Consumer-driven health care
For aficionados of free markets, the idea of empowering consumers to take control of their own health care and health insurance needs sounds wonderful. After all, the dysfunctional system of third-party payments for employer-based health insurance (in which neither patients nor doctors have much incentive to keep costs under control) has led to ever higher health care expenditures. As a result, by 2004, U.S. health care spending rose to $1.9 trillion, or about 16 percent of the gross domestic product (GDP). Health insurance premiums have risen at nearly double-digit rates for the past several years, too. General Motors and Ford blame rising health insurance rates for making them uncompetitive and forcing them to fire thousands of workers to cut costs. These companies are now clamoring for a federal bailout for their health care obligations.
The idea of consumer-driven health care is appealing. In other sectors of the economy where consumers get to choose, one usually sees falling costs and increasing productivity. Why not open up health care to the same beneficial influences? Give consumers incentives to shop around for medical care and insurance and let them balance costs and quality to fit their desires..... If individuals enjoy the same tax breaks as people who get their insurance through their companies, employees will eventually demand that their employers just give them the money and let them pick policies for themselves. The second proposal-allowing people to deduct all health expenditures from their income taxes-puts more money in their pockets. This extra money would enable many of the currently uninsured to buy insurance. These are swell ideas and they should be enacted.
But the main idea behind consumer-driven health care is a proposal to expand the use of high-deductible health insurance policies combined with health savings accounts (HSAs). With HSAs, consumers can put pre-tax money to pay for routine medical expenses into IRA-like accounts. Insurance policies qualify beginning with a deductible at $1,050 for an individual and $2,100 for a family. Individuals may annually salt away in HSAs any amount below or matching their deductible up to a maximum of $2,700. For families the limit is $5,450. This encourages Americans to invest in high-deductible policies, which typically cost about 40 percent less than traditional indemnity insurance policies.
Such policies do save companies and individuals money, according to a report released last week by the consultancy Deloitte Center for Health Solutions. The study found that premiums for high-deductible health insurance policies rose an average of 2.8 percent between 2004 and 2005 compared to an average of 7.3 percent for all types of health insurance plans. That means the high-deductible premium increase was less than the rate of inflation (3 percent) in 2004. So far, so good.
However, health insurance works by having the healthy pay for the treatments of the sick. A 2004 case study looking at when Humana Inc. began offering a high-deductible option found that this scheme broke down. The employees who chose to enroll in the high-deductible plan were, on average, 60 percent less likely to have used a variety of medical services in the prior year. In other words, healthy employees chose to take the high-deductible option and squirrel away some pre-tax money in HSAs. This finding supports critics who worry about the problem of adverse selection. They fear that people who expect to remain relatively healthy will overwhelmingly pick the cheaper high-deductible policies and leave the sick to pay ever higher premiums for traditional low-deductible policies.
My advice to President Bush on how really to jumpstart consumer-driven health care: mandatory private health insurance. Poor Americans would be offered a voucher with which they would buy private health coverage. Such vouchers could be paid for by abolishing Medicaid and the State Children's Health Insurance Programs. A similar system already works in Switzerland where, Harvard Business School professor Regina Herzlinger notes, "The Swiss enjoy excellent health status, ample capacity, and high quality resources at costs 30% lower than those of the United States." Mandatory private health insurance would avoid the problem of adverse selection, provide insurance for the currently uninsured and make consumer-driven health care work for every American.
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.
***************************
Sunday, February 12, 2006
Saturday, February 11, 2006
DENTISTRY COVERUP IN BRITAIN
Ministers embarrassed by the sight of long lines of people trying to sign up for an NHS dentist have come up with a simple solution: they have banned queues [lining up]. In an interview with The Times, Rosie Winterton, the minister in charge of dentistry, disclosed that an edict had gone out to local primary care trusts to make sure that future registrations take place over the phone or by appointment.
Ms Winterton, who is locked in a battle of wills with the British Dental Association (BDA) over government reforms, admitted that queueing for an NHS dentist was unacceptable. “Of course we want to confine the queues to history,” said Ms Winterton before talks with the BDA over a new dentists’ contract that she hopes will save NHS dentistry. The Government wants to reform the way in which dentists are paid. They will be asked to take on more NHS patients in return for an £80,000 salary, £80,000 in expenses and a new monitoring system.
Dentists say that the contract does not allow enough time for preventative work. They also want the monitoring suspended, claiming that it is too complicated. Ms Winterton is determined that the reforms should go ahead from April 1 despite threats of a mass exodus of dentists to the private sector. Hanging over the reforms is the pledge made by Tony Blair in 1999 that within two years everyone would be able to see an NHS dentist. It did not happen.
Ms Winterton defended her boss, saying that NHS Direct and 53 new dental access centres meant that people were able to get emergency NHS treatment. Under the reforms, six-monthly check-ups will end, with healthy patients told not to return for three years.
Source
OFFICIAL WAFFLE ABOUT MENTAL HEALTH IN AUSTRALIA
They haven't got a clue and virtually admit it by passing the buck to the bureaucrats. Simple principles such as people should be judged by their behaviour only rather than by some arbitrary and generally speculative diagnosis seem way beyond their ken
Experts will deliver by mid-year a blueprint on how to reform mental health as state and commonwealth leaders today agreed to a $1.1 billion injection for health reforms. After a meeting of the Council of Australian Governments (CoAG), Prime Minister John Howard announced the strategy for dealing with improvements in mental health. "We made a major commitment together to address the huge challenge of mental health," he said. "We will by not later than June ... have from our officials an assessment of individual areas of change and reform needed in mental health. "Both the Commonwealth and the states recognise that additional resources are needed." Mr Howard also paid tribute to former WA premier Geoff Gallop, who was not at the meeting because of his personal fight with depression.
Mr Howard said the mental health campaign would look at cannabis and amphetamine abuse. "We need as part of the campaign on mental health to address amphetamine and cannabis abuse," he said. He also said they had approved a new national health telephone network. It would include support services for mental health. "As part of the health reform program we're going to have national health telephone network which will have triage system to ensure efficient use of available GPs on a 24 hours, seven day a week basis," he said. "And as a major component of that we're going to include support services for mental health.
"We seek to engage the major non-government organisations such as Lifeline and Kids Healthline, both of which along with other organisations of a similar kind are often in receipt of calls from people who have mental health problems."
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.
***************************
Ministers embarrassed by the sight of long lines of people trying to sign up for an NHS dentist have come up with a simple solution: they have banned queues [lining up]. In an interview with The Times, Rosie Winterton, the minister in charge of dentistry, disclosed that an edict had gone out to local primary care trusts to make sure that future registrations take place over the phone or by appointment.
Ms Winterton, who is locked in a battle of wills with the British Dental Association (BDA) over government reforms, admitted that queueing for an NHS dentist was unacceptable. “Of course we want to confine the queues to history,” said Ms Winterton before talks with the BDA over a new dentists’ contract that she hopes will save NHS dentistry. The Government wants to reform the way in which dentists are paid. They will be asked to take on more NHS patients in return for an £80,000 salary, £80,000 in expenses and a new monitoring system.
Dentists say that the contract does not allow enough time for preventative work. They also want the monitoring suspended, claiming that it is too complicated. Ms Winterton is determined that the reforms should go ahead from April 1 despite threats of a mass exodus of dentists to the private sector. Hanging over the reforms is the pledge made by Tony Blair in 1999 that within two years everyone would be able to see an NHS dentist. It did not happen.
Ms Winterton defended her boss, saying that NHS Direct and 53 new dental access centres meant that people were able to get emergency NHS treatment. Under the reforms, six-monthly check-ups will end, with healthy patients told not to return for three years.
Source
OFFICIAL WAFFLE ABOUT MENTAL HEALTH IN AUSTRALIA
They haven't got a clue and virtually admit it by passing the buck to the bureaucrats. Simple principles such as people should be judged by their behaviour only rather than by some arbitrary and generally speculative diagnosis seem way beyond their ken
Experts will deliver by mid-year a blueprint on how to reform mental health as state and commonwealth leaders today agreed to a $1.1 billion injection for health reforms. After a meeting of the Council of Australian Governments (CoAG), Prime Minister John Howard announced the strategy for dealing with improvements in mental health. "We made a major commitment together to address the huge challenge of mental health," he said. "We will by not later than June ... have from our officials an assessment of individual areas of change and reform needed in mental health. "Both the Commonwealth and the states recognise that additional resources are needed." Mr Howard also paid tribute to former WA premier Geoff Gallop, who was not at the meeting because of his personal fight with depression.
Mr Howard said the mental health campaign would look at cannabis and amphetamine abuse. "We need as part of the campaign on mental health to address amphetamine and cannabis abuse," he said. He also said they had approved a new national health telephone network. It would include support services for mental health. "As part of the health reform program we're going to have national health telephone network which will have triage system to ensure efficient use of available GPs on a 24 hours, seven day a week basis," he said. "And as a major component of that we're going to include support services for mental health.
"We seek to engage the major non-government organisations such as Lifeline and Kids Healthline, both of which along with other organisations of a similar kind are often in receipt of calls from people who have mental health problems."
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.
***************************
Friday, February 10, 2006
MORE ON THE EXODUS OF GERMAN DOCTORS: YOU THOUGHT THE BRITISH SCENE WAS BAD!
German doctors are packing their scalpels and seeking their fortunes abroad, lured by the prospect of far higher pay and driven away by stifling bureaucracy in their country's health service
A little tower adorns the roof, and ivy surrounds the entrance to the elegant manor house in the northern English town of Chorley. From outside, there is nothing to indicate that Euxton Hall is a working hospital rather than a place of contemplation, tea and bridge. If it weren't for the old man on crutches struggling to get into a taxi with the help of a nurse. Markus Froehling, 49, the hospital's orthopedic surgeon, watches the scene. "Patients in England are tougher than in Germany," he says. In Germany a patient would have insisted on being taken home in an ambulance, he's sure of that.
Froehling keeps noticing differences between the British and German health systems. In Euxton Hall hospital, an hour's drive north of Manchester, the walls are covered with flower-patterned tapestries, there's a cappuccino machine for guests, everything appears welcoming and civilized. Above all, it's quiet, there's a very British atmosphere of calm. "You'll never get a bellowing chief physician around here," says Froehling, and he looks relieved about that.
But the comfortable atmosphere ends in the operating theater. When the muscular German grabs his scalpel, he starts working as if he were on a production line. The expert in hip surgery rams up to five new joints into the thighs of his patients each day. In Germany he rarely had to conduct two of these complicated operations a day. Froehling has been working in England for over a year, he's one of 2,600 German doctors in Britain who escaped from the woes of their country's health service to greener pastures. Away from Germany, the land of bad pay, long working hours, all-encroaching bureaucracy and rigid organization.
He operated on over 2,000 knees, hips and spines in Germany before he made up his mind. Like all guest workers, it was the money that initially lured him away. But escaping the insufferable self-importance of his superiors was almost as important, as well as fleeing the creeping loss of status of his profession in Germany. These days, the former demi-gods in white have to take to the streets like the steel workers to demonstrate for improved working conditions and better pay. In the old days, young doctors would allow themselves to be exploited during their training because they knew they could make big bucks later on. Now, it's no longer worth it.
Doctors used to tolerate the condescending treatment at the hands of their bosses because they hoped to be giving the orders themselves one day. But the chances of getting lucrative positions further down the line are steadily waning. That's why many trainee doctors end their careers before they even start. Only just over half of students starting medical degrees will end up as practicing doctors in Germany. Many become bureaucrats in the health service, find jobs in industry or emigrate.
Froehlich comes from a family of doctors. When he started as an assistant doctor in a hospital in the northern city of Bremen in 1982, he still believed in "the healing function of my profession". But after just a few shifts he came to the sobering realization that in everyday hospital life, the interests of the patients come last -- that is seen as the job of the head physician who "rules like a monarch."
When Froehling once alerted his superior to a mistake in how a patient was being treated, he was treated as if he had insulted royalty. He was yelled at. For the following three weeks his name did not appear on any operating timetables, and doctors who don't operate during their training fail to qualify for exams. Embittered, he came to terms with his superior's fantasies of omnipotence and went on to become senior physician at the orthopedic clinic at Frankfurt University.
He worked 60 hours a week, did mammoth shifts around the clock, fulfilled the demands of his superiors. That was reflected in his pay: alongside his standard salary he received additional payments for shift work, fees for medical reports and a share of the money from the treatment of private payments. But then his superior demanded a bigger share of the fees for medical reports and a row over money ensued.
The dispute says a lot about the unfair distribution of the 240 billion Euros spent on the German health service. While most medical staff work like dogs, the profits are pocketed by the few. The medical law in the western state of Hesse, where Froehlich was working, states that head physicians must distribute about 80 percent of proceeds from private patients to the clinic and to the doctors who treat them. But at Froehlich's Frankfurt clinic the boss was paying them smaller amounts.
The doctors knew their superior wasn't keeping clean accounts. But they also knew that such bevavior was standard practice in the German health service. No one said anything. Until one day a woman complained that she had paid cash but been treated as if she weren't a private patient. The head physician had taken the money but the computer database claimed she was insured under the public system. Research showed what the Marburger Bund doctor's association has suspected at many university clinics but hasn't been able to prove: head physicians had pocketed around 1 million Euros per year in this way. An auditor found that more than 10 million Euros was missing. The doctors got back only a fraction of that, Froehlich got around 155,000 Euros. He was the only one to leave.
When he got an offer from Sweden's Capio group to work at one its 21 clinics in Britain, he jumped at the chance. Now he's steering his Audi through the northern English countryside, headed towards the village of Renacres where he conducts operations once a week. More and more colleagues from Germany are ringing him up to ask him about jobs in Britain because they are sick of mounting bureaucracy and the growing power of hospital managers.
Most of the German doctors who emigrate go to the United States, which has taken about 2,700. Britain comes second, according to figures from the National Association of Statutory Health Insurance Physicians. Sweden, which has taken 700, and Norway, with 650, are becoming more popular. Special agencies lure doctors by placing advertisements in professional publications and doctors who want to supplement their income spend weekends working in Britain. After finishing their week's work in German practices they can earn up to 2,000 Euros for a weekend shift in a British hospital.
Doctors' salaries have fallen steadily in the last three years. Many a young clinic doctor gets paid less than a long-serving nurse even if he puts in 70 hours a week. Because ever fewer people are applying for such jobs there's a growing shortage of doctors in parts of the country. Many rural doctors are complaining that they can't find successors to hand their surgeries to.
The situation is disastrous for public health and a debacle for the economy. If the trend of recent years continues -- with only 7,000 of 12,000 medical students completing their training -- over 1 billion Euros of university costs will have been wasted. The deficit will continue to rise the more qualified doctors decide to earn their money abroad.
Froehling leans back in the chair of his office at Euxton Hall Hospital. His salary here is three times higher than it was in Germany. But his work has disadvantages too. His office is dark and tiny and his medical equipment isn't exactly modern. During operations he doesn't have two assistant doctors on hand to help him. He has to make do with a "leg holder," a semi-skilled helper. Unqualified assistants hand him the tools of his trade -- drills and hammers. Because of these limitations, he has had to change his surgical techniques to make sure he gets hips installed properly.
