AUSTRALIA: A LEGAL SAFEGUARD AGAINST HOSPITAL NEGLIGENCE TO BE REMOVED
As part of the "solution" to public hospital capacity shortfalls in Queensland
PUBLIC patients whose operations are botched will lose their right to sue the State Government under a plan to reduce hospital elective surgery waiting lists. Thousands of people who will have their operations outsourced to private hospitals will also be unable to access their case notes under the Freedom of Information Act if things go wrong. Under the plan, called Surgery Connect, a broker will be paid a one-off, $8.5 million fee to find private hospitals to treat the state's long-wait public patients.
Many of the operations will be complex, including shoulder surgery, hip and knee-replacements, prostatectomies and treatment of aortic aneurisms (swelling and weakness in the wall of the aorta). But, under the Surgery Connect model, the broker will be liable if an operation goes wrong. The tender closed on May 9.
The Queensland branch of the Australian Medical Association said it did not tender because the cost of insurance was too high. Queensland Health last night rejected claims it had washed its hands of public patients, saying they could sue the broker if problems arose. A department spokeswoman said patient notes would remain the property of private providers, but patients could access records under the Federal Privacy Act. However, legal advice obtained by The Courier-Mail said that, in regard to some matters, it could be harder to obtain information under the Federal Act.
AMAQ spokeswoman president Zelle Hodge said she was unsure who would be willing to take on the inherent risk associated with the model. "I think patients should be extremely worried not only as an individual but the bigger picture is this is just another way to run down the public hospital system," Dr Hodge said.
In a statement, Queensland Health said the rights of public patients would not be eroded: "The broker is required to indemnify Queensland Health and to maintain appropriate levels of insurance in respect of medical negligence claims," the statement said. "The broker is then responsible for ensuring the health providers it engages are appropriately credentialled and insured for such claims. "These measures are designed to provide a safety net for patients who may have suffered adverse consequences of medical treatment they have received from the private provider. "It would be remiss of Queensland Health if it did not ensure that such contractual requirements were imposed on private providers. It is also important to keep in mind that the broker and private providers are providing health services to these patients so it is expected that, legally, they would bear the risk."
The AMAQ last year held talks with the Government about outsourcing some public elective surgery but, under its plan, patients would be treated in public hospitals and, where possible, public doctors would operate in private hospitals. President-elect Dr Ross Cartmill said the arrangement included Queensland Health providing indemnity insurance.
Federal Health Minister Tony Abbott said contracts entered into by the Queensland Government and Queensland Health were issues for those bodies. "The outsourcing of elective surgery is an admission of defeat and an admission by Labor that the private health sector is an essential part of our health system."
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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Sunday, May 20, 2007
Saturday, May 19, 2007
What Healthcare and Higher Education Have in Common
Healthcare is notorious for runaway prices, which are due, in part, to this financing scheme: multiple payers. And these multiple payers have assured streams of revenue, which include:
* Employer-provided health insurance
* Health insurance purchased by the individual to comply with government mandates (as in Massachusetts' new healthcare system)
* Direct government grants (Medicaid)
* Dedicated taxes (Medicare)
If one payer doesn't pay a patient's tab entirely, then the provider just bills the other payers for the remainder. Out-of-pocket payments by patients get put on top of these other payments. A patient can have his medical bills paid by 3 or more parties. With multiple payers providing assured payments the market is subverted -- there is no pricing discipline. This leads inexorably to price inflation, which in the case of healthcare outruns the overall inflation rate big-time. Another enterprise that depends on multiple payers, assured payment, and heavy government involvement is higher education. And it, too, has raging inflation.
Assured payment results in waste and fraud. It has caused an explosion in medically unnecessary tests and procedures. It is why universities can provide their professors with cushy sinecures for precious little work. (How else could the University of Colorado afford a 6-digit compensation package for the likes of a Ward Churchill?) The hospitals and universities don't have to economize and prioritize; they can have it all. The money will be there for them.
Despite healthcare's soaring inflation rate, healthcare reformers want to throw yet more money at it. How are you going to get prices under control by pouring even more money into those assured streams of revenue? The reformers think that by eliminating paperwork and through other administrative efficiencies that they can reduce costs. (If so, what's the need for more money?) But the healthcare industry would respond to any increased cash flows by simply raising their fees, just as higher education does.
In 10 years, healthcare spending is projected to top $4 trillion, double what it is today, and much more than all federal spending today. Healthcare's share of GDP will increase from 15% to 20%.
The cure for healthcare inflation-and a great many other things, for that matter-is competition. And the way to get competition is by withholding funds, not assuring them. That's why Health Savings Accounts are so attractive. HSAs keep money out of the healthcare pipeline until you need it. And HSAs are also a fine incentive to improve your health by changing your lifestyle and habits, so that you won't have to tap into your own money.
The solution to the problem of multiple-payers in healthcare is not "single-payer", the "universal" system preferred by some reformists. Not if it means another government-run monopoly. (Government hates monopolies, except, of course, for government monopolies.)
Speaking of "universal": Congress should enact a nationwide law that allows all workers to divert their share of their company's health insurance budget into HSAs. That way if a company goes bust, like Enron, or stops providing health insurance to its employees, employees who have chosen this opt-out will at least have some healthcare money set aside. And because they would be universal, such HSAs would be portable, making it easier to change jobs, thereby making for a more dynamic economy.
America has not had a real market in healthcare since the 1940s. If we really want to reform our healthcare system, let's start by reintroducing healthcare to the market.
Source
More deadly NHS negligence
Simple procedures that could save the lives of thousands of hospital patients every year are still not routine in Britain. More than 12,500 patients a year die in hospitals from venous thromboembolism (VTE), blood clots that form in the veins of the legs or pelvis and travel to the heart or lungs. David Fitzmaurice, of the University of Birmingham, says that the condition kills at least ten times as many hospital patients as MRSA but gets far less publicity. Nationally – counting cases both in and out of hospital – at least 25,000 people die in Britain every year from VTE. “The number of deaths from VTE in the UK each year is five times greater than the combined total number of deaths from breast cancer, Aids and road traffic accidents,” Professor Fitzmaurice says in today’s British Medical Journal.
In hospitals, about 10 per cent of all deaths are caused by VTE, and many of these could be prevented. Drugs can reduce the rate by about 65 per cent, but an investigation by the Commons Health Select Committee found that as few as 20 per cent of patients were being treated appropriately. “A combination of factors may be responsible,” Professor Fitzmaurice says. “As a result of poor education, health professionals lack awareness of this condition. Venous thromboembolism is often a silent disease and often occurs after discharge from hospital.” He adds that the cost of the drugs may also be a barrier, although this is not clear.
The National Institute for Health and Clinical Excellence (NICE) published guidance last month that all patients undergoing major surgery should be assessed to identify their risk of developing blood clots. The formation of clots, known as deep vein thrombosis (DVT), occurs in more than 20 per cent of surgical patients and more than 40 per cent of patients undergoing major orthopaedic surgery. But it is also common in medical patients. Most of these thromboses are minor and cause no symptoms, but if the blood clot becomes loose it can travel to the lungs and cause VTE.
NICE’s suggestions for preventing blood clots include offering patients compression stockings, inflatable “boots” during operations and the use of blood-thinning medication. Professor Fitzmaurice says that NICE’s emphasis on compression stockings rather than drugs is controversial. It was not supported by a report of the Health Select Committee two years ago, which he says provided an opportunity to change practice. “Meanwhile, more than 25,000 may have died needlessly each year because of the failure to implement simple thromboprophylaxis in UK hospitals,” he concludes.
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Healthcare is notorious for runaway prices, which are due, in part, to this financing scheme: multiple payers. And these multiple payers have assured streams of revenue, which include:
* Employer-provided health insurance
* Health insurance purchased by the individual to comply with government mandates (as in Massachusetts' new healthcare system)
* Direct government grants (Medicaid)
* Dedicated taxes (Medicare)
If one payer doesn't pay a patient's tab entirely, then the provider just bills the other payers for the remainder. Out-of-pocket payments by patients get put on top of these other payments. A patient can have his medical bills paid by 3 or more parties. With multiple payers providing assured payments the market is subverted -- there is no pricing discipline. This leads inexorably to price inflation, which in the case of healthcare outruns the overall inflation rate big-time. Another enterprise that depends on multiple payers, assured payment, and heavy government involvement is higher education. And it, too, has raging inflation.
Assured payment results in waste and fraud. It has caused an explosion in medically unnecessary tests and procedures. It is why universities can provide their professors with cushy sinecures for precious little work. (How else could the University of Colorado afford a 6-digit compensation package for the likes of a Ward Churchill?) The hospitals and universities don't have to economize and prioritize; they can have it all. The money will be there for them.
Despite healthcare's soaring inflation rate, healthcare reformers want to throw yet more money at it. How are you going to get prices under control by pouring even more money into those assured streams of revenue? The reformers think that by eliminating paperwork and through other administrative efficiencies that they can reduce costs. (If so, what's the need for more money?) But the healthcare industry would respond to any increased cash flows by simply raising their fees, just as higher education does.
In 10 years, healthcare spending is projected to top $4 trillion, double what it is today, and much more than all federal spending today. Healthcare's share of GDP will increase from 15% to 20%.
The cure for healthcare inflation-and a great many other things, for that matter-is competition. And the way to get competition is by withholding funds, not assuring them. That's why Health Savings Accounts are so attractive. HSAs keep money out of the healthcare pipeline until you need it. And HSAs are also a fine incentive to improve your health by changing your lifestyle and habits, so that you won't have to tap into your own money.
The solution to the problem of multiple-payers in healthcare is not "single-payer", the "universal" system preferred by some reformists. Not if it means another government-run monopoly. (Government hates monopolies, except, of course, for government monopolies.)
Speaking of "universal": Congress should enact a nationwide law that allows all workers to divert their share of their company's health insurance budget into HSAs. That way if a company goes bust, like Enron, or stops providing health insurance to its employees, employees who have chosen this opt-out will at least have some healthcare money set aside. And because they would be universal, such HSAs would be portable, making it easier to change jobs, thereby making for a more dynamic economy.
America has not had a real market in healthcare since the 1940s. If we really want to reform our healthcare system, let's start by reintroducing healthcare to the market.
Source
More deadly NHS negligence
Simple procedures that could save the lives of thousands of hospital patients every year are still not routine in Britain. More than 12,500 patients a year die in hospitals from venous thromboembolism (VTE), blood clots that form in the veins of the legs or pelvis and travel to the heart or lungs. David Fitzmaurice, of the University of Birmingham, says that the condition kills at least ten times as many hospital patients as MRSA but gets far less publicity. Nationally – counting cases both in and out of hospital – at least 25,000 people die in Britain every year from VTE. “The number of deaths from VTE in the UK each year is five times greater than the combined total number of deaths from breast cancer, Aids and road traffic accidents,” Professor Fitzmaurice says in today’s British Medical Journal.
In hospitals, about 10 per cent of all deaths are caused by VTE, and many of these could be prevented. Drugs can reduce the rate by about 65 per cent, but an investigation by the Commons Health Select Committee found that as few as 20 per cent of patients were being treated appropriately. “A combination of factors may be responsible,” Professor Fitzmaurice says. “As a result of poor education, health professionals lack awareness of this condition. Venous thromboembolism is often a silent disease and often occurs after discharge from hospital.” He adds that the cost of the drugs may also be a barrier, although this is not clear.
The National Institute for Health and Clinical Excellence (NICE) published guidance last month that all patients undergoing major surgery should be assessed to identify their risk of developing blood clots. The formation of clots, known as deep vein thrombosis (DVT), occurs in more than 20 per cent of surgical patients and more than 40 per cent of patients undergoing major orthopaedic surgery. But it is also common in medical patients. Most of these thromboses are minor and cause no symptoms, but if the blood clot becomes loose it can travel to the lungs and cause VTE.
NICE’s suggestions for preventing blood clots include offering patients compression stockings, inflatable “boots” during operations and the use of blood-thinning medication. Professor Fitzmaurice says that NICE’s emphasis on compression stockings rather than drugs is controversial. It was not supported by a report of the Health Select Committee two years ago, which he says provided an opportunity to change practice. “Meanwhile, more than 25,000 may have died needlessly each year because of the failure to implement simple thromboprophylaxis in UK hospitals,” he concludes.
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Friday, May 18, 2007
Customer Health Care
It's Friday evening and you suspect that your child might have strep throat or a worsening ear infection. Do you bundle him up and wait half the night in an emergency room? Or do you suffer through the weekend and hope that you can get an appointment with your pediatrician on Monday -- taking time off your job to drive across town for another wait in the doctor's office?
Every parent has faced this dilemma. But now there are new options, courtesy of the competitive marketplace. You might instead be able to take a quick trip on Friday night to a RediClinic in the nearby Wal-Mart or a MinuteClinic at CVS, where you will be seen by a nurse practitioner within 15 minutes, most likely getting a prescription that you can have filled right there. Cost of the visit? Generally between $40 and $60.
These new retail health clinics are opening in big box stores and local pharmacies around the country to treat common maladies at prices lower than a typical doctor's visit and much lower than the emergency room. No appointment necessary. Open daytime, evenings and weekends. Most take insurance.
Much like the response to Hurricane Katrina, private companies are far ahead of the government in answering Americans' needs, this time for more accessible and more affordable health care. Political leaders across the country seeking to expand government's role in health care should take note.
Thousands of free-standing primary care clinics have been operating for years in malls and main streets around the country, often staffed by physicians and many offering a broad range of health services. The retail health clinics are creating a new model with more limited services at lower prices and almost always staffed by nurses. The Convenient Care Association estimates there are about 325 of these retail clinics operating nationwide today. Seventy-six of them are in Wal-Marts in 12 states, but the company announced last month it will expand to 400 clinics by the end of the decade and 2,000 in five to seven years. They will be run by outside firms, including for-profit ventures like RediClinic as well as local and regional health plans and hospitals.
The industry is rapidly expanding. You can find a MinuteClinic in the CVS on the Strip in Las Vegas. But you also will find many locally-run clinics in pharmacies and food stores across America, such as the Express Clinic in Miami, MediMin in Phoenix, and Curaquick in Sioux City, whose motto is "Get well soon."
Prices vary for services from flu shots ($15-$30), to care for allergies, poison ivy and pink eye ($50-$60), and tests for cholesterol, diabetes and pregnancy (less than $50). Competition already is starting to drive prices down.
Of all patients who have visited the clinics, almost half went there for a vaccination, and one-third received treatment for ear infections, colds, strep throat, skin rashes or sinus infections. Ninety percent said they were satisfied with the care they received. The nurses staffing the clinics are under physician supervision and follow strict protocols to refer patients to physicians or emergency rooms if problems are more serious.
Internists and family doctors are watching. Some see the clinics as useful in providing efficient care for a limited number of uncomplicated ailments, freeing physicians and hospitals to deal with more complex cases. But others are worried about lost business, fragmentation of care, and the quality of care if the clinics miss something serious.
