THE NHS AS "BIG BROTHER"
The Department of Health provoked uproar among doctors yesterday by asking GPs in England to send in correspondence from objectors who do not want their confidential medical records placed on the Spine, a national NHS database. Sir Liam Donaldson, the chief medical officer, said letters from patients who want to keep their private medical details out of the government's reach should be sent to Patricia Hewitt, the health secretary, for "full consideration". Campaigners who fear the national database will infringe patients' civil liberties said the exercise would give Ms Hewitt access to the names and addresses of patients most likely to be offended by government intrusion.
GPs wrote to the General Medical Council asking for a ruling on whether Sir Liam had broken the doctors' code of good practice by using his authority to encourage GPs to breach patient confidentiality without clinical justification. Sir Liam's letter complained about "misleading statements" in a Guardian article on November 1 that the police and other agencies might be able to access medical records once they had been loaded on to the national database. The article included a form of words patients could use to ask Ms Hewitt to refrain from uploading their records without their explicit consent. Sir Liam said patients were sending a similar request to GPs instead of the health secretary. He added: "If you do receive any such letters I would ask you to send them to the Department of Health so they may receive full consideration."
Hamish Meldrum, chairman of the BMA's GPs' committee, said: "The chief medical officer's intervention is not helpful and GPs should not forward these letters. It is possible that some patients might think this is a breach of confidentiality in that a letter sent to their GP is forwarded to somebody else without their consent." Paul Cundy, the BMA's spokesman on IT, said: "For a GP to forward such letters without the explicit consent of the patient would be a gross breach of privacy. In effect it is asking GPs to spy on his behalf. He should retract immediately. "Since these patients are objecting to the Big Brother society, this is an astonishingly incompetent gaffe."
Ross Anderson, professor of security engineering at Cambridge University, said: "It is not for the government to decide unilaterally to override the wishes of those patients who decide to write to their GP, but not to Ms Hewitt. For the chief medical officer to so recklessly put news management ahead of patient privacy is shocking." The government wants to start uploading a summary of patients' records in trial areas in the spring. Sir Liam reassured GPs: "There will be plenty of time to discuss patients' concerns with them before any data uploads ... in their areas."
Source
Unbelievable: Carelessness about meningococcal disease
What harm would precautionary antibiotics have done? A private doctor who failed to prescribe them in a risk situation would be sued for millions
The first rule to help doctors and nurses identify meningococcal disease is "listen closely to patients and friends", says an educational DVD that calls it the most rapidly lethal infectious disease known to man. But when George Khouzame raised concerns he might have passed on the illness to his girlfriend, Jehan Nassif, he was told he had probably only had the flu, the inquest into her death heard yesterday. Three days later Ms Nassif, 18, was dead.
Mr Khouzame and his cousin Elias had been overseas and both felt ill just before they returned to Australia. George's symptoms eased but Elias Khouzame became weak and had a headache, painful limbs and a fever. During a stopover he noticed red spots on his skin and suspected meningococcal disease. Back in Sydney, Elias went straight to hospital, while George attended a welcome-home party, where he kissed and cuddled Ms Nassif.
The next day a public health officer, Carla Ghezzi, spoke to George and his friends about their contact with Elias, who had been diagnosed with meningococcal disease, the inquest was told. George and his friends claim he told Ms Ghezzi he had had similar symptoms a day before his cousin and wondered whether he had passed the disease on to him. Ms Ghezzi allegedly told him: "If you had meningococcal you wouldn't be here now. You probably just had the flu." The inquest at Westmead Coroner's Court was told Ms Ghezzi also dismissed his concerns about Ms Nassif, though Ms Ghezzi had said she did not remember this part of the conversation.
Ms Nassif later briefly visited Elias in hospital, probably without wearing the prescribed face mask. National guidelines say anyone in close contact with a patient with meningococcal for at least four hours in the previous week should get antibiotics to prevent the spread of the disease, the court was told.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Wednesday, December 06, 2006
Tuesday, December 05, 2006
My health care is making me sick
Getting sick is high on my list of life's biggest hassles these days! Excuse me if I am sounding like an "old fogie" when I reminisce about the "good old days;" but, I can't help thinking back on my childhood (in the 50's and the 60's) when my mom and dad would call our family doctor who lived in the neighborhood.
Dr. Greenfield would keep my dad calmed down who was such a worry-wart that he would get sick along with me and my two sisters. Sometimes the doctor would just send a prescription, which I know is considered a no-no these days, however, I must confess to still being alive at the ripe old age of 55 and 7 months young! Other times we would go to his office, or would you believe he would even make a "house call." For those of you who are too young to have experienced this extinct phenomena . this is when the doctor actually comes to see you at home. Yes, you get to lie in bed in your jammies, under the covers watching TV and eating popsicles where you belong when you are sick. Such a novel idea.
I fondly remember the time I was about 12, I had some kind of bug that had me blowing chunks (my son's 90's term) for several days. As usual my dad got sick along with me, so my mom would have two people to clean up after. In comes Dr. Greenfield, trying as always to relax my worried father. (I see the two of them playing ping-pong in the dining room. Unfortunately, Dr Greenfield died shortly thereafter of a massive heart attack in his forties. There may have been a line between his overzealous medical practice and his untimely death, or maybe it was in his "genes?" I don't know what he charged for all of this, but there was no such thing as insurance and my parents were not wealthy. We just paid the bills as your health and your family are your own responsibility. After all, is that not what life is all about?
Needless to say, it was good while it lasted. Contrast that to medical care in the present.
The first question I get asked when I pursue medical treatment is who is your insurance company and the responsible party. There is no one who is willing to give you any simple advice or reassurance for fear of being blamed for wrongdoing or sued for malpractice. The doctor that I had for 25 years, all my adult life, recently quit taking my insurance provider. Sure, I could pay out of pocket for office calls or non-catastrophic expenses in order to stay with him, but what if the "big one" does hit? Then what? No one else knows my history or me.
I am really upset over this, as just when I am getting old enough to need a doctor BOOM-he is gone! I felt comfortable with Dr. John. I trusted him personally and professionally. We had worked together at a local hospital where I was a dietitian. He knew my family and husband. He knew my quirks and neuroses. He had seen me "au natural." This is a big deal to me - changing doctors. This is like getting a divorce and having to date again. I want my doctor back! I'm a person who won't even change grocery stores because I know where the food is.
A few (10) years ago when my father died, my mother in her grief called her health plan only to find the last doctor who had seen her was no longer there. My mother, at age 71, could not get anyone to give her a Valium during her crisis! For this kind of care we pay BIG BUCKS. Hundreds and thousands of dollars? I think we were all better off before the big insurance companies and the government came to rescue us concerning our health care needs.
I have heard that you can get antibiotics at pet stores for fish, and they are the same thing people take. I recently bought a ten-pack of penicillin pills at the local pet supplier for $3.89 because I have been sick with "whatever" for nearly a month. I wimped out and did not take them due to all the warnings on the label discouraging what I was about to do! (Some people actually do read warning labels) I guess logic did dictate that I was different from my Cichlids. I have saved the pills for the next case of "ICK!" in our tank.
But, alas, I have survived despite any medical treatment at all other than some aspirin, a little wine, a few over the counter remedies, and advice from my handy home medical advisor. I've read they are about to come out with a do-it-yourself PAP smear. I wish they would hurry up, as I am already overdue on that one too.
Source
Australia: Physiotherapy students victimized by a near-bankrupt health system
Pressure on public hospitals has become so extreme that [Queensland] physiotherapy students are being forced to travel thousands of kilometres at their own expense to secure clinical training. Gold Coast students Lauren McLune and Emma Armfield have spent the past six weeks sharing a cramped room in a Hobart backpacker hostel because Queensland's public hospital system cannot afford to provide the practical training they need to graduate.
The pair had only four days' notice of their Hobart placement - the closest available to Griffith University's Gold Coast campus. They estimate they have each spent at least $2000 on accommodation, food and travel while also maintaining their homes on the Gold Coast. Ms Armfield, 28, had to quit two of her three part-time jobs to take the Hobart placement. "We didn't know whether to laugh or cry," Ms McLune, 25, said. "We entered into this degree knowing that this could happen. However, four days' notice is a bit different to the month that people usually get given."
The students' plight reflects the growing pains afflicting the nation's medical workforce. And it is not just physiotherapy students. Australian Medical Association national president Mukesh Haikerwal said medicine and all allied health professions suffered similar problems because poorly funded public hospital resources were straining to provide patient care, leaving no money for training. "The universities are cash-strapped, the hospitals are cash-strapped and the quality of education is at risk," Dr Haikerwal said. "If you are looking at having 10 students standing around a bed, it's more difficult than having two students. And it wears out the goodwill of both the educators and the patients."
The commonwealth and states agreed to boost medical students numbers this year. Within a few years, the number of graduates will climb from about 1500 to 3200. "But where will they train?" Dr Haikerwal said. He said the inter-governmental agreement was "a furphy" because no consideration had been given to boosting the capacity of hospitals to provide hands-on training and internships.
While politicians had claimed credit for funding more university places, universities were stumped over how to turn out doctors and other professionals with adequate practical experience. Australian Physiotherapy Association president Cathy Nall blamed the commonwealth for under-funding university courses. "There's no subsidy provided for accommodation for physiotherapy students in the way that there is for medical students and no assistance with travel costs," Ms Nall said. She agreed it was common for students to take practical placements in Tasmania because it had no university physiotherapy course. But they usually came from South Australia or Victoria and were given months of notice.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Getting sick is high on my list of life's biggest hassles these days! Excuse me if I am sounding like an "old fogie" when I reminisce about the "good old days;" but, I can't help thinking back on my childhood (in the 50's and the 60's) when my mom and dad would call our family doctor who lived in the neighborhood.
Dr. Greenfield would keep my dad calmed down who was such a worry-wart that he would get sick along with me and my two sisters. Sometimes the doctor would just send a prescription, which I know is considered a no-no these days, however, I must confess to still being alive at the ripe old age of 55 and 7 months young! Other times we would go to his office, or would you believe he would even make a "house call." For those of you who are too young to have experienced this extinct phenomena . this is when the doctor actually comes to see you at home. Yes, you get to lie in bed in your jammies, under the covers watching TV and eating popsicles where you belong when you are sick. Such a novel idea.
I fondly remember the time I was about 12, I had some kind of bug that had me blowing chunks (my son's 90's term) for several days. As usual my dad got sick along with me, so my mom would have two people to clean up after. In comes Dr. Greenfield, trying as always to relax my worried father. (I see the two of them playing ping-pong in the dining room. Unfortunately, Dr Greenfield died shortly thereafter of a massive heart attack in his forties. There may have been a line between his overzealous medical practice and his untimely death, or maybe it was in his "genes?" I don't know what he charged for all of this, but there was no such thing as insurance and my parents were not wealthy. We just paid the bills as your health and your family are your own responsibility. After all, is that not what life is all about?
Needless to say, it was good while it lasted. Contrast that to medical care in the present.
The first question I get asked when I pursue medical treatment is who is your insurance company and the responsible party. There is no one who is willing to give you any simple advice or reassurance for fear of being blamed for wrongdoing or sued for malpractice. The doctor that I had for 25 years, all my adult life, recently quit taking my insurance provider. Sure, I could pay out of pocket for office calls or non-catastrophic expenses in order to stay with him, but what if the "big one" does hit? Then what? No one else knows my history or me.
I am really upset over this, as just when I am getting old enough to need a doctor BOOM-he is gone! I felt comfortable with Dr. John. I trusted him personally and professionally. We had worked together at a local hospital where I was a dietitian. He knew my family and husband. He knew my quirks and neuroses. He had seen me "au natural." This is a big deal to me - changing doctors. This is like getting a divorce and having to date again. I want my doctor back! I'm a person who won't even change grocery stores because I know where the food is.
A few (10) years ago when my father died, my mother in her grief called her health plan only to find the last doctor who had seen her was no longer there. My mother, at age 71, could not get anyone to give her a Valium during her crisis! For this kind of care we pay BIG BUCKS. Hundreds and thousands of dollars? I think we were all better off before the big insurance companies and the government came to rescue us concerning our health care needs.
