Sunday, April 30, 2006

The cost of free health care

(From The Other Club)

From the Fraser Institute. The link below permits you to read the whole thing:
Total Tax Bill for the Average Canadian Family has Increased 1,600 Percent Since 1961

The total tax bill of the average Canadian family has increased by 1,600 percent since 1961, according to a new book, Tax Facts 14, released today by The Fraser Institute. That translated into an additional $26,792 in taxes for the average Canadian family.

Canadians’ total tax bill now accounts for more of the family budget than shelter, food, and clothing combined. In contrast to the jump in taxes, expenditures on shelter increased by 1,006 percent, food by 481 percent and clothing by 439 percent over the same period.
The other cost of "free" health care is rationing; as Small Dead Animlas has been documenting, here
The family of a 57-year-old Meath Park woman says it will take at least three months before their mother gets to see a Saskatchewan oncologist who can tell her if her cancer is treatable or fatal.
and here.
18 month old Paige Hansen is currently in a hospital in Edmonton. Her family finally decided Thursday to seek help elsewhere (doing so without "permission" from SaskHealth, and therefore at their own expense) after waiting three weeks for diagnosis of her pain in Saskatoon. The child was "screaming every waking minute", and had stopped walking 6 days earlier. In the meantime, they were advised to give her children's Tylenol.

According to a family member being interviewed, the care they received in Edmonton began immediately, testing was done during the first night there. This morning they have a preliminary diagnosis of leukemia.
SaskHealth is the Province of Saskatchewan's monopoly. Saskatchewan is run by socialists - literally. Edmonton is in Alberta. It's like this: If you lived in Toledo your health"insurance" wouldn't pay for treatment in Ann Arbor even if all the hospitals in Ohio were refusing patients.

Supply and demand can be regulated fairly by markets; they cannot be fairly regulated by government.

Artificial limitation of supply to control prices never works. From price caps on gasoline in the 70's that produced interminable gas lineups, to 3 month waits to find out if your cancer is (now going to be?) fatal: This is your government, and it's here to get re-elected by appealing to your ignorance and gullibility.

Health fund reforms will benefit all Australians

An editorial from "The Australian" newspaper

When it comes to paying for their healthcare, Australians enjoy a system that for the most part strikes a sensible balance between the laissez-faire market of the US, that leaves millions unprotected, and the dangerously bureaucratic and inefficient socialised medicine schemes of nations such as Canada and Britain. But this does not mean there is not room for improvement. When Medibank, which later became Medicare, was first introduced in 1975, it was a breakthrough that provided universal healthcare and cost containment. But its creaky big-government model became as out of date as national wage cases, and led to long queues and rationing, and Australians have since sought - and received - far more choice in their healthcare.

After the policy changes of the late-1990s designed to increase the take-up of private health funds, enrolment numbers are once again flagging with 43 per cent - just under nine million people - of the nation covered by private medical coverage. Sensible reforms, such as those proposed this week by the Howard Government, can help reverse this trend. Scheduling out-patient treatments and preventative as well as lifestyle measures such as gym memberships once considered "extras" under basic hospital cover should reduce hospital admissions while saving money and lives. Diabetes claims 3300 Australian lives a year and costs $1.2 billion a year. Obesity is thought to cost the nation another $1.2 billion. And smoking kills 19,000 Australians a year through various preventable diseases, at a cost of some $21 billion. To save even 10 per cent of these costs and lives would be a boon for the health system and the country.

Other reforms are similarly encouraging. Dropping lifetime health cover penalties for fund members who retain their coverage for more than a decade removes another disincentive to signing up. And greater transparency about out-of-pocket costs is also a big win for consumers. Some 43 per cent of health fund members who stay in a private hospital wind up with a bill averaging $720, often not realising they will be slugged with extra charges. In addition to all this, the Government is also set to put Medibank Private up for sale. This is a sensible move for a host of reasons, not the least of which is that it removes the conflict of interest inherent with having a health insurance policy-maker owning a private insurance company.

With these reforms completed, the next step will be clear - namely, the Government should stop meddling in the rates set by private health funds. The industry is already competitive and price-sensitive, and at least one health fund's current advertising campaign uses its history of modest premium increases as its primary selling point. And given that health fund membership is reasonably elastic, it is in the health funds' interests to stay competitive with one another lest members get fed up with the cost and hop back into the public pool. There is no reason to require private health funds to continue to get approval for their premiums from Canberra.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Saturday, April 29, 2006


A hospital that is 3 million pounds in the red has spent 359,000 pounds caring for two elderly patients who have no medical need to be there. Both women have been fit enough to leave the Royal Hampshire County Hospital in Winchester since April 2004, but have remained on a general ward for the past two years at a cost of 246 pounds a day each. The hospital has begun legal action to have one of the women moved to a home, and has sought solicitors' advice in the second case.

Winchester and Eastleigh NHS Trust blamed "complicated family and funding issues" for patients not being discharged. It said that lawyers had been called in after negotiations failed. The hospital is currently accommodating 25 "bed blockers" who are healthy enough to leave.

Vera Hill is stranded as an inpatient until Hampshire County Council organises the two home carers that she needs to help her to dress, wash and prepare meals. The 92-year-old widow has been in hospital for nine months, and was declared fit enough to leave a month ago. She said: "I want to go to my own home. I want to be independent. I will go daft if I don't get out of here."

Powers established in 2004 mean that NHS trusts can fine councils that fail to provide care facilities for patients when they are ready to leave hospital, and last year Winchester and Eastleigh presented Hampshire County Council with a 120,000 pound bill. In total the council paid 625,200 pounds in delayed discharge fines to healthcare trusts around the country.

Patricia Banks, the council's executive member for adult social care, said that "great headway" had been made in reducing delayed discharges, and that 500 extra nursing home beds would be made available under a new scheme this year. "Our priority is always to ensure that the most appropriate care packages are in place to suit each patient's individual needs. Delays may occur when it is not possible to locate timely care."

Winchester and Eastleigh NHS Trust said that bed blocking was a "double-edged sword", that incurred costs in terms of capacity as well as the purely financial. Joanna Paul, the trust's director of operations and performance, said: "The national fining system does help a little but in some cases the real obstacles are family and funding issues. "Not all types of hospital beds are included and the fine of 100 pounds per day is less than half the actual cost." Ms Paul refused to comment in detail on individual cases but said: "Royal Hampshire County Hospital is an acute hospital; once patients are fit to leave it is right that they do so. "Our aim is for patients to get the right care and if that means going down the legal route then that is what we will do."

More here


The city's oldest hospital faces a federal investigation into its shuttered liver transplant program and is laying off nearly 8 percent of its staff, officials said. St. Vincent Medical Center said in a statement that it is "fully complying" with a subpoena received earlier this year from the U.S. attorney's office, which is probing possible criminal activity in the liver program.

The hospital, which is celebrating its 150th anniversary, closed the program in September after officials admitted that doctors in 2003 improperly arranged for a Saudi man to receive a liver intended for a higher-priority patient, who ultimately died without undergoing a transplant. Federal officials say staff at the 347-bed hospital tried to cover up the ethical breach by falsifying documents. Spokesmen for the hospital and the U.S. attorney's office declined to comment further on the investigation.

St. Vincent also is in financial trouble, having lost $12.2 million in the last fiscal year and more than $15 million in the first eight months of this one, according to a March 29 report from Standard & Poor's. The medical center said it gave layoff notices to 97 people on Monday, including managers and support staff. The hospital has been losing patients for several years and is having trouble recruiting doctors, and the problems were exacerbated by the revelations about the liver transplant program. In recent months, the hospital replaced its chief executive and was handed an unprecedented public sanction by the United Network for Organ Sharing. St. Vincent has said it will challenge the sanction in court.