German doctors who come to Britain must accept that the British health system is by no means exemplary compared with the German system, says Froehling. The National Health Service provides basic care but passes on orders to the growing number of private clinics. That is making health provision more efficient and patients are benefiting, he thinks.
Medicine men made in Germany remain in demand in Britain because of their solid training. But they aren't universally popular. Many local NHS doctors who treat private patients on the side have suffered big income losses as a result of the German competition. Some of the guest workers are already encountering the same envy and disapproval they were trying to escape in Germany. "Soon not every colleague will be giving us a friendly welcome," says Froehling.
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.
***************************
German doctors are packing their scalpels and seeking their fortunes abroad, lured by the prospect of far higher pay and driven away by stifling bureaucracy in their country's health service
A little tower adorns the roof, and ivy surrounds the entrance to the elegant manor house in the northern English town of Chorley. From outside, there is nothing to indicate that Euxton Hall is a working hospital rather than a place of contemplation, tea and bridge. If it weren't for the old man on crutches struggling to get into a taxi with the help of a nurse. Markus Froehling, 49, the hospital's orthopedic surgeon, watches the scene. "Patients in England are tougher than in Germany," he says. In Germany a patient would have insisted on being taken home in an ambulance, he's sure of that.
Froehling keeps noticing differences between the British and German health systems. In Euxton Hall hospital, an hour's drive north of Manchester, the walls are covered with flower-patterned tapestries, there's a cappuccino machine for guests, everything appears welcoming and civilized. Above all, it's quiet, there's a very British atmosphere of calm. "You'll never get a bellowing chief physician around here," says Froehling, and he looks relieved about that.
But the comfortable atmosphere ends in the operating theater. When the muscular German grabs his scalpel, he starts working as if he were on a production line. The expert in hip surgery rams up to five new joints into the thighs of his patients each day. In Germany he rarely had to conduct two of these complicated operations a day. Froehling has been working in England for over a year, he's one of 2,600 German doctors in Britain who escaped from the woes of their country's health service to greener pastures. Away from Germany, the land of bad pay, long working hours, all-encroaching bureaucracy and rigid organization.
He operated on over 2,000 knees, hips and spines in Germany before he made up his mind. Like all guest workers, it was the money that initially lured him away. But escaping the insufferable self-importance of his superiors was almost as important, as well as fleeing the creeping loss of status of his profession in Germany. These days, the former demi-gods in white have to take to the streets like the steel workers to demonstrate for improved working conditions and better pay. In the old days, young doctors would allow themselves to be exploited during their training because they knew they could make big bucks later on. Now, it's no longer worth it.
Doctors used to tolerate the condescending treatment at the hands of their bosses because they hoped to be giving the orders themselves one day. But the chances of getting lucrative positions further down the line are steadily waning. That's why many trainee doctors end their careers before they even start. Only just over half of students starting medical degrees will end up as practicing doctors in Germany. Many become bureaucrats in the health service, find jobs in industry or emigrate.
Froehlich comes from a family of doctors. When he started as an assistant doctor in a hospital in the northern city of Bremen in 1982, he still believed in "the healing function of my profession". But after just a few shifts he came to the sobering realization that in everyday hospital life, the interests of the patients come last -- that is seen as the job of the head physician who "rules like a monarch."
When Froehling once alerted his superior to a mistake in how a patient was being treated, he was treated as if he had insulted royalty. He was yelled at. For the following three weeks his name did not appear on any operating timetables, and doctors who don't operate during their training fail to qualify for exams. Embittered, he came to terms with his superior's fantasies of omnipotence and went on to become senior physician at the orthopedic clinic at Frankfurt University.
He worked 60 hours a week, did mammoth shifts around the clock, fulfilled the demands of his superiors. That was reflected in his pay: alongside his standard salary he received additional payments for shift work, fees for medical reports and a share of the money from the treatment of private payments. But then his superior demanded a bigger share of the fees for medical reports and a row over money ensued.
The dispute says a lot about the unfair distribution of the 240 billion Euros spent on the German health service. While most medical staff work like dogs, the profits are pocketed by the few. The medical law in the western state of Hesse, where Froehlich was working, states that head physicians must distribute about 80 percent of proceeds from private patients to the clinic and to the doctors who treat them. But at Froehlich's Frankfurt clinic the boss was paying them smaller amounts.
The doctors knew their superior wasn't keeping clean accounts. But they also knew that such bevavior was standard practice in the German health service. No one said anything. Until one day a woman complained that she had paid cash but been treated as if she weren't a private patient. The head physician had taken the money but the computer database claimed she was insured under the public system. Research showed what the Marburger Bund doctor's association has suspected at many university clinics but hasn't been able to prove: head physicians had pocketed around 1 million Euros per year in this way. An auditor found that more than 10 million Euros was missing. The doctors got back only a fraction of that, Froehlich got around 155,000 Euros. He was the only one to leave.
When he got an offer from Sweden's Capio group to work at one its 21 clinics in Britain, he jumped at the chance. Now he's steering his Audi through the northern English countryside, headed towards the village of Renacres where he conducts operations once a week. More and more colleagues from Germany are ringing him up to ask him about jobs in Britain because they are sick of mounting bureaucracy and the growing power of hospital managers.
Most of the German doctors who emigrate go to the United States, which has taken about 2,700. Britain comes second, according to figures from the National Association of Statutory Health Insurance Physicians. Sweden, which has taken 700, and Norway, with 650, are becoming more popular. Special agencies lure doctors by placing advertisements in professional publications and doctors who want to supplement their income spend weekends working in Britain. After finishing their week's work in German practices they can earn up to 2,000 Euros for a weekend shift in a British hospital.
Doctors' salaries have fallen steadily in the last three years. Many a young clinic doctor gets paid less than a long-serving nurse even if he puts in 70 hours a week. Because ever fewer people are applying for such jobs there's a growing shortage of doctors in parts of the country. Many rural doctors are complaining that they can't find successors to hand their surgeries to.
The situation is disastrous for public health and a debacle for the economy. If the trend of recent years continues -- with only 7,000 of 12,000 medical students completing their training -- over 1 billion Euros of university costs will have been wasted. The deficit will continue to rise the more qualified doctors decide to earn their money abroad.
Froehling leans back in the chair of his office at Euxton Hall Hospital. His salary here is three times higher than it was in Germany. But his work has disadvantages too. His office is dark and tiny and his medical equipment isn't exactly modern. During operations he doesn't have two assistant doctors on hand to help him. He has to make do with a "leg holder," a semi-skilled helper. Unqualified assistants hand him the tools of his trade -- drills and hammers. Because of these limitations, he has had to change his surgical techniques to make sure he gets hips installed properly.
German doctors who come to Britain must accept that the British health system is by no means exemplary compared with the German system, says Froehling. The National Health Service provides basic care but passes on orders to the growing number of private clinics. That is making health provision more efficient and patients are benefiting, he thinks.
Medicine men made in Germany remain in demand in Britain because of their solid training. But they aren't universally popular. Many local NHS doctors who treat private patients on the side have suffered big income losses as a result of the German competition. Some of the guest workers are already encountering the same envy and disapproval they were trying to escape in Germany. "Soon not every colleague will be giving us a friendly welcome," says Froehling.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, February 09, 2006
Five Myths to Socialized Medicine
In the United States there are about 14 million people - more than a third of the uninsured - who are, in principle, eligible to get free medical care by joining either the Medicaid program or the State Children's Health Insurance Program. And yet they don't bother to enroll.
To understand why they don't, you might go to the emergency room of Parkland Hospital in my hometown of Dallas. The uninsured and Medicaid patients come there to get their medical care. They all see the same doctors. They get the same treatment. If they're admitted to the hospital, they stay in the same beds. From the patient's point of view, there is no real reason to join Medicaid, because they get the same care whether or not they are formally insured. The doctors and nurses get paid the same regardless of who is enrolled in what plan. The only people who really care whether or not someone is enrolled in Medicaid are the hospital administrators, because that determines how they get their money. So they actually have paid employees who go through the emergency room and try to get people to sign up for Medicaid. Over half the time they fail. Then they literally go hospital room by hospital room, trying to get admitted patients to enroll in Medicaid. And even then they don't always succeed. Now, it's not that unusual for people to go to hospital emergency rooms for their care. It's a common feature of health systems around the world. It may not be an efficient way to deliver health care, but the same thing happens in Toronto and London. Canadians take pride in the fact that patients who get free care in Toronto emergency rooms are "insured." But in Dallas, we're ashamed to say that our patients are "uninsured", even though the care they receive in Dallas is probably better than the care they get in Toronto.
MYTH: "A RIGHT TO HEALTH CARE"
People who believe in socialized medicine have come to believe many myths. One is that socialized medicine gives you a right to health care. If you ask the head of Parkland Hospital and his counterpart in Toronto or London what the difference is in these systems, I think all three would say that in Toronto and London people have a "right" to health care, whereas in Dallas they do not. That is just not true. If you're a citizen of Canada, you don't really have a right to any particular health care service. You don't have a right to heart surgery. You don't even have a right to a place in the waiting line. If you're the hundredth person waiting for heart surgery, you're not entitled to the hundredth surgery. Other people can and do get in ahead of you. From time to time, even Americans go to Canada and jump the queue, because Americans can do something that Canadians cannot - Americans can pay for care. Canadian hospitals love to admit American patients, because that means cash into their budgets. The British government says that, at any one time, there are about a million people waiting to get into hospitals. According to the Fraser Institute, almost 900,000 Canadian patients are on the waiting list at any point in time. And, according to the New Zealand government, 90,000 people are on the waiting lists there. Those people constitute only about 1 to 2 percent of the population in those countries, but keep in mind that only about 15 percent of the population actually enters a hospital each year. Many of the people waiting are waiting in pain. Many are risking their lives by waiting. And there is no market mechanism in these countries to get care first to people who need it first.
MYTH: "HIGHER QUALITY"
Another myth has to do with the quality of care that patients receive. British ministers of health have told British citizens for years that their health system is the envy of the world. Canadian ministers of health say much the same thing. In fact, Canadian and British doctors see 50 percent more patients than American doctors do, and, as a consequence, they have less time to spend with each patient. In Britain, the typical general practitioner barely has time to take your temperature and write a prescription. And even if they discover something wrong with you, they may not have the technology to solve your problem. Among people with chronic renal failure, only half as many Canadians as Americans get dialysis, and only a third as many Britons on a per capita basis. The American rate of coronary bypass surgeries is three or four times what it is in Canada, and five times what it is in Britain. Britain is the country that invented the CAT scanner, back in the 1970s. For awhile it exported more than half the CAT scanners used in the world. Yet they bought very few for their own citizens. Today, Britain has half the number of CAT scanners per capita as we do in the United States. A similar problem exists in Canada.
MYTH: "MORE BANG FOR THE BUCK"
Yet another myth is that although the United States spends more on health care, we don't get more. That argument is often supported by pointing to life expectancy, which is not that much different among developed countries, and infant mortality, which is actually higher in the United States than it is in most other developed countries. What do we get for our money? The first thing we need to do is separate those phenomena that have little to do with health care from those that do. In the United States, life expectancy at birth for African American men is 68 years, while for Asian American men it's 81 years. We find wide differences in life expectancy among women, too. Nobody thinks that those differences are due to the health care system. What, then, would we want to look at if we really wanted to compare the efficacy of health care systems? We would look at those conditions for which we know medical services can make a real difference. Among women who are diagnosed with breast cancer, only one fifth die in the United States, compared to one third in France and Germany, and almost half in the United Kingdom and New Zealand. Among men who are diagnosed with prostate cancer, fewer than one fifth die in the United States, compared to one fourth in Canada, almost half in France, and more than half in the United Kingdom.
MYTH: "EQUAL ACCESS"
Perhaps no notion is more closely tied to national health insurance than the idea of equal access to health care. Every prime minister of health in Britain, from the day the National Health Service started, has said that is the primary goal of the NHS. Similar things are said in Canada and in other countries. The British government - unlike most other governments - studies the problem from time to time to see what kind of progress they're making. In 1980, they had a major report that said, essentially: "We really haven't made very much progress in achieving equality of access to health care in our country. In fact, it looks like things are worse today, in 1980, than they were 30 years ago when the British National Health Service was started." Everybody deplored the results of that report, and they all promised to do better. There were a lot of articles written, a lot of conferences, and a lot of discussions. Another 10 years passed and they pondered another report, which said that things had deteriorated further. Today we are long overdue for a third report, but no one expects the situation to have improved. It's true that racial and ethnic minorities are underserved in the United States. But we are hardly alone. In Canada, the indigenous groups are the Cree and the Inuits. In New Zealand, they are Maoris. In Australia, the Aborigines. Those populations have more health care problems, shorter life expectancies, higher infant--mortality, more health care needs, and they get less health care. When health care is rationed, racial and ethnic minorities do not usually do well in the rationing scheme. A Canadian study showed vast inequalities among the health regions of British Columbia. In some cases, there were spending differences of 10 to 1 in services provided in one area compared to another. That probably would not surprise most health policy analysts; you just don't usually get this kind of data. But if we had the data, we would probably find similar inequalities in access to health care all over the developed world. I'm especially interested in the elderly, because I find that - not only in Britain and Canada, but also in the United States - when people have to make decisions about who is going to get care and who is not, they frequently choose the younger patient. Surveys of the elderly show that senior citizens in the United States say it's much easier to get surgery, see doctors, see specialists, and enter hospitals, than say seniors in other countries.
MYTH: "LESS RED TAPE"
Then we have the myth that national health insurance is an efficient way to deliver health care. I hear this frequently repeated by advocates in the United States. Probably the most telling statistic for hospitals is average length of stay. In general, efficient hospitals get people in and out more quickly. By that standard, the U.S. hospital sector is the most efficient in the world. And I think by many other standards it would not be much in dispute that the U.S. hospital sector is far more efficient than the hospital sectors of other countries. In Britain, where at any one time there are a million people waiting to get into British hospitals, 15 percent of the beds are empty, and another 15 percent are filled with chronic patients who really don't need the services of hospital; they're simply using the hospital as an expensive nursing home. So, effectively, almost one-third of the beds are closed off to acute care patients. A study compared Kaiser in California with the NHS and concluded that, after you make all of the appropriate adjustments, Kaiser spends about the same per capita on its enrollees as Britain spends on its population. But the Kaiser enrollees were getting more care, more access to specialists, and other services. We often hear that Medicare and Medicaid are efficient. The government says Medicaid only spends about 2 percent of its budget on administration. But that ignores all the costs that are shifted to doctors and hospitals. When you incorporate all those costs, it turns out that actually Medicare is not very efficient at all.
WHAT'S MISSING IS CAPITALISM
While our health care system is more market-oriented than in most industrialized nations, we don't really have a free market in health care in the United States. Half the spending is done by government. Most of the rest is done by bureaucratic institutions. The cosmetic surgery market is about the only market where patients are really spending their own money. And guess what? It works like a real market. People get package prices. They can compare prices. And over the decade of the 1990s, the average price of cosmetic surgery actually went down in real terms, even as there were all kinds of technological innovations that we are told drive up costs else where. Most of what I'm telling you here today I learned, not from right-wing critics of national health insurance, but from people who believe in it. If you look at my book, there are probably a thousand different references, and 95 percent of them are references to government reports, academic studies, and newspaper investigations. And in almost every case, the author of those reports is someone who believes in national health insurance. No matter how many problems they document, no matter how many failures they write about, they don't give up their faith in the system.