I have heard that you can get antibiotics at pet stores for fish, and they are the same thing people take. I recently bought a ten-pack of penicillin pills at the local pet supplier for $3.89 because I have been sick with "whatever" for nearly a month. I wimped out and did not take them due to all the warnings on the label discouraging what I was about to do! (Some people actually do read warning labels) I guess logic did dictate that I was different from my Cichlids. I have saved the pills for the next case of "ICK!" in our tank.
But, alas, I have survived despite any medical treatment at all other than some aspirin, a little wine, a few over the counter remedies, and advice from my handy home medical advisor. I've read they are about to come out with a do-it-yourself PAP smear. I wish they would hurry up, as I am already overdue on that one too.
Source
Australia: Physiotherapy students victimized by a near-bankrupt health system
Pressure on public hospitals has become so extreme that [Queensland] physiotherapy students are being forced to travel thousands of kilometres at their own expense to secure clinical training. Gold Coast students Lauren McLune and Emma Armfield have spent the past six weeks sharing a cramped room in a Hobart backpacker hostel because Queensland's public hospital system cannot afford to provide the practical training they need to graduate.
The pair had only four days' notice of their Hobart placement - the closest available to Griffith University's Gold Coast campus. They estimate they have each spent at least $2000 on accommodation, food and travel while also maintaining their homes on the Gold Coast. Ms Armfield, 28, had to quit two of her three part-time jobs to take the Hobart placement. "We didn't know whether to laugh or cry," Ms McLune, 25, said. "We entered into this degree knowing that this could happen. However, four days' notice is a bit different to the month that people usually get given."
The students' plight reflects the growing pains afflicting the nation's medical workforce. And it is not just physiotherapy students. Australian Medical Association national president Mukesh Haikerwal said medicine and all allied health professions suffered similar problems because poorly funded public hospital resources were straining to provide patient care, leaving no money for training. "The universities are cash-strapped, the hospitals are cash-strapped and the quality of education is at risk," Dr Haikerwal said. "If you are looking at having 10 students standing around a bed, it's more difficult than having two students. And it wears out the goodwill of both the educators and the patients."
The commonwealth and states agreed to boost medical students numbers this year. Within a few years, the number of graduates will climb from about 1500 to 3200. "But where will they train?" Dr Haikerwal said. He said the inter-governmental agreement was "a furphy" because no consideration had been given to boosting the capacity of hospitals to provide hands-on training and internships.
While politicians had claimed credit for funding more university places, universities were stumped over how to turn out doctors and other professionals with adequate practical experience. Australian Physiotherapy Association president Cathy Nall blamed the commonwealth for under-funding university courses. "There's no subsidy provided for accommodation for physiotherapy students in the way that there is for medical students and no assistance with travel costs," Ms Nall said. She agreed it was common for students to take practical placements in Tasmania because it had no university physiotherapy course. But they usually came from South Australia or Victoria and were given months of notice.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Monday, December 04, 2006
"CARING" PUBLIC HOSPITALS
Three stories from the one day in one Australian State:
Kicked out (1)
A distressed woman was found close to collapse on a highway after hospital staff who treated her for a suspected heart attack refused to help her get home. The woman, 52, tried to walk the 20km from Atherton Hospital to her home near Yungaburra after explaining to staff she had no money and no one to pick her up. A Good Samaritan picked her up as she stumbled along the highway in her slippers and nightclothes in 30C heat. "They just don't seem to care any more," said the woman, who did not want to be identified. "The philosophy seems to be to get people in and get them out as quickly as they can."
An ambulance took the woman to Atherton Hospital after she woke with severe chest pains at 1am on Saturday, November 4. Doctors ruled out a heart attack, but could not identify the cause of her illness. She was told to go home later in the day.
"I went to the emergency counter and asked if they could help me get home," the woman said. "I didn't have any money on me for a taxi, my brother and daughter were overseas and my son was in Iraq. "I asked if an ambulance could take me, but she told me, 'No, the ambulance service is not a taxi service, madam'. I said I would just have to walk home. She shrugged her shoulders and turned her back."
The woman had walked for more than an hour when passing motorist Gail Fleming saw her in distress and offered her a lift. Ms Fleming, 58, from Atherton, said the woman was clutching her chest when she saw her walking up a hill about 4pm. "It was very hot and she was in a lot of stress," Ms Fleming said. "She just started crying straight away."
One Nation MP Rosa Lee Long raised the case in State Parliament last week to try to get more resources for hospitals in her Tablelands electorate. "She would never have made it home," Ms Long said. "These kinds of events cry out for an urgent roll-out of the promised extra funding, not in four or five years or even longer, but immediately."
Source
Kicked out (2)
Grandmother Gaynor Ralph was kicked out of Brisbane's Princess Alexandra Hospital with no shoes, no money and nowhere to go. Mrs Ralph, 75, was put in a taxi in only a hospital gown and her nightie despite telling staff she didn't know her son's new address. She had to be taken to a police station until officers could contact her son Charles. "I was appalled," he said yesterday. "She was told she had to go, even though they knew she had nowhere to go to." Mr Ralph was so stunned by his mother's treatment that he took pictures of her in the hospital gown after picking her up from the police station.
His mother had been in Europe when a medical emergency forced her to return to Australia for immediate treatment. She was flown to Brisbane because that's where her son lives. Mrs Ralph spent 60 hours in transit before being taken to the PA Hospital in a wheelchair with suspected deep vein thrombosis on Saturday, November 4. She was kept in hospital overnight, but a doctor examined her the next morning and told her to go home. Hospital staff gave her a taxi voucher and sent her packing.
"I had moved house and she didn't know where I'd moved to," Mr Ralph said. "Her mobile phone (battery) was flat and she didn't have any money because the hospital told us not to leave her with any valuables for security reasons."
Hospital staff said they were unable to reach Mr Ralph on his mobile phone, but police had no such problem. "I left late the night she was admitted, telling them I'd be back in the morning," Mr Ralph said. "As I arrived at the hospital I got a call from the police station to say that she was there. "I arrived at the station to find her in an ill-fitting hospital gown with no footwear."
His mother was in need of further treatment and should have been allowed to stay in hospital at least until he arrived, Mr Ralph said. "They knew I was coming and they still kicked her out," he said. "They will claim she agreed and she was willing to go. But they told her she had to go. "All she did as a frail old lady was comply to their demands." Mrs Ralph recovered at her son's home until she was well enough to return to her home in Tasmania.
State Opposition Health spokesman John-Paul Langbroek, who has been seeking answers for the Ralph family, said lives were being put at risk because under-funded hospitals were evicting patients too early. "It all comes back to 'bedlock'. Doctors are feeling pressure from above to clear the beds," he said.
Source
Wrong kneejoint fitted -- deliberately
An Ipswich grandmother who waited five years for a knee replacement has been told she needs the operation again -- because surgeons fitted the wrong joint. Marilyn Hohnke, 62, has been suffering pain in her left knee since 1999, when she was first put on the waiting list for surgery at the Royal Brisbane Hospital. She expected the operation in December 2004 would fix her problem, but was disappointed to find it made no difference. Now an examination has revealed her knee joint will never work properly because it is too big for her.
Mrs Hohnke is furious to be back on the waiting list for a second time, and says she feels let down by the health system. "It was terrible having to wait five years for this operation in the first place, but finding out that it was a complete waste of time is just so discouraging," she said. "I don't know how the doctors could have made such a mistake. "I was shocked when they told me that it was the only joint available on the day of the operation so they had to use it. "I am now at the back of the queue again and don't know how long it will be before I get it fixed. "In the meantime, I can't walk properly because it causes me great discomfort."
She has now opted to have the second knee operation at Ipswich Hospital and has been on the waiting list since May. Bosses at the Royal Brisbane Hospital said Mrs Hohnke was considered too young for the knee replacement in 1999, even though it was causing her pain. They said the operation had been a success...
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Three stories from the one day in one Australian State:
Kicked out (1)
A distressed woman was found close to collapse on a highway after hospital staff who treated her for a suspected heart attack refused to help her get home. The woman, 52, tried to walk the 20km from Atherton Hospital to her home near Yungaburra after explaining to staff she had no money and no one to pick her up. A Good Samaritan picked her up as she stumbled along the highway in her slippers and nightclothes in 30C heat. "They just don't seem to care any more," said the woman, who did not want to be identified. "The philosophy seems to be to get people in and get them out as quickly as they can."
An ambulance took the woman to Atherton Hospital after she woke with severe chest pains at 1am on Saturday, November 4. Doctors ruled out a heart attack, but could not identify the cause of her illness. She was told to go home later in the day.
"I went to the emergency counter and asked if they could help me get home," the woman said. "I didn't have any money on me for a taxi, my brother and daughter were overseas and my son was in Iraq. "I asked if an ambulance could take me, but she told me, 'No, the ambulance service is not a taxi service, madam'. I said I would just have to walk home. She shrugged her shoulders and turned her back."
The woman had walked for more than an hour when passing motorist Gail Fleming saw her in distress and offered her a lift. Ms Fleming, 58, from Atherton, said the woman was clutching her chest when she saw her walking up a hill about 4pm. "It was very hot and she was in a lot of stress," Ms Fleming said. "She just started crying straight away."
One Nation MP Rosa Lee Long raised the case in State Parliament last week to try to get more resources for hospitals in her Tablelands electorate. "She would never have made it home," Ms Long said. "These kinds of events cry out for an urgent roll-out of the promised extra funding, not in four or five years or even longer, but immediately."
Source
Kicked out (2)
Grandmother Gaynor Ralph was kicked out of Brisbane's Princess Alexandra Hospital with no shoes, no money and nowhere to go. Mrs Ralph, 75, was put in a taxi in only a hospital gown and her nightie despite telling staff she didn't know her son's new address. She had to be taken to a police station until officers could contact her son Charles. "I was appalled," he said yesterday. "She was told she had to go, even though they knew she had nowhere to go to." Mr Ralph was so stunned by his mother's treatment that he took pictures of her in the hospital gown after picking her up from the police station.
His mother had been in Europe when a medical emergency forced her to return to Australia for immediate treatment. She was flown to Brisbane because that's where her son lives. Mrs Ralph spent 60 hours in transit before being taken to the PA Hospital in a wheelchair with suspected deep vein thrombosis on Saturday, November 4. She was kept in hospital overnight, but a doctor examined her the next morning and told her to go home. Hospital staff gave her a taxi voucher and sent her packing.
"I had moved house and she didn't know where I'd moved to," Mr Ralph said. "Her mobile phone (battery) was flat and she didn't have any money because the hospital told us not to leave her with any valuables for security reasons."
Hospital staff said they were unable to reach Mr Ralph on his mobile phone, but police had no such problem. "I left late the night she was admitted, telling them I'd be back in the morning," Mr Ralph said. "As I arrived at the hospital I got a call from the police station to say that she was there. "I arrived at the station to find her in an ill-fitting hospital gown with no footwear."
His mother was in need of further treatment and should have been allowed to stay in hospital at least until he arrived, Mr Ralph said. "They knew I was coming and they still kicked her out," he said. "They will claim she agreed and she was willing to go. But they told her she had to go. "All she did as a frail old lady was comply to their demands." Mrs Ralph recovered at her son's home until she was well enough to return to her home in Tasmania.
State Opposition Health spokesman John-Paul Langbroek, who has been seeking answers for the Ralph family, said lives were being put at risk because under-funded hospitals were evicting patients too early. "It all comes back to 'bedlock'. Doctors are feeling pressure from above to clear the beds," he said.
Source
Wrong kneejoint fitted -- deliberately
An Ipswich grandmother who waited five years for a knee replacement has been told she needs the operation again -- because surgeons fitted the wrong joint. Marilyn Hohnke, 62, has been suffering pain in her left knee since 1999, when she was first put on the waiting list for surgery at the Royal Brisbane Hospital. She expected the operation in December 2004 would fix her problem, but was disappointed to find it made no difference. Now an examination has revealed her knee joint will never work properly because it is too big for her.