Another Southern California hospital, the University of California, Irvine Medical Center, also is being investigated by federal agencies for possible fraudulent billing related to its now-closed liver transplant program.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Friday, April 28, 2006

Desperate dentistry in England

Where socialized medicine ends up. Brits are told that they are entitled to "free" dentistry but the pay the NHS offers to dentists is so lousy that there are fewer and fewer NHS dentists around. So Brits pay for health insurance but cannot collect what they have paid for. Very often their only option is to pay a second time -- to go to an expensive private dentist

A woman told today how she got a friend to pull out one of her teeth with a pair of pliers and filmed the gruesome process on a mobile phone after failing to find an NHS dentist. Diane Hunter, 45, described how she became so exasperated after two years of toothache she opted for a DIY option. "In the end I just got really drunk and got a friend to pull it out with a pair of big pliers," she told the Bradford Telegraph and Argus. "There was a lots of blood but I just needed the tooth out - it was causing me great pain and it still is."

Miss Hunter, who lives in the Listerhills area of Bradford, said she has not seen a dentist for more than 20 years and failed in her search for any offering NHS care. She said she first tried the old schoolboy trick of tying one end of a piece of string around her tooth and the other around a door handle before slamming the door but it did not work. Miss Hunter told the paper she would never pull her own teeth out again. "I was going to do it again but I showed a nurse at the doctor's surgery what I had done and she said it could cause a heart attack," she said.

She even went to hospital for help at one point but was never given anything more than paracetamol. Her friend performed the DIY dentistry about six months ago.


More dangerous public medicine bungling in Australia

Melbourne's busiest trauma hospital is rebuilding its intensive care unit to eradicate a potentially dangerous fungus that has troubled it for four years. Just six years after it was opened, the State Government is spending $20 million upgrading The Alfred's intensive care unit, which the hospital expects to be completed in 2008. The Government initially announced the upgrade in October last year but failed to mention the aspergillus problem of 2002, instead alluding to "a range of challenges", citing emerging infectious diseases.

The airborne aspergillus fungus is no threat to healthy people. But it has the potential to harm people with vulnerable immune systems after a bone marrow, heart or lung transplant. In 2002, the hospital's intensive care unit had levels of aspergillus two to three times higher than acceptable. The hospital said levels were now "acceptable", and no patient was at risk.

The Alfred responded at the time by creating a separate intensive care unit with six beds for patients who had had transplants. Other patients are not believed to be at risk. The Alfred monitors levels of aspergillus each month and has changed the airflow management to increase the pressure within the unit and reduce the entry of outside air which may contain aspergillus.

But now the hospital wants to operate a single intensive care unit, bringing patients in from the secondary unit. The hospital's chief executive, Jennifer Williams, said a series of reviews had recommended that the safest solution was to rebuild it. "We very much want to get back to the situation we were in in 2002, where we had one intensive care unit," she said. "We don't want to put at risk those particularly sick patients in case the levels were to go up again, but they haven't gone up again. There have been no aspergillus infections since 2002 and we want this to continue."

Canberra Hospital director of infectious diseases, Peter Collignon, said aspergillus affected people when they breathed it in. It can often then form a lung infection and sometimes via the blood go to other parts of the body, but that only occurs in people who are very immuno-suppressed," he said. He said most major hospitals that cared for people with damaged immune systems would have infections caused by aspergillus, but it was difficult to know whether they picked it up in hospital or elsewhere.

Ms Williams said the unit would be built on the same site as the existing one. Planning is under way and the hospital will relocate patients when construction begins. She said it would be designed to minimise the chances of aspergillus entering the unit. "It's a matter of ensuring that the roof and the perimeter walls are completely sealed and the air-conditioning system is replaced with increased levels of air filtration capability," she said. The redesign will also boost the hospital's capacity to treat more patients, with more beds and facilities to deal with infection control, and new technology.

The Alfred acknowledged the elevated levels of aspergillus in 2002 when a patient with a compromised immune system died of aspergillus pneumonia. But it cannot be determined whether the patient contracted it in hospital or in the community. The fungus was also found in 41 other patients, but they were not infected with it. There have been no deaths or infections since.

Ben Hart, spokesman for Health Minister Bronwyn Pike, said The Alfred had tried a number of measures to solve the aspergillus problem, including building works to the air-conditioning and the roof. "But following that, it became apparent after a number of years that those measures weren't solving the problem and so therefore expert consultants were brought in to provide advice on what was the best course of action and The Alfred formed a view that the best course of action was a total rebuild," he said.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Thursday, April 27, 2006


Amid all the buzz about a possible avian-flu pandemic (and more noise soon as another season of West Nile virus infections begins), America is already ex periencing another perilous epidemic. The Centers for Disease Control and Prevention report that as many as 2 million patients nationwide contract bacterial infections in hospitals each year - and 90,000 die. The death rate in such cases is alarmingly high not because the patients are initially very ill, but because hospital germs increasingly are resistant to multiple antibiotics. Thus, the infections are difficult to treat.

But antibiotic resistance in hospital germs is merely a worst-case version of what is happening in the broader community in non-hospitalized patients - in common lung, skin and sinus infections, for example. That is, germs are becoming more resistant to the antibiotics we have - which means that we need new ones.

Federal health officials have adopted four main strategies - prevent infection, diagnose and treat infection, use antimicrobials sparingly and prevent transmission - but they have paid little attention to the shortage of new antibiotics. For decades we've relied largely on slight variations on old drugs to combat rapidly evolving pathogens. The last 37 years have brought just two new antibiotics with truly novel modes of action - Zyvox in 2000 and Cubicin in 2003 (and Cubicin is only used for skin infections).

Right now, the prospects for more are bleak. Over the last decade or so, all the major drug makers have dramatically trimmed or eliminated their antibacterial research programs, to focus instead on drugs that treat chronic ailments and lifestyle issues. Research costs are equally high - it now costs more than $800 million to bring an average new drug to market - and these other drugs are more likely to repay the investment. Whereas antibiotics cure a patient in days, and may not be required again for years, someone taking Lipitor for high cholesterol or Levitra for erectile dysfunction might pop these expensive pills every day for decades.

Congress hasn't managed a remedy. Legislation was proposed last year to create tax incentives for companies that develop new antibiotics, limit their liability for side effects (as has been done for childhood vaccines) and extend patents to compensate for time lost while awaiting FDA approval. But the bill also included an added feature, "wild-card exclusivity" - that turned out to be too wild. This would allow a firm that markets a new antibiotic to extend the patent on any product in its portfolio by up to two years, with the approval of federal officials.

The idea was to give, for example, Pfizer the incentive to discover an important new antibiotic, and so win more time to market Viagra before generic manufacturers could legally produce the drug. But, as written, it might have let companies reap such lucrative gains even for antibiotics little different from existing ones. Better policy - and politics - dictates that "wild card" antibiotics both be intended for treatment of serious or life-threatening conditions and address unmet medical needs.

We need also to adopt the kinds of critical FDA reforms suggested by the Infectious Diseases Society of America - to speed up clinical trials, goose regulators and encourage more innovative research.

The two novel antibiotics introduced since 2000 won't be enough to keep rapidly mutating pathogens at bay for long - and once a resistant bug appears, it will spread rapidly. Soon, there might not be any more "routine," easily treated infections.

Unless we create economic incentives for companies to develop antibiotics, it's unlikely that we'll see many more wonder drugs in the near future. Think about that the next time you or a loved one is hospitalized with a flesh-eating bacterial infection - or even if you've recently taken an antibiotic for bronchitis or a skin infection as an outpatient.


NHS targets are the real waste

Once again the NHS is in crisis. Essential staff are sacked, beds closed, GPs are scolded for "over production" because they have exceeded their targets. When will the mandarins realise that patients are not widgets on a production line for which targets can be imposed and delivered? If a patient needs a half hour of a doctor's time to help him/her come to terms with an unexpected cancer diagnosis, that is what the doctor will do because the professional ethos demands it.

All targets do is waste valuable time. Already nurses spend 40% of their time on computers, much of it designed to capture data needed for targets which also encourage managers to be deceitful and massage figures and make desperate efforts to rob Peter to pay Paul.

The alarming rates of hospital acquired infections that we now suffer (and die of) could be more easily avoided if staff had the time to practise the aseptic techniques that prevent HAIs.