They all believe that all the failures that they write about can be reformed away. They all believe that we just haven't tried hard enough to reform the system and make it work. Sadly, they are wrong. Virtually all of these problems are inevitable consequences of the politicization of medicine. Why do these systems over provide to the healthy and under provide to the sick? Well, in the United States, about 4 percent of the patients spend half the money. If you're a politician allocating health care dollars, you cannot afford to spend half your money on 4 percent of the voters - 4 percent who may be too sick to go to the polls and vote for you anyway. Why is the hospital sector so inefficient? Because it's in the self-interest of hospital managers to be inefficient. The chronic care patients and the empty beds are the cheap beds. It's the acute care patients that cost money. Why can the rich and powerful jump to the head of the waiting lines? Because those are the people who control the system. They can change the system. If members of parliament, the wealthy, and the powerful had to wait for care along with everyone else, these systems would not last for a minute
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.
***************************
In the United States there are about 14 million people - more than a third of the uninsured - who are, in principle, eligible to get free medical care by joining either the Medicaid program or the State Children's Health Insurance Program. And yet they don't bother to enroll.
To understand why they don't, you might go to the emergency room of Parkland Hospital in my hometown of Dallas. The uninsured and Medicaid patients come there to get their medical care. They all see the same doctors. They get the same treatment. If they're admitted to the hospital, they stay in the same beds. From the patient's point of view, there is no real reason to join Medicaid, because they get the same care whether or not they are formally insured. The doctors and nurses get paid the same regardless of who is enrolled in what plan. The only people who really care whether or not someone is enrolled in Medicaid are the hospital administrators, because that determines how they get their money. So they actually have paid employees who go through the emergency room and try to get people to sign up for Medicaid. Over half the time they fail. Then they literally go hospital room by hospital room, trying to get admitted patients to enroll in Medicaid. And even then they don't always succeed. Now, it's not that unusual for people to go to hospital emergency rooms for their care. It's a common feature of health systems around the world. It may not be an efficient way to deliver health care, but the same thing happens in Toronto and London. Canadians take pride in the fact that patients who get free care in Toronto emergency rooms are "insured." But in Dallas, we're ashamed to say that our patients are "uninsured", even though the care they receive in Dallas is probably better than the care they get in Toronto.
MYTH: "A RIGHT TO HEALTH CARE"
People who believe in socialized medicine have come to believe many myths. One is that socialized medicine gives you a right to health care. If you ask the head of Parkland Hospital and his counterpart in Toronto or London what the difference is in these systems, I think all three would say that in Toronto and London people have a "right" to health care, whereas in Dallas they do not. That is just not true. If you're a citizen of Canada, you don't really have a right to any particular health care service. You don't have a right to heart surgery. You don't even have a right to a place in the waiting line. If you're the hundredth person waiting for heart surgery, you're not entitled to the hundredth surgery. Other people can and do get in ahead of you. From time to time, even Americans go to Canada and jump the queue, because Americans can do something that Canadians cannot - Americans can pay for care. Canadian hospitals love to admit American patients, because that means cash into their budgets. The British government says that, at any one time, there are about a million people waiting to get into hospitals. According to the Fraser Institute, almost 900,000 Canadian patients are on the waiting list at any point in time. And, according to the New Zealand government, 90,000 people are on the waiting lists there. Those people constitute only about 1 to 2 percent of the population in those countries, but keep in mind that only about 15 percent of the population actually enters a hospital each year. Many of the people waiting are waiting in pain. Many are risking their lives by waiting. And there is no market mechanism in these countries to get care first to people who need it first.
MYTH: "HIGHER QUALITY"
Another myth has to do with the quality of care that patients receive. British ministers of health have told British citizens for years that their health system is the envy of the world. Canadian ministers of health say much the same thing. In fact, Canadian and British doctors see 50 percent more patients than American doctors do, and, as a consequence, they have less time to spend with each patient. In Britain, the typical general practitioner barely has time to take your temperature and write a prescription. And even if they discover something wrong with you, they may not have the technology to solve your problem. Among people with chronic renal failure, only half as many Canadians as Americans get dialysis, and only a third as many Britons on a per capita basis. The American rate of coronary bypass surgeries is three or four times what it is in Canada, and five times what it is in Britain. Britain is the country that invented the CAT scanner, back in the 1970s. For awhile it exported more than half the CAT scanners used in the world. Yet they bought very few for their own citizens. Today, Britain has half the number of CAT scanners per capita as we do in the United States. A similar problem exists in Canada.
MYTH: "MORE BANG FOR THE BUCK"
Yet another myth is that although the United States spends more on health care, we don't get more. That argument is often supported by pointing to life expectancy, which is not that much different among developed countries, and infant mortality, which is actually higher in the United States than it is in most other developed countries. What do we get for our money? The first thing we need to do is separate those phenomena that have little to do with health care from those that do. In the United States, life expectancy at birth for African American men is 68 years, while for Asian American men it's 81 years. We find wide differences in life expectancy among women, too. Nobody thinks that those differences are due to the health care system. What, then, would we want to look at if we really wanted to compare the efficacy of health care systems? We would look at those conditions for which we know medical services can make a real difference. Among women who are diagnosed with breast cancer, only one fifth die in the United States, compared to one third in France and Germany, and almost half in the United Kingdom and New Zealand. Among men who are diagnosed with prostate cancer, fewer than one fifth die in the United States, compared to one fourth in Canada, almost half in France, and more than half in the United Kingdom.
MYTH: "EQUAL ACCESS"
Perhaps no notion is more closely tied to national health insurance than the idea of equal access to health care. Every prime minister of health in Britain, from the day the National Health Service started, has said that is the primary goal of the NHS. Similar things are said in Canada and in other countries. The British government - unlike most other governments - studies the problem from time to time to see what kind of progress they're making. In 1980, they had a major report that said, essentially: "We really haven't made very much progress in achieving equality of access to health care in our country. In fact, it looks like things are worse today, in 1980, than they were 30 years ago when the British National Health Service was started." Everybody deplored the results of that report, and they all promised to do better. There were a lot of articles written, a lot of conferences, and a lot of discussions. Another 10 years passed and they pondered another report, which said that things had deteriorated further. Today we are long overdue for a third report, but no one expects the situation to have improved. It's true that racial and ethnic minorities are underserved in the United States. But we are hardly alone. In Canada, the indigenous groups are the Cree and the Inuits. In New Zealand, they are Maoris. In Australia, the Aborigines. Those populations have more health care problems, shorter life expectancies, higher infant--mortality, more health care needs, and they get less health care. When health care is rationed, racial and ethnic minorities do not usually do well in the rationing scheme. A Canadian study showed vast inequalities among the health regions of British Columbia. In some cases, there were spending differences of 10 to 1 in services provided in one area compared to another. That probably would not surprise most health policy analysts; you just don't usually get this kind of data. But if we had the data, we would probably find similar inequalities in access to health care all over the developed world. I'm especially interested in the elderly, because I find that - not only in Britain and Canada, but also in the United States - when people have to make decisions about who is going to get care and who is not, they frequently choose the younger patient. Surveys of the elderly show that senior citizens in the United States say it's much easier to get surgery, see doctors, see specialists, and enter hospitals, than say seniors in other countries.
MYTH: "LESS RED TAPE"
Then we have the myth that national health insurance is an efficient way to deliver health care. I hear this frequently repeated by advocates in the United States. Probably the most telling statistic for hospitals is average length of stay. In general, efficient hospitals get people in and out more quickly. By that standard, the U.S. hospital sector is the most efficient in the world. And I think by many other standards it would not be much in dispute that the U.S. hospital sector is far more efficient than the hospital sectors of other countries. In Britain, where at any one time there are a million people waiting to get into British hospitals, 15 percent of the beds are empty, and another 15 percent are filled with chronic patients who really don't need the services of hospital; they're simply using the hospital as an expensive nursing home. So, effectively, almost one-third of the beds are closed off to acute care patients. A study compared Kaiser in California with the NHS and concluded that, after you make all of the appropriate adjustments, Kaiser spends about the same per capita on its enrollees as Britain spends on its population. But the Kaiser enrollees were getting more care, more access to specialists, and other services. We often hear that Medicare and Medicaid are efficient. The government says Medicaid only spends about 2 percent of its budget on administration. But that ignores all the costs that are shifted to doctors and hospitals. When you incorporate all those costs, it turns out that actually Medicare is not very efficient at all.
WHAT'S MISSING IS CAPITALISM
While our health care system is more market-oriented than in most industrialized nations, we don't really have a free market in health care in the United States. Half the spending is done by government. Most of the rest is done by bureaucratic institutions. The cosmetic surgery market is about the only market where patients are really spending their own money. And guess what? It works like a real market. People get package prices. They can compare prices. And over the decade of the 1990s, the average price of cosmetic surgery actually went down in real terms, even as there were all kinds of technological innovations that we are told drive up costs else where. Most of what I'm telling you here today I learned, not from right-wing critics of national health insurance, but from people who believe in it. If you look at my book, there are probably a thousand different references, and 95 percent of them are references to government reports, academic studies, and newspaper investigations. And in almost every case, the author of those reports is someone who believes in national health insurance. No matter how many problems they document, no matter how many failures they write about, they don't give up their faith in the system.
They all believe that all the failures that they write about can be reformed away. They all believe that we just haven't tried hard enough to reform the system and make it work. Sadly, they are wrong. Virtually all of these problems are inevitable consequences of the politicization of medicine. Why do these systems over provide to the healthy and under provide to the sick? Well, in the United States, about 4 percent of the patients spend half the money. If you're a politician allocating health care dollars, you cannot afford to spend half your money on 4 percent of the voters - 4 percent who may be too sick to go to the polls and vote for you anyway. Why is the hospital sector so inefficient? Because it's in the self-interest of hospital managers to be inefficient. The chronic care patients and the empty beds are the cheap beds. It's the acute care patients that cost money. Why can the rich and powerful jump to the head of the waiting lines? Because those are the people who control the system. They can change the system. If members of parliament, the wealthy, and the powerful had to wait for care along with everyone else, these systems would not last for a minute
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, February 08, 2006
AN AUSTRALIAN PUBLIC MEDICINE DEBACLE CONTINUES
Hospital waiting lists blow-out hits 544 per cent
You see why about a third of Australians go private
Queenslanders are being forced to wait longer for urgent surgery in the state's troubled public hospital system, which is performing fewer operations than it did a year ago, according to elective surgery waiting-list figures released yesterday. In spite of more than $170 million promised by the Beattie Government in the past three years to reduce waiting times for elective surgery, yesterday's waiting list report indicates the Government has failed to make any inroads into waiting times.
The number of people waiting more than 30 days for urgent category one operations increased by a massive 544 per cent during the last three months of last year compared with the same period 12 months before. Category one operations include most cancer and heart procedures which can lead to death if not performed. In the same period the number of people waiting more than 90 days for semi-urgent category two operations increased by 281 per cent. Patients in category two are likely to have severe pain, severe fractures, blocked arteries, some tumours, and some types of bowel surgery.
More here
Baby dies 'waiting for ambulance'
Queensland health authorities have launched an investigation after a 14-month-old girl died while waiting for an ambulance. The girl's grandmother, who did not want to be named, said today the baby died yesterday afternoon after waiting to be transferred by ambulance from Gympie Hospital in south-east Queensland to Nambour Hospital in the Sunshine Coast hinterland. "She had to wait over three hours for an ambulance," the grandmother said. "As she was getting into the ambulance, my granddaughter started frothing at the mouth and my daughter asked a registered nurse what's wrong." The mother was told to get into the ambulance with her daughter. "Within two to three minutes, my granddaughter was dead in my daughter's arms," the grandmother said.
Emergency Services Minister Pat Purcell said the death of the girl was a tragedy but the ambulance had not taken three hours to arrive. "The Gympie Hospital requested an ambulance transfer within two hours to another hospital and the ambulance crew arrived in one hour and 25 minutes," Mr Purcell said. He could not comment further until the matter had been fully investigated. A spokesman for Queensland Health Minister Stephen Robertson said the matter had been referred to the coroner.
Opposition emergency services spokesman Ted Malone called for an open inquiry into the response time of the ambulance. "Sadly, we are hearing of long delays for ambulances every day," Mr Malone said. "In this case, the minister may be saying that the ambulance got there within a reasonable time, but long delays for ambulances are occurring all too often."
Last week, a pregnant 15-year-old Mareeba girl with life-threatening complications was left waiting two-and-half hours for an ambulance to take her from Mareeba Hospital in north Queensland to Cairns, about 60km away. The baby died at Cairns Hospital the following morning. A preliminary report by the Queensland Ambulance Service into that incident blamed "human error" but recognised that while mistakes had been made, it appeared to be a one-off occurrence and not a systemic issue.
Source
THE SUPERBUG DEBACLE IN BRITISH PUBLIC HOSPITALS CONTINUES
Half of all hospitals in England are failing to control the MRSA superbug in line with government targets in spite of a drive to improve awareness and ward hygiene, it has emerged. The latest figures for methicillin-resistant staphylococcus aureus (MRSA) released yesterday, reveal that the NHS is highly unlikely to achieve the goal of cutting rates by 50 per cent within the next two years. Specialist “hit squads” are being sent into 20 trusts facing the biggest challenges in reducing rates of the infection, which is thought to kill thousands of patients each year.
Jane Kennedy, the Health Minister, described the lack of progress as disappointing after the introduction of a series of high-profile government initiatives to address the issue. The data shows that there were 3,580 cases of MRSA bloodstream infections reported in England from April to September 2005. This was up from 3,525 for the same period the previous year, while the 2004-05 total of 7,269 represents only a slight drop in year-on-year comparisons.
In 2004 John Reid, the Health Secretary, set a target of reducing MRSA bloodstream infections by half — from an annual rate of 7,684 cases to 3,842 by 2008. But the Department of Health said yesterday that although about half of acute trusts were on target to meet this pledge, half were behind target.
Ms Kennedy said the NHS had to do better if it was to halve rates in two years’ time. “I am disappointed that despite many trusts making significant reductions in infections the overall figures do not reflect these improvements,” she said. She said that the “hit squads” would start work in Sandwell, Northumbria and Aintree NHS trusts before moving on to another 17 organisations facing difficulties with MRSA reduction over 2006
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.
***************************
Hospital waiting lists blow-out hits 544 per cent
You see why about a third of Australians go private
Queenslanders are being forced to wait longer for urgent surgery in the state's troubled public hospital system, which is performing fewer operations than it did a year ago, according to elective surgery waiting-list figures released yesterday. In spite of more than $170 million promised by the Beattie Government in the past three years to reduce waiting times for elective surgery, yesterday's waiting list report indicates the Government has failed to make any inroads into waiting times.
The number of people waiting more than 30 days for urgent category one operations increased by a massive 544 per cent during the last three months of last year compared with the same period 12 months before. Category one operations include most cancer and heart procedures which can lead to death if not performed. In the same period the number of people waiting more than 90 days for semi-urgent category two operations increased by 281 per cent. Patients in category two are likely to have severe pain, severe fractures, blocked arteries, some tumours, and some types of bowel surgery.