Mrs Hohnke is furious to be back on the waiting list for a second time, and says she feels let down by the health system. "It was terrible having to wait five years for this operation in the first place, but finding out that it was a complete waste of time is just so discouraging," she said. "I don't know how the doctors could have made such a mistake. "I was shocked when they told me that it was the only joint available on the day of the operation so they had to use it. "I am now at the back of the queue again and don't know how long it will be before I get it fixed. "In the meantime, I can't walk properly because it causes me great discomfort."
She has now opted to have the second knee operation at Ipswich Hospital and has been on the waiting list since May. Bosses at the Royal Brisbane Hospital said Mrs Hohnke was considered too young for the knee replacement in 1999, even though it was causing her pain. They said the operation had been a success...
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Sunday, December 03, 2006
HIGH-DEDUCTIBLE PLANS DO MAKE PEOPLE MORE CAREFUL ABOUT HEALTHCARE USE
People in a new kind of health plan that makes consumers pay for a bigger share of their care appear to be more cost-conscious than those in traditional plans, but half say they would switch if they had the chance, according to a survey released yesterday. The survey of 1,389 people by the nonprofit Kaiser Family Foundation found that 71 percent of those in the new "consumer-directed health plans" said the policies prompted them to consider cost when seeking health care, compared with 49 percent of those with more traditional employer-sponsored coverage.
For instance, people in the new plans were more likely to ask about the cost of a doctor's visit and inquire about the availability of lower-cost alternatives in treatments and tests. More than half, 55 percent, who sought care said the new plans have changed their approach to using health care.
Such findings are in line with assertions by the Bush administration and other advocates who say that the new plans will check spiraling health-care spending by giving consumers a financial incentive to shop around for the best care at a reasonable price -- and to get only the care they need.
"It's a cultural shift," said Devon Herrick, a health economist at the National Center for Policy Analysis in Dallas. "When you go to Wal-Mart you don't have to ask about price -- it's right there next to the good or service you are buying. Health care is not there yet, but it's getting that way. This is the early stages. We have the incentives to get people more responsible and asking about price."
In contrast with other plans that typically require $15 or $20 co-payments for visits to the doctor, the new plans can require consumers to shell out hundreds or thousands of dollars of their own money for medications, physicians' services and hospital care before most coverage kicks in. The plans have high annual deductibles, but their premiums tend to be lower.
Some consumers complain that the new plans are confusing, and the Kaiser survey found that the plans are not without problems. More than 60 percent of people in the plans said it is hard to find good information about the cost of doctors' services and hospital care; and about 50 percent said information on quality of care is hard to come by. Half of those enrolled in the plans said they would switch out if given the choice, compared with a third of those in traditional plans. And they were twice as likely as those in traditional plans to say that they went without care because of cost.
Gail Shearer, director of health policy analysis at Consumers Union, noted that the survey found that people in the new plans tend to be wealthier, healthier and more educated than their counterparts in traditional plans, and were more likely to be white. "Instead of our health system moving towards one where we're all in this together, this type of option is leading to more splitting the population into different segments and, to me, that's an unhealthy thing," Shearer said. She added that poorer, sicker consumers could get left behind.
The new plans are often coupled with special accounts that allow consumers -- or employers on behalf of their workers -- to set aside tax-free dollars to pay for medical expenses, with any unused money rolling over into the following year. About 3 million people are enrolled in such plans this year, and experts expect that number to grow. "The folks in the programs now are early adopters, pioneers," said Greg Scandlen, president of Consumers for Health Care Choices, a Hagerstown, Md.-based nonprofit group that favors the plans. "And they are really testing the waters, and I think they are already forcing a lot of change. . . . With any kind of new insurance plan it takes a while to figure out what it's all about."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
People in a new kind of health plan that makes consumers pay for a bigger share of their care appear to be more cost-conscious than those in traditional plans, but half say they would switch if they had the chance, according to a survey released yesterday. The survey of 1,389 people by the nonprofit Kaiser Family Foundation found that 71 percent of those in the new "consumer-directed health plans" said the policies prompted them to consider cost when seeking health care, compared with 49 percent of those with more traditional employer-sponsored coverage.
For instance, people in the new plans were more likely to ask about the cost of a doctor's visit and inquire about the availability of lower-cost alternatives in treatments and tests. More than half, 55 percent, who sought care said the new plans have changed their approach to using health care.
Such findings are in line with assertions by the Bush administration and other advocates who say that the new plans will check spiraling health-care spending by giving consumers a financial incentive to shop around for the best care at a reasonable price -- and to get only the care they need.
"It's a cultural shift," said Devon Herrick, a health economist at the National Center for Policy Analysis in Dallas. "When you go to Wal-Mart you don't have to ask about price -- it's right there next to the good or service you are buying. Health care is not there yet, but it's getting that way. This is the early stages. We have the incentives to get people more responsible and asking about price."
In contrast with other plans that typically require $15 or $20 co-payments for visits to the doctor, the new plans can require consumers to shell out hundreds or thousands of dollars of their own money for medications, physicians' services and hospital care before most coverage kicks in. The plans have high annual deductibles, but their premiums tend to be lower.
Some consumers complain that the new plans are confusing, and the Kaiser survey found that the plans are not without problems. More than 60 percent of people in the plans said it is hard to find good information about the cost of doctors' services and hospital care; and about 50 percent said information on quality of care is hard to come by. Half of those enrolled in the plans said they would switch out if given the choice, compared with a third of those in traditional plans. And they were twice as likely as those in traditional plans to say that they went without care because of cost.
Gail Shearer, director of health policy analysis at Consumers Union, noted that the survey found that people in the new plans tend to be wealthier, healthier and more educated than their counterparts in traditional plans, and were more likely to be white. "Instead of our health system moving towards one where we're all in this together, this type of option is leading to more splitting the population into different segments and, to me, that's an unhealthy thing," Shearer said. She added that poorer, sicker consumers could get left behind.
The new plans are often coupled with special accounts that allow consumers -- or employers on behalf of their workers -- to set aside tax-free dollars to pay for medical expenses, with any unused money rolling over into the following year. About 3 million people are enrolled in such plans this year, and experts expect that number to grow. "The folks in the programs now are early adopters, pioneers," said Greg Scandlen, president of Consumers for Health Care Choices, a Hagerstown, Md.-based nonprofit group that favors the plans. "And they are really testing the waters, and I think they are already forcing a lot of change. . . . With any kind of new insurance plan it takes a while to figure out what it's all about."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Saturday, December 02, 2006
BRITAIN: MORE CUTBACKS FOR THE SICK
On Britain's present trajectory, they will eventually just have bureaucrats and no medical staff at all
Hundreds of thousands of elderly people will no longer get home care services because of a funding shortfall and the widening impact of NHS cuts, the social care watchdog says. The Commission for Social Care Inspection reports today that nearly two thirds of the 150 councils that provide social services changed their criteria last year to provide social care only for the most dependent people. In more than 100 councils, elderly and disabled people who used to get regular help with cleaning, bathing, dressing and shopping will no longer be entitled to care unless they fall into the top two categories of "critical" or "substantial" risk. Only the very frail, immobile or those at risk of abuse will be entitled to these services, forcing other vulnerable people to rely on families or friends or to go without help.
The commission says that the situation is already getting worse in at least three authorities - North Yorkshire, Northumberland and West Berkshire - which are restricting home care to critical or life-threatening situations. It predicts that this situation will apply in many more authorities next year.
The number of households receiving home care has fallen by 174,000 since 1992 to 354,000 last year, a drop of 30 per cent. The commission says this is mainly because councils are concentrating scarce resources on the very needy. "People entitled to social care are getting better care," a commission official said. "But that leaves thousands of others with no care at all." Mervyn Kohler, of Help the Aged, said that withdrawing preventive services from less critical groups could affect their quality of life crucially. People who no longer had help with cleaning, shopping or dressing would stop inviting people round, lose their self esteem and stay in bed all day. "Councils will end up paying the price for restricting the criteria with more people becoming dependent. This is a foolish, short-term economy."
Councils are being forced to change their eligibility criteria because government grants for social services have failed to keep up with growing numbers of very elderly people, local authorities say. Many also complain that they are bearing the brunt of NHS cutbacks. In some cases they are treating people who would have been cared for in hospital, while in others primary care trusts are refusing to pay for services provided by local authorities where they would have done so in the past.
The commission's annual performance rating of adult social services for 2006 shows that three quarters of the 150 councils gained either two or three stars. Although no council was zero-rated, 33 got only one star; 24 of these had been given one star for the past three years. Ten councils went up to the highest three-star category, but nine dropped in the rankings to two stars. In total 25 councils improved their services, while 16 fell back.
Ivan Lewis, the Care Services Minister, said that a number of councils need to "up their game" as he announced plans to intervene in 21 councils which had failed to improve their ratings since 2002. "Adults and their carers who use services in this area deserve better, therefore I am asking (the commission) to work with these councils to develop improvement action plans by March next year," he said. Social care leaders broadly welcomed the latest league tables. John Coughlan, president of the Association of Directors of Social Services, said: "We cannot ignore the fact that these improvements have been made in the teeth of one of the most severe financial squeezes social care has experienced for a long while."
Source
The return of Hillarycare?
In the wake of the Democratic victory in the midterm congressional elections, Hillary Clinton announced that Democrats would once again make health care reform a top legislative priority. "Health care is coming back," Clinton said, apparently giddy with triumph, adding, "It may be a bad dream for some." Indeed, it may well be a nightmare for American health consumers. No one knows for certain what the new Democratic majority has in mind, but its initial proposals -- expanding Medicaid and the Medicare prescription drug program -- are certainly steps in the direction of more government interference in the medical marketplace.
Perhaps it has been so long that Americans have forgotten exactly what Hillarycare was. If so, it's worth reminding them. Under the Clinton plan, the government would have taken control of nearly one-seventh of the U.S. economy. It would have established the world's largest government program -- dwarfing even Social Security -- created a huge new bureaucracy and required massive tax increases.
The entire idea behind the Clinton health care plan was that government knew best -- better than businesses, better than doctors, and better than patients.The Clinton plan would have required every business in America to provide health care coverage to its employees, regardless of cost. The mandate would have devastated small businesses and cost thousands of jobs. Clinton's plan would also have forced Americans to give up their current health insurance, even if they were happy with it, in return for a government-designed standard benefit package that could be far more expensive. What the policy covered would be determined not by consumer preference or even medical necessity, but by the lobbying power of various special interests.
Such policies would have been "community rated," meaning that people would pay exactly the same premium regardless of whether they were healthy or on their death bed, practiced healthy lifestyles or smoked six packs a day. That would have meant a huge premium increase for young and healthy people.
The plan established rigid price controls through a series of premium caps and other measures. That, in turn, would have forced insurers to ration the care they provided. Clinton apparently hoped that indirect rationing through managed care would avoid the direct rationing that results from price controls under every other national health care system in the world. But just in case, the proposal would also have established a National Health Board, with back-up authority to ration health care directly if indirect rationing failed to reduce costs sufficiently. And the Clinton plan would have forced all Americans into managed care, effectively denying them the ability to choose their own doctors. Indeed, the Clinton proposal actually included criminal penalties for people who tried to pay for unapproved health care out of their own pockets.
There is no doubt that our health care system is badly in need of reform. Too many Americans lack health insurance. We need to do more to lower health care costs and increase access to care. The system is riddled with waste and the quality of care is uneven. Government health care programs like Medicare and Medicaid threaten future generations with an enormous burden of debt and taxes. But the answers to these problems lie with more choice and competition, not less. More government regulation, subsidies, and control would simply drain the medical marketplace of the quality, dynamism and innovation that save lives. Hillarycare would have put the health care equivalent of FEMA in charge of our health care system. Surely this is not what the American people voted for on Nov. 7.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
On Britain's present trajectory, they will eventually just have bureaucrats and no medical staff at all
Hundreds of thousands of elderly people will no longer get home care services because of a funding shortfall and the widening impact of NHS cuts, the social care watchdog says. The Commission for Social Care Inspection reports today that nearly two thirds of the 150 councils that provide social services changed their criteria last year to provide social care only for the most dependent people. In more than 100 councils, elderly and disabled people who used to get regular help with cleaning, bathing, dressing and shopping will no longer be entitled to care unless they fall into the top two categories of "critical" or "substantial" risk. Only the very frail, immobile or those at risk of abuse will be entitled to these services, forcing other vulnerable people to rely on families or friends or to go without help.