This government is too fond of suggesting useless ideas to improve patient care; I don't know whether to be horrified or amused at the appointment of "dignity nurses" given that treating patients with dignity should be central to the job of a nurse. Unfortunately, some modern nurses have not been properly trained in the skills needed to treat elderly patients with dignity. I fear for the existence of a once superb institution which I have always been passionate about.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Wednesday, April 26, 2006


Peter Owen, 19, was in agony for a week as he tried SIX times to have a tooth out. He was eventually rushed to hospital after an abcess on the tooth swelled so much that it blocked his windpipe. Peter had an emergency tracheotomy - where a breathing tube is inserted through a hole in the throat - and was on life support for two days.

Mum Wynn, 47, said last night: "Peter nearly died because there is a shortage of dentists. "It is shameful that someone should be taken to hospital fighting for his life just because of toothache." Peter was not registered with an NHS dentist when he developed raging toothache. Wynn rang NHS Direct who told her there were NO available dentists near their home in Colwyn Bay, North Wales. The nurse who answered suggested the emergency dentist at Royal Alexandra Hospital in Rhyl could see him - but not for six days.

Next day Peter went to a dental centre in his home town who told him the tooth must come out. But he was quoted a total of 121 pounds which he could not afford on his Jobseeker's Allowance. The next day he went to Colwyn Bay Community Hospital - but was told they were not taking any more dental patients. The day after that Peter's pain was becoming unbearable as his mouth began to swell.

Wynn called her doctors' surgery saying her son needed antibiotics for the pain. But she was told they did not deal with dental matters. Desperate, the pair then went to Glan Clwyd hospital where a nurse said he HAD to see a doctor. But after waiting two hours they had to go as Wynn was in agony with a shoulder problem. The following day Peter saw the dentist at Royal Alexandra Hospital who confirmed he needed the tooth out.

He prescribed antibiotics - and Peter made an appointment for an extraction four days later. But his condition got worse and the next day Wynn rang NHS Direct again, saying: "You're going to kill this lad." That night Peter could not breathe and dad Gareth rushed him back to Glan Clwyd, near Rhyl, where surgeons performed the emergency surgery. He was eventually allowed home a week later.

Wynn said: "It's a terrible story. These kids can't afford a private dentist and there are no NHS dentists anywhere. "I also blame the Welsh Assembly for the shortage of dentists in our area."

Conwy and Denbighshire NHS Trust said: "We can't discuss individual cases. But if Mrs Owen contacts patient services at the hospital we will discuss her concerns." A Welsh Assembly spokesman said: "Steps are being taken to address the issue of dentists."



National industrial action is being considered for the first time by nurses, amid mounting concern over job cuts, NHS deficits and the pace of reforms. As Tony Blair admitted that the health service faced a "challenging year", nursing leaders said that growing uncertainty in the NHS, and the fear that valid nursing concerns were simply being ignored, had pushed the profession into an "unprecedented position".

With Patricia Hewitt, the Health Secretary, receiving a rough ride as she spoke to a Unison conference, the Royal College of Nursing said that while it would not sanction full-scale walkouts, nurses refusing to work unpaid overtime was now a possibility. Beverly Malone, the RCN's general secretary, said that the action equated to an extra day's work per week for each nurse. "The reality gap between what the Government is saying and what we are experiencing at coalface level is very wide," she said.

Josie Irwin, head of employment relations at the RCN, said that the "work to rule" action had been considered before in localised disputes, but never on a national scale. "Nurses are feeling the most insecure they have ever felt about their jobs . . . there is clearly a temperature out there where members are considering the possibility of action in light of the redundancies, deficits and disappointing salary rises," she said. "The discontent has not been as widespread before, which does indicate a mood change across the NHS among the membership . . . this is the first time it has ever been discussed by the general secretary." Ms Irwin said that under RCN rules, members could not act in a way that was detrimental to the wellbeing of patients. She said that if the action occurred, health trusts would have to pay for agency staff or pay for nurses' overtime.

The nursing leaders were speaking on the second day of the RCN's annual conference in Bournemouth. Ms Hewitt is scheduled to speak to the conference tomorrow after facing sustained criticism for describing how the NHS had enjoyed its "best year ever". Yesterday 1,000 delegates sat in stony silence when Ms Hewitt was introduced at Unison's health workers' conference in Gateshead. She was heckled, booed and hissed during her speech. She slightly modified her claim, saying that it had been the "best year for patients". Her compliments and assurances were met with angry cries of derision and frequent interruptions from delegates. She said that she understood the concerns of those threatened with job losses, but change and reform were necessary if the founding ethics of the NHS were to be preserved. She said: "We've written a very big cheque for the NHS. But it's not a blank cheque. Overspending hospitals and organisations do have to put their houses in order."

After addressing the conference she faced a barrage of angry questions from delegates, who reeled off lists of ward closures and service cuts. Earlier Dave Prentis, the Unison general secretary, said that his union would not stand by and watch staff suffer "in a climate of fear". Unison would support members who had no option but to strike, he said, adding that patients would be hit by the cuts.

Mr Blair defended Ms Hewitt yesterday as he insisted that there had been significant improvements in the NHS since Labour came to power. He said that waiting lists had never been lower, cancer and cardiac care treatment was the best it had been, and there was a record number of extra doctors and nurses. He acknowledged difficulties as the service entered the next phase of its ten-year plan. "Whatever the challenge - and the next year will be very challenging - there have been improvements," he said. David Cameron, the Tory leader, criticised the Government's "arrogant" manner in blaming the crisis on health bosses. He said: "Nine thousand people are threatened with redundancy in the NHS and hospitals are threatened with closure. "This is not caused by reform but by a lack of reform and mismanagement."


Australia: Semi-urgent patients missing out in Victoria's public hospitals

One in four patients waiting for surgery is not treated within the Government's benchmark times, according to the Australian Medical Association. AMA state vice-president Dr Doug Travis said doctors were tired of telling patients their surgery had been postponed or they would have to wait months for an operation because of a shortage of hospital beds and doctors. Dr Travis, a surgeon in the public hospital system, claimed analysis of the State Government's Your Hospitals report released last week showed the Government aimed to treat only 80 per cent of semi-urgent patients within 90 days compared with the national benchmark of treating 100 per cent within 90 days. But he said the Your Hospitals report showed only 73 per cent of patients were treated within 90 days. "Doctors list patients as semi-urgent because they need to have their surgery within 90 days, but the Government does not seem to care that more than one in five people can't access the surgery they need in the time frame they need," he said. Dr Travis said it seemed the Government had decided to lower the benchmark to make the figures look good instead of investing in more doctors, nurses and beds.

The AMA has asked the State Government to include an extra $100 million in Victoria's 2006-07 health budget to pay for 300 extra beds and help ease demand in emergency waiting rooms and minimise elective surgery cancellations. Opposition health spokeswoman Helen Shardey said the report's presentation was dishonest. "If you're going to have a performance indicator, that's what you need to report on," she said.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Tuesday, April 25, 2006


Patients are being put at risk by NHS cuts as hospitals try to reduce services that have less demanding government targets, it was claimed yesterday. Nursing leaders said that "easy victims" in the NHS, such as care for the elderly and mentally ill, were bearing the brunt of widespread job losses, bed closures and other service reductions because of a 700 million pound deficit. New figures show that more than 13,000 job losses have been announced by hospitals and health trusts over the past six months. At least one third of the lost jobs are expected to be nurses.

Senior nurses and politicians condemned comments by Patricia Hewitt, the Health Secretary, that the NHS had had its "best year ever". Sylvia Denton and Beverly Malone, two of the country's top nurses, said that the dismissal of health staff was having a severe impact on patient care. "NHS deficits are hitting patient services and to claim otherwise is simply wrong," Dr Malone, general secretary of the Royal College of Nursing, said on the eve of the organisation's annual conference. "These are real services for real people with real illnesses, and we have to stop treating them as statistics on a balance sheet."

A survey by the college of 660 hospital-based senior nurses revealed that almost half had seen redundancies or a reduction in nursing posts where they work. Nearly 60 per cent of hospitals said that they did not have enough staff to give their patients the standards of care they would like. Figures compiled by the college show that job losses in the NHS were more than twice the level of 6,000 that had been reported. Dr Malone said that cuts to community hospitals, beds and services for older patients were already having a serious impact.