Rick Kellerman, president of the American Academy of Family Physicians, concedes, "The retail clinics are sending physicians a message that our current model of care is not always easy to access." The threat of competition from the in-store clinics means some doctors are keeping their practices open later and on Saturdays and holding an hour open for same-day appointments. Competition works.
And competition also worked to force prescription drug prices down: When Wal-Mart announced last year that it was dropping the price of several hundred generic medicines to $4 for a month's supply, other pharmacies, from Target to corner drug stores, followed suit. Wal-Mart now says that a third of all prescriptions filled at its pharmacies are for the $4 generics, and 30% of them are filled by people without insurance.
Take note, Congress: The market is providing cheaper medicines, more affordable care -- and it is also helping the uninsured. A Harris Interactive poll conducted in March for The Wall Street Journal said that 22% of those visiting the clinics were uninsured. Wal-Mart says that half of its clinic visitors are uninsured.
Retail clinics are particularly attractive to 4.5 million people with Health Savings Accounts who have health insurance with higher deductibles and want an affordable option for some of their routine care.
And the clinics are working to solve another problem that is vexing Washington -- creation of electronic medical records. Most retail clinics create computerized patient records, with the goal of making the records accessible throughout the chain. The records also can be emailed to a hospital or to the patient's regular doctor -- or sent by fax if necessary.
Critics of engaging private competition in the health sector will argue that the vast majority of health-care dollars are spent on a relatively small percentage of patients with serious illness, especially those with multiple chronic conditions.
But even coordination of care for those with chronic illnesses lends itself to patient-friendly solutions. The City of Asheville, North Carolina, cut its costs in half for employees with diabetes by teaming up with local pharmacists who did routine exams and got patients to their doctors or hospitals more quickly when they needed intervention. Employees received their medicines for free if they kept appointments, and their health improved.
Because health care is largely regulated and licensed at the state level, some states are more friendly than others at having non-physicians deliver care. California requires that clinics be a medical corporation owned by a physician. In Arizona, each site must be licensed, but in most other states, a single license will serve multiple clinics. Illinois is considering legislation to limit the number of nurses a doctor could supervise to two and restrict the clinics' right to advertise.
This industry is in its infancy and will hardly register in our nation's $2 trillion-plus health care bill. But just as Nucor overturned the steelmaking industry with a faster-better-cheaper way of making low-end rebar, these limited service clinics could be the disruptive innovator in our health-care system. Package pricing for more complex treatments, like knee replacement surgery, may not be far behind.
Government can get in the way, of course, with protectionist policies that throw up more regulatory barriers to entry. But retail clinics could be just the beginning of consumer-friendly innovations, if Congress were to change tax policies in a way that would allow people to have more control over their health spending, as President Bush has proposed.
The linchpin is giving people the same tax benefits whether they get their health insurance at work or on their own, or buy coverage through groups like churches, labor unions and professional or trade associations. Allowing people to buy health insurance across state lines would inject another dose of healthy competition into the system.
With many congressional leaders hostile to free-market solutions, these policy changes are unlikely in the next two years. But as consumers get a taste of what consumer-friendly health care is like, they may well demand that the top-down, centralized health-care delivery of the 20th century give way to a system more in tune with the demands of 21st-century consumers seeking greater value and efficiency.
Source
Massive closure of NHS emergency rooms in sight
Up to half of all hospital accident and emergency departments face cuts or closure under plans to improve patient care, presenting Gordon Brown with a massive dilemma as he takes over as Prime Minister. Ninety-two out of 204 A&E departments are under threat if guidance attributed to the Department of Health by NHS trusts is followed, the Conservatives claimed last night. Some NHS organisations are already using the guidance, which calls for A&E departments to serve a minimum population of 450,000 patients, to justify closures in smaller catchment areas. The average A&E unit currently serves just under 250,000 people.
But the plans are proving hugely unpopular, even though they have been promoted as in the interests of patients and NHS staff. Mr Brown, aware that the closures would come into force around the time of the next election, said last Friday that he would meet front-line NHS staff and patients to discuss health policy. It was clear last night that the Chancellor will not now face a leadership challenge as he prepares to succeed Tony Blair, having gathered a decisive 308th supporter among Labour's 353 MPs.
Last Sunday Mr Brown accepted that people were worried about the potential closure of A&E facilities and maternity services close to their homes, raising speculation that he was pondering a rethink. If so it is increasingly likely that he will move Patricia Hewitt, the Health Secretary, from her post to pave the way for changes.
The Conservative estimate of 92 nationwide cuts was based on figures in a report circulated to NHS trusts in Surrey. It states: "Current Department of Health and strategic health authority guidance suggests that, to be viable in terms of patient need, patient safety, staffing numbers and clinical training requirements, a full A&E department in the future would need to be supported by a catchment population of between 450,000 and 500,000 people." A staff briefing by Surrey Primary Care Trust in March repeated the figures, suggesting that such a catchment population was "national guidance".
Closures could mean seriously ill patients, such as those with heart problems or head injuries, having to travel longer distances to receive care in specialist treatment centres. Patients with minor injuries are expected to be treated in walk-in clinics or smaller A&E units. Such a scenario was supported by two reports published by the Government last year. These suggested that specialist high-tech centres could save 500 lives of people suffering heart attacks and result in 1,000 more stroke victims avoiding death and disability each year.
The changes are broadly supported by doctors' leaders but are fiercely opposed by patients' groups and MPs. Cuts to local NHS services have also been opposed by several senior Labour politicians in their own constituencies. The move to close A&Es comes just as demands on their facilities are rising. The number of attendances at A&E has risen by more than a million in the past three years and the average number of attendances at each is now 67,000.
A report published last year by the Royal College of Surgeons recommended that the minimum catchment population of a fully resourced A&E department should be at least 300,000. But there is debate about whether catchment areas alone should be used to allocate NHS services. Local geography, healthcare needs and staffing levels may have to be taken into account.
A Department of Health spokesman said there was no such official guidance from his department. "It is absolute rubbish to suggest that we are demanding the closure of A&E departments. "Any decisions about the shape of A&E services are taken locally so that services reflect the needs of the local population. Where local health authorities believe that patients can be better served by changing the way services should be delivered, it is right that they make those changes, and they will consult locally on any proposals."
But he admitted that the recommendations were taken from a report by the Royal College of Surgeons supported by Sir George Alberti, the former director of emergency care. He recently recommended the closure of an A&E department in North London. The remaining two A&Es serving the area will be left with catchment populations of 450,000 each.
The Tories claimed that this was evidence of central targets to close units based on the number of patients they served. Andrew Lansley, the Shadow Health Secretary, said: "Access to accident and emergency services is a vital component of the quality of NHS services. The public know that not every A&E department can provide every emergency service. But there is no clinical evidence which would justify shutting down A&E departments simply because they don't serve a catchment population in excess of 450,000. Yet that is the basis on which the Department of Health is seeking now to justify closures."
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
It's Friday evening and you suspect that your child might have strep throat or a worsening ear infection. Do you bundle him up and wait half the night in an emergency room? Or do you suffer through the weekend and hope that you can get an appointment with your pediatrician on Monday -- taking time off your job to drive across town for another wait in the doctor's office?
Every parent has faced this dilemma. But now there are new options, courtesy of the competitive marketplace. You might instead be able to take a quick trip on Friday night to a RediClinic in the nearby Wal-Mart or a MinuteClinic at CVS, where you will be seen by a nurse practitioner within 15 minutes, most likely getting a prescription that you can have filled right there. Cost of the visit? Generally between $40 and $60.
These new retail health clinics are opening in big box stores and local pharmacies around the country to treat common maladies at prices lower than a typical doctor's visit and much lower than the emergency room. No appointment necessary. Open daytime, evenings and weekends. Most take insurance.
Much like the response to Hurricane Katrina, private companies are far ahead of the government in answering Americans' needs, this time for more accessible and more affordable health care. Political leaders across the country seeking to expand government's role in health care should take note.
Thousands of free-standing primary care clinics have been operating for years in malls and main streets around the country, often staffed by physicians and many offering a broad range of health services. The retail health clinics are creating a new model with more limited services at lower prices and almost always staffed by nurses. The Convenient Care Association estimates there are about 325 of these retail clinics operating nationwide today. Seventy-six of them are in Wal-Marts in 12 states, but the company announced last month it will expand to 400 clinics by the end of the decade and 2,000 in five to seven years. They will be run by outside firms, including for-profit ventures like RediClinic as well as local and regional health plans and hospitals.
The industry is rapidly expanding. You can find a MinuteClinic in the CVS on the Strip in Las Vegas. But you also will find many locally-run clinics in pharmacies and food stores across America, such as the Express Clinic in Miami, MediMin in Phoenix, and Curaquick in Sioux City, whose motto is "Get well soon."
Prices vary for services from flu shots ($15-$30), to care for allergies, poison ivy and pink eye ($50-$60), and tests for cholesterol, diabetes and pregnancy (less than $50). Competition already is starting to drive prices down.
Of all patients who have visited the clinics, almost half went there for a vaccination, and one-third received treatment for ear infections, colds, strep throat, skin rashes or sinus infections. Ninety percent said they were satisfied with the care they received. The nurses staffing the clinics are under physician supervision and follow strict protocols to refer patients to physicians or emergency rooms if problems are more serious.
Internists and family doctors are watching. Some see the clinics as useful in providing efficient care for a limited number of uncomplicated ailments, freeing physicians and hospitals to deal with more complex cases. But others are worried about lost business, fragmentation of care, and the quality of care if the clinics miss something serious.
Rick Kellerman, president of the American Academy of Family Physicians, concedes, "The retail clinics are sending physicians a message that our current model of care is not always easy to access." The threat of competition from the in-store clinics means some doctors are keeping their practices open later and on Saturdays and holding an hour open for same-day appointments. Competition works.
And competition also worked to force prescription drug prices down: When Wal-Mart announced last year that it was dropping the price of several hundred generic medicines to $4 for a month's supply, other pharmacies, from Target to corner drug stores, followed suit. Wal-Mart now says that a third of all prescriptions filled at its pharmacies are for the $4 generics, and 30% of them are filled by people without insurance.
Take note, Congress: The market is providing cheaper medicines, more affordable care -- and it is also helping the uninsured. A Harris Interactive poll conducted in March for The Wall Street Journal said that 22% of those visiting the clinics were uninsured. Wal-Mart says that half of its clinic visitors are uninsured.
Retail clinics are particularly attractive to 4.5 million people with Health Savings Accounts who have health insurance with higher deductibles and want an affordable option for some of their routine care.
And the clinics are working to solve another problem that is vexing Washington -- creation of electronic medical records. Most retail clinics create computerized patient records, with the goal of making the records accessible throughout the chain. The records also can be emailed to a hospital or to the patient's regular doctor -- or sent by fax if necessary.
Critics of engaging private competition in the health sector will argue that the vast majority of health-care dollars are spent on a relatively small percentage of patients with serious illness, especially those with multiple chronic conditions.
But even coordination of care for those with chronic illnesses lends itself to patient-friendly solutions. The City of Asheville, North Carolina, cut its costs in half for employees with diabetes by teaming up with local pharmacists who did routine exams and got patients to their doctors or hospitals more quickly when they needed intervention. Employees received their medicines for free if they kept appointments, and their health improved.
Because health care is largely regulated and licensed at the state level, some states are more friendly than others at having non-physicians deliver care. California requires that clinics be a medical corporation owned by a physician. In Arizona, each site must be licensed, but in most other states, a single license will serve multiple clinics. Illinois is considering legislation to limit the number of nurses a doctor could supervise to two and restrict the clinics' right to advertise.
This industry is in its infancy and will hardly register in our nation's $2 trillion-plus health care bill. But just as Nucor overturned the steelmaking industry with a faster-better-cheaper way of making low-end rebar, these limited service clinics could be the disruptive innovator in our health-care system. Package pricing for more complex treatments, like knee replacement surgery, may not be far behind.
Government can get in the way, of course, with protectionist policies that throw up more regulatory barriers to entry. But retail clinics could be just the beginning of consumer-friendly innovations, if Congress were to change tax policies in a way that would allow people to have more control over their health spending, as President Bush has proposed.
The linchpin is giving people the same tax benefits whether they get their health insurance at work or on their own, or buy coverage through groups like churches, labor unions and professional or trade associations. Allowing people to buy health insurance across state lines would inject another dose of healthy competition into the system.
With many congressional leaders hostile to free-market solutions, these policy changes are unlikely in the next two years. But as consumers get a taste of what consumer-friendly health care is like, they may well demand that the top-down, centralized health-care delivery of the 20th century give way to a system more in tune with the demands of 21st-century consumers seeking greater value and efficiency.
Source
Massive closure of NHS emergency rooms in sight
Up to half of all hospital accident and emergency departments face cuts or closure under plans to improve patient care, presenting Gordon Brown with a massive dilemma as he takes over as Prime Minister. Ninety-two out of 204 A&E departments are under threat if guidance attributed to the Department of Health by NHS trusts is followed, the Conservatives claimed last night. Some NHS organisations are already using the guidance, which calls for A&E departments to serve a minimum population of 450,000 patients, to justify closures in smaller catchment areas. The average A&E unit currently serves just under 250,000 people.
But the plans are proving hugely unpopular, even though they have been promoted as in the interests of patients and NHS staff. Mr Brown, aware that the closures would come into force around the time of the next election, said last Friday that he would meet front-line NHS staff and patients to discuss health policy. It was clear last night that the Chancellor will not now face a leadership challenge as he prepares to succeed Tony Blair, having gathered a decisive 308th supporter among Labour's 353 MPs.
Last Sunday Mr Brown accepted that people were worried about the potential closure of A&E facilities and maternity services close to their homes, raising speculation that he was pondering a rethink. If so it is increasingly likely that he will move Patricia Hewitt, the Health Secretary, from her post to pave the way for changes.
The Conservative estimate of 92 nationwide cuts was based on figures in a report circulated to NHS trusts in Surrey. It states: "Current Department of Health and strategic health authority guidance suggests that, to be viable in terms of patient need, patient safety, staffing numbers and clinical training requirements, a full A&E department in the future would need to be supported by a catchment population of between 450,000 and 500,000 people." A staff briefing by Surrey Primary Care Trust in March repeated the figures, suggesting that such a catchment population was "national guidance".
Closures could mean seriously ill patients, such as those with heart problems or head injuries, having to travel longer distances to receive care in specialist treatment centres. Patients with minor injuries are expected to be treated in walk-in clinics or smaller A&E units. Such a scenario was supported by two reports published by the Government last year. These suggested that specialist high-tech centres could save 500 lives of people suffering heart attacks and result in 1,000 more stroke victims avoiding death and disability each year.
The changes are broadly supported by doctors' leaders but are fiercely opposed by patients' groups and MPs. Cuts to local NHS services have also been opposed by several senior Labour politicians in their own constituencies. The move to close A&Es comes just as demands on their facilities are rising. The number of attendances at A&E has risen by more than a million in the past three years and the average number of attendances at each is now 67,000.
