2 form of the disease among overweight children, meant the adolescents clinic could not treat everyone referred to it. A submission had been lodged with Queensland Health to hire more staff at the clinic, Mater Health Services said in a statement.
But Mr Mehan said Queensland Health had given the hospital group $206 million in a block grant this year, up from $191 million, and it had been up to it how to allocate the bulk of the funding. The Department had not been aware of Cruze's plight until yesterday, Mr Mehan said. State Liberal leader Bob Quinn said Cruze's plight "puts another human face" to Queensland's public health crisis.
Chief executive of the Queensland branch of Diabetes Australia Joe Tooma said it was disappointing that "we have got to the point where an important facility for treating children can't carry the load put on it". An estimated 21,000 people have Type 1 diabetes in Queensland, about 8 per cent of whom are aged under 17. The case load of the adolescents clinic at the Mater has increased from 20 to 200 patients in the past decade.
Source
VHA Is Not the Way
Many on the right argue that market forces will fix America's health-care sector. The Left wants government to play a larger role in medical care. Obvious success stories on either side of that divide have been rare, but that is why the transformation of the Veterans Health Administration (VHA) makes such an interesting case. Fifteen years ago, the VHA consisted mainly of run-down, poorly managed hospitals. Doctors were inexperienced, layers of bureaucracy crippled the system, and patient satisfaction was low. After a major overhaul in the mid-1990s, much of that changed. The VHA as a whole was restructured to focus on outpatient care, rather than costly hospital stays. Nearly empty hospitals were shuttered, and smaller clinics were opened to focus on the chronic-care needs of aging veterans.
The reengineering seems to have worked. As Philip Longman detailed in the January 2005 Washington Monthly, the VHA now minimizes medical errors, coordinates care, and maintains patient records with some of the most sophisticated technology available. Doctors and nurses no longer waste time chasing down patient charts and test results; computerized records help them deliver the right care to the right patient at the right time.
A New England Journal of Medicine study found that the VHA beat Medicare on 11 measures of quality. An Annals of Internal Medicine study concluded that the VHA provided better care for diabetes patients than private managed-care systems. And veterans seem to like it too. Understandably, prominent columnist Paul Krugman now points to the VHA as a model for reforming the entire health-care sector, arguing that federal management has improved quality and has been "highly successful in containing costs."
Its recent makeover notwithstanding, persistent problems at the VHA suggest it might make a poor model for reform. First, the Government Accountability Office (GAO) reported this month that spending on the VHA "has increased substantially in recent years," and that the agency "does not have a reliable basis" for claims that it has saved or will save taxpayer dollars through management efficiencies. Second, as the GAO report suggests, programs like the VHA allow politicians to play politics with people's health. When politicians choke off resources, as they sometimes do, the VHA copes by freezing enrollment, increasing waiting times, and rationing access to the latest prescription drugs. A recent study by Prof. Frank Lichtenberg of Columbia University estimated that "increased use of older drugs" has reduced the average lifespan of veterans under VHA care by two months. Finally, the fact that VHA's successes haven't been replicated in the private sector is actually evidence of how badly government has mismanaged the private sector.
Those successes could easily be replicated by private insurers and hospitals. The problem is that few have the financial incentive to do so, because federal tax law makes employers — rather than individual patients — the real customers. Knowing that most patients skip from plan to plan as they go from job to job, insurers have little incentive to provide certain services — such as preventive care or electronic medical records — that provide long-term benefits to patients.
Were Congress to remove barriers that prevent consumers from obtaining portable coverage that stays with them over the long term, private insurers would take more of a long-term interest in their customers' health. Were Congress to allow consumers to control all their health-care dollars, private insurers would have to compete more aggressively on the basis of quality and convenience.
No one had to mandate electronic financial records or online banking: Banks offered those services to cultivate long-term relationships with customers intent on obtaining value for their money. With the incentives properly aligned, insurers might offer long-term health insurance. Knowing that their customers will be around for 10 or more years, insurers would be more likely to offer electronic medical records, preventive care, disease management, and other services for which the VHA is hailed. That the VHA outperforms the private sector in some areas makes it tempting to conclude that government could manage health care more efficiently. But to reach that conclusion, one would have to ignore how badly government has mismanaged the private sector.
So before we turn the whole enchilada over to 536 politicians, perhaps we should first try letting workers control the health-care dollars that employers now control. It may even hasten the day that we get to check our medical records online.
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 private insurance you have enforceable rights. But this kid was told to go away and die until publicity got the politicians involved
Fifteen-year-old diabetic Cruze Poupouare has been told there's no place for him at Queensland's largest clinic for teenage sufferers of the disease because of a funding crisis. His mother, Doreen Poupouare, was fuming yesterday that money had been put ahead of her son's welfare. But Queensland Health pledged last night to help Cruze. Southern area health services general manager Terry Mehan told The Courier-Mail: "We will deal with this."
Mrs Poupouare was told on March 15 by the Mater Hospital's Adolescents with Diabetes Clinic that it was unable to take on Cruze – even though he had been referred there by his GP. The young man has battled Type 1 diabetes since he was a baby, and needs twice-daily injections of insulin. The Mater's child diabetes clinics were "booked beyond a level we consider critical in order to offer you safe and effective care", Mrs Poupouare was told. The letter to her continued: "Until we can obtain further government funding to improve our significantly diminished staffing levels, we are unable to accept any new patient referrals. "I do appreciate the significance of this dilemma and that it leaves you and your child without specialist care."