The Royal College of Nursing cited a range of examples of threatened hospital closures reported by its members, including in areas such as Wiltshire, Gloucester, East Yorkshire and Oxford. Vulnerable elderly patients were being moved frequently from bed to bed around hospitals as trusts struggled to find them specialist care, risking serious consequences for their health, Dr Malone added. She described the cuts - which included the loss of specialist beds for older adults recovering from falls, strokes and surgery - as "kneejerk" and that there was no strategy to cope with the repercussions for patients.

Other patient groups being affected include young cancer sufferers in the West Country, and research teams working on life-saving treatments such as cardiothoracic surgery.

The claims come as Ms Hewitt admitted that the Government was "not on track" to meet a number of public health targets. The Prime Minister was told in a progress report last week that 11 out of Labour's 26 key targets, known as public service agreements, were showing "red" or "amber" lights, indicating there was little prospect they would be met by the intended date of 2008 unless urgent action was taken. They include the promise of a CAT or MRI scan for any patient needing one, cutting waiting times for cancer treatment, cutting MRSA rates in half within 18 months, ending inequalities in infant mortality, reducing smoking rates in poorer households, raising life expectancy in deprived areas and reducing rates of teenage pregnancy and childhood obesity.

"Despite the headlines, actually the NHS has just had its best year ever," Ms Hewitt said, adding that the Government had come through one of the coldest winters for decades without bed emergencies and had cut waiting times to the lowest level ever.

Dr Malone and Mrs Denton, president of the Royal College of Nursing, said that the minister's view was without credibility. "If this is the best ever year I would not like to see the worst. It is as simple as that," Mrs Denton said. She added that the cuts had left nurses "not just demoralised, but really angry". Politicians including David Cameron, the Tory leader, echoed the nurses' surprise at Ms Hewitt's claims, saying that the NHS faced an emergency created by the Government. Christine Beasley, the Chief Nursing Officer, defended the Government's record. "We have 80,000 more nurses than in 1997, with starting pay rising by 55 per cent in the same period," she said.



Miscalculations in salary packages for NHS staff have led to a pay bill more than 600 million pounds higher than expected, it has emerged. The Department of Health acknowledged it had underestimated the financial impact of the so-called Agenda for Change package for nurses' pay by 220 million, while the cost of new consultants' contracts was 90 million more than expected.

The figures come on top of the 300 million overspend on GPs' pay admitted earlier this month by Health Secretary Patricia Hewitt, who said the department had not expected family doctors to be able to rack up 20-25% pay hikes under a new payment-by-results points system. Large salary increases resulting from the renegotiated contracts have been blamed for financial deficits running into hundreds of millions of pounds which have seen hospitals forced to sack thousands of staff. But despite the financial difficulties, Ms Hewitt insisted last night that the NHS was enjoying its "best year ever".

Some 7,000 job losses have already been confirmed in the NHS and there are predictions that the final figure may reach as high as 13,000, as managers struggle to cope with a total deficit estimated at more than 600 million.

But Ms Hewitt insisted that the deficit amounted to no more than 1% of the NHS's total budget and was "not a crisis", while job cuts were, in many cases, allowing the service to operate more efficiently. The figures on overspending on pay were uncovered in the Sunday Telegraph, which said Ms Hewitt was planning a series of speeches to shore up public confidence in the NHS.

Shadow health secretary Andrew Lansley told the paper: "The Government has totally lost control of the NHS's finances. No amount of rhetoric about reform will cover up the Government's gross mismanagement." Ms Hewitt insisted she was not "complacent" about the cash problems which have seen staff laid off and wards closed.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Monday, April 24, 2006


Almost half of senior nurses have seen cuts in staff or training posts in the last year in the trust where they work, the Royal College of Nursing (RCN) has revealed. On the eve of its congress, the RCN said 60% of senior nurses did not have enough staff to give patients the care they would like. Almost two-thirds (62%) of ward sisters and matrons feel they are under too much pressure, and 40% would resign if they could.

Eight out of 10 work unpaid overtime several times a week - with 30% doing so every shift. The poll of almost 1,000 senior nurses comes as the RCN said it believed 13,000 posts had been identified for cuts since October last year.

Since March 1 this year, more than 7,000 cuts have been announced by trusts up and down the country. The NHS is struggling with a deficit expected to top 623 million pounds this financial year.

In the survey, the nurses also said they wanted more resources, more time to spend with patients, and more time to educate staff and develop good practice. Dr Beverly Malone, general secretary of the RCN, said: "Put simply, this survey shows that senior nurses are under pressure, under-resourced and under-appreciated. "Patient care is suffering because of the huge pressures and demands these nurses are facing. They are working extremely hard in difficult circumstances, in a whirl of deficits and relentless reforms." She added: "Government actions on deficits and the headlong rush into reforms is leaving disaffection and disillusionment in its wake. When nearly half of the senior nurses surveyed want to quit, the Government has got to sit up and take this issue seriously.

Chief Nursing Officer Christine Beasley said: "I appreciate how anxious some nurses will feel at present and how demanding their job is. "I would like to reassure them that the threat of redundancy will be contained to as few people as possible and in many cases changes will be achieved through cutting down on agency staff, freezing non-essential vacant posts and redeploying staff into other roles."


British nurses taking their skills elsewhere -- to Australia

Hundreds of British nurses will be lured to NSW as the State Government plans to take advantage of the cash crisis in the British health system. The recruitment drive, to start next month, comes after 300 British nurses, also enticed by the Government, relocated to NSW last year. The state urgently needs an extra 1800 nurses and retiring NSW chief nursing officer Kathy Baker said the Government had "no choice" but to poach nurses from Britain. Three British recruitment agencies have been awarded contracts by the Government and a team from NSW will spend about three weeks in Britain next month, hiring more than 200 nurses.

Britain's cash-strapped National Health System is expected to slash at least 13,000 jobs in coming months. More than 7000 jobs have already been lost and dozens of hospitals are millions of dollars in the red.

Although the Howard Government recently announced an extra 1000 university undergraduate nursing positions, Professor Baker said she wasn't confident NSW would be allocated any. NSW Health Minister John Hatzistergos said the shortfall in Commonwealth-provided university training places was a major setback for staffing in public hospitals.

More here


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Sunday, April 23, 2006


In what appears to be an amazing success for American medicine, preliminary government figures released Wednesday showed that the annual number of deaths in the U.S. dropped by nearly 50,000 in 2004 - the biggest decline in nearly 70 years. The 2 percent decrease, reported by the National Center for Health Statistics, came as a shock to many, because the U.S. is aging, growing in population and getting fatter. In fact, some experts said they suspect the numbers may not hold up when a final report is released later this year. Nevertheless, center officials said the statistics, based on a review of about 90 percent of death records reported in all 50 states in 2004, were consistent across the country and were deemed solid enough to report.

The center said drops in the death rates for heart disease, cancer and stroke accounted for most of the decline. "We were surprised by the sharpness of the decrease. It's kind of historical," said statistician Arialdi Minino, lead author of the report. The government also said that U.S. life expectancy has inched up again to 77.9 years, a record high but still behind that of about two dozen other countries.

The preliminary number of U.S. deaths recorded for 2004 was 2,398,343. That represents a decline of 49,945 from the 2,448,288 recorded in 2003. U.S. deaths ordinarily rise slightly each year. The last decline in annual deaths occurred in 1997, a modest drop of 445 deaths from 1996, Minino said. The number of deaths has not dropped this steeply since 1938, when there were about 69,000 fewer than in 1937. A drop in 1944 came close - about 48,000 fewer deaths than the previous year. Health officials could not immediately say why the number of deaths fell so sharply in either of those years. "These are preliminary data," said Paul Terry, an assistant professor of epidemiology at Atlanta's Emory University. "But if it holds up, it's obviously very good news."