A report published last year by the Royal College of Surgeons recommended that the minimum catchment population of a fully resourced A&E department should be at least 300,000. But there is debate about whether catchment areas alone should be used to allocate NHS services. Local geography, healthcare needs and staffing levels may have to be taken into account.
A Department of Health spokesman said there was no such official guidance from his department. "It is absolute rubbish to suggest that we are demanding the closure of A&E departments. "Any decisions about the shape of A&E services are taken locally so that services reflect the needs of the local population. Where local health authorities believe that patients can be better served by changing the way services should be delivered, it is right that they make those changes, and they will consult locally on any proposals."
But he admitted that the recommendations were taken from a report by the Royal College of Surgeons supported by Sir George Alberti, the former director of emergency care. He recently recommended the closure of an A&E department in North London. The remaining two A&Es serving the area will be left with catchment populations of 450,000 each.
The Tories claimed that this was evidence of central targets to close units based on the number of patients they served. Andrew Lansley, the Shadow Health Secretary, said: "Access to accident and emergency services is a vital component of the quality of NHS services. The public know that not every A&E department can provide every emergency service. But there is no clinical evidence which would justify shutting down A&E departments simply because they don't serve a catchment population in excess of 450,000. Yet that is the basis on which the Department of Health is seeking now to justify closures."
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Thursday, May 17, 2007
Moore lines up US health system
He won an Oscar after taking aim at US gun culture in Bowling for Columbine and earned the Palme D'Or for giving the Bush administration both barrels in Fahrenheit 9/11. But as Michael Moore puts the US health system in the crosshairs for his latest, take-no-prisoners documentary - Sicko - the firebrand director is himself in the firing line. Not only are US Treasury officials investigating him for possibly breaking a trade embargo against Cuba during the making of the movie, which premieres at the Cannes film festival, but Moore has faced renewed scrutiny of his methods.
Manufacturing Dissent, a recent film about Moore's work, shows him twisting the truth and using footage out of context. Ironically the film was made by two admirers of the director, Canadians Rick Caine and Debbie Melnyk. "We agreed with his politics," said Caine, adding that they had initially set out to make a film that celebrated Moore. But they soon discovered a trail of broken promises to colleagues, exaggerations of facts, and footage used out of context.
Among the most startling revelations of the documentary is the claim that the central premise of Moore's seminal Roger and Me - that the boss of then-General Motors chairman Rogers Smith refused him an interview - is false.
Moore would not be interviewed for Manufacturing Dissent but may find it hard to evade questions at Cannes as he promotes Sicko, "a comedy about 45 million people with no health care in the richest country on Earth." Buzz around the film is guaranteed to be intense after news of the US Treasury probe, which was sparked by Moore's decision to take rescue workers from the site of 9/11's Ground Zero to Cuba for medical treatment.
The development has handed Moore a public relations bonanza on a platter as he attempts to rev up interest in the film. "The government going after Michael Moore is like Paris Hilton going to the clink: It's a brand extension," PR expert Eric Dezenhall said. "It can only help his career. It validates his shtick that he's the little guy being silenced by a large and sinister voice."
While a spokeswoman for Moore dismissed the US Treasury probe as politically motivated, Sicko's backers have already recruited a high-powered team of spin doctors to counter an expected offensive from the health industry. The Weinstein Co, which is handling Sicko, have hired political strategist Chris Lehane, a former press secretary to Al Gore and a White House spokesman during Bill Clinton's presidency, to manage the film's press campaign. The services of high-powered New York public relations consultant, Ken Sunshine, have also been retained. "If the HMOs (health-care providers) strike, I'm going to need two guys who can strike back," Harvey Weinstein told Daily Variety.
However, in a possible foretaste of things to come, the US health industry has already gone on the attack, questioning Moore's objectivity. The Pharmaceutical Research and Manufacturers of America issued a statement attacking Moore's record. "A review of America's health care system should be balanced, thoughtful and well-researched," the statement said. "You won't get that from Michael Moore. "Michael Moore is a political activist with a track record for sensationalism. He has no intention of being fair and balanced."
Source
Another big NHS shortfall
A key target in the Government's health reforms - to have thousands of community nurses treating the most seriously ill patients outside hospital - has been missed, with fewer than half the promised numbers in place. A pledge made three years ago to have 3,000 experienced nurses in post by March this year has been delayed, with social workers and less qualified staff having to make up the numbers looking after patients with chronic illnesses. Cost-cutting and a recruitment freeze in the NHS have forced ministers to revise the deadline back one year in order to benefit from record funding increases in 2007-08.
The retreat has emerged as Patricia Hewitt, the Health Secretary, prepares to outline today how œ8 billion of extra NHS funding will be spent this financial year. It is the last planned annual increase, and many NHS chiefs are already preparing for a subsequent period of drastic budgeting. There are more than 17.5 million people living with chronic conditions such as diabetes, arthritis and heart failure. The Department of Health has claimed that cuts to local hospital services could be justified by having experienced senior nurses treating these patients in or close to their homes.
But The Times has learnt that unqualified social workers, physiotherapists and less experienced staff are being used to boost the total number of "case managers" who care for the most chronically ill patients outside hospital. The department's latest estimate is that there were 1,470 community matrons working in the NHS in December, with an official NHS workforce survey suggesting that fewer than 100 were recruited last year.
The target, set by John Reid, the former Health Secretary, during Labour's "Big Conversation" in 2004, aimed to respond to patients' calls for more care nearer to their homes. Ministers claimed that the 500 million pounds community matrons' policy would soon pay for itself by saving 400 million a year through reduced hospital stays.
But Mrs Hewitt admitted yesterday that community care remained poor in some areas. Treating patients with long-term chronic conditions was the "really big challenge" facing the NHS, she said, but she made no direct admission that the target had been missed. "By March next year, 220,000 of the most needy patients will be getting support and care in their homes from 3,000 community matrons and other case managers," she added.
Josie Irwin, head of employment relations at the Royal College of Nursing, said that the figures amounted to a "spectacular failure" of a government policy.
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
He won an Oscar after taking aim at US gun culture in Bowling for Columbine and earned the Palme D'Or for giving the Bush administration both barrels in Fahrenheit 9/11. But as Michael Moore puts the US health system in the crosshairs for his latest, take-no-prisoners documentary - Sicko - the firebrand director is himself in the firing line. Not only are US Treasury officials investigating him for possibly breaking a trade embargo against Cuba during the making of the movie, which premieres at the Cannes film festival, but Moore has faced renewed scrutiny of his methods.
Manufacturing Dissent, a recent film about Moore's work, shows him twisting the truth and using footage out of context. Ironically the film was made by two admirers of the director, Canadians Rick Caine and Debbie Melnyk. "We agreed with his politics," said Caine, adding that they had initially set out to make a film that celebrated Moore. But they soon discovered a trail of broken promises to colleagues, exaggerations of facts, and footage used out of context.
Among the most startling revelations of the documentary is the claim that the central premise of Moore's seminal Roger and Me - that the boss of then-General Motors chairman Rogers Smith refused him an interview - is false.
Moore would not be interviewed for Manufacturing Dissent but may find it hard to evade questions at Cannes as he promotes Sicko, "a comedy about 45 million people with no health care in the richest country on Earth." Buzz around the film is guaranteed to be intense after news of the US Treasury probe, which was sparked by Moore's decision to take rescue workers from the site of 9/11's Ground Zero to Cuba for medical treatment.
The development has handed Moore a public relations bonanza on a platter as he attempts to rev up interest in the film. "The government going after Michael Moore is like Paris Hilton going to the clink: It's a brand extension," PR expert Eric Dezenhall said. "It can only help his career. It validates his shtick that he's the little guy being silenced by a large and sinister voice."
While a spokeswoman for Moore dismissed the US Treasury probe as politically motivated, Sicko's backers have already recruited a high-powered team of spin doctors to counter an expected offensive from the health industry. The Weinstein Co, which is handling Sicko, have hired political strategist Chris Lehane, a former press secretary to Al Gore and a White House spokesman during Bill Clinton's presidency, to manage the film's press campaign. The services of high-powered New York public relations consultant, Ken Sunshine, have also been retained. "If the HMOs (health-care providers) strike, I'm going to need two guys who can strike back," Harvey Weinstein told Daily Variety.
However, in a possible foretaste of things to come, the US health industry has already gone on the attack, questioning Moore's objectivity. The Pharmaceutical Research and Manufacturers of America issued a statement attacking Moore's record. "A review of America's health care system should be balanced, thoughtful and well-researched," the statement said. "You won't get that from Michael Moore. "Michael Moore is a political activist with a track record for sensationalism. He has no intention of being fair and balanced."
Source
Another big NHS shortfall
A key target in the Government's health reforms - to have thousands of community nurses treating the most seriously ill patients outside hospital - has been missed, with fewer than half the promised numbers in place. A pledge made three years ago to have 3,000 experienced nurses in post by March this year has been delayed, with social workers and less qualified staff having to make up the numbers looking after patients with chronic illnesses. Cost-cutting and a recruitment freeze in the NHS have forced ministers to revise the deadline back one year in order to benefit from record funding increases in 2007-08.
The retreat has emerged as Patricia Hewitt, the Health Secretary, prepares to outline today how œ8 billion of extra NHS funding will be spent this financial year. It is the last planned annual increase, and many NHS chiefs are already preparing for a subsequent period of drastic budgeting. There are more than 17.5 million people living with chronic conditions such as diabetes, arthritis and heart failure. The Department of Health has claimed that cuts to local hospital services could be justified by having experienced senior nurses treating these patients in or close to their homes.
But The Times has learnt that unqualified social workers, physiotherapists and less experienced staff are being used to boost the total number of "case managers" who care for the most chronically ill patients outside hospital. The department's latest estimate is that there were 1,470 community matrons working in the NHS in December, with an official NHS workforce survey suggesting that fewer than 100 were recruited last year.
The target, set by John Reid, the former Health Secretary, during Labour's "Big Conversation" in 2004, aimed to respond to patients' calls for more care nearer to their homes. Ministers claimed that the 500 million pounds community matrons' policy would soon pay for itself by saving 400 million a year through reduced hospital stays.
But Mrs Hewitt admitted yesterday that community care remained poor in some areas. Treating patients with long-term chronic conditions was the "really big challenge" facing the NHS, she said, but she made no direct admission that the target had been missed. "By March next year, 220,000 of the most needy patients will be getting support and care in their homes from 3,000 community matrons and other case managers," she added.
Josie Irwin, head of employment relations at the Royal College of Nursing, said that the figures amounted to a "spectacular failure" of a government policy.
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Wednesday, May 16, 2007
The political limits of "universal" health care
"Universal" government health care has once again returned as a political cause, with many Democrats believing it's the key to White House victory in 2008. They might want to study last week's news from Illinois, where Democratic Governor Rod Blagojevich's tax increase to finance health care became the political rout of the year. The Democratic House in Springfield killed the proposal, 107-0, after Mr. Blagojevich came out against his own idea when it became clear he was going to be humiliated. Only a month earlier he had said he was prepared to wage "the fight of the century" in defense of his plan to impose a $7.6 billion "gross receipts tax" on Illinois businesses.
Easily re-elected in November, the Governor used every trick in the "progressive" political playbook to sell his proposal. Instead of a general tax increase, he claimed it would be "targeted" for universal health care and education. Instead of raising individual taxes, he aimed at business and even built in an exemption for smaller firms. "These corporate guys, they can't avoid this tax," declared the Governor, sounding one of the "populist" themes that liberal columnists are now recommending for national Democrats.
Mr. Blagojevich also pitched his plan as a moral imperative, unveiling it while standing in the Fourth Presbyterian Church in Chicago and saying it was necessary to force businesses to pay their "fair" share of the tax burden. He wanted to force most employers to offer health insurance or pay a 3% payroll tax. Liberal special interest groups--including the state AFL-CIO and the Illinois Education Association--initially supported him.
But a funny thing happened on this road to Canadian health care. The state's more rational Democrats revolted, arguing it would drive businesses out of Illinois. Chicago Mayor Richard Daley was an early opponent, and Democratic Lieutenant Governor Patrick Quinn was cool to it. House Speaker Michael Madigan very publicly withheld his support and last week came out against the tax hike.
As tax increases go, this was one of the worst. A "gross receipts tax" is popular with politicians because it applies to every dollar of company revenue, not merely on profits, or on final sales the way a retail sales tax does. But this means the tax tends to hit hardest those small and medium-sized businesses that have healthy sales volumes but narrow profit margins. The tax is a huge revenue-raiser but can also be a job killer.
Mr. Blagojevich tried to soften this impact by creating an exemption for business with annual revenues of less than $5 million. But even with that exemption, retailers would feel the squeeze from the higher cost of goods. And because the tax applies to all business transactions, it creates what economists call a "pyramiding" effect that has a damaging overall economic impact.
The Tax Foundation estimated that Mr. Blagojevich's proposal would have been the largest state tax hike in the last decade, as a share of state general fund revenue--at 27% nearly double the next closest, which was Nevada's 14% increase in 2004. In per capita terms, the tax hike would average about $550 per Illinois resident.
All of this piled on top of the $1.5 billion in new taxes and fees that the Governor imposed in his first term. State revenue has been rising at a respectable 5% annual pace, but spending is rising faster. Jonathan Williams of the Tax Foundation says the Governor's proposed budget this year calls for a 13.2% spending increase, which comes on top of a near double digit increase a year ago. The cumulative impact of this rising tax and spending burden has been to drive businesses out of the state.
"To describe every major CEO in Illinois as fat cats is a mistake," said Chicago Mayor Daley. "They don't have to be here. They can go to Wisconsin. They can go to Indiana. They can go to India. They can go to China. So if you want to beat up businesses, go beat 'em up, and when they leave, just wave to 'em and they're going to wave back to you." Even Jesse Jackson disowned the Governor's plan, noting that "We all want health care. But business closer is not good health."
One lesson here is that it is far easier to talk about "progressive" political causes than to pay for them without doing larger economic harm. In today's global economy, the margin for policy mistakes is smaller, even for individual states. Mr. Daley may appreciate this better than Mr. Blagojevich because he knows the consequences of bad policy will harm Chicago long after the Governor retires to private equity, or some other "fat cat" job.
As for national Democrats, Presidential candidate John Edwards has already proposed a huge tax increase to pay for national health care. At least he's honest about what such promises require, but we doubt it will help his Presidential prospects. Illinois Senator Barack Obama has been silent on his Governor's tax implosion, but someone should get him on the record. And Hillary Clinton, well, we can't wait to see how "universal" her promises will be.
Source
Empowering patients: New Labour's unhealthiest idea?
Everyone slates Blair for Iraq while praising his health reforms. Yet his interventions in the NHS have alienated patients and degraded doctors
After Tony Blair's lip-trembling resignation speech, commentators were inclined to give him credit for his public sector reforms while questioning his judgement over Iraq. But New Labour's widely approved `patient-centred' reforms are a real threat to the quality of healthcare in Britain.