More here
Baby dies 'waiting for ambulance'
Queensland health authorities have launched an investigation after a 14-month-old girl died while waiting for an ambulance. The girl's grandmother, who did not want to be named, said today the baby died yesterday afternoon after waiting to be transferred by ambulance from Gympie Hospital in south-east Queensland to Nambour Hospital in the Sunshine Coast hinterland. "She had to wait over three hours for an ambulance," the grandmother said. "As she was getting into the ambulance, my granddaughter started frothing at the mouth and my daughter asked a registered nurse what's wrong." The mother was told to get into the ambulance with her daughter. "Within two to three minutes, my granddaughter was dead in my daughter's arms," the grandmother said.
Emergency Services Minister Pat Purcell said the death of the girl was a tragedy but the ambulance had not taken three hours to arrive. "The Gympie Hospital requested an ambulance transfer within two hours to another hospital and the ambulance crew arrived in one hour and 25 minutes," Mr Purcell said. He could not comment further until the matter had been fully investigated. A spokesman for Queensland Health Minister Stephen Robertson said the matter had been referred to the coroner.
Opposition emergency services spokesman Ted Malone called for an open inquiry into the response time of the ambulance. "Sadly, we are hearing of long delays for ambulances every day," Mr Malone said. "In this case, the minister may be saying that the ambulance got there within a reasonable time, but long delays for ambulances are occurring all too often."
Last week, a pregnant 15-year-old Mareeba girl with life-threatening complications was left waiting two-and-half hours for an ambulance to take her from Mareeba Hospital in north Queensland to Cairns, about 60km away. The baby died at Cairns Hospital the following morning. A preliminary report by the Queensland Ambulance Service into that incident blamed "human error" but recognised that while mistakes had been made, it appeared to be a one-off occurrence and not a systemic issue.
Source
THE SUPERBUG DEBACLE IN BRITISH PUBLIC HOSPITALS CONTINUES
Half of all hospitals in England are failing to control the MRSA superbug in line with government targets in spite of a drive to improve awareness and ward hygiene, it has emerged. The latest figures for methicillin-resistant staphylococcus aureus (MRSA) released yesterday, reveal that the NHS is highly unlikely to achieve the goal of cutting rates by 50 per cent within the next two years. Specialist “hit squads” are being sent into 20 trusts facing the biggest challenges in reducing rates of the infection, which is thought to kill thousands of patients each year.
Jane Kennedy, the Health Minister, described the lack of progress as disappointing after the introduction of a series of high-profile government initiatives to address the issue. The data shows that there were 3,580 cases of MRSA bloodstream infections reported in England from April to September 2005. This was up from 3,525 for the same period the previous year, while the 2004-05 total of 7,269 represents only a slight drop in year-on-year comparisons.
In 2004 John Reid, the Health Secretary, set a target of reducing MRSA bloodstream infections by half — from an annual rate of 7,684 cases to 3,842 by 2008. But the Department of Health said yesterday that although about half of acute trusts were on target to meet this pledge, half were behind target.
Ms Kennedy said the NHS had to do better if it was to halve rates in two years’ time. “I am disappointed that despite many trusts making significant reductions in infections the overall figures do not reflect these improvements,” she said. She said that the “hit squads” would start work in Sandwell, Northumbria and Aintree NHS trusts before moving on to another 17 organisations facing difficulties with MRSA reduction over 2006
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, February 07, 2006
Another public hospital system has to be bailed out by the private sector
Australia following Britain's lead
The Victorian state government has turned to private hospitals for help with reducing its surgery waiting lists. The Government will pay them to operate on 500 public patients. Up to 30 private hospitals, including Epworth and Healthscope, are believed to be interested in the six-month scheme, The Age newspaper says. The scheme would involve performing high-demand procedures in the private hospitals - including non-urgent orthopedic, vascular and plastic surgery - at a rate of $4000 per operation.
The plan has upset health unions, which believe the government should increase funding of the public system, but has been welcomed by private hospitals. Health Services Union state secretary Jeff Jackson said the government provided hospitals with "substantial sums of additional money, and that doesn't appear to have eased or resolved waiting lists in our hospitals".
Australian Medical Association Victorian vice-president Doug Travis said the money should buy more staff to open more beds. Opposition health spokeswoman Helen Shardey said the government's waiting list management had been "very poor". "This is ad hoc policy-making," Ms Shardey said. "It's not part of an overall strategy; it's grabbing at anything to try to fix the system and try to make people believe they're doing something."
Source
MORE AND MORE GOVERNMENT CONTROL AND RED TAPE FOR U.S. MEDICINE
New reimbursement reporting and compliance rules for physicians participating in Medicare went into effect on January 1 as part of the budget reconciliation bill that passed the House on December 19.... As outlined in Section 6110 of the Senate Deficit Reduction Omnibus Reconciliation Act of 2005, the new rules create a "values-based purchasing" provision in the Medicare program. That provision ties Medicare physician payments, as well as payments for other medical professionals, to new "quality" reporting and compliance requirements, reducing a doctor's payment by as much as 2 percent for certain services if the doctor or other professional fails to report "quality-related" data. Also included under the "values-based" purchasing provision are hospital inpatient services and the services of home health agencies and skilled nursing facilities.
The proposed reduction in payments to noncompliant physicians and providers (1 percent in the first year and 2 percent thereafter) will establish a funding pool to be redistributed the following year to physicians and other medical providers that do comply. The Congressional Budget Office (CBO) estimates the provision will reduce total Medicare spending by $4.5 billion over five years between 2006 and 2010.
The professional literature on values-based purchasing shows limited evidence of value in this approach. A recent article, "Early Experience with Pay for Performance from Concept to Practice," by Harvard University's Meredith B. Rosenthal and colleagues, in the October 12, 2005 Journal of the American Medical Association, attempted to fill the void of published research on this physician payment strategy. The accompanying JAMA editorial ("Pay for Performance Research: How to Learn What Clinicians and Policy Makers Need to Know," by R. Adams Dudley, M.D.) rightly noted there have been "only nine randomized controlled trials of Pay for Performance ... reported in the literature." A review by the Agency for Healthcare Research and Quality (AHRQ) cited in the Rosenthal study concluded "little unequivocal data" supported this approach.
Of particular interest in Rosenthal's study is the observation that a group of Pacific Northwest physicians who were not operating under a pay for performance bonus system scored higher than the California physicians who were. Hence, financial bonuses are likely a superfluous source of motivation when compared with other factors motivating typical physicians treating patients. These other motivators include the desire to help another human being who is suffering, pride in one's work, use of one's skills to meet the challenge of the individual medical case, and the desire to maintain a sterling reputation in one's community. And if these are not strong enough motivators, medical malpractice attorneys are looking over doctors' shoulders as they treat their patients.
In the literature relating to the Medicare "pay for performance" scheme (see, for example, "Pay for Performance or Compliance? A Second Opinion on Medicare Reimbursement," Heritage Foundation Backgrounder No. 1882, October 5, 2005), study after study suggests there are various problems with this approach. These include the lack of evidence for the usefulness of government-imposed guidelines, overemphasis on process in the payment system, the subversion of physicians' professional judgment in individual patient care, the undermining of personalized health care, inhibition of medical innovation, the threat of unproductive "gaming" in the payment system, and a weakening of the traditional doctor-patient relationship.
The new rules establish, in effect, government guidelines for the practice of medicine and tie Medicare payments to physician compliance with those guidelines. That constitutes a radical break from the original Medicare policy that prohibited federal officials from interfering in the practice of medicine.
The new system is pregnant with perverse incentives. Physicians will have every incentive to enroll in "obedience school" and carefully tend to the bureaucracy's paperwork and government guidelines to secure higher reimbursement in a tight fiscal environment, which will soon get tighter as the baby boom generation starts to retire. By diverting the focus of doctors and other medical professionals from appropriate, patient-centered medical care, the Medicare "values-based purchasing" provision will likely create new incentives for physicians and other medical professionals to game the system in unproductive ways. While doctors are fulfilling their reporting requirements, giving the government the data the government wants, real quality could decline even though the measured indicators look good.
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.
***************************
Australia following Britain's lead
The Victorian state government has turned to private hospitals for help with reducing its surgery waiting lists. The Government will pay them to operate on 500 public patients. Up to 30 private hospitals, including Epworth and Healthscope, are believed to be interested in the six-month scheme, The Age newspaper says. The scheme would involve performing high-demand procedures in the private hospitals - including non-urgent orthopedic, vascular and plastic surgery - at a rate of $4000 per operation.
The plan has upset health unions, which believe the government should increase funding of the public system, but has been welcomed by private hospitals. Health Services Union state secretary Jeff Jackson said the government provided hospitals with "substantial sums of additional money, and that doesn't appear to have eased or resolved waiting lists in our hospitals".
Australian Medical Association Victorian vice-president Doug Travis said the money should buy more staff to open more beds. Opposition health spokeswoman Helen Shardey said the government's waiting list management had been "very poor". "This is ad hoc policy-making," Ms Shardey said. "It's not part of an overall strategy; it's grabbing at anything to try to fix the system and try to make people believe they're doing something."
Source
MORE AND MORE GOVERNMENT CONTROL AND RED TAPE FOR U.S. MEDICINE
New reimbursement reporting and compliance rules for physicians participating in Medicare went into effect on January 1 as part of the budget reconciliation bill that passed the House on December 19.... As outlined in Section 6110 of the Senate Deficit Reduction Omnibus Reconciliation Act of 2005, the new rules create a "values-based purchasing" provision in the Medicare program. That provision ties Medicare physician payments, as well as payments for other medical professionals, to new "quality" reporting and compliance requirements, reducing a doctor's payment by as much as 2 percent for certain services if the doctor or other professional fails to report "quality-related" data. Also included under the "values-based" purchasing provision are hospital inpatient services and the services of home health agencies and skilled nursing facilities.
The proposed reduction in payments to noncompliant physicians and providers (1 percent in the first year and 2 percent thereafter) will establish a funding pool to be redistributed the following year to physicians and other medical providers that do comply. The Congressional Budget Office (CBO) estimates the provision will reduce total Medicare spending by $4.5 billion over five years between 2006 and 2010.
The professional literature on values-based purchasing shows limited evidence of value in this approach. A recent article, "Early Experience with Pay for Performance from Concept to Practice," by Harvard University's Meredith B. Rosenthal and colleagues, in the October 12, 2005 Journal of the American Medical Association, attempted to fill the void of published research on this physician payment strategy. The accompanying JAMA editorial ("Pay for Performance Research: How to Learn What Clinicians and Policy Makers Need to Know," by R. Adams Dudley, M.D.) rightly noted there have been "only nine randomized controlled trials of Pay for Performance ... reported in the literature." A review by the Agency for Healthcare Research and Quality (AHRQ) cited in the Rosenthal study concluded "little unequivocal data" supported this approach.
Of particular interest in Rosenthal's study is the observation that a group of Pacific Northwest physicians who were not operating under a pay for performance bonus system scored higher than the California physicians who were. Hence, financial bonuses are likely a superfluous source of motivation when compared with other factors motivating typical physicians treating patients. These other motivators include the desire to help another human being who is suffering, pride in one's work, use of one's skills to meet the challenge of the individual medical case, and the desire to maintain a sterling reputation in one's community. And if these are not strong enough motivators, medical malpractice attorneys are looking over doctors' shoulders as they treat their patients.
In the literature relating to the Medicare "pay for performance" scheme (see, for example, "Pay for Performance or Compliance? A Second Opinion on Medicare Reimbursement," Heritage Foundation Backgrounder No. 1882, October 5, 2005), study after study suggests there are various problems with this approach. These include the lack of evidence for the usefulness of government-imposed guidelines, overemphasis on process in the payment system, the subversion of physicians' professional judgment in individual patient care, the undermining of personalized health care, inhibition of medical innovation, the threat of unproductive "gaming" in the payment system, and a weakening of the traditional doctor-patient relationship.
The new rules establish, in effect, government guidelines for the practice of medicine and tie Medicare payments to physician compliance with those guidelines. That constitutes a radical break from the original Medicare policy that prohibited federal officials from interfering in the practice of medicine.
The new system is pregnant with perverse incentives. Physicians will have every incentive to enroll in "obedience school" and carefully tend to the bureaucracy's paperwork and government guidelines to secure higher reimbursement in a tight fiscal environment, which will soon get tighter as the baby boom generation starts to retire. By diverting the focus of doctors and other medical professionals from appropriate, patient-centered medical care, the Medicare "values-based purchasing" provision will likely create new incentives for physicians and other medical professionals to game the system in unproductive ways. While doctors are fulfilling their reporting requirements, giving the government the data the government wants, real quality could decline even though the measured indicators look good.
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, February 06, 2006
GLOBALIZED DENTISTRY NOW TAKING OFF
For fish-shop worker Harry Sharpe, the lure of a dental holiday in Asia proved impossible to resist. The Australian Dental Association may not be smiling about the growing trend, but Mr Sharpe is among hundreds of Aussies taking the bait of discount deals at overseas clinics. Mr Sharpe, from Currumbin on the Gold Coast, was quoted $15,000 by a local dentist for two bridges, a crown and four fillings. After some research, and consulting friends who had booked dental trips to Asia, Mr Sharpe, 52, visited a private clinic at Sebang in Puerto Galera in the Philippines, where he paid $1200 for the same work.
"All up it cost me $3000 for 2½ weeks there. You get a good holiday, a good feed and your teeth done at one-fifth of the price," Mr Sharpe said. "They were very good. I didn't feel one ounce of pain. And the diving and snorkeling there – it's like the Barrier Reef. "I bumped into about 50 Aussies, and 30 of them were there for their teeth. "It's a big thing, and it's getting bigger."
The dental association is worried by the trend, warning Australians to do some research before embarking on an overseas dental visit. Chief executive Robert Boyd-Boland said there were risks involved. "We've heard some good reports about some of the treatment overseas, then we've heard some not-so-good reports," Mr Boyd-Boland said. He added that a patient might initially save money, but then find corrective work was needed back in Australia. "It's a false economy. And infection control requirements are a bit unknown from country to country. "We have very strict infection controls here. Some of the practitioners there are obviously well qualified, but some of them wouldn't necessarily be registered here."
But overseas bookings look set to spiral, with Brisbane travel agents advertising dental holidays to Manila and patients such as Mr Sharpe encouraging his friends to book a trip. Advised of the dental association warnings, Mr Sharpe said: "It's the same in Australia. I've heard of shoddy stories. You do your checks. "I know of seven people who have gone overseas and haven't had one bad report."
Source
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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.
***************************
For fish-shop worker Harry Sharpe, the lure of a dental holiday in Asia proved impossible to resist. The Australian Dental Association may not be smiling about the growing trend, but Mr Sharpe is among hundreds of Aussies taking the bait of discount deals at overseas clinics. Mr Sharpe, from Currumbin on the Gold Coast, was quoted $15,000 by a local dentist for two bridges, a crown and four fillings. After some research, and consulting friends who had booked dental trips to Asia, Mr Sharpe, 52, visited a private clinic at Sebang in Puerto Galera in the Philippines, where he paid $1200 for the same work.