To see such a giant drop after years of annual increases was a little hard to swallow for some. "We will not make much of this until the final data come out," said Elizabeth Ward, director of surveillance research for the American Cancer Society. Overall, age-adjusted death rates fell to a record low of 801 deaths per 100,000 population in 2004, down from almost 833 deaths per 100,000 in 2003.

Heart disease continues to be the leading cause of death, accounting for 27 percent of the nation's deaths in 2004. Cancer was second, at about 23 percent, and strokes were third, at 6 percent. The good news: The age-adjusted death rate for all three killers dropped. The heart disease rate declined more than 6 percent, the cancer rate about 3 percent, and the stroke rate about 6.5 percent. Improvements in medical care, particularly in medications aimed at preventing heart disease, at least partly explain the improvements in the heart disease death rate, said Ken Thorpe, an Emory professor of health policy. Also, the flu season for 2004 was milder than 2003, which helped explain the more than 7 percent drop in the influenza death rate, Minino noted. The death rates for 11 of the 13 other leading causes of death also declined, with only Alzheimer's disease (the No. 7 killer) and high blood pressure and kidney disease related to high blood pressure (No. 13) inching up.

Even officials at the National Center for Health Statistics were "really kind of concerned" when they first saw their own numbers, said Bob Anderson, the agency's chief of mortality statistics. But the fact that decreases in the death rate were found nationwide gives them confidence that the findings are legitimate, and not the result of something like changes in data collection.

The government also reported that a baby born in 2004 could expect to live to nearly 78 - an increase of almost half a year from 2003. Women now have a life expectancy of 80.4, up from 80.1. Male life expectancy is 75.2, up from 74.8. The life expectancy for whites - 78.3 - was up only slightly from the previous year. The increase for blacks was larger, with a rise from 72.7 to 73.3. The government also reported that the infant mortality rate has dropped to 6.76 deaths per 1,000 births, down from 6.85 the year before. But a huge racial disparity persists. The rate for whites was 5.65 per 1,000 births, for blacks, 13.65. Japan, Monaco and San Marino had the highest life expectancy, 82 years, in 2004, according to World Health Organization statistics. Australia, Iceland, Italy, Sweden and Switzerland have a life expectancy of 81. Canada, France, Israel, Norway, Spain and Britain are among the other countries with life expectancies above 78.


Sydney Hospital on life support

Historic Sydney Hospital is sitting on some of the most valuable real estate in the heart of Sydney. Work out for yourself what the gleam in the eye of the NSW government might be

Sydney hospital's capacity has been run down to the point where half-a-million people living and working in the city have been left far more exposed to the consequences of a terrorist attack or a bird flu outbreak, a hospital administrator has warned. The chairman of the Department of Medicine at Sydney Hospital, John Graham, told a biosecurity workshop last week that he had appealed to the Federal Government to remove the hospital from state control and declare it a "national security hospital". He said there was consensus among intelligence experts that the No. 1 terrorist target in Australia was the Sydney CBD. The first case of avian flu in Australia was also likely to walk through the doors of Sydney Hospital, most probably in the form of a visitor staying in a hotel.

Yet the state's health administration had run the hospital down to the point where it had only 100 beds left from an original 550, while its general and orthopedic surgeons had been ordered to work elsewhere. Dr Graham said the hospital needed an extra 100 beds, the restoration of its intensive care unit and the rehiring of up to 20 general and orthopedic surgeons to handle a terrorist attack or big infectious diseases outbreak. "I am the canary down the coalmine and I am asphyxiating," Dr Graham told the Herald yesterday. "It doesn't matter if I fall off my perch, but it matters if the half-a-million who come into the Sydney CBD every day have their health jeopardised. I, for one, am not prepared to let the NSW Health Department sit back and do the wrong thing."

A discussion paper on Dr Graham's proposals has been sent to the Prime Minister, and Dr Graham said he had met the federal Minister for Health, Tony Abbott, late last year to discuss the issue. A briefing note seen by the Herald from Dr Graham to the Deputy Commissioner of NSW Police Andrew Scipione says some senior NSW health officers privately agree that Sydney Hospital in its present state cannot adequately deal with a disaster in the city. However, the head of the NSW Health Counter Disaster Unit, David Cooper, said yesterday that state planning was "not about one hospital; it's about the whole network".

The biosecurity workshop, which looked at threats from infectious diseases and bioterrorism, was sponsored by the University of Sydney. A workshop speaker from the Prime Minister's Department, who did not want to be named, said the likelihood of a terrorist attack involving biological agents was low, but could not be ruled out. The former federal co-ordinator of emergency services David Templeman issued a warning about the ageing of the 500,000 volunteers whom the emergency services rely on. The average age of volunteers had risen to 47, from about 37 10 to 15 years ago. This was due not just to an ageing population and declining birthrate, but to a decline in the volunteering tradition among younger people.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Saturday, April 22, 2006

22 April, 2006


An alarming rise in the number of women giving birth prematurely risks overloading the NHS and may be linked to increases in obese and older mothers, according to doctors. A study of more than 600,000 births over the past decade found that the number of deliveries occurring before nine months of pregnancy had increased by almost a quarter. Researchers also found that among women without factors that normally increase the chances of a pre-term birth - such as fertility treatment, an earlier premature birth or cervical surgery - the rate had increased more than 50 per cent.

Leading obstetricians yesterday gave warning that the rise was likely to be replicated in "similar societies" such as Britain, although comprehensive data has yet to be collated. They said that the trend carried serious implications for the NHS with chronic illnesses such as diabetes, high blood pressure and heart disease linked to early deliveries. Pre-term babies are also at greater risk of developing severe mental and physical disabilities. A quarter of babies born after 25 weeks or less have such problems, and a high number of children born at 32 weeks have educational and behavioural problems by the age of 7. Although premature deliveries account for fewer than 1 in 10 births, they result in 75 per cent of neonatal deaths and most neonatal intensive care admissions.

Writing in an editorial accompanying the Danish study, published this week in the British Medical Journal, doctors said that it was essential that the exact causes of the growth were investigated. Andrew Shennan, Professor of Obstetrics at King's College London School of Medicine, at St Thomas's Hospital, said that the growing number of women deciding to postpone having children and increasing female obesity were "good candidates" to explain the trends. More accurate ultrasound dating of conceptions might also play a role, he added. "We know about the problems encountered with severely premature births, but I worry about the more subtle things that are clearly happening to a much larger number of babies, such as educational problems and chronic conditions like diabetes and hypertension," Professor Shennan said. "If you want really to address the big health problems affecting society, this is where to start."

Professor Shennan and his co-author, Susan Bewley, concluded that if the findings from Denmark were accurate the implications for neonatologists, health economists, teachers, parents, and children were worrying. "Premature babies are at great risk of death and disability, and the total health burden to the population will not change unless the number can be reduced," he said.

The Danish study included four national birth registries of 646,000 deliveries - almost all live births - in Denmark between 1995 and 2004. The authors said that the prevalence of several premature birth risk factors - IVF, high maternal age, first-time mothers and elective early deliveries - have changed in recent years and may explain the increases in pre-term deliveries.

Concerns have been raised by many gynaecologists and obstetricians about the health impacts of the rapid rise of career women becoming pregnant later in life. Fertility problems increase after 35, and greatly so for women over 40. According to the Office for National Statistics, the over-35s have the fastest-growing birthrates. Women having babies in their forties have nearly doubled in ten years. The number in their thirties is up by two thirds and outstrips those in their twenties. Charlotte Davies, of the baby charity Tommy's, said that research was urgently needed. "If this increase continues, and is extrapolated to the UK, then it's very concerning and means that we need, more than ever, to work out exactly why it's happening and bring in preventive measures."


A truly insane public medicine system

It has spent $2 million to sort out a $300 matter. It shows how nasty and irresponsible bureaucrats can be

A $300 overtime claim by ambulance staff has led to a five-year, $2 million legal and wages bill -- paid for by Queensland taxpayers. And the wrangling between Queensland Ambulance Service management and the officers could go on for at least another year.