When, a week earlier, Blair visited the offices of the King's Fund, New Labour's favourite health policy think tank, to give a speech commemorating a decade of National Health Service reforms, he received a generally positive response from the assembled ranks of health experts and professionals (1). King's Fund chief executive Niall Dickson set the tone in his congratulations to the prime minister on the eve of his departure for providing `unprecedented levels of funding' and `significant improvements in key areas'. Though there were some reservations about disruptive reorganisations, there was general agreement that New Labour reforms have succeeded in their key objective of making the NHS more responsive to patients. While the soundbites about `patient-centred' healthcare may appear merely banal, they reflect the corrosive cynicism of New Labour that is Tony Blair's true legacy to the NHS.
Speaking to the King's Fund conference immediately before the prime minister, David Pink, chief executive of the Long Term Medical Conditions Alliance, a consortium of more than 100 patient organisations, welcomed the government's commitment to a `patient-centred' NHS. As Pink acknowledged, the very presence on such a distinguished platform of somebody speaking from the perspective of patients was a potent symbol of the transformation of health policy under Blair. He enthusiastically endorsed a number of initiatives that, while purporting to advance patient interests, reveal the destructive consequences of the government's attempts to reform healthcare according to the rhetoric of choice and empowerment.
While many commentators have criticised the Quality and Outcomes Framework (QOF) as a crude target-driven payment-by-results system imposed on general practice, Pink welcomed `a major national programme that has turned the NHS's attention to helping people monitor and maintain their own health'. In practice, QOF operates as a financial lever to shift medical practice away from the diagnosis and treatment of disease towards intrusive and moralising interventions in patients' personal lives, justified by the dogma that this improves health and prevents disease. Far from benefiting those with chronic conditions, this shift is depriving them of continuity of care while doctors' energies are consumed with medicalising the worried well. The provision of an incentive bonus to GPs for recording patients' preferences about where they would like to die - a choice over which neither patient nor doctor is in practice able to exert much influence - aptly symbolises QOF's contribution to patient empowerment (2).
Another New Labour health initiative approved by David Pink is the Expert Patient Programme, a series of formal training sessions through which people learn to manage their own chronic illnesses. (As, according to the Long Term Medical Conditions Alliance, there are some 17million people with such conditions in Britain, at least one in four of the population is deemed eligible for this programme - though only 23,000 have so far participated.) For Pink, `the great significance of this programme is that it is an acknowledgement of the vital role that patients and their families have in improving their own health' - and he welcomed the support of the British Medical Association for the programme.
Though the Expert Patient Programme (EPP) has a commonsensical appeal, it is imbued with bad faith: it offers an illusory empowerment to patients with chronic illness and an illusory relief from the burden of caring for patients with chronic illness to doctors (3). If the EPP was widely taken up, it would affirm an identity as sufferer from chronic illness for a growing proportion of the population while imposing an increasing burden of responsibility for their own care on those with chronic disease. While patronising patients, EPP implicitly degrades doctors, devaluing medical science and professional expertise. Who benefits? Not patients, not doctors, not society; perhaps a few politicians and health policy bureaucrats.
David Pink is also a staunch advocate of `patient and public involvement' in the NHS, another of the favoured slogans of New Labour. Given the `democratic deficit' resulting from the decline in popular participation in political parties, local councils and elections, the government has sought to increase public involvement in many areas of public life, from the arts to schools to hospitals. Such initiatives inevitably have an artificial and bureaucratic character, particularly in the sphere of healthcare, which people - at least in the past - sought to avoid when they were well and to keep to a minimum when they were sick.
New Labour's promotion of `patient and public involvement' has led to the cultivation of the professional patient (together with the professional carer) who purports to express the interests of patients (and carers) in general. Of course, members of the public who are able and willing to assume these roles are inevitably unrepresentative of patients and carers in general - and, unlike local councillors and MPs, are not subject even to the episodic recall of the ballot box and hence are under no obligation or even pressure to reflect the interests of those they purport to represent.
In his enthusiasm for `patient and public involvement' David Pink personifies the defects of these initiatives. While he speaks on behalf of people with chronic illnesses to top politicians and policymakers, he was not elected by people with chronic illnesses and he is in no way answerable or accountable to them. Indeed, as the chief executive of a meta-quango, which strictly represents a number of organisations (also unrepresentative and unaccountable) rather than individuals with chronic illnesses, he is as remote from such individuals as any politician (and vastly more remote than the average GP). In fact, what emerges is that his status at the King's Fund assembly of health policymakers is conferred by government endorsement of his position rather than by any democratic mandate.
It is thus perhaps not surprising to find that, of all the assembled dignitaries, he provides the perfect warm-up man for Tony Blair on his tenth anniversary celebrations.
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
"Universal" government health care has once again returned as a political cause, with many Democrats believing it's the key to White House victory in 2008. They might want to study last week's news from Illinois, where Democratic Governor Rod Blagojevich's tax increase to finance health care became the political rout of the year. The Democratic House in Springfield killed the proposal, 107-0, after Mr. Blagojevich came out against his own idea when it became clear he was going to be humiliated. Only a month earlier he had said he was prepared to wage "the fight of the century" in defense of his plan to impose a $7.6 billion "gross receipts tax" on Illinois businesses.
Easily re-elected in November, the Governor used every trick in the "progressive" political playbook to sell his proposal. Instead of a general tax increase, he claimed it would be "targeted" for universal health care and education. Instead of raising individual taxes, he aimed at business and even built in an exemption for smaller firms. "These corporate guys, they can't avoid this tax," declared the Governor, sounding one of the "populist" themes that liberal columnists are now recommending for national Democrats.
Mr. Blagojevich also pitched his plan as a moral imperative, unveiling it while standing in the Fourth Presbyterian Church in Chicago and saying it was necessary to force businesses to pay their "fair" share of the tax burden. He wanted to force most employers to offer health insurance or pay a 3% payroll tax. Liberal special interest groups--including the state AFL-CIO and the Illinois Education Association--initially supported him.
But a funny thing happened on this road to Canadian health care. The state's more rational Democrats revolted, arguing it would drive businesses out of Illinois. Chicago Mayor Richard Daley was an early opponent, and Democratic Lieutenant Governor Patrick Quinn was cool to it. House Speaker Michael Madigan very publicly withheld his support and last week came out against the tax hike.
As tax increases go, this was one of the worst. A "gross receipts tax" is popular with politicians because it applies to every dollar of company revenue, not merely on profits, or on final sales the way a retail sales tax does. But this means the tax tends to hit hardest those small and medium-sized businesses that have healthy sales volumes but narrow profit margins. The tax is a huge revenue-raiser but can also be a job killer.
Mr. Blagojevich tried to soften this impact by creating an exemption for business with annual revenues of less than $5 million. But even with that exemption, retailers would feel the squeeze from the higher cost of goods. And because the tax applies to all business transactions, it creates what economists call a "pyramiding" effect that has a damaging overall economic impact.
The Tax Foundation estimated that Mr. Blagojevich's proposal would have been the largest state tax hike in the last decade, as a share of state general fund revenue--at 27% nearly double the next closest, which was Nevada's 14% increase in 2004. In per capita terms, the tax hike would average about $550 per Illinois resident.
All of this piled on top of the $1.5 billion in new taxes and fees that the Governor imposed in his first term. State revenue has been rising at a respectable 5% annual pace, but spending is rising faster. Jonathan Williams of the Tax Foundation says the Governor's proposed budget this year calls for a 13.2% spending increase, which comes on top of a near double digit increase a year ago. The cumulative impact of this rising tax and spending burden has been to drive businesses out of the state.
"To describe every major CEO in Illinois as fat cats is a mistake," said Chicago Mayor Daley. "They don't have to be here. They can go to Wisconsin. They can go to Indiana. They can go to India. They can go to China. So if you want to beat up businesses, go beat 'em up, and when they leave, just wave to 'em and they're going to wave back to you." Even Jesse Jackson disowned the Governor's plan, noting that "We all want health care. But business closer is not good health."
One lesson here is that it is far easier to talk about "progressive" political causes than to pay for them without doing larger economic harm. In today's global economy, the margin for policy mistakes is smaller, even for individual states. Mr. Daley may appreciate this better than Mr. Blagojevich because he knows the consequences of bad policy will harm Chicago long after the Governor retires to private equity, or some other "fat cat" job.
As for national Democrats, Presidential candidate John Edwards has already proposed a huge tax increase to pay for national health care. At least he's honest about what such promises require, but we doubt it will help his Presidential prospects. Illinois Senator Barack Obama has been silent on his Governor's tax implosion, but someone should get him on the record. And Hillary Clinton, well, we can't wait to see how "universal" her promises will be.
Source
Empowering patients: New Labour's unhealthiest idea?
Everyone slates Blair for Iraq while praising his health reforms. Yet his interventions in the NHS have alienated patients and degraded doctors
After Tony Blair's lip-trembling resignation speech, commentators were inclined to give him credit for his public sector reforms while questioning his judgement over Iraq. But New Labour's widely approved `patient-centred' reforms are a real threat to the quality of healthcare in Britain.
When, a week earlier, Blair visited the offices of the King's Fund, New Labour's favourite health policy think tank, to give a speech commemorating a decade of National Health Service reforms, he received a generally positive response from the assembled ranks of health experts and professionals (1). King's Fund chief executive Niall Dickson set the tone in his congratulations to the prime minister on the eve of his departure for providing `unprecedented levels of funding' and `significant improvements in key areas'. Though there were some reservations about disruptive reorganisations, there was general agreement that New Labour reforms have succeeded in their key objective of making the NHS more responsive to patients. While the soundbites about `patient-centred' healthcare may appear merely banal, they reflect the corrosive cynicism of New Labour that is Tony Blair's true legacy to the NHS.
Speaking to the King's Fund conference immediately before the prime minister, David Pink, chief executive of the Long Term Medical Conditions Alliance, a consortium of more than 100 patient organisations, welcomed the government's commitment to a `patient-centred' NHS. As Pink acknowledged, the very presence on such a distinguished platform of somebody speaking from the perspective of patients was a potent symbol of the transformation of health policy under Blair. He enthusiastically endorsed a number of initiatives that, while purporting to advance patient interests, reveal the destructive consequences of the government's attempts to reform healthcare according to the rhetoric of choice and empowerment.
While many commentators have criticised the Quality and Outcomes Framework (QOF) as a crude target-driven payment-by-results system imposed on general practice, Pink welcomed `a major national programme that has turned the NHS's attention to helping people monitor and maintain their own health'. In practice, QOF operates as a financial lever to shift medical practice away from the diagnosis and treatment of disease towards intrusive and moralising interventions in patients' personal lives, justified by the dogma that this improves health and prevents disease. Far from benefiting those with chronic conditions, this shift is depriving them of continuity of care while doctors' energies are consumed with medicalising the worried well. The provision of an incentive bonus to GPs for recording patients' preferences about where they would like to die - a choice over which neither patient nor doctor is in practice able to exert much influence - aptly symbolises QOF's contribution to patient empowerment (2).
Another New Labour health initiative approved by David Pink is the Expert Patient Programme, a series of formal training sessions through which people learn to manage their own chronic illnesses. (As, according to the Long Term Medical Conditions Alliance, there are some 17million people with such conditions in Britain, at least one in four of the population is deemed eligible for this programme - though only 23,000 have so far participated.) For Pink, `the great significance of this programme is that it is an acknowledgement of the vital role that patients and their families have in improving their own health' - and he welcomed the support of the British Medical Association for the programme.
Though the Expert Patient Programme (EPP) has a commonsensical appeal, it is imbued with bad faith: it offers an illusory empowerment to patients with chronic illness and an illusory relief from the burden of caring for patients with chronic illness to doctors (3). If the EPP was widely taken up, it would affirm an identity as sufferer from chronic illness for a growing proportion of the population while imposing an increasing burden of responsibility for their own care on those with chronic disease. While patronising patients, EPP implicitly degrades doctors, devaluing medical science and professional expertise. Who benefits? Not patients, not doctors, not society; perhaps a few politicians and health policy bureaucrats.
David Pink is also a staunch advocate of `patient and public involvement' in the NHS, another of the favoured slogans of New Labour. Given the `democratic deficit' resulting from the decline in popular participation in political parties, local councils and elections, the government has sought to increase public involvement in many areas of public life, from the arts to schools to hospitals. Such initiatives inevitably have an artificial and bureaucratic character, particularly in the sphere of healthcare, which people - at least in the past - sought to avoid when they were well and to keep to a minimum when they were sick.
New Labour's promotion of `patient and public involvement' has led to the cultivation of the professional patient (together with the professional carer) who purports to express the interests of patients (and carers) in general. Of course, members of the public who are able and willing to assume these roles are inevitably unrepresentative of patients and carers in general - and, unlike local councillors and MPs, are not subject even to the episodic recall of the ballot box and hence are under no obligation or even pressure to reflect the interests of those they purport to represent.
In his enthusiasm for `patient and public involvement' David Pink personifies the defects of these initiatives. While he speaks on behalf of people with chronic illnesses to top politicians and policymakers, he was not elected by people with chronic illnesses and he is in no way answerable or accountable to them. Indeed, as the chief executive of a meta-quango, which strictly represents a number of organisations (also unrepresentative and unaccountable) rather than individuals with chronic illnesses, he is as remote from such individuals as any politician (and vastly more remote than the average GP). In fact, what emerges is that his status at the King's Fund assembly of health policymakers is conferred by government endorsement of his position rather than by any democratic mandate.
It is thus perhaps not surprising to find that, of all the assembled dignitaries, he provides the perfect warm-up man for Tony Blair on his tenth anniversary celebrations.
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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Tuesday, May 15, 2007
NHS RADIOTHERAPY FAILURE
Cancer patients are being systematically let down by the radiotherapy services in England, a damning government report concludes. Lengthy waits and huge variations in service from place to place mean that tens of thousands of patients every year are receiving substandard service, reducing their chances of survival. The report to ministers from a top-level committee, whose broad conclusions were first revealed in The Times last month, calls for urgent action. "Unless action is taken without delay, the Government will lose the opportunity to save lives, and services in this country will fall further behind those of other comparable countries" the National Radiotherapy Advisory Group says.
The NHS delivers 1.5 million courses of treatment every year, when the optimum would be 2.5 million, the report says. Variations between areas are said to be "unacceptable", with the best-served areas delivering two and a half times as many courses as the worst. But it does not specify which areas are bad and which less bad.
Karol Sikora, a cancer specialist, said: "The report shows how bad things really are, but disguises just how bad the local gaps in services are. These areas which have fallen behind must be named too in order to target improvements." Since 1997 the Government has invested more money in radiotherapy, but even this increase has fallen far short. The problems arise from miscalculations made 15 to 20 years ago, when the need for radiotherapy was significantly underestimated.
It was wrongly believed that radiotherapy would not have a key role to play in future cancer treatments and that demand for it would fall. This was a gross misjudgment, as demand has increased and will continue to increase as the population ages. Radiation treatments involve large doses given by linear accelerators, given in a series of smaller doses to reduce injury to healthy tissue. Typically, an entire course might comprise 15 to 40 treatments. The most productive centres deliver more than 10,000 courses per linear accelerator (linac) per year, the least productive only about 5,000.