The commission says that the situation is already getting worse in at least three authorities - North Yorkshire, Northumberland and West Berkshire - which are restricting home care to critical or life-threatening situations. It predicts that this situation will apply in many more authorities next year.
The number of households receiving home care has fallen by 174,000 since 1992 to 354,000 last year, a drop of 30 per cent. The commission says this is mainly because councils are concentrating scarce resources on the very needy. "People entitled to social care are getting better care," a commission official said. "But that leaves thousands of others with no care at all." Mervyn Kohler, of Help the Aged, said that withdrawing preventive services from less critical groups could affect their quality of life crucially. People who no longer had help with cleaning, shopping or dressing would stop inviting people round, lose their self esteem and stay in bed all day. "Councils will end up paying the price for restricting the criteria with more people becoming dependent. This is a foolish, short-term economy."
Councils are being forced to change their eligibility criteria because government grants for social services have failed to keep up with growing numbers of very elderly people, local authorities say. Many also complain that they are bearing the brunt of NHS cutbacks. In some cases they are treating people who would have been cared for in hospital, while in others primary care trusts are refusing to pay for services provided by local authorities where they would have done so in the past.
The commission's annual performance rating of adult social services for 2006 shows that three quarters of the 150 councils gained either two or three stars. Although no council was zero-rated, 33 got only one star; 24 of these had been given one star for the past three years. Ten councils went up to the highest three-star category, but nine dropped in the rankings to two stars. In total 25 councils improved their services, while 16 fell back.
Ivan Lewis, the Care Services Minister, said that a number of councils need to "up their game" as he announced plans to intervene in 21 councils which had failed to improve their ratings since 2002. "Adults and their carers who use services in this area deserve better, therefore I am asking (the commission) to work with these councils to develop improvement action plans by March next year," he said. Social care leaders broadly welcomed the latest league tables. John Coughlan, president of the Association of Directors of Social Services, said: "We cannot ignore the fact that these improvements have been made in the teeth of one of the most severe financial squeezes social care has experienced for a long while."
Source
The return of Hillarycare?
In the wake of the Democratic victory in the midterm congressional elections, Hillary Clinton announced that Democrats would once again make health care reform a top legislative priority. "Health care is coming back," Clinton said, apparently giddy with triumph, adding, "It may be a bad dream for some." Indeed, it may well be a nightmare for American health consumers. No one knows for certain what the new Democratic majority has in mind, but its initial proposals -- expanding Medicaid and the Medicare prescription drug program -- are certainly steps in the direction of more government interference in the medical marketplace.
Perhaps it has been so long that Americans have forgotten exactly what Hillarycare was. If so, it's worth reminding them. Under the Clinton plan, the government would have taken control of nearly one-seventh of the U.S. economy. It would have established the world's largest government program -- dwarfing even Social Security -- created a huge new bureaucracy and required massive tax increases.
The entire idea behind the Clinton health care plan was that government knew best -- better than businesses, better than doctors, and better than patients.The Clinton plan would have required every business in America to provide health care coverage to its employees, regardless of cost. The mandate would have devastated small businesses and cost thousands of jobs. Clinton's plan would also have forced Americans to give up their current health insurance, even if they were happy with it, in return for a government-designed standard benefit package that could be far more expensive. What the policy covered would be determined not by consumer preference or even medical necessity, but by the lobbying power of various special interests.
Such policies would have been "community rated," meaning that people would pay exactly the same premium regardless of whether they were healthy or on their death bed, practiced healthy lifestyles or smoked six packs a day. That would have meant a huge premium increase for young and healthy people.
The plan established rigid price controls through a series of premium caps and other measures. That, in turn, would have forced insurers to ration the care they provided. Clinton apparently hoped that indirect rationing through managed care would avoid the direct rationing that results from price controls under every other national health care system in the world. But just in case, the proposal would also have established a National Health Board, with back-up authority to ration health care directly if indirect rationing failed to reduce costs sufficiently. And the Clinton plan would have forced all Americans into managed care, effectively denying them the ability to choose their own doctors. Indeed, the Clinton proposal actually included criminal penalties for people who tried to pay for unapproved health care out of their own pockets.
There is no doubt that our health care system is badly in need of reform. Too many Americans lack health insurance. We need to do more to lower health care costs and increase access to care. The system is riddled with waste and the quality of care is uneven. Government health care programs like Medicare and Medicaid threaten future generations with an enormous burden of debt and taxes. But the answers to these problems lie with more choice and competition, not less. More government regulation, subsidies, and control would simply drain the medical marketplace of the quality, dynamism and innovation that save lives. Hillarycare would have put the health care equivalent of FEMA in charge of our health care system. Surely this is not what the American people voted for on Nov. 7.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Friday, December 01, 2006
Canada: Waiting-times failure a worry
Federal Health Minister Tony Clement says the fact that patients at nearly half of Canada's cancer treatment centres are not getting critical radiation treatments within the target period of four weeks bolsters his argument for guaranteed waiting times. A study by the Canadian Association of Radiation Oncologists found that only 50 to 60 per cent of the centres are able to provide radiation treatment within the four-week period. Prostate cancer patients were among the least well served: 70 per cent of Canadian hospitals could not deliver the radiation treatment within four weeks. And breast cancer numbers were also disturbing, with only 53 per cent of hospitals meeting the target.
Mr. Clement said the waiting-time figures, which were obtained by The Globe and Mail, are a worry. But they prove the need for provinces to promise to pay to send patients elsewhere for treatment when it can't be delivered locally in a timely manner, he told a news conference. "Benchmarks and targets without recourse is an empty promise," said Mr. Clement, whose government has made reduced waiting times the centrepiece of its health-care strategy. "That is why we have sought to engage the provinces and territories, not just to create benchmarks, but to take the next logical step, which is to have the recourse which creates the guarantee."
Clinically acceptable standards for radiation and four other priority treatments were agreed upon in December of 2005 at a meeting between provincial health ministers and Ujjal Dosanjh, who was then the Liberal minister of health.
The Conservatives were elected a month later on a promise that they would get the provinces to set targets to meet those standards by next month -- and they said they would work with the provinces to bring in the proposed guarantees. But the provinces have been less-than-willing partners in the push for guarantees because the federal government is offering them no extra money for the initiative. Mr. Clement will meet with his provincial and territorial counterparts at a meeting in Moncton in two weeks and the discussion around guaranteed waiting times promises to be heated.
Les Vertesi, a councillor with the Health Council of Canada, a federal-provincial-territorial body that monitors the revamping of the health-care system, said yesterday the radiation oncologists' study confirms that "we had a problem all along." But he stressed that all the provinces are taking the issue of waiting times very seriously. Canada's waiting-list problem -- not just for cancer services but for all priority areas -- is "bigger than people anticipated and it's going to take a lot longer to clean up than people have thought."
Bill Hryniuk, past chairman of the board for the Cancer Advocacy Coalition of Canada, said he didn't understand why the federal government would select a waiting time of four weeks -- double what the radiation oncologists recommended. "Everybody who has to wait with cancer suffers mentally and that has to be a No. 1 consideration," Dr. Hryniuk, a medical oncologist, said yesterday. "It's frustrating for patients," Dianna Schreuer, past president of the Canadian Breast Cancer Network, said in a telephone interview from Halifax. "It doesn't meet the standards and it's frustrating for the oncologists delivering the service." She called the figures from the Canadian Association of Radiation Oncologists a "call to arms," describing it as a problem that's going to take some time to fix.
Opposition members in the House of Commons, meanwhile, have taken up the attack. Ruby Dhalla, the Liberal health critic, said the waiting times for radiation outlined in The Globe were indicative of the Conservative government's failure on the file. The report shows that cancer patients "are taking out loans, racking up financial debt and worrying about financial ruin, all in an effort to pay for their treatment that they so desperately need," Ms. Dhalla told the House of Commons. "The Conservatives promised to reduce wait times for cancer patients but, instead, the patients are waiting longer than ever."
Mr. Clement countered, saying that, under the Liberals, the average waiting time from specialist consultation to treatment doubled from 9.3 weeks in 1993 to 17.8 weeks in 2003.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Federal Health Minister Tony Clement says the fact that patients at nearly half of Canada's cancer treatment centres are not getting critical radiation treatments within the target period of four weeks bolsters his argument for guaranteed waiting times. A study by the Canadian Association of Radiation Oncologists found that only 50 to 60 per cent of the centres are able to provide radiation treatment within the four-week period. Prostate cancer patients were among the least well served: 70 per cent of Canadian hospitals could not deliver the radiation treatment within four weeks. And breast cancer numbers were also disturbing, with only 53 per cent of hospitals meeting the target.
Mr. Clement said the waiting-time figures, which were obtained by The Globe and Mail, are a worry. But they prove the need for provinces to promise to pay to send patients elsewhere for treatment when it can't be delivered locally in a timely manner, he told a news conference. "Benchmarks and targets without recourse is an empty promise," said Mr. Clement, whose government has made reduced waiting times the centrepiece of its health-care strategy. "That is why we have sought to engage the provinces and territories, not just to create benchmarks, but to take the next logical step, which is to have the recourse which creates the guarantee."
Clinically acceptable standards for radiation and four other priority treatments were agreed upon in December of 2005 at a meeting between provincial health ministers and Ujjal Dosanjh, who was then the Liberal minister of health.
The Conservatives were elected a month later on a promise that they would get the provinces to set targets to meet those standards by next month -- and they said they would work with the provinces to bring in the proposed guarantees. But the provinces have been less-than-willing partners in the push for guarantees because the federal government is offering them no extra money for the initiative. Mr. Clement will meet with his provincial and territorial counterparts at a meeting in Moncton in two weeks and the discussion around guaranteed waiting times promises to be heated.
Les Vertesi, a councillor with the Health Council of Canada, a federal-provincial-territorial body that monitors the revamping of the health-care system, said yesterday the radiation oncologists' study confirms that "we had a problem all along." But he stressed that all the provinces are taking the issue of waiting times very seriously. Canada's waiting-list problem -- not just for cancer services but for all priority areas -- is "bigger than people anticipated and it's going to take a lot longer to clean up than people have thought."
Bill Hryniuk, past chairman of the board for the Cancer Advocacy Coalition of Canada, said he didn't understand why the federal government would select a waiting time of four weeks -- double what the radiation oncologists recommended. "Everybody who has to wait with cancer suffers mentally and that has to be a No. 1 consideration," Dr. Hryniuk, a medical oncologist, said yesterday. "It's frustrating for patients," Dianna Schreuer, past president of the Canadian Breast Cancer Network, said in a telephone interview from Halifax. "It doesn't meet the standards and it's frustrating for the oncologists delivering the service." She called the figures from the Canadian Association of Radiation Oncologists a "call to arms," describing it as a problem that's going to take some time to fix.
Opposition members in the House of Commons, meanwhile, have taken up the attack. Ruby Dhalla, the Liberal health critic, said the waiting times for radiation outlined in The Globe were indicative of the Conservative government's failure on the file. The report shows that cancer patients "are taking out loans, racking up financial debt and worrying about financial ruin, all in an effort to pay for their treatment that they so desperately need," Ms. Dhalla told the House of Commons. "The Conservatives promised to reduce wait times for cancer patients but, instead, the patients are waiting longer than ever."
Mr. Clement countered, saying that, under the Liberals, the average waiting time from specialist consultation to treatment doubled from 9.3 weeks in 1993 to 17.8 weeks in 2003.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Thursday, November 30, 2006
British Labour's health chaos: you couldn't make it up
They are trying to close an A&E [ER] department in Casualty. In Holby City more and more patients have to be transferred to specialist centres elsewhere. In No 10 they wish everyone could understand what the scriptwriters do: the NHS is changing.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
They are trying to close an A&E [ER] department in Casualty. In Holby City more and more patients have to be transferred to specialist centres elsewhere. In No 10 they wish everyone could understand what the scriptwriters do: the NHS is changing.