The saga started in 2001 and has seen four separate investigations, numerous court cases and staff suspended on full pay pending decisions. The wages bill alone for three staff suspended on full pay for three years and eight months was between $600,000 and $800,000. A source said the QAS legal bill had topped $1 million "a long time ago" and that the State Government spent hundreds of thousands of dollars flying relieving staff into Mount Isa and Doomadgee to cover the suspended officers.

The Industrial Relations Commission will soon hand down a finding in relation to a paramedic claiming unfair dismissal for his part in the overtime claim. Ken Gramm, 52, a decorated ambulance officer, was fired last year for allegedly falsifying records. Mr Gramm strenuously denied all allegations. He was suspended on full pay of $85,000 a year in February 2002. A Mount Isa magistrate ruled there was no evidence of dishonesty, and the Crime and Misconduct Commission also found no case to answer. But Ambulance Commissioner Jim Higgins ordered another internal investigation, and Mr Gramm was found guilty on five of 14 counts relating to overtime claims involving just over $300. Sources said the QAS rejected an early offer by Mr Gramm to repay the disputed amount.

Another court case begins on April 24, when a former communications operator takes on WorkCover after it refused a medical payout following his sacking from the QAS. Greg Haddow, 43, was also suspended on full pay in 2002 amid claims he helped Mr Gramm falsify the overtime. Mr Haddow -- who denied any wrongdoing -- was also cleared by the courts, the CMC and an internal investigation. But sources said QAS bosses "medically terminated" Mr Haddow last year after he had been on stress leave and Workcover refused a payout. Mr Haddow appealed against that decision, and his case is due to be heard in Townsville Magistrates Court.

The only officer who admitted a role in falsifying overtime claims was not sacked -- he has been promoted. He also had been suspended on full pay. QAS declined to comment, as Mr Gramm and Mr Haddow's cases are before the courts.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Friday, April 21, 2006


Hundreds of infertile women could be spared the most distressing side effects of IVF by a drug regime too rarely used in Britain, a leading specialist said yesterday. Newer fertility drugs that act quickly without triggering menopausal symptoms can be as effective as standard therapies but are offered by only one in twenty British clinics, according to Bill Ledger, Professor of Obstetrics and Gynaecology at the University of Sheffield.

Gonadotrophin-releasing hormone (GnRH) antagonists were developed in the 1990s and are used in 80 per cent of IVF cycles in Scandinavian countries. They halve the length of a cycle and avoid side effects of hormonal drugs such as hot flushes, night sweats, mood swings and insomnia. They also significantly lower the risk of ovarian hyperstimulation syndrome, the most dangerous complication of IVF apart from multiple births.

Despite these advantages, GnRH antagonists are unpopular with British fertility doctors, who consider that they slightly reduce the chances of a successful pregnancy compared with traditional long-protocol IVF drugs. Professor Ledger said that many clinics were too frightened of falling in the success-rate league tables. Early clinical trials of GnRH antagonists found that they produced an average of 1.0 to 2.3 fewer eggs and 0.2 to 0.5 fewer good-quality embryos in each cycle. Pregnancy rates were slightly lower, but not statistically significant. Professor Ledger said the studies took place before most doctors had experience of the new drugs.

Success rates in clinics that regularly use GnRH antagonists are now comparable to those using older drugs. The one trial that examined clinics experienced in the new regime had found no appreciable difference in pregnancy rates. "The uptake of these drugs has been slower because of the conservative nature of IVF in Britain," he said. "Clinics are terrified of a drop of a few points in their success rates if they switch."

IVF involves stimulating ovaries to over-produce eggs, so that a dozen or so can be harvested and fertilised at the same time. For this to happen, it is necessary first to stop the normal menstrual cycle using drugs that block the action of GnRH, traditionally done with a class called GnRH agonists. These drugs stimulate a flare in hormone levels before they fall, and must be given for two to three weeks before the ovaries can be stimulated and egg collection can begin. This long period is responsible for the menopausal symptoms.

GnRH antagonists work differently, neutralising the hormone's action completely so that the pituitary gland cannot respond. There is no hormone spike and a cycle is "downregulated" much more quickly. This means that GnRH antagonists can be given six days after a woman has started taking drugs to stimulate her ovaries. Treatment continues only for the critical period in which downregulation is essential, about five days, and does not continue for long enough to cause side effects.


If Medicare Were a Country

Most health care reform proposals assume that it is the private health care system that needs fixing. However, over the past 25 years, government spending on health care has been increasing at a faster rate than private spending on health care. Medicare accounts for more than 15 percent of health care spending in the United States. Fiscal projections for the middle of this century show that the looming cost of Medicare is by far the biggest problem for the federal budget. And yet, in too many discussions of health care reform, Medicare is ignored.

The implicit assumption is that policy changes are required in other parts of the health care system, but Medicare ought to be left alone. That may be comfortable politically, but simple arithmetic will show that it is not realistic if we wish to rein in health care spending. We are not going to achieve meaningful progress in curbing health care spending without touching Medicare.

In 2004, health care spending in the United States totaled $1.9 trillion, an average of $6,280 per person. Many observers put this figure in perspective by using other countries as a benchmark. For example, in 2003, health care spending in France was only $2,900per person.

Along these lines, the table below treats Medicare as a country, and compares its budget to the health care budget of France. In the table, health care spending in France is multiplied by the ratio of population in the United States to the population in France. This provides an estimate of what France would spend if its population were 300 million people, as in the U.S.

France:* 900 ($ billion)
United States: 1,900
Medicare: 300
Non-Medicare: 1,600

*scaled up by the ratio of population in the United States to the population in France [Sources: for France, OECD Health Data 2005; for U.S., Centers for Medicare and Medicaid Services, press release Jan. 10, 2006 and author calculations]

This division between the countries of Medicare and non-Medicare provides some perspective on the limitations of health care reform if we leave Medicare alone. For example, suppose that the goal of health care reform is to reduce our health care budget to the level that would prevail if our per capita health care spending were the same as in France. That would mean our total health care budget would be $900 billion. If we leave Medicare at $300 billion, our non-Medicare spending would have to be cut from $1600 billion to $600 billion, a 67 percent reduction. This little exercise in arithmetic brings out some important truths:

1. Although other countries use single-payer health care systems and those countries have lower per capita health care expenditures, a single-payer system in the United States would not necessarily reduce our health care expenditures.

The country of Medicare already is a single-payer system, and yet it is part of the problem of extravagant U.S. health care spending, not part of the solution. Indeed, Medicare expenditures on Americans age 65 and over exceed France's expenditures on that age group by the same ratio that spending on Americans under age 65 (which is predominantly privately financed) exceeds spending on the non-elderly in France.

2. Whether we attempt to move toward a market solution or a government solution, if the goal of health care reform is to put our nation's health care spending on a diet, seniors will have to participate in the reduction program.

Many people claim that the American health care system wastes money compared with other countries' health care systems. However, what this exercise shows is that waste in the American health care system is not confined to that part of health spending that is privately financed. Resources are not managed any better under Medicare than under private health insurance. Proponents of health care reform must face that reality.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Thursday, April 20, 2006


A row over a “breakthrough” treatment for diabetes broke out yesterday as it was rejected for NHS use by the Government’s drug watchdog on the grounds that it was not cost effective. The new product, insulin that is inhaled, could transform the lives of sufferers, who have to inject insulin up to five times a day. However, it costs about £500 a year more per patient. This latest example of “drug rationing” came as Tony Blair insisted that the NHS was not facing disaster despite thousands of job losses and cutbacks in expensive treatments as a result of a financial squeeze. Mr Blair also defended soaring pay rises for doctors that will see some earn more than £250,000 this year. The Prime Minister admitted that the NHS was at a “crunch point” but insisted he was still on course for an historic “end to traditional waiting” by 2008.

About 800,000 people in Britain use insulin injections to control symptoms of diabetes, a disease that can have very serious effects. Health experts are giving warning of an explosion in type 2 diabetes of 10 per cent of cases a year as the population becomes fatter and takes less exercise. Inhaled insulin has been heralded as the greatest potential advance in treatment for 80 years. Simon O’Neill, director of care and policy at Diabetes UK, said: “The Government has put patient choice on the NHS agenda. Diabetes UK is disappointed that the guidance on inhaled insulin does not reflect this as we believe it could offer an alternative treatment in improving the lives of some people with diabetes. “We believe that new treatments should not be restricted because of costs and greater emphasis should be placed on patient choices and preferences.”