The report calls for a target of at least 8,000 courses a year immediately, and 8,300 a year by 2010-11. Linacs should be kept running nine hours a day on average, with some running for as long as 11.5 hours a day. They should be operated year-round, including Bank Holidays (with the exception of Christmas Day, Boxing Day, and one day at Easter), and include some treatments on Saturdays. But the report rules out seven-day working because there are insufficient staff and patients may be reluctant.
Michael Williams, Vice-President of the Royal College of Radiologists, and co-chair-man of the advisory group, said: "Radiotherapy is one of the most effective cancer treatments available, but the UK has fallen short in its provision. "This is the main finding of a second report published in the current issue of the journal Clinical Oncology. The research confirms that substantially less radiotherapy is given in the UK than is standard practice elsewhere in Europe and the USA."
Professor Janet Husband, president of the college, said, "The report will be extremely valuable in determining future development and in building on the substantial investment in modern equipment achieved as part of the Cancer Plan."
Source
NHS DOCTOR-TRAINING MELTDOWN CONTINUES
An emergency review of the appointments system for junior doctors is being dominated by government apparatchiks, leading doctors claim in a letter to The Times today. The system and attempts to rescue it are a fiasco, write Morris Brown, Professor of Clinical Pharmacology at Cambridge, and more than a dozen leading specialists, as doctors prepare to challenge the outcome of the review in court. The hearing, which begins on Wednesday, will seek to have the computer-based Medical Training Application System (MTAS) declared so unfair as to be an abuse of power. It is expected to take two days. Victory for the doctors would leave the Department of Health, which has apologised for the debacle, in confusion.
In their letter to The Times, Professor Brown and colleagues say that MTAS has so far failed every task, and the review set up to rescue it “has become top-heavy with DoH apparatchiks”. The issue, in the Times letter and later today in court, is whether it is fair to allow doctors in England, who have already spent ten years training, a single interview to determine their futures. There are about 32,000 junior doctors applying for about 20,000 posts, which they will take up in August. Nobody knows the exact figures, nor how many of the applicants come from outside the UK. The doctors are mostly in their mid to late20s, and are applying for “run-through” training posts lasting five years, which would end with them ready to apply for jobs as consultants. Hospitals that pick the wrong applicants will be stuck with them for five years, so finding the right ones is crucial.
Applicants who fail to get a run-through post will not necessarily be unemployed but their careers will stall. To get a doctor to this stage costs the state 250,000 pounds in education and training costs. The potential losses would easily exceed 1 billion if, say, 5,000 UK-trained applicants gave up medicine or decided to go abroad. One official, who did wish to be named, blamed the department for a failure to match the expansion of medical schools to an equivalent growth in training posts.
This year, the difficulties are compounded by a failed attempt by the department to exclude foreign graduates. Under European law it cannot exclude EU graduates, but relatively few of them apply. The key is graduates from outside the EU, traditionally one of the mainstays of the NHS. The department attempted to cut off these applicants by saying they would need work permits. A challenge in court by the British Association of Physicians of Indian Origin (BAPIO) was rejected, but leave to appeal was granted. Pending the result of that appeal, the department was forced to allow nonEU doctors to apply in the first round of selection.
Thousands more found another way round, by joining the “highly skilled migrant” programme. They qualified for that by virtue of already working in the NHS as, for example, senior house officers. As a result, it is estimated that between 10,000 and 11,000 of the applicants for the 20,000 posts originate from outside the UK and Europe, maybe half of them through the highly skilled migrants programme. Nobody knows quite how many, nor do the application forms enable hospitals to distinguish home from foreign applicants.
So who is in charge? “Nobody is,” said the official who spoke to The Times. “The system was developed in isolation from workforce planning. So it was impossible to find any one person who would ask: ‘Will this work?’ .” RemedyUK, the pressure group bringing the action, hopes the court will say the process is unlawful, but expects a solution to require negotiation.
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Cancer patients are being systematically let down by the radiotherapy services in England, a damning government report concludes. Lengthy waits and huge variations in service from place to place mean that tens of thousands of patients every year are receiving substandard service, reducing their chances of survival. The report to ministers from a top-level committee, whose broad conclusions were first revealed in The Times last month, calls for urgent action. "Unless action is taken without delay, the Government will lose the opportunity to save lives, and services in this country will fall further behind those of other comparable countries" the National Radiotherapy Advisory Group says.
The NHS delivers 1.5 million courses of treatment every year, when the optimum would be 2.5 million, the report says. Variations between areas are said to be "unacceptable", with the best-served areas delivering two and a half times as many courses as the worst. But it does not specify which areas are bad and which less bad.
Karol Sikora, a cancer specialist, said: "The report shows how bad things really are, but disguises just how bad the local gaps in services are. These areas which have fallen behind must be named too in order to target improvements." Since 1997 the Government has invested more money in radiotherapy, but even this increase has fallen far short. The problems arise from miscalculations made 15 to 20 years ago, when the need for radiotherapy was significantly underestimated.
It was wrongly believed that radiotherapy would not have a key role to play in future cancer treatments and that demand for it would fall. This was a gross misjudgment, as demand has increased and will continue to increase as the population ages. Radiation treatments involve large doses given by linear accelerators, given in a series of smaller doses to reduce injury to healthy tissue. Typically, an entire course might comprise 15 to 40 treatments. The most productive centres deliver more than 10,000 courses per linear accelerator (linac) per year, the least productive only about 5,000.
The report calls for a target of at least 8,000 courses a year immediately, and 8,300 a year by 2010-11. Linacs should be kept running nine hours a day on average, with some running for as long as 11.5 hours a day. They should be operated year-round, including Bank Holidays (with the exception of Christmas Day, Boxing Day, and one day at Easter), and include some treatments on Saturdays. But the report rules out seven-day working because there are insufficient staff and patients may be reluctant.
Michael Williams, Vice-President of the Royal College of Radiologists, and co-chair-man of the advisory group, said: "Radiotherapy is one of the most effective cancer treatments available, but the UK has fallen short in its provision. "This is the main finding of a second report published in the current issue of the journal Clinical Oncology. The research confirms that substantially less radiotherapy is given in the UK than is standard practice elsewhere in Europe and the USA."
Professor Janet Husband, president of the college, said, "The report will be extremely valuable in determining future development and in building on the substantial investment in modern equipment achieved as part of the Cancer Plan."
Source
NHS DOCTOR-TRAINING MELTDOWN CONTINUES
An emergency review of the appointments system for junior doctors is being dominated by government apparatchiks, leading doctors claim in a letter to The Times today. The system and attempts to rescue it are a fiasco, write Morris Brown, Professor of Clinical Pharmacology at Cambridge, and more than a dozen leading specialists, as doctors prepare to challenge the outcome of the review in court. The hearing, which begins on Wednesday, will seek to have the computer-based Medical Training Application System (MTAS) declared so unfair as to be an abuse of power. It is expected to take two days. Victory for the doctors would leave the Department of Health, which has apologised for the debacle, in confusion.
In their letter to The Times, Professor Brown and colleagues say that MTAS has so far failed every task, and the review set up to rescue it “has become top-heavy with DoH apparatchiks”. The issue, in the Times letter and later today in court, is whether it is fair to allow doctors in England, who have already spent ten years training, a single interview to determine their futures. There are about 32,000 junior doctors applying for about 20,000 posts, which they will take up in August. Nobody knows the exact figures, nor how many of the applicants come from outside the UK. The doctors are mostly in their mid to late20s, and are applying for “run-through” training posts lasting five years, which would end with them ready to apply for jobs as consultants. Hospitals that pick the wrong applicants will be stuck with them for five years, so finding the right ones is crucial.
Applicants who fail to get a run-through post will not necessarily be unemployed but their careers will stall. To get a doctor to this stage costs the state 250,000 pounds in education and training costs. The potential losses would easily exceed 1 billion if, say, 5,000 UK-trained applicants gave up medicine or decided to go abroad. One official, who did wish to be named, blamed the department for a failure to match the expansion of medical schools to an equivalent growth in training posts.
This year, the difficulties are compounded by a failed attempt by the department to exclude foreign graduates. Under European law it cannot exclude EU graduates, but relatively few of them apply. The key is graduates from outside the EU, traditionally one of the mainstays of the NHS. The department attempted to cut off these applicants by saying they would need work permits. A challenge in court by the British Association of Physicians of Indian Origin (BAPIO) was rejected, but leave to appeal was granted. Pending the result of that appeal, the department was forced to allow nonEU doctors to apply in the first round of selection.
Thousands more found another way round, by joining the “highly skilled migrant” programme. They qualified for that by virtue of already working in the NHS as, for example, senior house officers. As a result, it is estimated that between 10,000 and 11,000 of the applicants for the 20,000 posts originate from outside the UK and Europe, maybe half of them through the highly skilled migrants programme. Nobody knows quite how many, nor do the application forms enable hospitals to distinguish home from foreign applicants.
So who is in charge? “Nobody is,” said the official who spoke to The Times. “The system was developed in isolation from workforce planning. So it was impossible to find any one person who would ask: ‘Will this work?’ .” RemedyUK, the pressure group bringing the action, hopes the court will say the process is unlawful, but expects a solution to require negotiation.
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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Monday, May 14, 2007
NHS 'failing on mixed-sex wards'
The NHS is failing to ensure all non-emergency hospital patients are kept in single-sex accommodation, the government has admitted. Campaigners say mixed-sex accommodation denies patients the chance of treatment with "privacy, respect and dignity".
Ministers were insisting as recently as November that 99% of patients were being seen in single-sex wards. But the government has now announced that 28 NHS trusts - 15% of the total - need more help achieving this. The promise to end mixed-sex accommodation was first made in the 1997 general election manifesto after Tony Blair attacked the Conservatives for failing to have "the wit" to end the practice. A target was introduced in 2000 that within two years 95% of patients would be in single-sex accommodation.
The government's definition includes separate wards or bays divided by fixed partitions, which campaigners say is not enough. Patients also needed access to single-sex toilet facilities. Departments such as intensive care and A&E do not have to fully comply for practical reasons, although they are expected to make an effort.
Last year, ministers said NHS managers had reported just 1% of patients were seen in mixed wards. But the government launched an inquiry after reports from patients and a survey by the Healthcare Commission cast doubt on the claim.
Chief nursing officer Christine Beasley, who conducted the inquiry, has now concluded the NHS had to do more to keep male and female patients separate. Her report called on all hospitals to review their practices and said 28 trusts were receiving support to change their practices because they were falling a long-way short. It did not identify how many patients were staying in mixed accommodation, although campaigners said it ran into many thousands. The report also failed to explain why NHS managers had given ministers what turned out to be incorrect information.
Professor Beasley said: "I am asking the NHS to do more to ensure that when there is no choice but to mix patients, that more safeguards are taken to ensure that privacy is maintained."
Health Secretary Patricia Hewitt said: "The NHS overall has an excellent record of treating people with dignity and respect. "However, this report shows there is clearly still more work for the NHS to do to meet our commitment to eliminate mixed-sex accommodation wherever possible."
Katherine Murphy, of the Patients Association, said: "Patients have a right to be treated in a safe environment with privacy, respect and dignity. "Patients continue to complain and for years politicians have promised to rectify this problem. "After more than 10 years of promises broken by a succession of ministers, it is time for action."
The Patient Forums organisation said a survey it carried out of 2,500 patients in March this year found 25% had shared a ward or bay with members of the opposite sex. Chair Jacquie Pearce-Gervis said: "We would like to see an eradication of mixed sex wards in order for all patients to spend their time in hospital recovering and not worrying that their dignity or privacy could be compromised."
Shadow health secretary Andrew Lansley accused the government of trying to bury bad news by publishing the report on the day Tony Blair was expected to announce his resignation. "Labour will never learn that the public are fed up with their style of government instead of dealing with the problems being faced by patients."
Source
Cancer, and good and bad arguments against socialized medicine
Post lifted from Tiger Hawk . See the original for links
Captain Ed declared today that "US healthcare saves more lives than socialized medicine." Maybe it does, and maybe it doesn't. I'm quite sure, though, that Ed's evidence -- a recent study that shows a correlation between the availability of certain anti-cancer drugs and survival rates in more than 60 countries -- does not necessarily support the proposition in the title of Ed's post. The Anchoress, bless her soul, is no closer to the target with her headline: "US Cancer Care 10X better than socialized UK."
There are a number of obvious objections to these post titles and the underlying claims made for them, but the most devestating one is this: It hardly matters if cancer cure rates are higher in the United States if we also have higher rates of advanced stage cancer because of other aspects in our health care system, such as infrequent or non-existent screening for an unfortunately large proportion of the population. Sure, we may cure more cancers than those parlor pinks in Europe, but perhaps we have more cancers to cure because we do a poorer job of detecting precancerous changes when they can be treated without drugs. Now, I don't know that any of the foregoing is true -- although I suspect it is -- but one cannot determine from Ed's post or the underlying links whether it isn't true. The conclusion in the post heading is therefore a leap of faith rather than a bankable conclusion.
That said, there are versions of socialized medicine that raise troubling questions that are quite independent from "collective" public health outcomes. First, better collective results do not necessarily make for a more just system. A socialized single-payer system might, for example, decide that it was wasting money on too-frequent screening of women for cervical cancer at the cost of, say, insufficient "well baby" care. A bureaucratic decision to shift resources from the first to the second might save the lives of more children than the lives lost to undetected cervical cancer, and so result in a "better" public health outcome. That collective victory, however, would be cold comfort to the dying woman who would have elected more frequent Pap smears but was not allowed even to pay for them out of her own pocket (for fear of creating an alternative private system for "the rich"). A rigid single-payer system does not allow for different appetites for risk -- those judgments become "social," rather than individual. That forced substitution of bureaucratic decision for individual choice is itself dehumanizing, whether socialists admit it or not.
Second, the supporters of hard single-payer systems completely ignore the rights -- yes, I mean the rights -- of physicians and other healthcare providers. Extra: TigerHawk points to the first reader who identifies the author and context of this quotation:
"I quit when medicine was placed under State control, some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected tot he privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything -- except the desires of the doctors. Men considered only the 'welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only 'to serve.' That a man who's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards -- never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind -- yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it -- and still less safe, if he is the sort who doesn't."
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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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
The NHS is failing to ensure all non-emergency hospital patients are kept in single-sex accommodation, the government has admitted. Campaigners say mixed-sex accommodation denies patients the chance of treatment with "privacy, respect and dignity".
Ministers were insisting as recently as November that 99% of patients were being seen in single-sex wards. But the government has now announced that 28 NHS trusts - 15% of the total - need more help achieving this. The promise to end mixed-sex accommodation was first made in the 1997 general election manifesto after Tony Blair attacked the Conservatives for failing to have "the wit" to end the practice. A target was introduced in 2000 that within two years 95% of patients would be in single-sex accommodation.