The voters certainly don’t get it. It used to be Labour’s boast that it was the party of the NHS. And it was true: every single poll showed Labour ahead of the Conservatives on the health service, always. Until this summer. In the past ten years Labour has achieved the extraordinary feat of turning a 49-point lead over the Tories on health into a four-point lead for the Tories (Ipsos MORI). That’s a stunning fall at a time when spending on the NHS under Labour has ballooned from £35 billion to £80 billion, and waiting lists have fallen from 18 to six months.
In part the decline reflects growing cynicism about the Government in general, in part it is a riposte to overblown promises about “saving the NHS”. Ten years after promising to “save” it, the health service has a £500 million debt and 60 hospitals are threatened with closure or downgrading.
What went wrong? First, not as much as it sounds. The debt isn’t a lot for a health service with a budget of £80 billion. Gordon Brown could flick that away with a stroke of his pen, or his big clunking fist.
Nor is it on the whole that the Conservative Party is trusted more with the NHS; Labour is just trusted less. Four in ten people say that they don’t know who would do the best job any more.
That’s the good news for the Government. The rest is bad. With hospital closures imminent and a ferocious Conservative assault on the territory, including a cheeky campaign to “stop Brown’s NHS cuts”, Labour is worried. Not quite worried sick, but it should be.
The drive to cut the debt has coincided with a big push towards “reconfiguration” of services — hospital closures to you and me. It is almost impossible now for ministers to disentangle in people’s minds the idea that the local health service is in debt with the fact that their hospital is under threat. The Government argues that the closure or downgrading of some hospitals was always implicit in its reforms, regardless of the current financial difficulties, as some treatment was brought “closer to the people” while greater specialisation saw fewer, more specialised hospitals. I don’t remember them championing hospital closures when they published their reform programme, the NHS Plan, six years ago. It was an implicit not an explicit part of it.
The area I live in is in debt and has a number of hospitals under threat. Throughout Surrey and Sussex, in East Anglia and other threatened areas, this is the big conversation. It dominates local media. What ministers may have hoped could be contained in a few mainly Conservative rural areas has spilled over into the national press, and they haven’t even started shutting any of the hospitals yet. We are in a pre-consultation planning period, when health authorities are drawing up plans for public consultation next year, and rumours abound as to what hideousness they may contain. The vacuum of information is filled by local GPs, who tell patients they cannot take on the extra work the Government says they are going to do when the hospital closes: no staff, and no space to expand the surgery.
What mastermind at the heart of government, I wonder, planned this? And planned it so perfectly that the next election is going to coincide with massive hospital cuts?
“It’s the right thing to do,” they repeat. Tony Blair is not for turning. Fewer, more specialised hospitals will be safer for patients who will end up overall with better services, not worse. And what is more, we won’t get to the maximum 18-week wait between GP referral and treatment by the end of 2008 unless we do it.
So between spring next year and the end of 2008 the Government is simultaneously going to jump through the hoops of closing hospitals, reorganise local services, open new treatment centres and make the biggest, deepest cut yet in waiting lists? Forget it.
There is a broader tension in government policy that nobody can resolve: just as it claims to be bringing care closer to the people, it is planning to take local A&E and maternity departments further away from them. Local health planners calculate how long an ambulance with a flashing blue light might take to reach the specialist hospital, not an ordinary driver distracted by a sick family member in the car. Ministers have realised that these are the issues that have to be addressed, tangibly, in the local reorganisation proposals, which is why they have been put back until next year.
Let’s assume that the Government is right and a lot of conditions — asthma, diabetes, heart disease, arthritis — as well as many minor operations could be better and more cheaply managed in local communities or at home than in big hospitals. Let’s allow too that superhospitals with knobs on have a better chance of saving the life of a seriously injured person, and that babies are marginally more safely delivered in larger specialist centres (which is why mothers at high risk will be transferred there anyway).
That still won’t answer the “local” problem. People do not feel safe without access to an A&E that they can reach within a reasonable time. They would prefer to have their babies in a local hospital, which means maintaining a full maternity unit — there were some terrible problems in Kidderminster when the maternity unit was downgraded to a midwife-led one. And when a baby is born, or someone is taken ill in the night, the family wants to be able to visit the next day, without making a two to three-hour round trip, plus the visit time.
These are human needs outside the medical charts, and the Government has failed to grasp them. I wonder if it’s too late to ask Casualty’s scriptwriters for help.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Wednesday, November 29, 2006
Filth and shame in an NHS hospital
Twenty-four hours to save the NHS! I wonder how often that promise comes back to haunt Tony Blair 10 years later. Week after week reliable reports and the government’s own figures tell a disgraceful story of incompetence, debt, misery and filth in the National Health Service. That story is supported, week after week, by heart-rending personal accounts of horrors on the wards.
The broken new Labour promise that caught most public attention last week was the failure to abolish mixed-sex wards. Janet Street-Porter, the ferocious media personality, wrote about the misery of her sister when dying of cancer in a mixed-sex NHS ward. Plenty of other people have tried to draw attention to this disgrace and Baroness Knight, the Conservative peer, has been campaigning about it for years but — such is the spirit of the times — it takes a loud-mouth celebrity to get public attention.
Source
Sex-offender doctor still allowed to practice
What government mismanagement of medical training leads to
A Tasmanian doctor who sexually assaulted female patients will be practising again by June next year after the Medical Complaints Tribunal factored the state's general practitioner shortage into his punishment. The tribunal last month found Dr Ulhas Lad guilty of professional misconduct over his dealings with two female patients between April 2003 and July 2004. Dr Lad, 61, from Blackmans Bay, was yesterday suspended from practising until June 2007 and ordered to see only male patients when he resumes.
Medical Complaints Tribunal chairman David Porter, QC, said one of the factors the tribunal considered was "the regrettable situation that exists in this state in relation to general practitioners". Should an order to deregister Dr Lad be made there would be no little difficulty in filling the void, Mr Porter said.
Dr Lad's suspension and restriction to male patients arose from a complaint by a woman identified by the tribunal as AB. Mr Porter said Dr Lad's professional misconduct when dealing with AB involved a serious breach of trust and a gross violation of the doctor-patient relationship. Dr Lad sexually assaulted the woman at his surgery on a number of occasions, Mr Porter said. He said Dr Lad fondled his patient's breasts and buttocks, and had her separate her buttocks while she was bent over.
Dr Lad also performed a sex act in front of her at his surgery one night when she went there for pain relief. Mr Porter said the sex act was outrageous behaviour and a serious affront to the patient's dignity. He said Dr Lad's sexual assault of another female patient known as YZ3 was seen by the tribunal as previous relevant conduct.
The tribunal had also taken into account the overwhelming level of support for Dr Lad from the general and professional community, Mr Porter said. Dr Lad's lawyer Ken Procter, SC, presented the tribunal with 32 character references for his client. "We note all that has been said on behalf of Dr Lad," Mr Porter said.
Dr Lad was also fined $1000 for his professional misconduct in relation to a separate complaint by a second female patient known as CD. The woman said Dr Lad required her to undress to be weighed and made inappropriate comments when she saw him for antibiotics for the flu. Mr Porter said Dr Lad's behaviour towards CD was thoroughly inappropriate and his remarks were offensive. The $1000 fine imposed by the tribunal was one-fifth of the maximum amount it could impose, he said.
During the hearing seven more former patients came forward to complain about Dr Lad after reading reports of the case in the Mercury. Dr Lad denied the allegations against him. But the tribunal found it preferred the evidence of patient AB to that of Dr Lad, whose evidence was deemed "not at all convincing".
Dr Lad refused to comment as he left the Federal Court in Davey St, Hobart, yesterday. But his daughter Aparna said her father was innocent. Patient numbers at the surgery operated by her father and mother Dr Geeta Lad had not dropped since the women's complaints were made public nor since the tribunal's guilty finding, she said. Dr Lad's son Anoop said his father could rest easy because he had a clear conscience. The family would be looking at appeal options, he said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Twenty-four hours to save the NHS! I wonder how often that promise comes back to haunt Tony Blair 10 years later. Week after week reliable reports and the government’s own figures tell a disgraceful story of incompetence, debt, misery and filth in the National Health Service. That story is supported, week after week, by heart-rending personal accounts of horrors on the wards.
The broken new Labour promise that caught most public attention last week was the failure to abolish mixed-sex wards. Janet Street-Porter, the ferocious media personality, wrote about the misery of her sister when dying of cancer in a mixed-sex NHS ward. Plenty of other people have tried to draw attention to this disgrace and Baroness Knight, the Conservative peer, has been campaigning about it for years but — such is the spirit of the times — it takes a loud-mouth celebrity to get public attention.
The same thing happened when Lord Winston made a fuss about the dreadful treatment that his elderly mother received in hospital. Only then did the government stop denying that there was anything wrong.
Street-Porter published extracts last week of the diary of Patricia Balsom, her dying sister. They were horrifying. Among the miseries she endured was lying neglected in a mixed ward, where she was woken more than once to see a naked male patient masturbating opposite her bed. Her shocking stories prompted a flood of others.
The late Eileen Fahey, for instance, dying of cancer, was put onto a mixed geriatric ward where confused people wandered about without supervision. One man with dementia regularly masturbated at the nurses’ station and tried to get into women patients’ beds; he was a threat to them all but staff took no notice, according to her daughter Maureen. Other patients have to give answers to intimate questions in the hearing of other patients. One deaf old man was repeatedly asked when he last had an erection, until tears ran down his cheeks.
A former midwife described eloquently on Radio 4 the indignities of being in a 24-bed mixed-sex ward, stripped of all dignity and intimidated. Bedlam was the word she used, and it applies even more accurately to the secure psychiatric mixed ward in London endured by Susan Craig last year, after a breakdown. She suffered regular sexual harassment, with mentally ill men groping her and exposing themselves. The nurses disbelieved her and told her husband she was “flaunting herself”.
If so (I don’t believe them), their job was to protect a patient from her own folly. Instead they chose, in modern cant, to blame the victim. Sexual harassment is only a small part of the problem. Many people, both men and women, feel their modesty is violated by such closeness to random members of the opposite sex, even when they are not threatened.
Patients lie naked, half washed and forgotten, their sick and ageing flesh exposed to everyone, while nurses rush elsewhere. It is commonplace to have to walk to filthy mixed lavatories with gowns wide open at the back. At a time of sickness and anxiety many people are profoundly embarrassed to be surrounded by a clutter of bed pans, colostomy bags, nakedness, cries of pain and sweat, blood and tears — their own and other people’s.
All this is much worse, for many, when they are surrounded by members of the opposite sex; shame and anxiety are not the best bedfellows of hope and healing. Much has been written about the rape of modesty and the death of shame. However, it is still true in this weary country that most men and women prefer to perform private bodily functions alone if possible, and among their own sex only, if not. That’s why we have separate public lavatories and separate changing rooms in shops and clubs and pubs. That’s why people put up towels on the beach. That’s why women give birth in female wards, not in mixed wards or not — I hope — so far.
Source
Sex-offender doctor still allowed to practice
What government mismanagement of medical training leads to
A Tasmanian doctor who sexually assaulted female patients will be practising again by June next year after the Medical Complaints Tribunal factored the state's general practitioner shortage into his punishment. The tribunal last month found Dr Ulhas Lad guilty of professional misconduct over his dealings with two female patients between April 2003 and July 2004. Dr Lad, 61, from Blackmans Bay, was yesterday suspended from practising until June 2007 and ordered to see only male patients when he resumes.
Medical Complaints Tribunal chairman David Porter, QC, said one of the factors the tribunal considered was "the regrettable situation that exists in this state in relation to general practitioners". Should an order to deregister Dr Lad be made there would be no little difficulty in filling the void, Mr Porter said.