The draft guidance, from the National Institute for Health and Clinical Excellence (NICE) was “perverse and short-sighted”, said Pfizer, the drug company that markets Exubera, the first form of insulin that can be inhaled rather than injected. “NICE must not be allowed to undermine clinicians’ ability to work with their patients to improve management of this debilitating long-term condition,” it said.

Diabetes UK also urged NICE to reconsider the guidance, which is now up for consultation before a final decision is taken. “This is a medical breakthrough and it is the potential first step to improving the lives of some people with diabetes,” the charity said. “It will be unfortunate if people in England have limited access while it becomes available in other countries.”

Ever since the 1920s, diabetic patients have had to inject themselves with insulin, sometimes as often as five times a day, to control the disease. Exubera represents an alternative approach in which insulin in a fine, dry powder form is taken from an inhaler. Pfizer argues that its trials show inhaled insulin to be as effective as injected insulin, and that many people who are developing diabetes are too slow to acknowledge and control it. They do not want to start injecting insulin, but are willing to start inhaling it. “The choice here is quite simple,” Pfizer said. “Force patients to keep enduring the burden of multiple daily injections, or give them an alternative. In a clinical trial, three times as many patients chose to start on insulin therapy when the inhaled option was made available.”

Kate Lloyd, Medical Director of Pfizer UK, said: “This is a terrible decision. It could deprive clinicians of the opportunity to benefit patients by starting insulin much earlier and cutting future costs of diabetes and its complications including heart disease, amputation, blindness and kidney failure. “NICE has rejected Exubera on the grounds of cost-effectiveness. But if people aren’t willing to inject, injected insulin can’t be cost-effective either. “They accept that inhaled insulin might be effective for some patients, but say it is difficult to identify them. We find that desperately concerning. NICE takes the view that because they can’t identify suitable patients, nobody else can.”

In its draft guidance, NICE says that using injected insulin is “not usually a concern for the majority of people with diabetes, given the availability of patient support and education, modern small needle types and insulin pens.” It adds that inhaled insulin would not fully replace the injected form and that people would still need to use needles for measuring glucose levels in the blood. It accepts that inhaled insulin is as effective as the injected form, and says it would cost just over £1,100 per patient per year, about twice the average cost of injected insulin. Patients might prefer it, but patient preferences were only relevant if they translated into real health benefits. The fact that patients who need insulin are more likely to take it if they can get inhalers “is insufficient to provide support for a cost-effective use of this therapy”.


Canada's Socialized Health Care Is Not the Model to Follow

American politicians on the stump are fond of citing Canada's socialized health care system as a superior alternative to the mixture of public and private health spending in the United States. Such rhetoric may attract votes, but we Canadians, trapped in a broken and deteriorating system, have reasons to disagree. In 1967, when Canada adopted the British socialist model, our country was near the top of international rankings for the effectiveness of our medical spending. The U.N.'s World Health Organization now places Canada about 30th on that list.

Vancouver's Fraser Institute recently released a comprehensive study that measured Canadian Medicare's performance. Called How Good Is Canadian Health Care? An International Comparison of Health Care Systems, the report included only countries that have publicly funded systems with universal access. It excluded the United States and Mexico, which do not.

Of the countries in the Organisation for Economic Cooperation and Development, only Iceland spends more on an age-adjusted basis than Canada does on health care. No other countries follow Canada's model of monopolistic public provision of health insurance. Canada is the only OECD country that outlaws privately funded purchases of basic medical services.

* With respect to hard indicators of performance, Canada's record is alarming for a prosperous country:

* How many doctors per capita does Canada have? We rank 16th out of 23 OECD countries.

* What about access to high-tech diagnostic tools? We rank 15th for MRIs, 17th for CT scanners and eighth for radiation machines. We are tied for last for lithotripters (devices that destroy stones in the urinary system).

* What percentage of our total life expectancy will we live free of disability? We rank 14th.

* What are the rates for infant and perinatal mortality? We rank 16th and 12th.

* What about potential years of life lost to disease? We rank ninth.

* What is our incidence of breast cancer mortality? We rank sixth.

By only one measure is Canada's performance commensurate with its rate of spending: It has the lowest incidence of mortality from colorectal cancer per dollar spent. Ultimately, the researchers conclude that the Canadian health care model is inferior: "It produces inferior age-adjusted access to physicians and technology, produces longer waiting times, is less successful in preventing deaths from preventable causes and costs more than any of the other systems that have comparable objectives."

The problem is progressive. For 13 years, Fraser has been tracking waiting lists for common medical procedures. Its latest findings indicate that waiting times for surgical and other therapeutic treatments in Canada increased in 2003: "Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, rose from 16.5 weeks in 2001-02 to 17.7 weeks in 2003."

The structure of Canada's system is dictated by the federal government, but most health services are delivered by the provinces. Waiting lists and spending levels therefore vary quite widely from province to province. Manitoba spends 12 percent more per capita than the Canadian average. Despite significantly higher spending levels, comparative data on the current state of hospital crowding, waiting lists, delays and denials of medical procedures indicate no significant difference in health care outcomes.

Although the average wait in Manitoba for a primary joint replacement is about nine months, many of the top surgeons have patients who wait for two years, according to the Winnipeg Free Press: "The longer they wait, the more trouble they have, partly because they are in worse condition when they have the surgery."

This dynamic is the unmeasur-able cost of Canada's socialized health care. Because timely treatment is routinely denied, people cannot work or lead normal lives. The costs in lost production - never mind the losses due to pain and suffering - are difficult to quantify. Economists have calculated the cost of adverse consequences for cardiac patients waiting for surgery. They broadly estimated it at from $1,100 to $5,600 annually per patient.

When you consider last year's average of 17.7 weeks of waiting for all treatments, the staggering hidden price Canadians pay for socialized medicine becomes clearer. This does not include the people who die while waiting for bypasses, radiation or chemotherapy, or because treatment was started too late.

When the results are considered, it is hard to understand why anyone would advocate the Canadian model. Americans should be more cautious when they extol its virtues. You may get what you ask for.

Source. The full Fraser Inst. report is here (Big PDF).


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Wednesday, April 19, 2006


Four children's hospitals have warned ministers that they face large deficits and cuts in services as a result of the latest NHS reforms. The chief executives of Great Ormond Street Hospital for Children in London, Alder Hey in Liverpool and Sheffield and Birmingham Children's Hospitals say in a letter that the operation of the tariff - the list of fixed prices for NHS procedures - will leave them about 22 million pounds a year worse off.

The tariff is a key feature of payment by results, one of the NHS reforms the Prime Minister is expected to extol in a speech today. Payment by results means that hospitals are paid for what they do, according to the fixed prices laid down in the tariff. Specialist hospitals have long argued that the tariff is insufficiently sophisticated to take account of the greater complexity of the operations and other procedures they carry out.

There have been discussions about adding special supplements to the tariff for children's hospitals to try to reduce the losses, but in a letter sent to Lord Warner, the Health Minister, and Sir Ian Carruthers, acting chief executive of the NHS, the hospitals say that this has not been done in the latest version of the tariff. Based on calculations that they have made so far, Great Ormond Street expects to lose 5.93 million in 2006-07, Alder Hey 11.03 million, Sheffield 2.5 million, and Birmingham Children's Hospital at least 2.6 million - a total of 22 million. These forecasts "pose fundamental problems for business continuity and access to specialist services", the letter says. "It has been clear to us for some time that these problems are largely the result of an inaccurate and highly insensitive tariff."

To make ends meet, the hospitals say, they will have to identify those services on which they stand to lose most money and stop providing them. Obvious candidates include heart, brain and spinal surgery. "We are extremely concerned that vital specialist paediatric capacity, particularly in surgical specialties, will be lost at regional and national levels this year, which will lead to public concern," the letter says. "The new opportunities presented by choice and through payment by results should be benefiting children and young people, but quite the opposite seems to be the case."