"All up it cost me $3000 for 2½ weeks there. You get a good holiday, a good feed and your teeth done at one-fifth of the price," Mr Sharpe said. "They were very good. I didn't feel one ounce of pain. And the diving and snorkeling there – it's like the Barrier Reef. "I bumped into about 50 Aussies, and 30 of them were there for their teeth. "It's a big thing, and it's getting bigger."
The dental association is worried by the trend, warning Australians to do some research before embarking on an overseas dental visit. Chief executive Robert Boyd-Boland said there were risks involved. "We've heard some good reports about some of the treatment overseas, then we've heard some not-so-good reports," Mr Boyd-Boland said. He added that a patient might initially save money, but then find corrective work was needed back in Australia. "It's a false economy. And infection control requirements are a bit unknown from country to country. "We have very strict infection controls here. Some of the practitioners there are obviously well qualified, but some of them wouldn't necessarily be registered here."
But overseas bookings look set to spiral, with Brisbane travel agents advertising dental holidays to Manila and patients such as Mr Sharpe encouraging his friends to book a trip. Advised of the dental association warnings, Mr Sharpe said: "It's the same in Australia. I've heard of shoddy stories. You do your checks. "I know of seven people who have gone overseas and haven't had one bad report."
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, February 05, 2006
YOU EVEN WAIT TO GET ON A WAITING LIST IN AUSTRALIAN PUBLIC MEDICINE SYSTEMS
Covered up by government deception, of course. Imagine how bad it would be if so many Australians did not go to private hospitals instead
The Victorian Government has been accused by the opposition of manipulating hospital statistics and spending money on advertising to mislead voters on the parlous condition of the state's health system. Elective surgery waiting lists put out by the Victoria Government were vastly underestimated, opposition health spokeswoman Helen Shardey said today. Mrs Shardey said there were 20,000 people at least still waiting to visit specialists before they could be placed on surgery waiting lists. "This is what I call the waiting waiting list," she said. The numbers included about 700 children who were waiting to get an appointment in the Royal Children's Hospital.
"I appreciate not all people waiting to attend an appointment are going to be lining up for elective surgery but it's likely a high proportion will," she said. "The figures the Government is presenting are not a true indication of the parlous state of health in Victoria. "(They) should take action to reduce the waiting lists instead of wasting money on advertising, trying to con Victorians into thinking that the health system is running well."
The Victorian Government has recently launched an advertising campaign highlighting a reduction in the time that people wait for surgery. The Government has provided $30 million funding for 16,260 additional outpatient beds at 18 clinics across the state as part of a blitz on waiting lists planned over the next six months. "This is all part of a major push to reduce times for Victorians waiting for outpatient consultation," Victorian Health Minister Bronwyn Pike said today.
But, Mrs Shardye said the $30 million announced in last year's budget. She said the Victorian Government was deliberately hiding the problem by modifying the information that was released. "They changed the quarterly hospital reporting it is now only six monthly with less information (and) they changed the method by which ambulance bypass is being recorded... to cover up (the fact) there were probably about 4000 bypasses of hospitals occurring last year," she said. Mrs Shardey said the Liberal Party was yet to release its health policy and could not guarantee it would direct more funds to the health budget
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.
***************************
Covered up by government deception, of course. Imagine how bad it would be if so many Australians did not go to private hospitals instead
The Victorian Government has been accused by the opposition of manipulating hospital statistics and spending money on advertising to mislead voters on the parlous condition of the state's health system. Elective surgery waiting lists put out by the Victoria Government were vastly underestimated, opposition health spokeswoman Helen Shardey said today. Mrs Shardey said there were 20,000 people at least still waiting to visit specialists before they could be placed on surgery waiting lists. "This is what I call the waiting waiting list," she said. The numbers included about 700 children who were waiting to get an appointment in the Royal Children's Hospital.
"I appreciate not all people waiting to attend an appointment are going to be lining up for elective surgery but it's likely a high proportion will," she said. "The figures the Government is presenting are not a true indication of the parlous state of health in Victoria. "(They) should take action to reduce the waiting lists instead of wasting money on advertising, trying to con Victorians into thinking that the health system is running well."
The Victorian Government has recently launched an advertising campaign highlighting a reduction in the time that people wait for surgery. The Government has provided $30 million funding for 16,260 additional outpatient beds at 18 clinics across the state as part of a blitz on waiting lists planned over the next six months. "This is all part of a major push to reduce times for Victorians waiting for outpatient consultation," Victorian Health Minister Bronwyn Pike said today.
But, Mrs Shardye said the $30 million announced in last year's budget. She said the Victorian Government was deliberately hiding the problem by modifying the information that was released. "They changed the quarterly hospital reporting it is now only six monthly with less information (and) they changed the method by which ambulance bypass is being recorded... to cover up (the fact) there were probably about 4000 bypasses of hospitals occurring last year," she said. Mrs Shardey said the Liberal Party was yet to release its health policy and could not guarantee it would direct more funds to the health budget
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, February 04, 2006
An American Doctor in the Canadian Health Care System
As an Emergency Room doctor, I have been able to practice in several countries including Canada. And while the fish may be bigger in Canada, the grass is not greener and the health system is not better than in the U.S. First of all, primary care is easily available in Canada. Thereafter, specialty care is a real challenge. I will never forget having to call every day to a cardiologist's office to try to get a patient of mine bumped up the list to get an angiogram because he was having chest pain just getting to the bathroom. Somewhere about the time I learned the names of the receptionist's goldfish, I finally got him an appointment. He could easily have died waiting in line - something bureaucrats don't mind in big systems. I saw that both in Canada and in Saudi Arabia (for the non-VIPs) - the line meant health care was available ... eventually, if you survived.
Secondly, if you compare the space and equipment in a Canadian Hospital (outside a few key cities) to a US Hospital, you will think that you were going from a high mileage Volkswagen to an almost new Chevy Tahoe. Everything is better on this side of the border, which is why all of the hospital elite cross the border for their care (money often out of pocket). The Mayo Clinic has thrived due to Canada more than Minnesota.
Third, the decision making in Canada is made to look like it is citizen based. But it is really very centralized with a group of rotating urban consultants that show up in rural garb with all the facilitator gab about patient empowerment. The one I got to work with brought some ten inches of documents with him which quickly depressed the citizen committee. He offered then to help the people by simplifying all the issues. Then he gave the committee the summer off as he reported montly meetings wherein their input was being garnered - all lies. In the end, the citizens were told that they had approved closing urgent care in the snowbound area of Emo, Ontario. I helped mobilize 600 citizens to suddenly join and take over the hospital district board of three hospitals in angry reaction. It was all bogus.
Fourth, Canada hired a US consultant to come in to Winnipeg and downsize the main hospital - the one that already had lines waiting. This was necessary because the federal government was no longer willing to match the provinces 50:50 in funding. Government knows that distant consultants can come in, downsize, and go home - never caring about outcome. Most Canadians thought the health system was one of the dimmest rather than the brightest of the crown jewels.
Fifth, the physicians were all grouped into a giant IPA for each province. If they went over budget in patient expenses, they were billed for the difference. I still ignore my Ontario bill that tries to follow me. So the docs are programmed to say "No", just as the Permanente physicians do - and for the same reasons.
Sixth, medical malpractice suits are almost unheard of even though malpractice is quite common. I witnessed one of my patients who got an ectopic pregnancy on each side of a supposed tubal cauterization. Another patient had a poorly repaired ankle fracture with life long pain. The richest surgeon in the province was near our small town because he offered to do all specialty cases - messing up ortho, then urology, etc. I helped him retire as I left by simple patient empowerment. But no one else cared - he saved the other docs money.
Seventh, the local docs tried to "get me up to speed" and also pointed out that I was like a "K-Mart" coming to town and sending my income south of the border. The unfilled position should have been left empty. I got up to my own speed and shared my opinion with the public. I am a team player - I just formulate my team with mostly patients.
So go ahead and believe that everything is great where the rivers flow north. But for those who want to dig deeper, look to the source of the comments and find out how they would individually benefit by a national health system here. Anticipate global mediocrity. Everyone would be on board, but the train would run a lot slower - some dying in the journey.
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.
***************************
As an Emergency Room doctor, I have been able to practice in several countries including Canada. And while the fish may be bigger in Canada, the grass is not greener and the health system is not better than in the U.S. First of all, primary care is easily available in Canada. Thereafter, specialty care is a real challenge. I will never forget having to call every day to a cardiologist's office to try to get a patient of mine bumped up the list to get an angiogram because he was having chest pain just getting to the bathroom. Somewhere about the time I learned the names of the receptionist's goldfish, I finally got him an appointment. He could easily have died waiting in line - something bureaucrats don't mind in big systems. I saw that both in Canada and in Saudi Arabia (for the non-VIPs) - the line meant health care was available ... eventually, if you survived.
Secondly, if you compare the space and equipment in a Canadian Hospital (outside a few key cities) to a US Hospital, you will think that you were going from a high mileage Volkswagen to an almost new Chevy Tahoe. Everything is better on this side of the border, which is why all of the hospital elite cross the border for their care (money often out of pocket). The Mayo Clinic has thrived due to Canada more than Minnesota.
Third, the decision making in Canada is made to look like it is citizen based. But it is really very centralized with a group of rotating urban consultants that show up in rural garb with all the facilitator gab about patient empowerment. The one I got to work with brought some ten inches of documents with him which quickly depressed the citizen committee. He offered then to help the people by simplifying all the issues. Then he gave the committee the summer off as he reported montly meetings wherein their input was being garnered - all lies. In the end, the citizens were told that they had approved closing urgent care in the snowbound area of Emo, Ontario. I helped mobilize 600 citizens to suddenly join and take over the hospital district board of three hospitals in angry reaction. It was all bogus.
Fourth, Canada hired a US consultant to come in to Winnipeg and downsize the main hospital - the one that already had lines waiting. This was necessary because the federal government was no longer willing to match the provinces 50:50 in funding. Government knows that distant consultants can come in, downsize, and go home - never caring about outcome. Most Canadians thought the health system was one of the dimmest rather than the brightest of the crown jewels.
Fifth, the physicians were all grouped into a giant IPA for each province. If they went over budget in patient expenses, they were billed for the difference. I still ignore my Ontario bill that tries to follow me. So the docs are programmed to say "No", just as the Permanente physicians do - and for the same reasons.
Sixth, medical malpractice suits are almost unheard of even though malpractice is quite common. I witnessed one of my patients who got an ectopic pregnancy on each side of a supposed tubal cauterization. Another patient had a poorly repaired ankle fracture with life long pain. The richest surgeon in the province was near our small town because he offered to do all specialty cases - messing up ortho, then urology, etc. I helped him retire as I left by simple patient empowerment. But no one else cared - he saved the other docs money.
Seventh, the local docs tried to "get me up to speed" and also pointed out that I was like a "K-Mart" coming to town and sending my income south of the border. The unfilled position should have been left empty. I got up to my own speed and shared my opinion with the public. I am a team player - I just formulate my team with mostly patients.
So go ahead and believe that everything is great where the rivers flow north. But for those who want to dig deeper, look to the source of the comments and find out how they would individually benefit by a national health system here. Anticipate global mediocrity. Everyone would be on board, but the train would run a lot slower - some dying in the journey.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, February 03, 2006
THE ABSURD EMPLOYER SPONSPORSHIP SYSTEM GRADUALLY ON THE WAY OUT IN THE USA?
There is NO sense in giving tax breaks to employer schemes only. In Australia, EACH INDIVIDUAL deals directly with the health insurer
President Bush wants to bring to healthcare the same "ownership society" approach that gained him little political traction during last year's Social Security debate but remains central to his self-help view of America. By proposing new tax breaks for the health savings accounts he won congressional approval for three years ago, analysts said, Bush hopes to nudge the nation away from the employer-sponsored health insurance on which most working Americans depend. Instead, Bush wants to use sweeping new tax incentives to encourage workers to set aside their own money to cover routine medical expenses and get individually purchased insurance plans to meet larger costs.
In his State of the Union address to a joint session of Congress and an accompanying news release from the White House, the president put forth a healthcare strategy remarkably similar to the plan he promoted last year to permit younger workers to divert a portion of their Social Security taxes into stock and bond accounts that they would own. "He is walking down the same road as he did with Social Security," said Robert D. Reischauer, a former director of the Congressional Budget Office and president of the nonpartisan Urban Institute, a Washington think tank. "He wants to shift more of the responsibility and risk now borne by insurance onto individuals."
Bush indirectly acknowledged the link between the two policy prescriptions by calling for a bipartisan commission to examine the problems of cost and coverage that loom for all of the government's major safety net programs with the coming retirement of the baby boom generation. "Congress did not act last year on my proposal to save Social Security, yet the rising cost of entitlements is a problem that is not going away," Bush told lawmakers and a national television audience.
He cast his healthcare initiatives primarily in terms of helping workers who do not have the kind of comprehensive health insurance traditionally provided by large companies — especially the self-employed and those employed by small businesses. But his strategy of greater reliance on individuals has important implications for most working Americans because even major corporations are seeking ways to reduce the burden of providing traditional insurance.
The theory behind the president's proposal is that individuals who shop for their own insurance and spend their own dollars from personal health savings accounts will drive a harder bargain with care providers than employers and the government have done. That, he argues, will help tame spiraling costs. To encourage individuals to take on the job, the government already offers health savings accounts that combine a bare-bones insurance policy with a personal account into which people deposit money and from which they withdraw funds to pay medical bills — all tax-free. In this regard, health savings accounts are unique in the federal tax code; no other type of account provides tax breaks for deposits and withdrawals.
Health savings accounts are an arrangement in which consumers deposit their own money into special accounts — sometimes with contributions from employers. That money, which is not counted in taxable income, can be used to pay for routine medical costs. At the same time, workers get less-than-comprehensive insurance for major medical problems; again, employers can contribute to the cost. The insurance policies feature lower monthly premiums than comprehensive plans because they pay for less coverage. The president proposed to sweeten the deal by permitting individuals to deduct the premium cost of the bare-bones policy from their taxable income, and by steeply increasing the tax-free amount that people can put into health savings accounts.
The exact size of the of the proposed increase was somewhat unclear Tuesday. The White House news release describing Bush's plan suggested that individuals could deduct all out-of-pocket medical expenses from their taxable income by paying for them with health savings accounts. Under current law, people can deduct medical expenses only if they exceed 7.5% of their adjusted gross income. In addition, the release said that the president wanted to give individuals who set up health savings accounts a tax credit that could be worth as much as $1,500 a year for an individual in the top tax bracket. "The president proposed allowing Americans … to cover all out-of-pocket costs under their HSA policy," the White House release said. The Bush plan "will allow patients to cover all their out-of-pocket expenses tax-free through their HSAs," it said.
However, independent analysts said they believed Bush's proposed tax breaks would not be open-ended. They said that the 2003 law establishing health savings accounts set a cap on out-of-pocket expenses at $5,250 for an individual and $10,500 for families, and these probably limit how much in medical expenses people could deduct from their taxes. Even with the limit, however, the president's proposal would nearly double the amount people could contribute to their accounts tax-free. Under current law, the maximum contribution for an individual is $2,700 and for families $5,450.
The White House clearly believes that its proposed tax incentives would give health savings accounts a huge boost. About 3 million have qualified for the accounts and some experts have estimated that number could rise to 14 million by 2010. With the new incentives, White House officials said that number could jump to more than 20 million by the end of the decade.