Dr Lad's suspension and restriction to male patients arose from a complaint by a woman identified by the tribunal as AB. Mr Porter said Dr Lad's professional misconduct when dealing with AB involved a serious breach of trust and a gross violation of the doctor-patient relationship. Dr Lad sexually assaulted the woman at his surgery on a number of occasions, Mr Porter said. He said Dr Lad fondled his patient's breasts and buttocks, and had her separate her buttocks while she was bent over.
Dr Lad also performed a sex act in front of her at his surgery one night when she went there for pain relief. Mr Porter said the sex act was outrageous behaviour and a serious affront to the patient's dignity. He said Dr Lad's sexual assault of another female patient known as YZ3 was seen by the tribunal as previous relevant conduct.
The tribunal had also taken into account the overwhelming level of support for Dr Lad from the general and professional community, Mr Porter said. Dr Lad's lawyer Ken Procter, SC, presented the tribunal with 32 character references for his client. "We note all that has been said on behalf of Dr Lad," Mr Porter said.
Dr Lad was also fined $1000 for his professional misconduct in relation to a separate complaint by a second female patient known as CD. The woman said Dr Lad required her to undress to be weighed and made inappropriate comments when she saw him for antibiotics for the flu. Mr Porter said Dr Lad's behaviour towards CD was thoroughly inappropriate and his remarks were offensive. The $1000 fine imposed by the tribunal was one-fifth of the maximum amount it could impose, he said.
During the hearing seven more former patients came forward to complain about Dr Lad after reading reports of the case in the Mercury. Dr Lad denied the allegations against him. But the tribunal found it preferred the evidence of patient AB to that of Dr Lad, whose evidence was deemed "not at all convincing".
Dr Lad refused to comment as he left the Federal Court in Davey St, Hobart, yesterday. But his daughter Aparna said her father was innocent. Patient numbers at the surgery operated by her father and mother Dr Geeta Lad had not dropped since the women's complaints were made public nor since the tribunal's guilty finding, she said. Dr Lad's son Anoop said his father could rest easy because he had a clear conscience. The family would be looking at appeal options, he said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Tuesday, November 28, 2006
UNBELIEVABLE MEDI-CAL BUREAUCRACY
And California's Democrat legislators want to subject Californians to more of this!!
The physicians at Roseville Pediatrics say they almost stopped seeing Medi-Cal patients this year out of frustration. It took a year and a half for state workers to issue the practice a new Medi-Cal billing number after a move, said Dr. Ravinder Khaira, one of the two pediatricians at the clinic. During the wait, Khaira said, the clinic was forced to float about $100,000 the state owed for services to low-income patients enrolled in the government health insurance program for the poor. On top of that, workers handling the application were unreachable by telephone, Khaira said. The only way to communicate was via regular mail. "The only reason I would even consider remaining with Medi-Cal is because we want to take care of the kids," Khaira said. "The sheer volume of paperwork that needs to be done is at least triple what would be necessary for commercial insurance."
State officials dispute some details of Khaira's account, saying they have computer records showing the delay was only about a year. They say some of that delay occurred because the clinic filled out the forms incorrectly.
But Khaira's story illustrates one of the hurdles the state faces in trying to attract and retain doctors in the program, which covers more than 6 million poor Californians. According to the California Health Care Foundation, Medi-Cal has about 46 primary care doctors for every 100,000 patients. The standard for Medicaid, the federal program that funds Medi-Cal, is about 60 to 80 doctors per 100,000 patients. The strains on the system could grow if the number of people receiving Medi-Cal continues to increase. Gov. Arnold Schwarzenegger has said he wants to ensure all children eligible for the program are enrolled, which could add hundreds of thousands of new patients to the system.
Stan Rosenstein, the state's Medi-Cal director, said the Department of Health Services recently has made great strides in cutting down delays for doctors seeking to be certified to treat Medi-Cal patients. Two years ago, there was a backlog of about 11,000 applications from doctors waiting to be approved, and the wait averaged six months. Now, after the state hired management consultants and temporarily redirected staff members, there are about 3,000 pending applications, and the average wait is down to about 35 days, Rosenstein said. "Approximately 35 days is as good as we're probably going to get," Rosenstein said. "That is a very good status. The application processing takes time."
Part of the reason it takes time, Rosenstein said, is that the state has enacted new controls to make sure that doctors aren't committing fraud. Still, the system is not equipped to handle problems quickly. When there is a glitch with an application, the state communicates with doctors through the mail. Khaira said he tried to call a phone number listed on the enrollment forms and got a recording. "We are currently unable to staff the call center due to budget reductions and loss of staff," said the message, which was still on the Department of Health Services provider information line as of this week. "You may communicate directly to the branch using regular mail."
Rosenstein said the message was "terrible customer service." He said he had directed his staff members to take it down earlier this year. "I had thought it was changed, and we will get it changed," he said. Under the current system, Rosenstein said, doctors can leave a message and have their calls returned, though there is no way for them to be connected directly for live assistance.
In September, the Legislature approved Senate Bill 1353, which would have enacted some steps to streamline the doctor enrollment process. The governor vetoed the measure, sponsored by the California Medical Association, saying it could potentially create opportunities for fraud in the $33 billion program. The CMA is still hoping for improvements. "We think you can create a more efficient process and still prevent fraud," said Karen Nikos, a spokeswoman for the organization, which represents doctors. "We're having a hard time convincing physicians they should serve in these communities. It's the red-tape issue that the government is so famous for."
Rosenstein said the state is concerned about keeping an adequate number of doctors available to serve Medi-Cal patients. "We want to attract physicians, and we want to make it easier," he said. "We just have to have the balance we need to have strict fraud control."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
And California's Democrat legislators want to subject Californians to more of this!!
The physicians at Roseville Pediatrics say they almost stopped seeing Medi-Cal patients this year out of frustration. It took a year and a half for state workers to issue the practice a new Medi-Cal billing number after a move, said Dr. Ravinder Khaira, one of the two pediatricians at the clinic. During the wait, Khaira said, the clinic was forced to float about $100,000 the state owed for services to low-income patients enrolled in the government health insurance program for the poor. On top of that, workers handling the application were unreachable by telephone, Khaira said. The only way to communicate was via regular mail. "The only reason I would even consider remaining with Medi-Cal is because we want to take care of the kids," Khaira said. "The sheer volume of paperwork that needs to be done is at least triple what would be necessary for commercial insurance."
State officials dispute some details of Khaira's account, saying they have computer records showing the delay was only about a year. They say some of that delay occurred because the clinic filled out the forms incorrectly.
But Khaira's story illustrates one of the hurdles the state faces in trying to attract and retain doctors in the program, which covers more than 6 million poor Californians. According to the California Health Care Foundation, Medi-Cal has about 46 primary care doctors for every 100,000 patients. The standard for Medicaid, the federal program that funds Medi-Cal, is about 60 to 80 doctors per 100,000 patients. The strains on the system could grow if the number of people receiving Medi-Cal continues to increase. Gov. Arnold Schwarzenegger has said he wants to ensure all children eligible for the program are enrolled, which could add hundreds of thousands of new patients to the system.
Stan Rosenstein, the state's Medi-Cal director, said the Department of Health Services recently has made great strides in cutting down delays for doctors seeking to be certified to treat Medi-Cal patients. Two years ago, there was a backlog of about 11,000 applications from doctors waiting to be approved, and the wait averaged six months. Now, after the state hired management consultants and temporarily redirected staff members, there are about 3,000 pending applications, and the average wait is down to about 35 days, Rosenstein said. "Approximately 35 days is as good as we're probably going to get," Rosenstein said. "That is a very good status. The application processing takes time."
Part of the reason it takes time, Rosenstein said, is that the state has enacted new controls to make sure that doctors aren't committing fraud. Still, the system is not equipped to handle problems quickly. When there is a glitch with an application, the state communicates with doctors through the mail. Khaira said he tried to call a phone number listed on the enrollment forms and got a recording. "We are currently unable to staff the call center due to budget reductions and loss of staff," said the message, which was still on the Department of Health Services provider information line as of this week. "You may communicate directly to the branch using regular mail."
Rosenstein said the message was "terrible customer service." He said he had directed his staff members to take it down earlier this year. "I had thought it was changed, and we will get it changed," he said. Under the current system, Rosenstein said, doctors can leave a message and have their calls returned, though there is no way for them to be connected directly for live assistance.
In September, the Legislature approved Senate Bill 1353, which would have enacted some steps to streamline the doctor enrollment process. The governor vetoed the measure, sponsored by the California Medical Association, saying it could potentially create opportunities for fraud in the $33 billion program. The CMA is still hoping for improvements. "We think you can create a more efficient process and still prevent fraud," said Karen Nikos, a spokeswoman for the organization, which represents doctors. "We're having a hard time convincing physicians they should serve in these communities. It's the red-tape issue that the government is so famous for."
Rosenstein said the state is concerned about keeping an adequate number of doctors available to serve Medi-Cal patients. "We want to attract physicians, and we want to make it easier," he said. "We just have to have the balance we need to have strict fraud control."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Monday, November 27, 2006
Immovable public hospital bureaucracy
In the Australian State of Queensland
Jayant Patel, wanted in Queensland on manslaughter charges, was yesterday labelled a scapegoat by the investigator who first probed his work. Bundaberg Hospital Inquiry Commissioner Tony Morris QC said Dr Patel, allegedly responsible for patient deaths and hiding out in Portland in the USA, was never the problem.
The high-profile barrister, guest speaker at the Whistleblowers Australia conference in Brisbane, instead launched a blistering attack on Queensland Health. "In a strange sort of way he is almost a distraction," Mr Morris said. "Perhaps the enduring tragedy of Jayant Patel is . . . he has become a scapegoat for everything that is wrong in Queensland Health. Patel is not, and never was, the problem." Mr Morris, who was ousted as the inquiry's head after displaying "ostensible bias" against Bundaberg Hospital's managers, said bureaucratic over-administration was at the "heart of the problem". His comments yesterday were a departure from the interim inquiry report handed down in Parliament in June last year.
Yesterday he slammed Queensland Health for not implementing real reform since the Bundaberg crisis and "a bureaucracy which actively obstructs every attempt to do so". "In 2006, Queensland Health continues to recycle the self-same individuals whose apathy and dereliction produced the disaster which they are now still pretending to address."
Mr Morris singled out Bundaberg Hospital nurse Toni Hoffman for her blowing the whistle on Dr Patel. Ms Hoffman today will be presented with the Whistleblower of the Year Award jointly with Dr Con Aroney, who made disclosures about people dying on waiting lists.
Warrants for Dr Patel's arrest were issued in the Brisbane Magistrates Court on Wednesday. Detectives provided affidavits on charges, including three counts of manslaughter, five counts of grievous bodily harm, four counts of negligent acts causing harm and eight counts of fraud. Queensland Director of Prosecutions Leanne Clare will now make a formal request for extradition through Federal Justice Minister Chris Ellison.
Source
How amazing! Public hospital stays open a bit longer!
In the Australian State of New South Wales
The NSW government will try to cut hospital waiting lists by offering patients elective surgery over the Christmas break and recalling staff early from holidays. The period that public hospitals operate at reduced capacity will be trimmed from six to four weeks this year. Clinical staff typically take leave at this time, equipment undergoes maintenance and patients often defer surgery to avoid spending Christmas in hospital.
This year, however, patients who have been waiting a long time for elective surgery or who are overdue will be offered treatment during the holiday break, Health Minister John Hatzistergos says. Mr Hatzistergos said a new government policy would ensure patients requiring surgery within 30 days would be treated appropriately. Patients with less urgent conditions would be treated within 365 days and would not have to wait more than 12 months due to reduced hospital activity during the holiday season, he said. "We're making real progress in reducing waiting times and waiting lists but there's still more work to do," he said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
In the Australian State of Queensland
Jayant Patel, wanted in Queensland on manslaughter charges, was yesterday labelled a scapegoat by the investigator who first probed his work. Bundaberg Hospital Inquiry Commissioner Tony Morris QC said Dr Patel, allegedly responsible for patient deaths and hiding out in Portland in the USA, was never the problem.