The government's definition includes separate wards or bays divided by fixed partitions, which campaigners say is not enough. Patients also needed access to single-sex toilet facilities. Departments such as intensive care and A&E do not have to fully comply for practical reasons, although they are expected to make an effort.
Last year, ministers said NHS managers had reported just 1% of patients were seen in mixed wards. But the government launched an inquiry after reports from patients and a survey by the Healthcare Commission cast doubt on the claim.
Chief nursing officer Christine Beasley, who conducted the inquiry, has now concluded the NHS had to do more to keep male and female patients separate. Her report called on all hospitals to review their practices and said 28 trusts were receiving support to change their practices because they were falling a long-way short. It did not identify how many patients were staying in mixed accommodation, although campaigners said it ran into many thousands. The report also failed to explain why NHS managers had given ministers what turned out to be incorrect information.
Professor Beasley said: "I am asking the NHS to do more to ensure that when there is no choice but to mix patients, that more safeguards are taken to ensure that privacy is maintained."
Health Secretary Patricia Hewitt said: "The NHS overall has an excellent record of treating people with dignity and respect. "However, this report shows there is clearly still more work for the NHS to do to meet our commitment to eliminate mixed-sex accommodation wherever possible."
Katherine Murphy, of the Patients Association, said: "Patients have a right to be treated in a safe environment with privacy, respect and dignity. "Patients continue to complain and for years politicians have promised to rectify this problem. "After more than 10 years of promises broken by a succession of ministers, it is time for action."
The Patient Forums organisation said a survey it carried out of 2,500 patients in March this year found 25% had shared a ward or bay with members of the opposite sex. Chair Jacquie Pearce-Gervis said: "We would like to see an eradication of mixed sex wards in order for all patients to spend their time in hospital recovering and not worrying that their dignity or privacy could be compromised."
Shadow health secretary Andrew Lansley accused the government of trying to bury bad news by publishing the report on the day Tony Blair was expected to announce his resignation. "Labour will never learn that the public are fed up with their style of government instead of dealing with the problems being faced by patients."
Source
Cancer, and good and bad arguments against socialized medicine
Post lifted from Tiger Hawk . See the original for links
Captain Ed declared today that "US healthcare saves more lives than socialized medicine." Maybe it does, and maybe it doesn't. I'm quite sure, though, that Ed's evidence -- a recent study that shows a correlation between the availability of certain anti-cancer drugs and survival rates in more than 60 countries -- does not necessarily support the proposition in the title of Ed's post. The Anchoress, bless her soul, is no closer to the target with her headline: "US Cancer Care 10X better than socialized UK."
There are a number of obvious objections to these post titles and the underlying claims made for them, but the most devestating one is this: It hardly matters if cancer cure rates are higher in the United States if we also have higher rates of advanced stage cancer because of other aspects in our health care system, such as infrequent or non-existent screening for an unfortunately large proportion of the population. Sure, we may cure more cancers than those parlor pinks in Europe, but perhaps we have more cancers to cure because we do a poorer job of detecting precancerous changes when they can be treated without drugs. Now, I don't know that any of the foregoing is true -- although I suspect it is -- but one cannot determine from Ed's post or the underlying links whether it isn't true. The conclusion in the post heading is therefore a leap of faith rather than a bankable conclusion.
That said, there are versions of socialized medicine that raise troubling questions that are quite independent from "collective" public health outcomes. First, better collective results do not necessarily make for a more just system. A socialized single-payer system might, for example, decide that it was wasting money on too-frequent screening of women for cervical cancer at the cost of, say, insufficient "well baby" care. A bureaucratic decision to shift resources from the first to the second might save the lives of more children than the lives lost to undetected cervical cancer, and so result in a "better" public health outcome. That collective victory, however, would be cold comfort to the dying woman who would have elected more frequent Pap smears but was not allowed even to pay for them out of her own pocket (for fear of creating an alternative private system for "the rich"). A rigid single-payer system does not allow for different appetites for risk -- those judgments become "social," rather than individual. That forced substitution of bureaucratic decision for individual choice is itself dehumanizing, whether socialists admit it or not.
Second, the supporters of hard single-payer systems completely ignore the rights -- yes, I mean the rights -- of physicians and other healthcare providers. Extra: TigerHawk points to the first reader who identifies the author and context of this quotation:
"I quit when medicine was placed under State control, some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected tot he privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything -- except the desires of the doctors. Men considered only the 'welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only 'to serve.' That a man who's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards -- never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind -- yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it -- and still less safe, if he is the sort who doesn't."
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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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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Sunday, May 13, 2007
Canadian Drugs, Eh?: Washington fights over an unwanted program
Listen to Maine Sen. Olympia Snowe discuss importing drugs from Canada, and you'll hear endless happy talk about "more competitive prices," "substantial savings" and how "crucial" reimportation is to "the American consumer." What you won't hear Ms. Snowe mention much is the drug-import program of Portland, Maine.
Interesting that, since Portland was one of those cities that gained notoriety a few years back for defying federal law and setting up a Canada import program that it promised would save its thousands of city employees and their dependents a bundle on drugs. Three years in, it has attracted all of 350 participants.
That was also the flame-out fate of a statewide plan by Gov. John Baldacci to empower the Penobscot Indian Nation to build a distribution center to import price-controlled Canadian drugs for some 325,000 uninsured and underinsured Mainers. The tribe in February unceremoniously closed the program (which never got its hands on Canadian drugs, but morphed into a domestic mail-order business), having attracted just 3,000 Medicaid recipients.
Ditto, all across America. Three years ago, grandstanding governors and mayors vowed to break federal law and set up state-run drug import programs, giving millions of citizens the "opportunity" to buy cheap Canadian drugs. The media showered these souls with headlines, praised them for being on the side of poor, strapped U.S. consumers--then forgot all about it. Today, most state-import programs are on life support, while some have closed completely. Never mind all Washington's hifalutin arguments about intellectual property, free trade and safety; the overwhelming majority of Americans appear to have little use for import programs that offer few drugs at long wait times, under suspect safety conditions and with minimal savings.
All of which helps explain this week's bizarre, and highly cynical, Senate votes on drug imports. Many of the very senators who supported or co-sponsored Ms. Snowe's amendment to change federal law and allow Canadian imports hail from states that have seen their own high-profile programs wither or die. That includes Wisconsin's Herb Kohl and Russ Feingold, Missouri's Claire McCaskill and Dick Durbin of Illinois.
These folks know firsthand that Canadian imports aren't really that popular and won't save much, if any, money. But they do like what this debate offers, namely the chance to bash U.S. pharma companies and to stand with "overcharged" U.S. consumers. The votes are more a sideshow, and it explains why some senators, who publicly support the easing of drug-import laws, also voted for a poison pill that gutted Ms. Snowe's amendment on safety concerns. It isn't as if masses of Canadian drug fans will come storming down their doors.
If anything, Portland is a success compared to the more high-profile state programs that got rolling in 2004. When Illinois Gov. Rod Blagojevich introduced his I-Save-RX program, which was initially joined by neighboring Wisconsin, he dramatically declared that "the nearly 13 million people who live in Illinois and the more than five million people who live in Wisconsin will have the opportunity to save hundreds--and in some cases even thousands--of dollars each year on the high cost of their medicine." Mr. Blagoevich spent nearly $1 million in taxpayer dollars developing it, including some 500 state workers from two dozen agencies who spent 5,600 hours flacking the program.
All this caused Illinois Auditor General William Holland to get curious about just how much benefit this wonder program was producing, and last fall he issued a stunning report. Over 19 months of operation, a grand total of 3,689 Illinois residents had used the program, which equals approximately 0.02% of the population. Results from the four other participating states were even more laughably dismal. Wisconsin had 321 people use the program; Kansas 267; Missouri 460; and Vermont 217. Mr. Holland also noted that the program was, er, illegal, and that the state had failed to implement quality control.
Things haven't been much rosier for Minnesota Gov. Tim Pawlenty, a Republican who felt it expedient to throw over the U.S. drug industry in favor of a few populist headlines. Mr. Pawlenty promised in 2003 that his Minnesota RxConnect program would serve some 700,000 people. A representative from Minnesota's department of human services explained to me this week that the state (conveniently) does not break out the number of people who use its program. But according to its latest statistics, Minnesota RxConnect last month filled a total of 138 prescriptions. That's for the whole state. Programs like those in Springfield, Mass., have simply closed.
Ask program administrators why so few people use Canadian imports, and they'll give you a frank, and long, list. Many consumers are wary about safety issues. They like having a relationship with a local pharmacist, and like knowing their drugs have undergone a U.S. quality check. Many drugs aren't available: that includes anything that needs to be taken immediately (antibiotics, for instance), or specialty drugs (such as injections for diabetics, which are hard to ship). It's also the case that many chronic diseases are today managed with generics, which remain cheaper in the U.S. Those that do use import programs tend to be a very small population that take maintenance drugs, say for high blood pressure, or cholesterol.
Perhaps an even bigger point is that huge numbers of Americans don't even pay for their drugs, but rather farm out their bills to an insurer. That's even more the case now that seniors are getting their drugs through Medicare. Joseph Bruno, the former Republican minority leader in Maine's legislature and now full-time CEO of a chain of pharmacies in that state, points out that 94.5% of his customers get prescriptions paid by a third party and so aren't price-sensitive.
"This is nothing but political posturing," he says of the U.S. Senate debate. He also notes that many of the infamous "bus trips" from Maine to Canada were in fact ginned up by labor unions that wanted to elevate drug prices into a political issue, and that successfully left the false impression that Americans were falling all over themselves for Canadian meds. "If you look at the numbers, that's just not the case." Still, don't expect the political caterwauling over imports to go away any time soon. There's still too much political upside to talking up a program that few Americans really want to use.
Source
NHS Specialist stroke care 'lottery'
A third of stroke patients are still not treated in a specialist unit despite improvements in access, a national audit has shown. And fewer than half of patients receive brain imaging within 24 hours, a figure experts said was "unacceptably low". Welsh patients fare the worst with only nine specialist units in the country, the Royal College of Physicians found.
The government said it would publish a National Stroke Strategy this summer to "accelerate" the rate of improvement. Patients who receive care in a specialist unit have a 50% reduced risk of death and better long-term recovery. National guidelines published in 2001 recommend all patients are treated in a specialist unit but similar guidelines were not introduced in Wales until 2006.
The College said there had been significant improvements but some hospitals had failed to recognise that stroke patients needed "21st century care". The audit, funded by the Healthcare Commission, found the number of eligible hospitals in England with stroke units increased from 82% in 2004 to 97% in 2006. But only 28% of patients in Wales were treated in a stroke unit compared with 64% in England and 73% in Northern Ireland. Only 15% of patients are admitted to a stroke unit on the day they arrive at hospital. And although brain scans are needed to determine treatment, patients admitted on a weekend often have to wait until the next working day. Those with minor strokes who are in hospital for less than two days are least likely to have access to specialist services.
Dr Tony Rudd, chair of the Intercollegiate Stroke Network, said more than 90% of patients should be treated in stroke units. "And not to have done imaging by 24 hours is not really good enough. We need to differentiate between bleeds and blocked arteries."
He added: "The failure of the majority of hospitals in Wales to offer stroke unit care is scandalous and needs urgent action" Dr Rudd, who is also consultant in stroke medicine at St Thomas' Hospital in London, said the National Service Framework in the UK had successfully increased the number of specialist units but there still wasn't the capacity to deal with every patient.
Dr Jonathan Boyce, head of clinical audit at the Healthcare Commission, said the study showed welcome improvements. "But there is still too much variation, too many places and regions that are not responding as well as they could to minimise the harm done by this serious and common condition. "They now need to get their house in order."
Joe Korner, director of communications for The Stroke Association, added: "Stroke units can halve your chance of dying from a stroke, so it is a scandal that getting treated on one is a matter of luck or your postcode."
A spokesperson for Health and Social Services at the Welsh Assembly said the report showed stroke services in Wales needed improvement but there was a strategy in place. "Over the last year, NHS organisations in Wales have been required to develop more appropriate models of care for patients suffering with strokes. "Officials at the Welsh Assembly Government will work with the NHS to develop clear national priorities for action."
Professor Roger Boyle, national clinical director for stroke and heart disease, said the pace of improvement needed to accelerate. He said a national stroke strategy would be published for consultation this summer which will include a toolkit to help hospitals commission stroke services. He added: "I would also urge the NHS to use this report as a tool to examine how their stroke services."
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Listen to Maine Sen. Olympia Snowe discuss importing drugs from Canada, and you'll hear endless happy talk about "more competitive prices," "substantial savings" and how "crucial" reimportation is to "the American consumer." What you won't hear Ms. Snowe mention much is the drug-import program of Portland, Maine.
Interesting that, since Portland was one of those cities that gained notoriety a few years back for defying federal law and setting up a Canada import program that it promised would save its thousands of city employees and their dependents a bundle on drugs. Three years in, it has attracted all of 350 participants.
That was also the flame-out fate of a statewide plan by Gov. John Baldacci to empower the Penobscot Indian Nation to build a distribution center to import price-controlled Canadian drugs for some 325,000 uninsured and underinsured Mainers. The tribe in February unceremoniously closed the program (which never got its hands on Canadian drugs, but morphed into a domestic mail-order business), having attracted just 3,000 Medicaid recipients.
Ditto, all across America. Three years ago, grandstanding governors and mayors vowed to break federal law and set up state-run drug import programs, giving millions of citizens the "opportunity" to buy cheap Canadian drugs. The media showered these souls with headlines, praised them for being on the side of poor, strapped U.S. consumers--then forgot all about it. Today, most state-import programs are on life support, while some have closed completely. Never mind all Washington's hifalutin arguments about intellectual property, free trade and safety; the overwhelming majority of Americans appear to have little use for import programs that offer few drugs at long wait times, under suspect safety conditions and with minimal savings.
All of which helps explain this week's bizarre, and highly cynical, Senate votes on drug imports. Many of the very senators who supported or co-sponsored Ms. Snowe's amendment to change federal law and allow Canadian imports hail from states that have seen their own high-profile programs wither or die. That includes Wisconsin's Herb Kohl and Russ Feingold, Missouri's Claire McCaskill and Dick Durbin of Illinois.
These folks know firsthand that Canadian imports aren't really that popular and won't save much, if any, money. But they do like what this debate offers, namely the chance to bash U.S. pharma companies and to stand with "overcharged" U.S. consumers. The votes are more a sideshow, and it explains why some senators, who publicly support the easing of drug-import laws, also voted for a poison pill that gutted Ms. Snowe's amendment on safety concerns. It isn't as if masses of Canadian drug fans will come storming down their doors.