Analysts were unable Tuesday to estimate the cost to the government of boosting the amount people could contribute tax-free to health savings accounts, but they predicted that it would run into the tens of billions of dollars over the next decade. A previous administration proposal to make premiums for bare-bones insurance tax-deductible was estimated to cost nearly $30 billion over 10 years.
Some critics challenged the administration's assertion that health savings accounts would help solve the nation most pressing healthcare problems — rapidly rising medical costs and an increasing number of Americans with no health insurance. And they warned that any expansion of the individual accounts could undermine the existing employer-based health insurance system. In addition, critics said that Bush's reliance on tax breaks effectively limited the benefits of his proposals to those who paid substantial taxes. "HSAs are going to do nothing for medical inflation, which is pricing almost all of us out of healthcare," said California Insurance Commissioner John Garamendi. The president's new tax breaks "will be a significant benefit to the wealthy, but it won't do much for the middle class because they have no extra money to put into another savings account."
Account proponents argue that by giving individuals the kind of tax breaks that employers get for providing healthcare, the savings accounts encourage more people to get health insurance and to become more involved in managing their own health. "If we're going to solve our nation's healthcare problems, patients are going to have to be involved," said John C. Goodman, president of the conservative National Center for Policy Analysis and a longtime advocate of health savings accounts. "Research shows that people with chronic diseases like diabetes can manage their healthcare on their own," he said.
But critics say the president's approach will encourage healthy people with few medical costs to split off from the traditional employer-based insurance system. That could destabilize the employer system by leaving it to cover a larger proportion of older, less healthy and therefore higher-cost people. "The real danger is that the employers market erodes fast," said Robert Greenstein, executive director of the liberal Center on Budget and Policy Priorities in Washington.
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.
***************************
There is NO sense in giving tax breaks to employer schemes only. In Australia, EACH INDIVIDUAL deals directly with the health insurer
President Bush wants to bring to healthcare the same "ownership society" approach that gained him little political traction during last year's Social Security debate but remains central to his self-help view of America. By proposing new tax breaks for the health savings accounts he won congressional approval for three years ago, analysts said, Bush hopes to nudge the nation away from the employer-sponsored health insurance on which most working Americans depend. Instead, Bush wants to use sweeping new tax incentives to encourage workers to set aside their own money to cover routine medical expenses and get individually purchased insurance plans to meet larger costs.
In his State of the Union address to a joint session of Congress and an accompanying news release from the White House, the president put forth a healthcare strategy remarkably similar to the plan he promoted last year to permit younger workers to divert a portion of their Social Security taxes into stock and bond accounts that they would own. "He is walking down the same road as he did with Social Security," said Robert D. Reischauer, a former director of the Congressional Budget Office and president of the nonpartisan Urban Institute, a Washington think tank. "He wants to shift more of the responsibility and risk now borne by insurance onto individuals."
Bush indirectly acknowledged the link between the two policy prescriptions by calling for a bipartisan commission to examine the problems of cost and coverage that loom for all of the government's major safety net programs with the coming retirement of the baby boom generation. "Congress did not act last year on my proposal to save Social Security, yet the rising cost of entitlements is a problem that is not going away," Bush told lawmakers and a national television audience.
He cast his healthcare initiatives primarily in terms of helping workers who do not have the kind of comprehensive health insurance traditionally provided by large companies — especially the self-employed and those employed by small businesses. But his strategy of greater reliance on individuals has important implications for most working Americans because even major corporations are seeking ways to reduce the burden of providing traditional insurance.
The theory behind the president's proposal is that individuals who shop for their own insurance and spend their own dollars from personal health savings accounts will drive a harder bargain with care providers than employers and the government have done. That, he argues, will help tame spiraling costs. To encourage individuals to take on the job, the government already offers health savings accounts that combine a bare-bones insurance policy with a personal account into which people deposit money and from which they withdraw funds to pay medical bills — all tax-free. In this regard, health savings accounts are unique in the federal tax code; no other type of account provides tax breaks for deposits and withdrawals.
Health savings accounts are an arrangement in which consumers deposit their own money into special accounts — sometimes with contributions from employers. That money, which is not counted in taxable income, can be used to pay for routine medical costs. At the same time, workers get less-than-comprehensive insurance for major medical problems; again, employers can contribute to the cost. The insurance policies feature lower monthly premiums than comprehensive plans because they pay for less coverage. The president proposed to sweeten the deal by permitting individuals to deduct the premium cost of the bare-bones policy from their taxable income, and by steeply increasing the tax-free amount that people can put into health savings accounts.
The exact size of the of the proposed increase was somewhat unclear Tuesday. The White House news release describing Bush's plan suggested that individuals could deduct all out-of-pocket medical expenses from their taxable income by paying for them with health savings accounts. Under current law, people can deduct medical expenses only if they exceed 7.5% of their adjusted gross income. In addition, the release said that the president wanted to give individuals who set up health savings accounts a tax credit that could be worth as much as $1,500 a year for an individual in the top tax bracket. "The president proposed allowing Americans … to cover all out-of-pocket costs under their HSA policy," the White House release said. The Bush plan "will allow patients to cover all their out-of-pocket expenses tax-free through their HSAs," it said.
However, independent analysts said they believed Bush's proposed tax breaks would not be open-ended. They said that the 2003 law establishing health savings accounts set a cap on out-of-pocket expenses at $5,250 for an individual and $10,500 for families, and these probably limit how much in medical expenses people could deduct from their taxes. Even with the limit, however, the president's proposal would nearly double the amount people could contribute to their accounts tax-free. Under current law, the maximum contribution for an individual is $2,700 and for families $5,450.
The White House clearly believes that its proposed tax incentives would give health savings accounts a huge boost. About 3 million have qualified for the accounts and some experts have estimated that number could rise to 14 million by 2010. With the new incentives, White House officials said that number could jump to more than 20 million by the end of the decade.
Analysts were unable Tuesday to estimate the cost to the government of boosting the amount people could contribute tax-free to health savings accounts, but they predicted that it would run into the tens of billions of dollars over the next decade. A previous administration proposal to make premiums for bare-bones insurance tax-deductible was estimated to cost nearly $30 billion over 10 years.
Some critics challenged the administration's assertion that health savings accounts would help solve the nation most pressing healthcare problems — rapidly rising medical costs and an increasing number of Americans with no health insurance. And they warned that any expansion of the individual accounts could undermine the existing employer-based health insurance system. In addition, critics said that Bush's reliance on tax breaks effectively limited the benefits of his proposals to those who paid substantial taxes. "HSAs are going to do nothing for medical inflation, which is pricing almost all of us out of healthcare," said California Insurance Commissioner John Garamendi. The president's new tax breaks "will be a significant benefit to the wealthy, but it won't do much for the middle class because they have no extra money to put into another savings account."
Account proponents argue that by giving individuals the kind of tax breaks that employers get for providing healthcare, the savings accounts encourage more people to get health insurance and to become more involved in managing their own health. "If we're going to solve our nation's healthcare problems, patients are going to have to be involved," said John C. Goodman, president of the conservative National Center for Policy Analysis and a longtime advocate of health savings accounts. "Research shows that people with chronic diseases like diabetes can manage their healthcare on their own," he said.
But critics say the president's approach will encourage healthy people with few medical costs to split off from the traditional employer-based insurance system. That could destabilize the employer system by leaving it to cover a larger proportion of older, less healthy and therefore higher-cost people. "The real danger is that the employers market erodes fast," said Robert Greenstein, executive director of the liberal Center on Budget and Policy Priorities in Washington.
Source
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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, February 02, 2006
ANOTHER UK CHANGE OF DIRECTION
"Thrashing about" might describe it better. They clearly do not know where to turn.
The community hospital, a part of the health service threatened with widespread closures, is to be recast as a centrepiece of the NHS after a government rethink. Sweeping changes to the NHS, outlined yesterday in the long-awaited community services White Paper, will mean community hospitals taking on a significant role in efforts to provide more care to patients closer to home. The initiative comes after big cuts to community hospital care, with more than 90 thought to be at threat of imminent closure. Many of these will now be redeveloped as part of the restructuring of primary care, and the Government plans to build a “new generation” of 50 community hospitals over the next ten years. The hospitals, modelled on “polyclinics” pioneered in Germany, will be state-of-the-art but without the A&E departments that generate emergency pressures on district general hospitals.
The move is designed to provide more care and treatment outside the costly setting of traditional acute hospitals. The White Paper also pledges to improve access to GP practices, encouraging them to stay open for longer to meet local demand. In areas that are under-served by GPs and primary care services, private providers could be brought in. The reforms are also designed to provide more support for carers and encourage people to have regular health “MoTs”. While the 200-page White Paper was broadly welcomed last night, it raised concerns as to how acute hospitals would cope with fewer patients — and the resulting reduced income.
Chris Ham, former head of strategy at the Department of Health, said that it would likely prompt the closure or severe scaling-back of larger hospitals. He added that those hospitals tied into long-term repayment contracts with the private sector could face serious problems.
The White Paper said that in its aim to deliver more specialist care locally, “a new generation of community facilities” would need to be created. It stated that over the next five years the Government will develop “a new generation of modern NHS community hospitals”, as set out in its manifesto pledge. There are about 350 community hospitals in England, mostly owned and run by primary care trusts.
Patricia Hewitt, the Health Secretary, said that over the next ten years she wanted to see 5 per cent of resources — about £2.5 billion from the NHS budget — shifted from secondary to primary care. “Nearly 90 per cent of patient contact occurs in the community and is trusted, but we still spend below the European average on primary care,” she said. She said that where community hospitals were not considered viable to serve the local population, it was right that they should close, adding: “But if there are community facilities that are needed for the long-term they shouldn’t be closed down due to short-term budgetary problems.”
Ms Hewitt denied that taking more treatment out of hospitals would destabilise finances. She said that hospitals would be more able to treat the most complex patients while more routine procedures were carried out locally. The Health Secretary added that the Government was working with the medical royal colleges to consider which specialities — such as dermatology, orthopaedics and gynaecology — could be bought out of hospitals and nearer to people.
Details of health MOTs — providing people with check-ups at key points in their life — were also outlined. The initiative will take the form of a questionnaire that patients complete online or on paper. If problems are shown up they may be invited for a face-to-face consultation with a GP. The White Paper said that it would soon be easier for patients to register with the practice they wanted but the idea of letting patients register with two GPs — one near home and one near where their work — has been ruled out after being branded difficult and costly. Reforms of social care will include a respite service, to give people a break from caring for relatives or friends, and other support such as a helpline.
Health campaigners and doctors last night insisted that more money was needed if the Government was to succeed in meeting its ambitious pledges. Many questioned how the NHS would be able to pay for the plans set out in the White Paper as it is already hundreds of millions of pounds in the red.
Ms Hewitt said that some funding for the reforms would come from the Department of Health’s central budget, while other aspects would be covered by the large increases in funding for the NHS set for the next few years.
Andrew Lansley, the Conservative health spokesman, said that the White Paper left many questions unanswered. “Many primary care trusts are cutting back precisely the community-based services on which her care plan depends,” he said. “The White Paper fails to face up to the reality of the NHS today. It fails to provide the necessary long-term reforms which will deliver the improvements in the NHS which everyone — staff and patients, so badly want.”
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.
***************************
"Thrashing about" might describe it better. They clearly do not know where to turn.
The community hospital, a part of the health service threatened with widespread closures, is to be recast as a centrepiece of the NHS after a government rethink. Sweeping changes to the NHS, outlined yesterday in the long-awaited community services White Paper, will mean community hospitals taking on a significant role in efforts to provide more care to patients closer to home. The initiative comes after big cuts to community hospital care, with more than 90 thought to be at threat of imminent closure. Many of these will now be redeveloped as part of the restructuring of primary care, and the Government plans to build a “new generation” of 50 community hospitals over the next ten years. The hospitals, modelled on “polyclinics” pioneered in Germany, will be state-of-the-art but without the A&E departments that generate emergency pressures on district general hospitals.
The move is designed to provide more care and treatment outside the costly setting of traditional acute hospitals. The White Paper also pledges to improve access to GP practices, encouraging them to stay open for longer to meet local demand. In areas that are under-served by GPs and primary care services, private providers could be brought in. The reforms are also designed to provide more support for carers and encourage people to have regular health “MoTs”. While the 200-page White Paper was broadly welcomed last night, it raised concerns as to how acute hospitals would cope with fewer patients — and the resulting reduced income.
Chris Ham, former head of strategy at the Department of Health, said that it would likely prompt the closure or severe scaling-back of larger hospitals. He added that those hospitals tied into long-term repayment contracts with the private sector could face serious problems.
The White Paper said that in its aim to deliver more specialist care locally, “a new generation of community facilities” would need to be created. It stated that over the next five years the Government will develop “a new generation of modern NHS community hospitals”, as set out in its manifesto pledge. There are about 350 community hospitals in England, mostly owned and run by primary care trusts.
Patricia Hewitt, the Health Secretary, said that over the next ten years she wanted to see 5 per cent of resources — about £2.5 billion from the NHS budget — shifted from secondary to primary care. “Nearly 90 per cent of patient contact occurs in the community and is trusted, but we still spend below the European average on primary care,” she said. She said that where community hospitals were not considered viable to serve the local population, it was right that they should close, adding: “But if there are community facilities that are needed for the long-term they shouldn’t be closed down due to short-term budgetary problems.”
Ms Hewitt denied that taking more treatment out of hospitals would destabilise finances. She said that hospitals would be more able to treat the most complex patients while more routine procedures were carried out locally. The Health Secretary added that the Government was working with the medical royal colleges to consider which specialities — such as dermatology, orthopaedics and gynaecology — could be bought out of hospitals and nearer to people.
Details of health MOTs — providing people with check-ups at key points in their life — were also outlined. The initiative will take the form of a questionnaire that patients complete online or on paper. If problems are shown up they may be invited for a face-to-face consultation with a GP. The White Paper said that it would soon be easier for patients to register with the practice they wanted but the idea of letting patients register with two GPs — one near home and one near where their work — has been ruled out after being branded difficult and costly. Reforms of social care will include a respite service, to give people a break from caring for relatives or friends, and other support such as a helpline.
Health campaigners and doctors last night insisted that more money was needed if the Government was to succeed in meeting its ambitious pledges. Many questioned how the NHS would be able to pay for the plans set out in the White Paper as it is already hundreds of millions of pounds in the red.
Ms Hewitt said that some funding for the reforms would come from the Department of Health’s central budget, while other aspects would be covered by the large increases in funding for the NHS set for the next few years.
Andrew Lansley, the Conservative health spokesman, said that the White Paper left many questions unanswered. “Many primary care trusts are cutting back precisely the community-based services on which her care plan depends,” he said. “The White Paper fails to face up to the reality of the NHS today. It fails to provide the necessary long-term reforms which will deliver the improvements in the NHS which everyone — staff and patients, so badly want.”
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, February 01, 2006
SOCIALIZED MEDICINE BY PHONE!