Steve Webb, the Liberal Democrat health spokesman, said: "The whole process of NHS reform is being conducted at breakneck speed, simply in order to guarantee the Prime Minister a `legacy'. "On present form, the Prime Minister's legacy risks being a decimated NHS, thrown into chaos by over-hasty reform and permanent revolution."

The letter could not have come to light at a worse moment for the Prime Minister. In his speech today to the New Health Network, Mr Blair will herald the new tariff system as central to the government health reforms as he attempts to shift the focus away from the financial deficits that have forced hospitals to cancel operations and make redundancies. He will claim that his structural changes to the NHS have reached "crunch point" and will vow not to back down.

The first phase of Labour's health reforms, in which ministers used strong central targets to improve services and bring down waiting lists, is complete, he will say. The Government is now embarking on the second stage in which the idea of an old monolithic NHS will be abandoned and replaced with one that is more decentralised.


Australian public health officials 'unreceptive' to superbug concern

Federal health authorities have been "unreceptive" to concerns about an evolving epidemic of new strains of golden staph, a senior public health official says.

Dr Keryn Christiansen, of Royal Perth Hospital (RPH), says community acquired methicillan resistant staphylococcus aureus, or CA-MRSA, is increasing for unknown reasons in some parts of Australia and particularly Western Australia. Dr Christiansen and co-authors of a study published in this month's Australian Medical Journal, surveyed 2,600 golden staph isolates (germs) collected from around Australia. Nationally, the appearance of the CA-MRSA strain rose from 4.7 per cent to 7.3 per cent of the sample, compared with similar surveys in 2000 and 2002. WA had a quarter of all national cases of CA-MRSA, between July 2004 and February 2005. The article refers to the issue as an "evolving epidemic".

But Dr Christiansen, head of microbiology and infectious diseases at RPH, says she has had trouble drawing the issue to the attention of federal authorities. "Unfortunately we've been unable to engage the federal government in this," she told AAP. "They've got other things on their agenda like pandemic flu and bio-terrorism and they're really putting a lot of money into that and not looking at this."

Methicillin-resistant Staphylococcus (MRSA), or Golden Staph, has long plagued hospital patients but other virulent related strains are now infecting people who have had no hospital contact. "In the past when we've seen the resistant strains, we've seen them in hospitals and they've been resistant to many, many antibiotics," said Dr Christiansen. "What we're seeing now is something completely different. "These patients have had no contact with hospitals, have never acquired these organisms from hospital contact and when you look at the organism genetically, they are quite distinct from the hospital variety. "Our other concern is that some of these strains contain a toxin called Panton-Valentine leukocidin (PVL), and this toxin actually breaks down white blood cells."

Dr Christiansen said they were not sure why the number of cases in WA was so high, but the state had a rigorous reporting process, not in place in other states and territories. "Every single MRSA that's isolated in this state is notified and we collect at my lab - we actually get the organism and we test it," she said. "We're not really sure why they should be so high ... we've got a few studies going to try and look at reasons for our high rates. "Our concern is that it is becoming more and more resistant and therefore will be difficult to treat," Dr Christiansen said.

Symptoms of community-acquired MRSA could be sores that turned into large abscesses or carbuncles, or wound infections that did not respond to treatment. A federal department of health spokeswoman said the department had met Dr Christiansen and there was ongoing discussion with expert committees on the best way to address community-acquired infections



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


Tuesday, April 18, 2006


In a little more than a year, four patients have died at hospitals in Santa Clara County alone due to medical errors that could have been prevented, according to state Sen. Elaine Alquist's office. Not that anyone would know. California doesn't have an easy system for providing public information about hospital safety records. To check the records, residents must go to a state office and look through paper files. Meanwhile, state inspectors charged with enforcing safety regulations visit hospitals only once every three years.

Alquist, D-Santa Clara, says public accountability at hospitals needs to improve. She has introduced SB 1301, which would require hospitals to start reporting medical errors - such as giving a patient the wrong medication - directly to the state Department of Health Services within 48 hours after they occur. It would require the state to put the information on a public Web site. And it would require state inspectors to monitor hospitals annually. The bill would also shorten the time the state has to respond to complaints about hospital care. Right now, inspectors have six months to follow up on a complaint. Alquist wants to reduce that to 45 days.

There's been a lot of public scrutiny of whether the state does a good enough job monitoring nursing homes and non-medical facilities such as child-care centers and homes for the elderly. Now, Alquist says, it's time to focus on acute care. "My goal is not to castigate anyone," Alquist said. "My goal is simply to see that hospitals are a safe place for sick people. ... We have a lot of good people who work in hospitals who are trying to do their best, but sometimes the systems have broken down." Citing various medical studies, Alquist's office estimates that there are an average of five to 10 fatalities due to mistakes at each hospital every year. The California Hospital Association opposes the bill, but not the idea of increased public awareness.

The group, a membership organization of hospitals throughout California, would support the measure if the public data were not hospital-specific and if it could not be used as evidence in a lawsuit, said Debby Rogers, vice president for quality and patient safety at the organization. "We want to create an environment where people are willing to talk about their mistakes," she said. "There may be some that would see posting the outcomes on the Internet as not necessarily the environment we want to create." Rogers said the hospital association and other groups are already working to improve public information about hospitals - and to improve hospitals' awareness of how to prevent mistakes. "The more we look at issues, the better we can get at identifying them," she said. "We're catching things we may not have caught five years ago."

The Schwarzenegger administration has not taken an official position on the bill, said Lea Brooks, a spokeswoman for the Department of Health Services. But the administration is in the midst of improving inspections of health facilities, and has included funds to hire more than 100 inspectors for hospitals and nursing homes in the proposed budget for next year, Brooks said. The ultimate goal, Alquist said, is to reduce errors. "The public believes they are safe in hospitals," she said. "And I want them to be safe."



Under a provision of the Deficit Reduction Act of 2005, as of July 1 all US citizens who sign up for Medicaid or renew their benefits will have to provide documentation of their citizenship. Eligibility rules for legal immigrants have not changed. Almost all of the state's poorest residents will have to show proof of US citizenship to continue getting medical care by July 1, under a little-noticed federal law that could endanger coverage for many, as Massachusetts is trying to expand access to healthcare.

Born out of ongoing efforts in Washington to clamp down on illegal immigration, the new federal requirement compels anyone seeking Medicaid coverage to provide a birth certificate, a passport, or another form of identification in order to sign up for benefits or renew them. No such proof is required now. The requirement was tucked into the Deficit Reduction Act of 2005, which President Bush signed into law earlier this year

The measure was part of an effort to limit the skyrocketing growth of federal entitlement programs. It has surfaced as Massachusetts begins to implement its sweeping healthcare plan, which aims to bring health coverage to almost all of the state's uninsured, in part by enrolling those in Medicaid who are eligible but who have not signed up.

Healthcare specialists voiced fear that because many Medicaid recipients -- including the homeless and the mentally disabled -- won't be able to easily produce documentation of their citizenship, they will have difficultly receiving care at community health centers, hospitals, or anywhere else. ''So we've got people in nursing homes, people in the [state Department of Mental Retardation] institutions, we've got the homeless, we've got the . . . mentally ill who now will have to come up with some verification to prove that they're citizens," said Victoria Pulos, health law attorney at the Massachusetts Law Reform Institute. ''It's ironic that this is happening in the state where part of the health reform plan is to make sure that everyone who's eligible for Medicaid is enrolled."

The new federal requirement, which all states have to comply with, would apply to the vast majority of the more than 1 million people on MassHealth, the Massachusetts Medicaid program. The intent is to prevent undocumented immigrants from posing as citizens and taking advantage of taxpayer-funded healthcare benefits that are afforded only to legal residents. (Under federal law, undocumented immigrants can receive only emergency Medicaid care; Massachusetts has 40,000 on such a program, which is called MassHealth Limited.) Less than three months before the new citizenship requirement takes effect, though, Massachusetts and other states are waiting for guidance from the federal government on how it will work

More here


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.