If anything, Portland is a success compared to the more high-profile state programs that got rolling in 2004. When Illinois Gov. Rod Blagojevich introduced his I-Save-RX program, which was initially joined by neighboring Wisconsin, he dramatically declared that "the nearly 13 million people who live in Illinois and the more than five million people who live in Wisconsin will have the opportunity to save hundreds--and in some cases even thousands--of dollars each year on the high cost of their medicine." Mr. Blagoevich spent nearly $1 million in taxpayer dollars developing it, including some 500 state workers from two dozen agencies who spent 5,600 hours flacking the program.
All this caused Illinois Auditor General William Holland to get curious about just how much benefit this wonder program was producing, and last fall he issued a stunning report. Over 19 months of operation, a grand total of 3,689 Illinois residents had used the program, which equals approximately 0.02% of the population. Results from the four other participating states were even more laughably dismal. Wisconsin had 321 people use the program; Kansas 267; Missouri 460; and Vermont 217. Mr. Holland also noted that the program was, er, illegal, and that the state had failed to implement quality control.
Things haven't been much rosier for Minnesota Gov. Tim Pawlenty, a Republican who felt it expedient to throw over the U.S. drug industry in favor of a few populist headlines. Mr. Pawlenty promised in 2003 that his Minnesota RxConnect program would serve some 700,000 people. A representative from Minnesota's department of human services explained to me this week that the state (conveniently) does not break out the number of people who use its program. But according to its latest statistics, Minnesota RxConnect last month filled a total of 138 prescriptions. That's for the whole state. Programs like those in Springfield, Mass., have simply closed.
Ask program administrators why so few people use Canadian imports, and they'll give you a frank, and long, list. Many consumers are wary about safety issues. They like having a relationship with a local pharmacist, and like knowing their drugs have undergone a U.S. quality check. Many drugs aren't available: that includes anything that needs to be taken immediately (antibiotics, for instance), or specialty drugs (such as injections for diabetics, which are hard to ship). It's also the case that many chronic diseases are today managed with generics, which remain cheaper in the U.S. Those that do use import programs tend to be a very small population that take maintenance drugs, say for high blood pressure, or cholesterol.
Perhaps an even bigger point is that huge numbers of Americans don't even pay for their drugs, but rather farm out their bills to an insurer. That's even more the case now that seniors are getting their drugs through Medicare. Joseph Bruno, the former Republican minority leader in Maine's legislature and now full-time CEO of a chain of pharmacies in that state, points out that 94.5% of his customers get prescriptions paid by a third party and so aren't price-sensitive.
"This is nothing but political posturing," he says of the U.S. Senate debate. He also notes that many of the infamous "bus trips" from Maine to Canada were in fact ginned up by labor unions that wanted to elevate drug prices into a political issue, and that successfully left the false impression that Americans were falling all over themselves for Canadian meds. "If you look at the numbers, that's just not the case." Still, don't expect the political caterwauling over imports to go away any time soon. There's still too much political upside to talking up a program that few Americans really want to use.
Source
NHS Specialist stroke care 'lottery'
A third of stroke patients are still not treated in a specialist unit despite improvements in access, a national audit has shown. And fewer than half of patients receive brain imaging within 24 hours, a figure experts said was "unacceptably low". Welsh patients fare the worst with only nine specialist units in the country, the Royal College of Physicians found.
The government said it would publish a National Stroke Strategy this summer to "accelerate" the rate of improvement. Patients who receive care in a specialist unit have a 50% reduced risk of death and better long-term recovery. National guidelines published in 2001 recommend all patients are treated in a specialist unit but similar guidelines were not introduced in Wales until 2006.
The College said there had been significant improvements but some hospitals had failed to recognise that stroke patients needed "21st century care". The audit, funded by the Healthcare Commission, found the number of eligible hospitals in England with stroke units increased from 82% in 2004 to 97% in 2006. But only 28% of patients in Wales were treated in a stroke unit compared with 64% in England and 73% in Northern Ireland. Only 15% of patients are admitted to a stroke unit on the day they arrive at hospital. And although brain scans are needed to determine treatment, patients admitted on a weekend often have to wait until the next working day. Those with minor strokes who are in hospital for less than two days are least likely to have access to specialist services.
Dr Tony Rudd, chair of the Intercollegiate Stroke Network, said more than 90% of patients should be treated in stroke units. "And not to have done imaging by 24 hours is not really good enough. We need to differentiate between bleeds and blocked arteries."
He added: "The failure of the majority of hospitals in Wales to offer stroke unit care is scandalous and needs urgent action" Dr Rudd, who is also consultant in stroke medicine at St Thomas' Hospital in London, said the National Service Framework in the UK had successfully increased the number of specialist units but there still wasn't the capacity to deal with every patient.
Dr Jonathan Boyce, head of clinical audit at the Healthcare Commission, said the study showed welcome improvements. "But there is still too much variation, too many places and regions that are not responding as well as they could to minimise the harm done by this serious and common condition. "They now need to get their house in order."
Joe Korner, director of communications for The Stroke Association, added: "Stroke units can halve your chance of dying from a stroke, so it is a scandal that getting treated on one is a matter of luck or your postcode."
A spokesperson for Health and Social Services at the Welsh Assembly said the report showed stroke services in Wales needed improvement but there was a strategy in place. "Over the last year, NHS organisations in Wales have been required to develop more appropriate models of care for patients suffering with strokes. "Officials at the Welsh Assembly Government will work with the NHS to develop clear national priorities for action."
Professor Roger Boyle, national clinical director for stroke and heart disease, said the pace of improvement needed to accelerate. He said a national stroke strategy would be published for consultation this summer which will include a toolkit to help hospitals commission stroke services. He added: "I would also urge the NHS to use this report as a tool to examine how their stroke services."
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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Saturday, May 12, 2007
US Cancer Care 10X better than socialized UK
Post lifted from The Anchoress . See the original for links
Gaius tells it:
"Seriously, do you really think socialized medicine is a good idea? Do you really believe that the code phrase "Universal Health Care" is anything but socialized medicine? Read this article from the Telegraph before you answer. Read it all the way through because the really important information is buried toward the end. Because it matters."
Gaius highlights a bit: "British cancer patients are substantially more likely to die of the disease than those in other western European countries because of poor access to the latest drugs, according to an authoritative report to be published today."
[...]
The proportion of colorectal cancer patients with access to the drug Avastin was 10 times higher in the US than it was in Europe, with the UK having a lower uptake than the European average."
It seems very strange to me that while Canada, Britain, France and the other countries with socialized health care systems find those systems in steady decline, the Democrats keep telling us that socialized medicine is the way to go. It's certainly the way to put an enormous amount of money and citizen control within the power of the Government.but will it save you're life? Not if there's a waiting list, and not if - as I suspect - availability of treatment will only be sanctioned by the government if you have lived your life by their standards. `Smith!' screamed the shrewish voice from the telescreen. `6079 Smith W.! Yes, you! Bend lower, please!
Money and power.I can't think of any other rational reason why the Democrats want to push us toward a health care system that clearly does not work.
The other thing that worries me about socialized medicine is that there is no incentive there for the best-and-the-brightest to undertake the arduous work (and heavy cost) of obtaining medical degrees, so that they can be under the power of the Government, rather than allowed to strike out on their own. Then who will be our next doctors? The second tier students? The third? Socialism too often is a showcase for mediocrity. It doesn't work. The private sector is imperfect, and there are certainly issues within our health care system that need addressing, particularly for the un-insured, but throwing us into this fresh hell is not the answer.
Maybe the answer is to help uninsured people, especially those with children, to buy into the same health insurance plan (or a reduced one, with reduced premiums) that our government employees tap into. Would that work?
Seems to me with all the big plans out there, already in existence, there should be a way for un-insured folks to participate for a manageable fee. People don't need to be "given" things - all that does is strip them of their dignity and their sense of self-pride [See comments section for an expansion of that thought - admin]. But there must be a way to include them in some sort of discounted participation. We need some new people in government, with new ideas. These tired, old ones need to be put to bed.
***************************
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Post lifted from The Anchoress . See the original for links
Gaius tells it:
"Seriously, do you really think socialized medicine is a good idea? Do you really believe that the code phrase "Universal Health Care" is anything but socialized medicine? Read this article from the Telegraph before you answer. Read it all the way through because the really important information is buried toward the end. Because it matters."
Gaius highlights a bit: "British cancer patients are substantially more likely to die of the disease than those in other western European countries because of poor access to the latest drugs, according to an authoritative report to be published today."
[...]
The proportion of colorectal cancer patients with access to the drug Avastin was 10 times higher in the US than it was in Europe, with the UK having a lower uptake than the European average."
It seems very strange to me that while Canada, Britain, France and the other countries with socialized health care systems find those systems in steady decline, the Democrats keep telling us that socialized medicine is the way to go. It's certainly the way to put an enormous amount of money and citizen control within the power of the Government.but will it save you're life? Not if there's a waiting list, and not if - as I suspect - availability of treatment will only be sanctioned by the government if you have lived your life by their standards. `Smith!' screamed the shrewish voice from the telescreen. `6079 Smith W.! Yes, you! Bend lower, please!
Money and power.I can't think of any other rational reason why the Democrats want to push us toward a health care system that clearly does not work.
The other thing that worries me about socialized medicine is that there is no incentive there for the best-and-the-brightest to undertake the arduous work (and heavy cost) of obtaining medical degrees, so that they can be under the power of the Government, rather than allowed to strike out on their own. Then who will be our next doctors? The second tier students? The third? Socialism too often is a showcase for mediocrity. It doesn't work. The private sector is imperfect, and there are certainly issues within our health care system that need addressing, particularly for the un-insured, but throwing us into this fresh hell is not the answer.
Maybe the answer is to help uninsured people, especially those with children, to buy into the same health insurance plan (or a reduced one, with reduced premiums) that our government employees tap into. Would that work?
Seems to me with all the big plans out there, already in existence, there should be a way for un-insured folks to participate for a manageable fee. People don't need to be "given" things - all that does is strip them of their dignity and their sense of self-pride [See comments section for an expansion of that thought - admin]. But there must be a way to include them in some sort of discounted participation. We need some new people in government, with new ideas. These tired, old ones need to be put to bed.
***************************
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Friday, May 11, 2007
NHS holds up cancer drugs
The UK has one of the worst records over access to cancer drugs as stark inequalities exist across the world, a Swedish study says. Researchers ranked the UK in the bottom group for its "slow and low" uptake of drugs after analysing the sales of 67 treatments in 25 countries. The US, Austria, France and Switzerland were the best, the Karolinska Institute and Stockholm School of Economics said. But the UK government said it had speeded up the drug approval process.
The researchers said getting new treatments to patients quickly and in large numbers was reflected in the survival rates. France had the highest five-year survival rate in Europe at 71% for women and 53% for men, compared to 53% and 43% in the UK respectively. The research was funded by drugs firm Roche, but independent experts said that did not invalidate the findings.
The greatest differences in uptake, measured by the proportion of patients given the drugs and how quickly they came on to the individual markets after being produced, was seen in bowel and lung cancer drugs. The US's uptake of bowel cancer treatment bevacizumab was 10 times the European average, the researchers said. In Europe the likes of France and German had higher than average use, compared to "very low" in Italy and the UK.
For lung cancer, uptake of erlotinib was 10 times higher than the European avearge in the US and three times higher in Germany. Uptake in Australia, the UK, Norway and Poland was slow.
In the UK, the first sale of breast cancer drug trastuzumab was in autumn 2000, nearly two years after it hit the market in the US and a full 12 months after it was given in Switzerland and France. Along with the UK, New Zealand, Poland, Czech Republic and South Africa were ranked at the bottom of the overall league.
Lead researcher Dr Bengt Jonsson said: "It is our hope that this report will inspire policy-makers and decision-makers to take action to address these imbalances so that access to new innovative cancer drugs does not become dependent on the patient's couintry of residence. "Cancer research continues to grow, with many new drugs and treatments expected to be introduced in the coming years. "Countries need to address urgently how they are going to accommodate newer drugs into health care systems and pay for them."
In the NHS, the National Institute for Health and Clinical Excellence (NICE) has responsibility for recommending if new drug treatments should be provided by the health service. The system has been heavily criticised because of a backlog in assessing treatments and for restricting access to them. But a Department of Health spokesman said NICE was essential in ensuring that the NHS used the most effective treatments. And he said measures had been taken to speed up the approval process for key drugs. "We are making good progress in ensuring cancer patients have access to the drugs they need. "For example draft guidance was available within two weeks of Herceptin for early breast cancer being licensed." [And the guidance was not to use it generally!]
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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The UK has one of the worst records over access to cancer drugs as stark inequalities exist across the world, a Swedish study says. Researchers ranked the UK in the bottom group for its "slow and low" uptake of drugs after analysing the sales of 67 treatments in 25 countries. The US, Austria, France and Switzerland were the best, the Karolinska Institute and Stockholm School of Economics said. But the UK government said it had speeded up the drug approval process.
The researchers said getting new treatments to patients quickly and in large numbers was reflected in the survival rates. France had the highest five-year survival rate in Europe at 71% for women and 53% for men, compared to 53% and 43% in the UK respectively. The research was funded by drugs firm Roche, but independent experts said that did not invalidate the findings.
The greatest differences in uptake, measured by the proportion of patients given the drugs and how quickly they came on to the individual markets after being produced, was seen in bowel and lung cancer drugs. The US's uptake of bowel cancer treatment bevacizumab was 10 times the European average, the researchers said. In Europe the likes of France and German had higher than average use, compared to "very low" in Italy and the UK.
For lung cancer, uptake of erlotinib was 10 times higher than the European avearge in the US and three times higher in Germany. Uptake in Australia, the UK, Norway and Poland was slow.
In the UK, the first sale of breast cancer drug trastuzumab was in autumn 2000, nearly two years after it hit the market in the US and a full 12 months after it was given in Switzerland and France. Along with the UK, New Zealand, Poland, Czech Republic and South Africa were ranked at the bottom of the overall league.
Lead researcher Dr Bengt Jonsson said: "It is our hope that this report will inspire policy-makers and decision-makers to take action to address these imbalances so that access to new innovative cancer drugs does not become dependent on the patient's couintry of residence. "Cancer research continues to grow, with many new drugs and treatments expected to be introduced in the coming years. "Countries need to address urgently how they are going to accommodate newer drugs into health care systems and pay for them."
In the NHS, the National Institute for Health and Clinical Excellence (NICE) has responsibility for recommending if new drug treatments should be provided by the health service. The system has been heavily criticised because of a backlog in assessing treatments and for restricting access to them. But a Department of Health spokesman said NICE was essential in ensuring that the NHS used the most effective treatments. And he said measures had been taken to speed up the approval process for key drugs. "We are making good progress in ensuring cancer patients have access to the drugs they need. "For example draft guidance was available within two weeks of Herceptin for early breast cancer being licensed." [And the guidance was not to use it generally!]
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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Thursday, May 10, 2007
Rethinking research funding
Dr. Jerry Avorn, a professor of medicine at Harvard Medical School, shows in his article below how full of anger at drug companies he is. Perhaps he thinks they have not given him all the presents he is entitled to. He is, however, bereft of ideas about how to improve on the present system.