Congestion at overstretched hospital emergency departments could worsen under a plan to assess sick people via a national hotline, doctors warn. Under the plan, a 24-hour national call centre staffed by triage nurses will direct sick people to a pharmacy, doctor or hospital, depending on the seriousness of their complaints. The plan, to cost up to $40 million, aims to ease pressure on emergency departments by sending those with minor ailments elsewhere. The Council of Australian Government meeting will consider the proposal on February 10 with some states, including NSW, already behind the idea after successful local trials.
A spokeswoman for federal Health Minister Tony Abbott confirmed the plan was on the agenda for the COAG meeting. But the Australian Medical Association has warned that hospital congestion could worsen under the proposal, with studies showing most people who go to emergency departments need to be there. The phone triage plan would probably not reduce the number of people presenting at emergency departments, AMA president Dr Mukesh Haikerwal said. "The people that turn up to emergency departments by and large need to be there and such a system may well increase the demand of people needing to be seen in a general practice or in an emergency department."
But NSW Premier Morris Iemma said the system had worked in a Hunter Valley trial and a national scheme was long overdue. "This is an initiative whose time has come and is one that we have, for a long time, been pressing the Commonwealth to make as part of the after-hours service," he said. But his position was undermined by federal Labor's health spokeswoman Julia Gillard, who said the plan had failed in Britain. A shortage of doctors was the fundamental problem, Ms Gillard said. A better scheme was proposed by Labor at the last election that would put callers in contact with local services, she said. "Labor's model is a model that will actually get you a doctor if you need one after hours," she said.
Doctors Reform Society president Tim Woodruff backed the AMA, calling the proposal a gimmick that would have no real impact on emergency department pressures and waiting times. "Instead of properly addressing all the problems in our public hospitals, the Federal Government spends $2.5 billion every year on supporting the private hospital sector and offered an extra $40 million for a hotline, which will have a marginal impact at best," he said. – AAP
Source
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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.
***************************
Congestion at overstretched hospital emergency departments could worsen under a plan to assess sick people via a national hotline, doctors warn. Under the plan, a 24-hour national call centre staffed by triage nurses will direct sick people to a pharmacy, doctor or hospital, depending on the seriousness of their complaints. The plan, to cost up to $40 million, aims to ease pressure on emergency departments by sending those with minor ailments elsewhere. The Council of Australian Government meeting will consider the proposal on February 10 with some states, including NSW, already behind the idea after successful local trials.
A spokeswoman for federal Health Minister Tony Abbott confirmed the plan was on the agenda for the COAG meeting. But the Australian Medical Association has warned that hospital congestion could worsen under the proposal, with studies showing most people who go to emergency departments need to be there. The phone triage plan would probably not reduce the number of people presenting at emergency departments, AMA president Dr Mukesh Haikerwal said. "The people that turn up to emergency departments by and large need to be there and such a system may well increase the demand of people needing to be seen in a general practice or in an emergency department."
But NSW Premier Morris Iemma said the system had worked in a Hunter Valley trial and a national scheme was long overdue. "This is an initiative whose time has come and is one that we have, for a long time, been pressing the Commonwealth to make as part of the after-hours service," he said. But his position was undermined by federal Labor's health spokeswoman Julia Gillard, who said the plan had failed in Britain. A shortage of doctors was the fundamental problem, Ms Gillard said. A better scheme was proposed by Labor at the last election that would put callers in contact with local services, she said. "Labor's model is a model that will actually get you a doctor if you need one after hours," she said.
Doctors Reform Society president Tim Woodruff backed the AMA, calling the proposal a gimmick that would have no real impact on emergency department pressures and waiting times. "Instead of properly addressing all the problems in our public hospitals, the Federal Government spends $2.5 billion every year on supporting the private hospital sector and offered an extra $40 million for a hotline, which will have a marginal impact at best," he said. – AAP
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, January 31, 2006
"EQUALITY" IN BRITAIN'S SOCIALIZED HEALTH-CARE SYSTEM
Equality always was a myth in British health care (well-connected people have always got their services promptly) and it is steadily getting more so. But at least now Brits don't have to go abroad for prompt health care
National Health Service patients are paying for enhanced levels of care and operations that are no longer available free at hospitals across England. The superior treatment for fee-paying NHS patients has been criticised as creating a two-tier health service and privatisation by stealth. This week an NHS trust in Yorkshire will become the latest to offer the service, with a new dermatology clinic performing operations that were once free of charge on patients who are prepared to pay. The operations will be carried out in an NHS hospital by NHS doctors and nurses during NHS time.
The growth in add-on services has alarmed some experts. Professor Allyson Pollock, director of the Centre for International Public Health Policy at Edinburgh University, says the most vulnerable patients are suffering as a result of fees being widely introduced. “It is shocking that NHS patients can pay for a higher level of care. They are getting priority treatment and are able to pick and choose,” said Pollock.
The Foundation Skin clinic, to be opened by Harrogate and District NHS Foundation Trust, has been described by managers as a “halfway house” between state and private care. NHS patients will be able to pay the trust to remove moles and warts, to screen moles or to have Botox injections to reduce heavy sweating. Some of these services were offered free by the trust until 2003, when it stopped paying for them. The new rates will be lower than those charged by private hospitals, however. The trust admits that the clinic has been set up in response to NHS funding shortages and said patients are happy to pay for treatments no longer available for free. Dr Kay Baxter, consultant dermatologist at the trust, said: “This clinic has been developed to fill a genuine gap in patient service. A local cosmetic exclusion policy has been in place since early 2003. “The NHS currently faces many difficult decisions with regard to the funding of treatments. Our patients are very understanding of the reasons behind the cosmetic exclusion policy. They are pleased to be able to access treatment not ordinarily available on the NHS while supporting their local health service.”
Many other NHS trusts across England are now charging patients for treatments or levels of care that would previously have been free. Patients giving birth at Queen Charlotte’s and Chelsea NHS hospital in London can secure one-to-one treatment from a midwife if they pay 4,000 pounds, under the new Jentle Midwifery scheme. One-to-one midwife care is the recommended standard of treatment and has been shown to reduce the need for medical interventions. It is not available to all women because of a shortage of midwives. The Hammersmith Hospitals NHS Trust, which runs Queen Charlotte’s and Chelsea, says revenue from the scheme, which has so far been used by 74 women, goes back into the NHS and has already paid for 2½ midwives’ salaries
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.
***************************
Equality always was a myth in British health care (well-connected people have always got their services promptly) and it is steadily getting more so. But at least now Brits don't have to go abroad for prompt health care
National Health Service patients are paying for enhanced levels of care and operations that are no longer available free at hospitals across England. The superior treatment for fee-paying NHS patients has been criticised as creating a two-tier health service and privatisation by stealth. This week an NHS trust in Yorkshire will become the latest to offer the service, with a new dermatology clinic performing operations that were once free of charge on patients who are prepared to pay. The operations will be carried out in an NHS hospital by NHS doctors and nurses during NHS time.
The growth in add-on services has alarmed some experts. Professor Allyson Pollock, director of the Centre for International Public Health Policy at Edinburgh University, says the most vulnerable patients are suffering as a result of fees being widely introduced. “It is shocking that NHS patients can pay for a higher level of care. They are getting priority treatment and are able to pick and choose,” said Pollock.
The Foundation Skin clinic, to be opened by Harrogate and District NHS Foundation Trust, has been described by managers as a “halfway house” between state and private care. NHS patients will be able to pay the trust to remove moles and warts, to screen moles or to have Botox injections to reduce heavy sweating. Some of these services were offered free by the trust until 2003, when it stopped paying for them. The new rates will be lower than those charged by private hospitals, however. The trust admits that the clinic has been set up in response to NHS funding shortages and said patients are happy to pay for treatments no longer available for free. Dr Kay Baxter, consultant dermatologist at the trust, said: “This clinic has been developed to fill a genuine gap in patient service. A local cosmetic exclusion policy has been in place since early 2003. “The NHS currently faces many difficult decisions with regard to the funding of treatments. Our patients are very understanding of the reasons behind the cosmetic exclusion policy. They are pleased to be able to access treatment not ordinarily available on the NHS while supporting their local health service.”
Many other NHS trusts across England are now charging patients for treatments or levels of care that would previously have been free. Patients giving birth at Queen Charlotte’s and Chelsea NHS hospital in London can secure one-to-one treatment from a midwife if they pay 4,000 pounds, under the new Jentle Midwifery scheme. One-to-one midwife care is the recommended standard of treatment and has been shown to reduce the need for medical interventions. It is not available to all women because of a shortage of midwives. The Hammersmith Hospitals NHS Trust, which runs Queen Charlotte’s and Chelsea, says revenue from the scheme, which has so far been used by 74 women, goes back into the NHS and has already paid for 2½ midwives’ salaries
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.
***************************
Monday, January 30, 2006
Brits acknowledge the limits of State control of medical services
They're so desperate they are clutching at any hope
Ministers are hoping to rescue the NHS from its continuing cash problems through a "semi-privatised" scheme that trains patients to avoid hospital or their GP. The Expert Patient Programme, which has cut hospital visits by 16 per cent in trial areas, is to have its budget tripled before becoming a not-for-profit company, The Times understands.
Details of the "flotation" will be carried in a make-or-break White Paper on patient care outside hospital to be published this month.
Patricia Hewitt, the Health Secretary, wants the White Paper to spell out how the NHS will reduce demand for the most expensive form of treatment - in hospitals. Training patients how to "self-care" will be at the core of the proposals. Although the cost savings for hospitals and GPs would be several years down the line, the change in emphasis to self-care is one reason why some of the biggest hospital-building schemes in the NHS are now under review. Ms Hewitt believes that the best way to expand the Expert Patient Programme rapidly is by allowing NHS managers or outside providers to take it over from state control. She is expected to pave the way by increasing the budget from 6 million pounds a year to 18 million pounds.
The programme works by running training courses for patients with chronic conditions such as diabetes, asthma, multiple sclerosis and arthritis. They learn how to treat themselves when previously they would have gone to their doctor or the hospital accident and emergency department, and to avoid such emergencies altogether by looking after themselves better.
The programme, set up four years ago, was based on an American "self-care" plan devised to save on the astronomical costs of US hospital care and was tested in various areas of Britain. Six months into the trials, GP consultations fell by 7 per cent, while local outpatient visits and emergency care attendances dropped by 10 per cent and 16 per cent respectively. Hospital admissions among those on the scheme were also reduced by 13 per cent. Patients said that they became better at controlling symptoms, more confident, and better at using information from books and support groups.
A senior NHS source said that, despite initial concerns from some GPs, ministers were impressed with the benefits to patients as well as potential cost savings. The source added: "The Expert Patient Programme is an excellent example of how the NHS is changing the way it works with people with long-term conditions. We want to build on this experience as part of expanding and developing self-care. "We want the EPP to help more of the 17 million people in England with long-term conditions so that more people understand and can do more to manage their own conditions."
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.
***************************
They're so desperate they are clutching at any hope
Ministers are hoping to rescue the NHS from its continuing cash problems through a "semi-privatised" scheme that trains patients to avoid hospital or their GP. The Expert Patient Programme, which has cut hospital visits by 16 per cent in trial areas, is to have its budget tripled before becoming a not-for-profit company, The Times understands.
Details of the "flotation" will be carried in a make-or-break White Paper on patient care outside hospital to be published this month.
Patricia Hewitt, the Health Secretary, wants the White Paper to spell out how the NHS will reduce demand for the most expensive form of treatment - in hospitals. Training patients how to "self-care" will be at the core of the proposals. Although the cost savings for hospitals and GPs would be several years down the line, the change in emphasis to self-care is one reason why some of the biggest hospital-building schemes in the NHS are now under review. Ms Hewitt believes that the best way to expand the Expert Patient Programme rapidly is by allowing NHS managers or outside providers to take it over from state control. She is expected to pave the way by increasing the budget from 6 million pounds a year to 18 million pounds.
The programme works by running training courses for patients with chronic conditions such as diabetes, asthma, multiple sclerosis and arthritis. They learn how to treat themselves when previously they would have gone to their doctor or the hospital accident and emergency department, and to avoid such emergencies altogether by looking after themselves better.
The programme, set up four years ago, was based on an American "self-care" plan devised to save on the astronomical costs of US hospital care and was tested in various areas of Britain. Six months into the trials, GP consultations fell by 7 per cent, while local outpatient visits and emergency care attendances dropped by 10 per cent and 16 per cent respectively. Hospital admissions among those on the scheme were also reduced by 13 per cent. Patients said that they became better at controlling symptoms, more confident, and better at using information from books and support groups.
A senior NHS source said that, despite initial concerns from some GPs, ministers were impressed with the benefits to patients as well as potential cost savings. The source added: "The Expert Patient Programme is an excellent example of how the NHS is changing the way it works with people with long-term conditions. We want to build on this experience as part of expanding and developing self-care. "We want the EPP to help more of the 17 million people in England with long-term conditions so that more people understand and can do more to manage their own conditions."
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, January 29, 2006
THE BRITISH MONEY SINK
The more money British public hospitals get, the LESS they are able to do their job
The full scale of the crisis facing the NHS was laid bare last night by ministers who admitted that up to 50 trusts had lost control of their finances. Patricia Hewitt, the Health Secretary, "named and shamed" 18 NHS trusts who have plunged into substantial deficit and will now have outside accountants imposed on them to find millions of pounds of savings. A further 32 organisations will be given additional "advice and management support", while another 19 needed "drive and focus" to meet their financial targets.
Her comments came as a survey of hospital managers found that more than three quarters of NHS trusts currently in deficit have cut staff, 52 per cent have closed wards while 48 per cent are delaying work, and another 38 per cent have cancelled services or restricted eligibility for services.
Ms Hewitt admitted that it was a "difficult and anxious time" for NHS staff as years of huge financial generosity ended with the health service last year recording its first financial deficit since 1999-2000. At 76.4 billion pounds, the NHS budget is now larger than the gross domestic product of 155 members of the United Nations, she said. "It is one of the largest and most complex organisations in the world, and three quarters of trusts have delivered improvements within their budget."
The NHS Confederation, which represents managers, yesterday gave warning that the financial problems were undermining public confidence. "It is wrong of the Government to simply blame NHS managers" said Gill Morgan, the confederation's chief executive. "The causes of the current problems are deep-rooted and long-term." They would never be resolved until politicians allowed NHS managers to "make some painful decisions" - such as closing hospitals or reducing the number of beds. "A fixation with buildings is preventing the development of new and imaginative services," she said.
Andrew Lansley, the Shadow Health Secretary, said: "We warned that ministers had lost financial control and Ms Hewitt's statement confirms this is the case. "There are clearly systematic problems because at the same time as resources to the NHS are increasing dramatically, costs have ballooned. "Instead of the Department of Health blaming trusts, Patricia Hewitt should come to Parliament and make a full statement on the financial prospects for the NHS, for this year and the coming financial year".
Yesterday she declined to say whether the most recent figures showed any improvement in financial performance.
Source
Free film here: "Dead Meat is a short film which shows the reality of health care under Canada's socialized medical system: Canadians wait ... and wait. And sometimes - they die while waiting for free government health care. Filmmakers Stuart Browning and Blaine Greenberg are currently in production on a feature-length film exploring health care in the U.S. and Canada slated for release in late 2006. As an interim offering, they have produced this short.