An angry Ms Poupouare, a credit manager from Camira, west of Brisbane, said last night that she was "gutted" by the rejection. "I have never had treatment like this before . . . to be told you can't be seen at a hospital because of funding issues," she said. Recently arrived from New Zealand with Cruze and his sister, Alycia, 12, Ms Poupouare, 44, said she would have to consider returning there with her family. Their private health fund in New Zealand would not cover her son in Australia, and no insurer here would cover his existing condition , she said.
Mater Health Services said a doubling in four years of Type 1 diabetes patients, combined with the rising incidence of the lifestyle-related Type 2 form of the disease among overweight children, meant the adolescents clinic could not treat everyone referred to it. A submission had been lodged with Queensland Health to hire more staff at the clinic, Mater Health Services said in a statement.
But Mr Mehan said Queensland Health had given the hospital group $206 million in a block grant this year, up from $191 million, and it had been up to it how to allocate the bulk of the funding. The Department had not been aware of Cruze's plight until yesterday, Mr Mehan said. State Liberal leader Bob Quinn said Cruze's plight "puts another human face" to Queensland's public health crisis.
Chief executive of the Queensland branch of Diabetes Australia Joe Tooma said it was disappointing that "we have got to the point where an important facility for treating children can't carry the load put on it". An estimated 21,000 people have Type 1 diabetes in Queensland, about 8 per cent of whom are aged under 17. The case load of the adolescents clinic at the Mater has increased from 20 to 200 patients in the past decade.
Source
VHA Is Not the Way
Many on the right argue that market forces will fix America's health-care sector. The Left wants government to play a larger role in medical care. Obvious success stories on either side of that divide have been rare, but that is why the transformation of the Veterans Health Administration (VHA) makes such an interesting case. Fifteen years ago, the VHA consisted mainly of run-down, poorly managed hospitals. Doctors were inexperienced, layers of bureaucracy crippled the system, and patient satisfaction was low. After a major overhaul in the mid-1990s, much of that changed. The VHA as a whole was restructured to focus on outpatient care, rather than costly hospital stays. Nearly empty hospitals were shuttered, and smaller clinics were opened to focus on the chronic-care needs of aging veterans.
The reengineering seems to have worked. As Philip Longman detailed in the January 2005 Washington Monthly, the VHA now minimizes medical errors, coordinates care, and maintains patient records with some of the most sophisticated technology available. Doctors and nurses no longer waste time chasing down patient charts and test results; computerized records help them deliver the right care to the right patient at the right time.
A New England Journal of Medicine study found that the VHA beat Medicare on 11 measures of quality. An Annals of Internal Medicine study concluded that the VHA provided better care for diabetes patients than private managed-care systems. And veterans seem to like it too. Understandably, prominent columnist Paul Krugman now points to the VHA as a model for reforming the entire health-care sector, arguing that federal management has improved quality and has been "highly successful in containing costs."
Its recent makeover notwithstanding, persistent problems at the VHA suggest it might make a poor model for reform. First, the Government Accountability Office (GAO) reported this month that spending on the VHA "has increased substantially in recent years," and that the agency "does not have a reliable basis" for claims that it has saved or will save taxpayer dollars through management efficiencies. Second, as the GAO report suggests, programs like the VHA allow politicians to play politics with people's health. When politicians choke off resources, as they sometimes do, the VHA copes by freezing enrollment, increasing waiting times, and rationing access to the latest prescription drugs. A recent study by Prof. Frank Lichtenberg of Columbia University estimated that "increased use of older drugs" has reduced the average lifespan of veterans under VHA care by two months. Finally, the fact that VHA's successes haven't been replicated in the private sector is actually evidence of how badly government has mismanaged the private sector.
Those successes could easily be replicated by private insurers and hospitals. The problem is that few have the financial incentive to do so, because federal tax law makes employers — rather than individual patients — the real customers. Knowing that most patients skip from plan to plan as they go from job to job, insurers have little incentive to provide certain services — such as preventive care or electronic medical records — that provide long-term benefits to patients.
Were Congress to remove barriers that prevent consumers from obtaining portable coverage that stays with them over the long term, private insurers would take more of a long-term interest in their customers' health. Were Congress to allow consumers to control all their health-care dollars, private insurers would have to compete more aggressively on the basis of quality and convenience.
No one had to mandate electronic financial records or online banking: Banks offered those services to cultivate long-term relationships with customers intent on obtaining value for their money. With the incentives properly aligned, insurers might offer long-term health insurance. Knowing that their customers will be around for 10 or more years, insurers would be more likely to offer electronic medical records, preventive care, disease management, and other services for which the VHA is hailed. That the VHA outperforms the private sector in some areas makes it tempting to conclude that government could manage health care more efficiently. But to reach that conclusion, one would have to ignore how badly government has mismanaged the private sector.
So before we turn the whole enchilada over to 536 politicians, perhaps we should first try letting workers control the health-care dollars that employers now control. It may even hasten the day that we get to check our medical records online.
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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