He notes that, in spite of huge research efforts, new drug approvals have dropped off. He does not for a moment consider that the huge and ever-rising costs of getting a drug through the FDA approval process might have something to do with that. Leftists don't criticize bureaucracy. They LOVE bureaucracy! His solution to the problems he sees? Take money off the companies that produce the drugs -- thus making it HARDER for them to get new drugs approved!
His proposals (if we can call them that) are extremely fuzzy but he seems to think that governments can do it all! I wonder what he has in mind as an example of something that governments do well? His proposal is a simple Leftist kneejerk, untroubled by any evidence for its efficacy. It is true that governments already fund a lot of research but actually doing the research is a different matter entirely. Government business enterprises have been sold off worldwide in recent decades but dinosaur Avorn seems to want to create new ones!
THE BIOTECHNOLOGY Industry Organization is holding its annual mega meeting in Boston this week at a pivotal time in the industry's history. Medically, biotech is at the growing edge of therapeutics. Most older, conventional drug companies have become massive marketing engines with a dulled innovative edge -- only 18 new drugs were approved by the FDA in all of 2006. By contrast, many biotech companies retain their roots as research-based operations where the scientists' agenda can still compete with that of the sales department. Some of the most exciting new treatments for cancer, autoimmune diseases, and even vision loss are emerging from this creative new sector.
But amid the breakthrough findings, lavish entertainment, and self-congratulation that will fill the convention attendees' schedules this week, some important worries may not get the attention they merit. The first relates to costs. Not the cost of the luxury harbor tours and exorbitant meals that participants will enjoy in the coming days; I'm referring to what patients (or taxpayers) have to pay to get access to these wondrous discoveries.
Regimens that can cost tens of thousands of dollars a year per patient can cloud the moral judgment of those who purvey them. For example, a confluence of interests among biotech giant Amgen, for-profit dialysis centers, and kidney disease consultants seems to have led to substantial over prescribing of the company's flagship blood-building product, erythropoietin -- a lucrative practice that probably increases the risk of side effects and even death. Another dilemma: A new biotech product, Lucentis, can reverse the vision loss caused by macular degeneration, a devastating cause of blindness. But the drug costs $2,000 for each monthly injection. Many ophthalmologists are convinced that equally miraculous results could be provided to far more patients with use of a very similar biotech product, Avastin, at only $50 per dose. Yet Genentech, which makes Avastin, has not agreed to sponsor a clinical trial to study this possibility, which could also save Medicare hundreds of millions of dollars in the coming years. That's probably because Genentech makes both Lucentis and Avastin, and use of the more affordable drug would cut into the more expensive drug's expected profits.
Biotech has brought to market a number of important new cancer treatments. But pricing a lifesaving cancer regimen at over $50,000 is guaranteed to put that treatment beyond the reach of many patients. It doesn't cost anywhere near that much to produce these drugs. Rather, the industry argues that these sky-high prices are justified to fuel the expensive research it performs. But many biotech advances are heavily based on publicly funded research supported by the National Institutes of Health and by foundations. Current policies allow companies to charge whatever they want for a new drug, with no payback required for most of the indispensable, taxpayer-supported basic research that made it possible. With the federal deficit threatening to flatline the NIH budget for the first time in a generation, and venture capital speculators increasingly preferring to fund safer "late-stage" companies with nearly marketable products, savvy conventioneers this week must be worried about where the next decade's miracle cures will come from -- as we all should be.
The breathtaking five-figure prices that some biotech drugs command per course of therapy warrant a rethinking of this "trickle-down" approach to supporting science -- a strategy that amounts to the growing privatization of medical research. The example of biotech's older, flabbier siblings is not encouraging: Only about 14 cents of every dollar paid for Big Pharma's products makes its way back into research and development, according to the companies' own figures.
A safer course for the nation would be to take some of the billions the nation is paying for these expensive products and use it to rev up NIH funding, protecting the flow of scientific innovation on which new biotech products depend. The companies could then come in and do the hard work needed to bring those discoveries to market. They should be rewarded fairly, even handsomely for that important work -- but not at levels that will pauper the rest of us or the federal treasury. And we need a better way to provide reasonable compensation for the taxpayer-supported research on which breakthrough products are based. Public funding of university-based research, not extortionate drug prices, is the safest way to guarantee "the miracle cures of tomorrow." It might make for fewer luxury harbor cruises at future BIO conventions, but we can live with that.
Source
Yet another proposal about how to fix the unfixable
The NHS should be run outside politics by a board appointed by Parliament, the British Medical Association says. The NHS should have its own constitution and make clear that it cannot provide everything possible, focusing instead on core services that meet the needs of the great majority of patients most of the time, it says. These changes would prevent day-to-day political meddling and let patients know what they could expect, the BMA says in a discussion paper.
The plans arise from dissatisfaction among the medical community about the Government's reforms, James Johnson, chairman of the BMA Council said. There was "intense unhappiness" in the entire workforce, with reforms that lacked logic or coherence. Professionals had been marginalised by changes over 15-20 years, and the "constant dabbling" by politicians was dividing managers from clinicians, he said.
The recommendations envisage the NHS as an organisation that is a cross between the BBC and an old-style nationalised industry: run by a board, reporting to Parliament, and governed by a constitution that would set out principles, rights, and responsibilities. Patient input would be strengthened by greater local involvement, the division between purchasers and providers eroded if not abolished, and clinical leadership given greater priority.
Mr Johnson, a surgeon, said that the current reforms were "probably just about as unpopular as you can get. They lack cohesion; they are contradictory. "It is absolutely right the politicians set the guidelines, but day-to-day dabbling when a particular topic becomes headlines is not good for the service," he said. For the Secretary of State to have to react to every local eventuality "can't be the best use of Cabinet ministers' time. We think the way forward is for the service to be vested in a board of governors. The Government would set the amount of money and the general direction of travel for the NHS without any further interference." The board of governors would ensure compliance with the NHS constitution. It would appoint an executive management board, to include the NHS Chief Executive and Chief Medical Officer.
Some rationing of services appeared inescapable, Mr Johnson said, as treatments became more costly and the population aged. The list of services provided should be decided through debate between politicians, professionals and the public. Hamish Meldrum, chairman of the BMA's GPs committee, said that this did not mean the association favoured rationing. "We will continue to press for all necessary resources, but we do believe rationing may be inevitable. What we are recommending, if rationing is to take place, is that it's done in an open manner."
Andy Burnham, the Health Minister, said: "We resist any call to make the NHS a slimmed-down, emergency service, because that's what it would become if we started rationing care. The NHS should continue to be comprehensive and universal. Further independence within the NHS should be considered only if it improves services. We are already devolving decision-making. "
Andrew Lansley, the Shadow Health Secretary, thought the BMA was too pessimistic, and that bureaucratisation and demoralisation could be reversed. "I endorse some of the principles - taking politicians out of the day-to-day running of the NHS; reengaging professionals and focusing the Secretary of State and department on public health challenges," he said.
Nigel Edwards, of the NHS Confederation, which represents most NHS organisations, said that producing a written constitution would be extremely difficult. "The NHS exists in a cash-limited system and has a multitude of competing priorities," he said. "It is extremely difficult to reach a consensus on expensive drugs and treatments that pleases everyone. "We need to confront the reality that if the public do not want cost to be a factor in NHS decisions, they may have to prepared to pay more. "The confederation agrees that the NHS should be more independent of central government control. However, the structure of this is less important than ensuring devolution of power to local trust level."
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
***************************
Dr. Jerry Avorn, a professor of medicine at Harvard Medical School, shows in his article below how full of anger at drug companies he is. Perhaps he thinks they have not given him all the presents he is entitled to. He is, however, bereft of ideas about how to improve on the present system.
He notes that, in spite of huge research efforts, new drug approvals have dropped off. He does not for a moment consider that the huge and ever-rising costs of getting a drug through the FDA approval process might have something to do with that. Leftists don't criticize bureaucracy. They LOVE bureaucracy! His solution to the problems he sees? Take money off the companies that produce the drugs -- thus making it HARDER for them to get new drugs approved!
His proposals (if we can call them that) are extremely fuzzy but he seems to think that governments can do it all! I wonder what he has in mind as an example of something that governments do well? His proposal is a simple Leftist kneejerk, untroubled by any evidence for its efficacy. It is true that governments already fund a lot of research but actually doing the research is a different matter entirely. Government business enterprises have been sold off worldwide in recent decades but dinosaur Avorn seems to want to create new ones!
THE BIOTECHNOLOGY Industry Organization is holding its annual mega meeting in Boston this week at a pivotal time in the industry's history. Medically, biotech is at the growing edge of therapeutics. Most older, conventional drug companies have become massive marketing engines with a dulled innovative edge -- only 18 new drugs were approved by the FDA in all of 2006. By contrast, many biotech companies retain their roots as research-based operations where the scientists' agenda can still compete with that of the sales department. Some of the most exciting new treatments for cancer, autoimmune diseases, and even vision loss are emerging from this creative new sector.
But amid the breakthrough findings, lavish entertainment, and self-congratulation that will fill the convention attendees' schedules this week, some important worries may not get the attention they merit. The first relates to costs. Not the cost of the luxury harbor tours and exorbitant meals that participants will enjoy in the coming days; I'm referring to what patients (or taxpayers) have to pay to get access to these wondrous discoveries.
Regimens that can cost tens of thousands of dollars a year per patient can cloud the moral judgment of those who purvey them. For example, a confluence of interests among biotech giant Amgen, for-profit dialysis centers, and kidney disease consultants seems to have led to substantial over prescribing of the company's flagship blood-building product, erythropoietin -- a lucrative practice that probably increases the risk of side effects and even death. Another dilemma: A new biotech product, Lucentis, can reverse the vision loss caused by macular degeneration, a devastating cause of blindness. But the drug costs $2,000 for each monthly injection. Many ophthalmologists are convinced that equally miraculous results could be provided to far more patients with use of a very similar biotech product, Avastin, at only $50 per dose. Yet Genentech, which makes Avastin, has not agreed to sponsor a clinical trial to study this possibility, which could also save Medicare hundreds of millions of dollars in the coming years. That's probably because Genentech makes both Lucentis and Avastin, and use of the more affordable drug would cut into the more expensive drug's expected profits.
Biotech has brought to market a number of important new cancer treatments. But pricing a lifesaving cancer regimen at over $50,000 is guaranteed to put that treatment beyond the reach of many patients. It doesn't cost anywhere near that much to produce these drugs. Rather, the industry argues that these sky-high prices are justified to fuel the expensive research it performs. But many biotech advances are heavily based on publicly funded research supported by the National Institutes of Health and by foundations. Current policies allow companies to charge whatever they want for a new drug, with no payback required for most of the indispensable, taxpayer-supported basic research that made it possible. With the federal deficit threatening to flatline the NIH budget for the first time in a generation, and venture capital speculators increasingly preferring to fund safer "late-stage" companies with nearly marketable products, savvy conventioneers this week must be worried about where the next decade's miracle cures will come from -- as we all should be.
The breathtaking five-figure prices that some biotech drugs command per course of therapy warrant a rethinking of this "trickle-down" approach to supporting science -- a strategy that amounts to the growing privatization of medical research. The example of biotech's older, flabbier siblings is not encouraging: Only about 14 cents of every dollar paid for Big Pharma's products makes its way back into research and development, according to the companies' own figures.
A safer course for the nation would be to take some of the billions the nation is paying for these expensive products and use it to rev up NIH funding, protecting the flow of scientific innovation on which new biotech products depend. The companies could then come in and do the hard work needed to bring those discoveries to market. They should be rewarded fairly, even handsomely for that important work -- but not at levels that will pauper the rest of us or the federal treasury. And we need a better way to provide reasonable compensation for the taxpayer-supported research on which breakthrough products are based. Public funding of university-based research, not extortionate drug prices, is the safest way to guarantee "the miracle cures of tomorrow." It might make for fewer luxury harbor cruises at future BIO conventions, but we can live with that.
Source
Yet another proposal about how to fix the unfixable
The NHS should be run outside politics by a board appointed by Parliament, the British Medical Association says. The NHS should have its own constitution and make clear that it cannot provide everything possible, focusing instead on core services that meet the needs of the great majority of patients most of the time, it says. These changes would prevent day-to-day political meddling and let patients know what they could expect, the BMA says in a discussion paper.
The plans arise from dissatisfaction among the medical community about the Government's reforms, James Johnson, chairman of the BMA Council said. There was "intense unhappiness" in the entire workforce, with reforms that lacked logic or coherence. Professionals had been marginalised by changes over 15-20 years, and the "constant dabbling" by politicians was dividing managers from clinicians, he said.
The recommendations envisage the NHS as an organisation that is a cross between the BBC and an old-style nationalised industry: run by a board, reporting to Parliament, and governed by a constitution that would set out principles, rights, and responsibilities. Patient input would be strengthened by greater local involvement, the division between purchasers and providers eroded if not abolished, and clinical leadership given greater priority.
Mr Johnson, a surgeon, said that the current reforms were "probably just about as unpopular as you can get. They lack cohesion; they are contradictory. "It is absolutely right the politicians set the guidelines, but day-to-day dabbling when a particular topic becomes headlines is not good for the service," he said. For the Secretary of State to have to react to every local eventuality "can't be the best use of Cabinet ministers' time. We think the way forward is for the service to be vested in a board of governors. The Government would set the amount of money and the general direction of travel for the NHS without any further interference." The board of governors would ensure compliance with the NHS constitution. It would appoint an executive management board, to include the NHS Chief Executive and Chief Medical Officer.
Some rationing of services appeared inescapable, Mr Johnson said, as treatments became more costly and the population aged. The list of services provided should be decided through debate between politicians, professionals and the public. Hamish Meldrum, chairman of the BMA's GPs committee, said that this did not mean the association favoured rationing. "We will continue to press for all necessary resources, but we do believe rationing may be inevitable. What we are recommending, if rationing is to take place, is that it's done in an open manner."
Andy Burnham, the Health Minister, said: "We resist any call to make the NHS a slimmed-down, emergency service, because that's what it would become if we started rationing care. The NHS should continue to be comprehensive and universal. Further independence within the NHS should be considered only if it improves services. We are already devolving decision-making. "
Andrew Lansley, the Shadow Health Secretary, thought the BMA was too pessimistic, and that bureaucratisation and demoralisation could be reversed. "I endorse some of the principles - taking politicians out of the day-to-day running of the NHS; reengaging professionals and focusing the Secretary of State and department on public health challenges," he said.
Nigel Edwards, of the NHS Confederation, which represents most NHS organisations, said that producing a written constitution would be extremely difficult. "The NHS exists in a cash-limited system and has a multitude of competing priorities," he said. "It is extremely difficult to reach a consensus on expensive drugs and treatments that pleases everyone. "We need to confront the reality that if the public do not want cost to be a factor in NHS decisions, they may have to prepared to pay more. "The confederation agrees that the NHS should be more independent of central government control. However, the structure of this is less important than ensuring devolution of power to local trust level."
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?
For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.
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