The high-profile barrister, guest speaker at the Whistleblowers Australia conference in Brisbane, instead launched a blistering attack on Queensland Health. "In a strange sort of way he is almost a distraction," Mr Morris said. "Perhaps the enduring tragedy of Jayant Patel is . . . he has become a scapegoat for everything that is wrong in Queensland Health. Patel is not, and never was, the problem." Mr Morris, who was ousted as the inquiry's head after displaying "ostensible bias" against Bundaberg Hospital's managers, said bureaucratic over-administration was at the "heart of the problem". His comments yesterday were a departure from the interim inquiry report handed down in Parliament in June last year.
Yesterday he slammed Queensland Health for not implementing real reform since the Bundaberg crisis and "a bureaucracy which actively obstructs every attempt to do so". "In 2006, Queensland Health continues to recycle the self-same individuals whose apathy and dereliction produced the disaster which they are now still pretending to address."
Mr Morris singled out Bundaberg Hospital nurse Toni Hoffman for her blowing the whistle on Dr Patel. Ms Hoffman today will be presented with the Whistleblower of the Year Award jointly with Dr Con Aroney, who made disclosures about people dying on waiting lists.
Warrants for Dr Patel's arrest were issued in the Brisbane Magistrates Court on Wednesday. Detectives provided affidavits on charges, including three counts of manslaughter, five counts of grievous bodily harm, four counts of negligent acts causing harm and eight counts of fraud. Queensland Director of Prosecutions Leanne Clare will now make a formal request for extradition through Federal Justice Minister Chris Ellison.
Source
How amazing! Public hospital stays open a bit longer!
In the Australian State of New South Wales
The NSW government will try to cut hospital waiting lists by offering patients elective surgery over the Christmas break and recalling staff early from holidays. The period that public hospitals operate at reduced capacity will be trimmed from six to four weeks this year. Clinical staff typically take leave at this time, equipment undergoes maintenance and patients often defer surgery to avoid spending Christmas in hospital.
This year, however, patients who have been waiting a long time for elective surgery or who are overdue will be offered treatment during the holiday break, Health Minister John Hatzistergos says. Mr Hatzistergos said a new government policy would ensure patients requiring surgery within 30 days would be treated appropriately. Patients with less urgent conditions would be treated within 365 days and would not have to wait more than 12 months due to reduced hospital activity during the holiday season, he said. "We're making real progress in reducing waiting times and waiting lists but there's still more work to do," he said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Sunday, November 26, 2006
NHS PLAYING FAST AND LOOSE WITH DEFINITIONS AGAIN
Their favourite way of meeting their "targets"
The government has been accused of failing to meet a promise to scrap mixed-sex wards in NHS hospitals. The Department of Health said its targets had been achieved, and 99% of trusts are providing single sex accommodation. But patients groups said they were getting an increasing number of calls from people who think they have been in mixed-sex wards.
There appears to be confusion about the definition of the term. Katherine Murphy, from the Patients Association, said there had been 25-30 calls in the last month to the charity's helpline, mostly from elderly patients, who had been nursed on mixed-sex wards.
Andrew Lansley said it was not acceptable to claim that partitioned single-sex bays on mixed-sex wards were doing the job. "If you can be seen by patients of another sex, and they are coming and going past your bed in order to go to the toilet facilities you may not think you have the privacy you want."
The government pledged to scrap mixed-sex wards when it came to power in 1997. Health Secretary Patricia Hewitt said most trusts offered single-sex wards, but said more could be done.
More here
Australian public hospital nurse recognised with whistleblower award
The woman who alerted authorities to the Bundaberg Hospital crisis will be recognised at the annual Whistleblowers Australia conference this weekend. Bundaberg Base Hospital nurse Toni Hoffman will receive the Whistleblower of the Year award for uncovering the alleged criminal malpractice of overseas-trained surgeon Jayant Patel. Patel is allegedly linked with 17 patient deaths, and earlier this week a Brisbane Magistrate approved an arrest warrant for the 56-year-old doctor who fled to the US.
Ms Hoffman says she is thrilled to receive the award. "It's a great honour and I hope to be able to improve whistleblower protection through raising awareness," she said.
The national director for Whistleblowers Australia, Greg McMahon, says it was Ms Hoffman's concern for the community that earned her the award. "Toni Hoffman took the view that more was required of her because of her responsibility so that everybody needed to be protected," he said. Ms Hoffman will share the title with heart specialist Dr Con Aroney, who is being honoured for his role in revealing cutbacks at Brisbane's Prince Charles Hospital in 2004.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Their favourite way of meeting their "targets"
The government has been accused of failing to meet a promise to scrap mixed-sex wards in NHS hospitals. The Department of Health said its targets had been achieved, and 99% of trusts are providing single sex accommodation. But patients groups said they were getting an increasing number of calls from people who think they have been in mixed-sex wards.
There appears to be confusion about the definition of the term. Katherine Murphy, from the Patients Association, said there had been 25-30 calls in the last month to the charity's helpline, mostly from elderly patients, who had been nursed on mixed-sex wards.
Andrew Lansley said it was not acceptable to claim that partitioned single-sex bays on mixed-sex wards were doing the job. "If you can be seen by patients of another sex, and they are coming and going past your bed in order to go to the toilet facilities you may not think you have the privacy you want."
The government pledged to scrap mixed-sex wards when it came to power in 1997. Health Secretary Patricia Hewitt said most trusts offered single-sex wards, but said more could be done.
More here
Australian public hospital nurse recognised with whistleblower award
The woman who alerted authorities to the Bundaberg Hospital crisis will be recognised at the annual Whistleblowers Australia conference this weekend. Bundaberg Base Hospital nurse Toni Hoffman will receive the Whistleblower of the Year award for uncovering the alleged criminal malpractice of overseas-trained surgeon Jayant Patel. Patel is allegedly linked with 17 patient deaths, and earlier this week a Brisbane Magistrate approved an arrest warrant for the 56-year-old doctor who fled to the US.
Ms Hoffman says she is thrilled to receive the award. "It's a great honour and I hope to be able to improve whistleblower protection through raising awareness," she said.
The national director for Whistleblowers Australia, Greg McMahon, says it was Ms Hoffman's concern for the community that earned her the award. "Toni Hoffman took the view that more was required of her because of her responsibility so that everybody needed to be protected," he said. Ms Hoffman will share the title with heart specialist Dr Con Aroney, who is being honoured for his role in revealing cutbacks at Brisbane's Prince Charles Hospital in 2004.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Saturday, November 25, 2006
CASH-STRAPPED NHS CANNOT AFFORD NEEDED DRUGS
Plenty of money to pay an army of "administrators", though
The cost of making the breast cancer drug Herceptin available on the NHS will mean that health trusts have to deny patients other treatments, according to doctors writing in the British Medical Journal. Herceptin works for up to 25 per cent of breast cancer patients with a particular defective gene. But the cost of treating 75 patients with the 20,000 pound-a- year drug is equivalent to providing cancer treatment for more than 350 patients - while still requiring 500,000 pounds in extra funding.
In July the National Institute for Health and Clinical Excellence (NICE) recommended Herceptin for those with HER2- positive breast cancer. But three cancer specialists have now challenged the wisdom of the decision. Writing in the BMJ, the doctors, from Norfolk and Norwich University Hospital NHS Trust, calculated that in drug costs alone they would have to find 1.9 million pounds to treat 75 patients with Herceptin. Supplementary costs pushed the figure to 2.3 million, according to Ann Barrett, Tom Roques and Matthew Small.
The team, working with Richard Smith, a health economist from the University of East Anglia, said that they could fund Herceptin if they dropped post-surgery cancer treatments for 355 other patients - 16 of whom were likely to be cured. Or they could stop palliative chemotherapy for 208 patients. Either way they would also need to find 500,000 pounds. The doctors write: "These untreated patients will be people we know. We will be the ones to tell them they are not getting a treatment that has been proved to be effective, which costs relatively little, because it is not the `treatment of the moment'."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Plenty of money to pay an army of "administrators", though
The cost of making the breast cancer drug Herceptin available on the NHS will mean that health trusts have to deny patients other treatments, according to doctors writing in the British Medical Journal. Herceptin works for up to 25 per cent of breast cancer patients with a particular defective gene. But the cost of treating 75 patients with the 20,000 pound-a- year drug is equivalent to providing cancer treatment for more than 350 patients - while still requiring 500,000 pounds in extra funding.
In July the National Institute for Health and Clinical Excellence (NICE) recommended Herceptin for those with HER2- positive breast cancer. But three cancer specialists have now challenged the wisdom of the decision. Writing in the BMJ, the doctors, from Norfolk and Norwich University Hospital NHS Trust, calculated that in drug costs alone they would have to find 1.9 million pounds to treat 75 patients with Herceptin. Supplementary costs pushed the figure to 2.3 million, according to Ann Barrett, Tom Roques and Matthew Small.
The team, working with Richard Smith, a health economist from the University of East Anglia, said that they could fund Herceptin if they dropped post-surgery cancer treatments for 355 other patients - 16 of whom were likely to be cured. Or they could stop palliative chemotherapy for 208 patients. Either way they would also need to find 500,000 pounds. The doctors write: "These untreated patients will be people we know. We will be the ones to tell them they are not getting a treatment that has been proved to be effective, which costs relatively little, because it is not the `treatment of the moment'."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Friday, November 24, 2006
New Hearing for Suit Against FDA
Why on earth anyone would oppose this is incomprehensible. Only bureaucratic rigidity can explain the opposition
A federal court agreed yesterday to rehear a case that aims to get terminally ill patients early access to experimental drugs unlikely to be approved before they die. The full 10-judge U.S. Court of Appeals for the District of Columbia Circuit will probably hear the case next summer, said Richard A. Samp, chief counsel for the Washington Legal Foundation.
The group, with the Abigail Alliance for Better Access to Developmental Drugs, sued the Food and Drug Administration in 2003. It is seeking broader access to drugs that have undergone preliminary safety testing in as few as 20 people and have yet to be approved by the FDA.
In 2004, a district court dismissed the case. In May, a three-judge appeals panel reinstated the lawsuit in a 2 to 1 decision. The FDA, in turn, appealed and asked for the full court to rehear the case.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Why on earth anyone would oppose this is incomprehensible. Only bureaucratic rigidity can explain the opposition
A federal court agreed yesterday to rehear a case that aims to get terminally ill patients early access to experimental drugs unlikely to be approved before they die. The full 10-judge U.S. Court of Appeals for the District of Columbia Circuit will probably hear the case next summer, said Richard A. Samp, chief counsel for the Washington Legal Foundation.
The group, with the Abigail Alliance for Better Access to Developmental Drugs, sued the Food and Drug Administration in 2003. It is seeking broader access to drugs that have undergone preliminary safety testing in as few as 20 people and have yet to be approved by the FDA.
In 2004, a district court dismissed the case. In May, a three-judge appeals panel reinstated the lawsuit in a 2 to 1 decision. The FDA, in turn, appealed and asked for the full court to rehear the case.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Thursday, November 23, 2006
Weird: NHS hospitals to advertise themselves
Spending the money on hiring more doctors and reducing their waiting lists has not occurred to anybody, apparently
NHS hospitals are to be allowed to attract patients by advertising, under a Department of Health code. A draft version says that the NHS needs to give “reliable information” to assist patient choice, and should not spend too much on advertisements. There is unlikely to be a cap on trusts’ spending but costly television advertising is likely to be ruled out.
In consultation with GPs, patients now have a choice, albeit limited, of which hospital to have treatment at. Under the new payment-by-results system, hospitals are being given funds per patient treated. The successes of hospitals could be presented to patients through advertising; some independent hospital chains already advertise their services to GPs.
Gill Morgan, of the NHS Confederation, said: “We are trying to change the NHS from being a service where you get what you’re given, really, to a service where patients are much more able to choose what they want.”
Jonathan Fielden, of the British Medical Association, said: “NHS hospitals will have no option but to invest in marketing tactics if they are to survive against private firms. It is a sad indictment of government policy to consider spending public money on advertising NHS services when hospitals are having to make cutbacks in patient care, and redundancies.” The department said that a code on advertising would be put out to consultation soon.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Spending the money on hiring more doctors and reducing their waiting lists has not occurred to anybody, apparently
NHS hospitals are to be allowed to attract patients by advertising, under a Department of Health code. A draft version says that the NHS needs to give “reliable information” to assist patient choice, and should not spend too much on advertisements. There is unlikely to be a cap on trusts’ spending but costly television advertising is likely to be ruled out.