***************************
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 more money British public hospitals get, the LESS they are able to do their job
The full scale of the crisis facing the NHS was laid bare last night by ministers who admitted that up to 50 trusts had lost control of their finances. Patricia Hewitt, the Health Secretary, "named and shamed" 18 NHS trusts who have plunged into substantial deficit and will now have outside accountants imposed on them to find millions of pounds of savings. A further 32 organisations will be given additional "advice and management support", while another 19 needed "drive and focus" to meet their financial targets.
Her comments came as a survey of hospital managers found that more than three quarters of NHS trusts currently in deficit have cut staff, 52 per cent have closed wards while 48 per cent are delaying work, and another 38 per cent have cancelled services or restricted eligibility for services.
Ms Hewitt admitted that it was a "difficult and anxious time" for NHS staff as years of huge financial generosity ended with the health service last year recording its first financial deficit since 1999-2000. At 76.4 billion pounds, the NHS budget is now larger than the gross domestic product of 155 members of the United Nations, she said. "It is one of the largest and most complex organisations in the world, and three quarters of trusts have delivered improvements within their budget."
The NHS Confederation, which represents managers, yesterday gave warning that the financial problems were undermining public confidence. "It is wrong of the Government to simply blame NHS managers" said Gill Morgan, the confederation's chief executive. "The causes of the current problems are deep-rooted and long-term." They would never be resolved until politicians allowed NHS managers to "make some painful decisions" - such as closing hospitals or reducing the number of beds. "A fixation with buildings is preventing the development of new and imaginative services," she said.
Andrew Lansley, the Shadow Health Secretary, said: "We warned that ministers had lost financial control and Ms Hewitt's statement confirms this is the case. "There are clearly systematic problems because at the same time as resources to the NHS are increasing dramatically, costs have ballooned. "Instead of the Department of Health blaming trusts, Patricia Hewitt should come to Parliament and make a full statement on the financial prospects for the NHS, for this year and the coming financial year".
Yesterday she declined to say whether the most recent figures showed any improvement in financial performance.
Source
Free film here: "Dead Meat is a short film which shows the reality of health care under Canada's socialized medical system: Canadians wait ... and wait. And sometimes - they die while waiting for free government health care. Filmmakers Stuart Browning and Blaine Greenberg are currently in production on a feature-length film exploring health care in the U.S. and Canada slated for release in late 2006. As an interim offering, they have produced this short.
***************************
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, January 28, 2006
Demanding the Impossible From Our Health Care
Almost everyone agrees that we ought to ``fix the health care system'' -- a completely meaningless phrase despite its popularity with politicians, pundits and ``experts.'' Indeed, it is popular precisely because it is meaningless. The people who proclaim it rarely tell you the discomforting choices it might involve. Instead, they focus on a few specific shortcomings of our $1.9 trillion health-industrial complex and imply that, if we correct these often-serious flaws, we'll have ``fixed'' the system or at least made a good start. This is rarely true, and so most forays into ``health reform'' end with disillusion.
We are about to start the cycle again. By most accounts, President Bush plans to highlight health care in his forthcoming State of the Union address. His proposals may or may not have merit, but they surely won't fix the health system in any fundamental way. The reason is that most Americans don't want to fix the system in that sense. Most are satisfied with their care. Most don't see (or pay directly) most of their costs. Because politicians -- of both parties -- reflect public opinion, they won't do more than tinker. Unfortunately, tinkering isn't enough. As everyone knows, health spending has risen steadily. In 2004, it totaled 16 percent of national income, up from 7.2 percent in 1970. As health insurance becomes more costly, the number of uninsured, now about 46 million, may grow. Worse, health costs may depress wage gains, raise taxes and squeeze other government programs.
Here's the paradox: A health-care system that satisfies most of us as individuals may hurt us as a society. Let me offer myself as an example. All my doctors are in small practices. I like it that way. It seems to make for closer personal connections. But I'm always stunned by how many people they employ for non-medical chores -- appointments, record-keeping, insurance collections. A bigger practice, though more impersonal, might be more efficient. Because insurance covers most of my medical bills, I don't have any stake in switching.
On a grander scale, that's our predicament. Americans generally want their health-care system to do three things: (1) provide needed care to all people, regardless of income; (2) maintain our freedom to pick doctors and their freedom to recommend the best care for us; and (3) control costs. The trouble is that these laudable goals aren't compatible. We can have any two of them, but not all three. Everyone can get care with complete choice -- but costs will explode, because patients and doctors have no reason to control them. We can control costs but only by denying care or limiting choices.
Disliking the inconsistencies, we hide them -- to individuals. We subsidize employer-paid health insurance by excluding it from income taxes (the 2006 cost to government: an estimated $126 billion). Most workers don't see the full costs of their health care. Nor do Medicare recipients, whose costs are paid mainly by other people's payroll taxes. We're living in a fantasy world. Given our inconsistent expectations, no health-care system -- not one completely run by government or one following ``market'' principles -- can satisfy public opinion. Politicians and pundits can score cheap points by emphasizing one goal or another (insure the uninsured, cover drugs for Medicare recipients, expand ``choice'') without facing the harder job: finding a better balance among competing goals.
Every attempt to do so has failed. Consider the ``managed care'' experiment of the 1990s. The idea was simple: herd patients into health maintenance organizations or large physician networks; impose ``best practices'' on doctors and patients as a way to encourage preventive medicine and eliminate wasteful spending; and cut costs through administrative economies. But managed care upset doctors and patients. After a backlash, managed care relaxed cost controls.
Now, some say that because the ``market'' has failed, greater government control is the answer. Private insurance has high overhead costs and generates too much paperwork. True. Still, there's not much evidence that over long periods government controls health spending any better. From 1970 to 2003, Medicare spending rose an average of 9 percent annually. In the same years, private insurance costs rose 10.1 percent annually.
Americans want more health care for less money, and when they don't get it, they indict drug companies, insurers, trial lawyers and bureaucrats. Although these familiar scapegoats may not be blameless, the real problem is us. We demand the impossible. The changes we truly need are political. We need to reconnect people with the public consequences of their private acts. We should curb the subsidization of private insurance. Medicare recipients should pay more of their bills. But these changes won't happen because people don't want to see the costs. We don't have the health-care system we need, but we do have the one we deserve.
Source
SICK GOVERNMENT USES FIREMEN TO GIVE MEDICAL CARE
More fallout from the closure of emergency services at Caboolture hospital
A fire crew was dispatched to give urgent first aid to a Bribie Island man who had a heart attack because ambulances were busy transporting patients away from the troubled Caboolture Hospital. Fire officers gave oxygen for almost 1 1/2 hours to retired NSW police officer John Kenny, 57, until an ambulance was available. As well as having to wait for an ambulance, Mr Kenny was diverted away from Caboolture Hospital's emergency department which normally would have treated heart attack victims in the area.
A Queensland Ambulance Service spokesman last night confirmed a fire truck had been sent to Mr Kenny because it was "an unusually busy night". He denied ambulance crews had been busy diverting patients from the Caboolture Hospital. "Every available crew in the area were on a code-one emergency response," he said. "It was just an unusually busy period at that stage. "We responded with a firefighting crew who all have advance first-aid and lifesaving equipment on their trucks. "While it doesn't happen very often, we do have a standing agreement with the fire service to do this sort of thing. They are a great back-up. It is better having someone with advanced first-aid and life-saving equipment than no one at all." The spokesman said that at all times ambulance officers were in contact with Mr Kenny and the fire officers treating him.
Mr Kenny said he telephoned for the ambulance at 3am on Saturday and was shocked 10 minutes later to hear a fire engine siren outside and four fire officers walking into his home. "They put me on some oxygen and said there were no ambulances available," Mr Kenny said last night. "I didn't believe it. I thought someone was playing a bad joke on me. It took an ambulance an hour and a half to get there. "In the end an ambulance came from Caboolture station. They said they were spending all their time running people around the place because there is no Caboolture Hospital."
Mr Kenny has been in Brisbane's Prince Charles Hospital waiting for an angiogram since Saturday morning. He said the person he was sharing his room with had been waiting for most of that time for a 10-minute stress test which he was unlikely to get before Friday. "I moved here seven years ago and I remember (Premier) Peter Beattie saying we've got the best hospital system in the world. It's world-class," Mr Kenny said. "It might have been then, but, by God, it's not now. "You can give the firies and the ambos a real wrap. But you can give the people running the place -- the State Government -- the thumbs-down."
A spokeswoman for Mr Beattie said last night the Premier was unable to comment until he had been briefed on the circumstances. Opposition health spokesman Bruce Flegg said the incident showed other emergency services were being drawn into the problems confronting the state's public health system. "Heart attack carries with it a very high risk of sudden death," Dr Flegg said. "Failing to dispatch the properly equipped ambulance and paramedics increases the risk the patient will not survive." He said the failure to send an ambulance was compounded by the fact that the nearest hospital, Caboolture, was not taking patients such as Mr Kenny.
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.
***************************
Almost everyone agrees that we ought to ``fix the health care system'' -- a completely meaningless phrase despite its popularity with politicians, pundits and ``experts.'' Indeed, it is popular precisely because it is meaningless. The people who proclaim it rarely tell you the discomforting choices it might involve. Instead, they focus on a few specific shortcomings of our $1.9 trillion health-industrial complex and imply that, if we correct these often-serious flaws, we'll have ``fixed'' the system or at least made a good start. This is rarely true, and so most forays into ``health reform'' end with disillusion.
We are about to start the cycle again. By most accounts, President Bush plans to highlight health care in his forthcoming State of the Union address. His proposals may or may not have merit, but they surely won't fix the health system in any fundamental way. The reason is that most Americans don't want to fix the system in that sense. Most are satisfied with their care. Most don't see (or pay directly) most of their costs. Because politicians -- of both parties -- reflect public opinion, they won't do more than tinker. Unfortunately, tinkering isn't enough. As everyone knows, health spending has risen steadily. In 2004, it totaled 16 percent of national income, up from 7.2 percent in 1970. As health insurance becomes more costly, the number of uninsured, now about 46 million, may grow. Worse, health costs may depress wage gains, raise taxes and squeeze other government programs.
Here's the paradox: A health-care system that satisfies most of us as individuals may hurt us as a society. Let me offer myself as an example. All my doctors are in small practices. I like it that way. It seems to make for closer personal connections. But I'm always stunned by how many people they employ for non-medical chores -- appointments, record-keeping, insurance collections. A bigger practice, though more impersonal, might be more efficient. Because insurance covers most of my medical bills, I don't have any stake in switching.
On a grander scale, that's our predicament. Americans generally want their health-care system to do three things: (1) provide needed care to all people, regardless of income; (2) maintain our freedom to pick doctors and their freedom to recommend the best care for us; and (3) control costs. The trouble is that these laudable goals aren't compatible. We can have any two of them, but not all three. Everyone can get care with complete choice -- but costs will explode, because patients and doctors have no reason to control them. We can control costs but only by denying care or limiting choices.
Disliking the inconsistencies, we hide them -- to individuals. We subsidize employer-paid health insurance by excluding it from income taxes (the 2006 cost to government: an estimated $126 billion). Most workers don't see the full costs of their health care. Nor do Medicare recipients, whose costs are paid mainly by other people's payroll taxes. We're living in a fantasy world. Given our inconsistent expectations, no health-care system -- not one completely run by government or one following ``market'' principles -- can satisfy public opinion. Politicians and pundits can score cheap points by emphasizing one goal or another (insure the uninsured, cover drugs for Medicare recipients, expand ``choice'') without facing the harder job: finding a better balance among competing goals.
Every attempt to do so has failed. Consider the ``managed care'' experiment of the 1990s. The idea was simple: herd patients into health maintenance organizations or large physician networks; impose ``best practices'' on doctors and patients as a way to encourage preventive medicine and eliminate wasteful spending; and cut costs through administrative economies. But managed care upset doctors and patients. After a backlash, managed care relaxed cost controls.
Now, some say that because the ``market'' has failed, greater government control is the answer. Private insurance has high overhead costs and generates too much paperwork. True. Still, there's not much evidence that over long periods government controls health spending any better. From 1970 to 2003, Medicare spending rose an average of 9 percent annually. In the same years, private insurance costs rose 10.1 percent annually.
Americans want more health care for less money, and when they don't get it, they indict drug companies, insurers, trial lawyers and bureaucrats. Although these familiar scapegoats may not be blameless, the real problem is us. We demand the impossible. The changes we truly need are political. We need to reconnect people with the public consequences of their private acts. We should curb the subsidization of private insurance. Medicare recipients should pay more of their bills. But these changes won't happen because people don't want to see the costs. We don't have the health-care system we need, but we do have the one we deserve.
Source
SICK GOVERNMENT USES FIREMEN TO GIVE MEDICAL CARE
More fallout from the closure of emergency services at Caboolture hospital
A fire crew was dispatched to give urgent first aid to a Bribie Island man who had a heart attack because ambulances were busy transporting patients away from the troubled Caboolture Hospital. Fire officers gave oxygen for almost 1 1/2 hours to retired NSW police officer John Kenny, 57, until an ambulance was available. As well as having to wait for an ambulance, Mr Kenny was diverted away from Caboolture Hospital's emergency department which normally would have treated heart attack victims in the area.
A Queensland Ambulance Service spokesman last night confirmed a fire truck had been sent to Mr Kenny because it was "an unusually busy night". He denied ambulance crews had been busy diverting patients from the Caboolture Hospital. "Every available crew in the area were on a code-one emergency response," he said. "It was just an unusually busy period at that stage. "We responded with a firefighting crew who all have advance first-aid and lifesaving equipment on their trucks. "While it doesn't happen very often, we do have a standing agreement with the fire service to do this sort of thing. They are a great back-up. It is better having someone with advanced first-aid and life-saving equipment than no one at all." The spokesman said that at all times ambulance officers were in contact with Mr Kenny and the fire officers treating him.
Mr Kenny said he telephoned for the ambulance at 3am on Saturday and was shocked 10 minutes later to hear a fire engine siren outside and four fire officers walking into his home. "They put me on some oxygen and said there were no ambulances available," Mr Kenny said last night. "I didn't believe it. I thought someone was playing a bad joke on me. It took an ambulance an hour and a half to get there. "In the end an ambulance came from Caboolture station. They said they were spending all their time running people around the place because there is no Caboolture Hospital."
Mr Kenny has been in Brisbane's Prince Charles Hospital waiting for an angiogram since Saturday morning. He said the person he was sharing his room with had been waiting for most of that time for a 10-minute stress test which he was unlikely to get before Friday. "I moved here seven years ago and I remember (Premier) Peter Beattie saying we've got the best hospital system in the world. It's world-class," Mr Kenny said. "It might have been then, but, by God, it's not now. "You can give the firies and the ambos a real wrap. But you can give the people running the place -- the State Government -- the thumbs-down."
A spokeswoman for Mr Beattie said last night the Premier was unable to comment until he had been briefed on the circumstances. Opposition health spokesman Bruce Flegg said the incident showed other emergency services were being drawn into the problems confronting the state's public health system. "Heart attack carries with it a very high risk of sudden death," Dr Flegg said. "Failing to dispatch the properly equipped ambulance and paramedics increases the risk the patient will not survive." He said the failure to send an ambulance was compounded by the fact that the nearest hospital, Caboolture, was not taking patients such as Mr Kenny.
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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