In consultation with GPs, patients now have a choice, albeit limited, of which hospital to have treatment at. Under the new payment-by-results system, hospitals are being given funds per patient treated. The successes of hospitals could be presented to patients through advertising; some independent hospital chains already advertise their services to GPs.
Gill Morgan, of the NHS Confederation, said: “We are trying to change the NHS from being a service where you get what you’re given, really, to a service where patients are much more able to choose what they want.”
Jonathan Fielden, of the British Medical Association, said: “NHS hospitals will have no option but to invest in marketing tactics if they are to survive against private firms. It is a sad indictment of government policy to consider spending public money on advertising NHS services when hospitals are having to make cutbacks in patient care, and redundancies.” The department said that a code on advertising would be put out to consultation soon.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Wednesday, November 22, 2006
Hospitals drop ball on heart attacks, researchers say
Only about one-third of hospitals provide emergency care to heart attack patients quickly enough to meet scientific guidelines for saving lives, researchers reported Sunday. Even the top performers meet the American Heart Association and American College of Cardiology guidelines for prompt care in just half of their cases, researchers say. "Even among the better hospitals, only a few hospitals routinely meet the recommended guidelines," says Yale cardiologist Harlan Krumholz, a leader of the research team and an architect of a national campaign launched Sunday to help hospitals improve their performance. "By next year, we're going to change that."
About 200,000 people a year have heart attacks caused by blockages in crucial arteries that supply the heart with blood. About 10,000 patients die of these heart attacks in hospitals each year.
Studies show that reopening clogged arteries by inflating a tiny balloon at the site of the blockage is the best way to treat a severe heart attack. The procedure, balloon angioplasty, can cut a patient's risk of dying by 40 percent, but only if it is done within 90 minutes of the patient's arrival at the hospital, the "door-to-balloon" time. If every hospital met the guidelines, Krumholz says, doctors could save about 1,000 lives each year. A study reported in March in the journal Circulation showed that 80 percent of people live within an hour's drive of a hospital that provides balloon angioplasty.
Yet only about one-third of heart attack patients get angioplasty within the 90-minute window. The new study surveyed 365 hospitals to determine what procedures they have in place to get patients angioplasty quickly. Just 35 percent reported an average door-to-balloon time of 90 minutes or less, 48 percent had a door-to-balloon time of 91 to 120 minutes, 13 percent came in at 121 to 150 minutes and 4 percent topped 150.
The study was released Sunday at an American Heart Association meeting and online by the New England Journal of Medicine. Hospitals agreed to participate if they weren't individually identified. Doctors said consumers can contact their local hospitals and ask whether they meet the American Heart Association and American College of Cardiology guidelines for heart attack care. The study was designed to help launch the new campaign, called D2B, by providing hospitals with ways to improve performance. "This is a national undertaking to try to save the lives of people who have heart attacks," says Steven Nissen of the Cleveland Clinic and president of the American College of Cardiology. "We're losing too many lives."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Only about one-third of hospitals provide emergency care to heart attack patients quickly enough to meet scientific guidelines for saving lives, researchers reported Sunday. Even the top performers meet the American Heart Association and American College of Cardiology guidelines for prompt care in just half of their cases, researchers say. "Even among the better hospitals, only a few hospitals routinely meet the recommended guidelines," says Yale cardiologist Harlan Krumholz, a leader of the research team and an architect of a national campaign launched Sunday to help hospitals improve their performance. "By next year, we're going to change that."
About 200,000 people a year have heart attacks caused by blockages in crucial arteries that supply the heart with blood. About 10,000 patients die of these heart attacks in hospitals each year.
Studies show that reopening clogged arteries by inflating a tiny balloon at the site of the blockage is the best way to treat a severe heart attack. The procedure, balloon angioplasty, can cut a patient's risk of dying by 40 percent, but only if it is done within 90 minutes of the patient's arrival at the hospital, the "door-to-balloon" time. If every hospital met the guidelines, Krumholz says, doctors could save about 1,000 lives each year. A study reported in March in the journal Circulation showed that 80 percent of people live within an hour's drive of a hospital that provides balloon angioplasty.
Yet only about one-third of heart attack patients get angioplasty within the 90-minute window. The new study surveyed 365 hospitals to determine what procedures they have in place to get patients angioplasty quickly. Just 35 percent reported an average door-to-balloon time of 90 minutes or less, 48 percent had a door-to-balloon time of 91 to 120 minutes, 13 percent came in at 121 to 150 minutes and 4 percent topped 150.
The study was released Sunday at an American Heart Association meeting and online by the New England Journal of Medicine. Hospitals agreed to participate if they weren't individually identified. Doctors said consumers can contact their local hospitals and ask whether they meet the American Heart Association and American College of Cardiology guidelines for heart attack care. The study was designed to help launch the new campaign, called D2B, by providing hospitals with ways to improve performance. "This is a national undertaking to try to save the lives of people who have heart attacks," says Steven Nissen of the Cleveland Clinic and president of the American College of Cardiology. "We're losing too many lives."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Tuesday, November 21, 2006
A NEW CONCEPT FOR CALIFORNIA: HEALTH INSURANCE MANDATES COST MONEY!
A task force established by Gov. Arnold Schwarzenegger to draft a plan for dealing with skyrocketing health costs in California is considering calling for repeal of some treatment mandates on health maintenance organizations. Administration aides said the proposal -- which would require approval by the Legislature -- is one of many under consideration as part of the long-awaited plan the Republican governor says he will unveil in his State of the State speech in January. "Right now, the administration is combing through hundreds of ideas and concepts," said Adam Mendelsohn, the governor's communications director. "No idea is in, no idea is out, and there is no specific plan developed."
Michael Shaw, assistant director for the National Federation of Independent Business, said relaxation of some mandates would lower premium costs for small-business owners and allow them to provide coverage for more employees. "The No. 1 reason that small businesses do not provide health care in many cases is that they simply can't afford it," said Shaw, whose organization has met with members of the governor's task force to urge them to repeal mandates. Employers have complained about the more than 50 mandates since 1999, when Gov. Gray Davis signed health care legislation requiring HMOs to offer a host of treatment and preventive care services. Included are coverage for a variety of mental illnesses, including anorexia and bulimia, cancer screenings and contraception. Employers blame the mandates for contributing to the 55 percent rise in insurance premiums in the last five years alone.
Schwarzenegger has said that reducing the ranks of the more than 6 million uninsured people in California will be one of his top priorities in the coming year. "We feel we shouldn't have 6 million people uninsured," the governor said last week. "We maybe cannot solve the whole problem, but we definitely can cut it in half and do something that really is impressive and shows the rest of the nation that it can be done."
But Beth Capell, a spokeswoman for Health Access, a coalition of more than 200 consumer and community groups that lobby for increased health care coverage for Californians, said she hoped the administration would come up with better proposals. "The idea that eliminating such basic care as Pap smears, mammograms and childhood immunizations saves money has been disproved by study after study," Capell said. "What's the point of having health insurance if it doesn't get you any health care?" Schwarzenegger aides did not specify which mandates would be under consideration for repeal.
Shaw, whose organization represents 35,000 employers in the state, said that because group insurance plans are required to provide more benefits than individual plans, many small business have been priced out of the market. "So we want to create a set of rules for all plans that treat individuals equally but do not cost people the ability to afford health care," he said. Shaw said single men, for example, should not be forced to pay for maternity care "simply because the state determined that it should be part of health coverage."
But state Sen. Sheila Kuehl, who as a member of the Assembly was involved in the crafting of the HMO mandates, said repealing some of the requirements would not improve health care in California. Kuehl, D-Santa Monica, this year wrote a bill that would have insured all Californians and abolished the role of private insurance companies in California, instead setting up a single-payer system in which the state would take over the role of insurers. Schwarzenegger vetoed the measure, Senate Bill 840, saying he opposes "government-run" health care.
"I think (eliminating mandates) is the least desirable way to lower the cost of health care for people in California because it does nothing to address the record profits of the for-profit insurance companies," Kuehl said.
The administration has said the governor's plan will include several measures designed to squeeze cost savings out of the health care system, including reining in overuse of services. A possible model is a program in Illinois that would require doctors to file prescriptions electronically rather than filling them out by hand.
Source
Pennypinching Australian State government tries to cut back on medical training
And Leftists say that private business is characterized by short-term thinking!
A group of the state's most senior emergency doctors has resigned en masse from a high-level government committee, signalling worsening relations between the Iemma Government and its frontline physicians. The doctors say the Government is forcing them to halve the time they spend teaching registrars, which would result in hospitals losing their accreditation to train doctors in emergency medicine. The end result, they warned, was an exodus of young doctors from the NSW health system and dangerously understaffed emergency departments.
In an open letter to the Premier, Morris Iemma, the doctors say NSW Health's plans would result in an unsafe level of care for patients and, as emergency medicine was a compulsory rotation, it would prevent interns from becoming registered. They note that even at current staffing levels not one NSW public hospital met the minimum specialist staffing requirements endorsed by state and territory health ministers.
The dispute began, the doctors say, when they learnt that NSW Health was reneging on a pay deal struck in April that gave a 25 per cent allowance for city-based emergency specialists filling shifts in rural and regional hospitals. The department said it would pay the allowance only if the doctors reduced their clinical support duties such as registrar training, further education and taking part in quality improvement programs. Any reduction in these duties would breach guidelines set by the Australasian College of Emergency Medicine - 75 per cent clinical work and 25 per cent clinical support work - the doctors say.
The executive director of the Australian Salaried Medical Officers Federation, Sim Mead, said NSW Health was pushing for clinical support work to be limited to 10 per cent of doctors' time. "If they move to 10 per cent, the accreditation for all emergency departments for registrar training in NSW will be withdrawn and the registrar workforce would be completely destroyed. "Why would a registrar want to work in a hospital without a training program, if their aim was to become a qualified specialist?"
After months of talks, the specialists have resigned from the Government's emergency advisory committee, the Emergency Care Taskforce. Rod Bishop is a senior emergency physician and was, until he resigned, co-chair of the taskforce. Dedicated to the specialty for 17 years, he is deeply frustrated and disappointed at the attitude of NSW Health. "There is a terrible workforce issue - no emergency department in the state meets the minimum staff specialist requirements . nor do we have the supply of registrars . to meet predicted future needs." If NSW Health did not offer emergency specialists a reasonable employment package, doctors would leave and the losers would be the patients, he said.
A letter to the director-general of NSW Health, Robyn Kruk, sent 18 days ago, has gone unanswered, and the NSW Industrial Relations Commission is trying to resolve the matter through conciliation. The chairman of the NSW Faculty of the Australasian College of Emergency Medicine, Tony Joseph, also a senior emergency specialist in one of the state's largest public hospitals, said NSW Health did not appear to care that hospitals would lose their training accreditation if its plan was implemented. It preferred to rely on locums paid up to $200 an hour to staff emergency departments, rather than increasing its workforce of emergency specialists, who were paid half that amount. A spokeswoman for NSW Health said the department would conduct a work study and liaise with the college and the union on the matter.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
A task force established by Gov. Arnold Schwarzenegger to draft a plan for dealing with skyrocketing health costs in California is considering calling for repeal of some treatment mandates on health maintenance organizations. Administration aides said the proposal -- which would require approval by the Legislature -- is one of many under consideration as part of the long-awaited plan the Republican governor says he will unveil in his State of the State speech in January. "Right now, the administration is combing through hundreds of ideas and concepts," said Adam Mendelsohn, the governor's communications director. "No idea is in, no idea is out, and there is no specific plan developed."
Michael Shaw, assistant director for the National Federation of Independent Business, said relaxation of some mandates would lower premium costs for small-business owners and allow them to provide coverage for more employees. "The No. 1 reason that small businesses do not provide health care in many cases is that they simply can't afford it," said Shaw, whose organization has met with members of the governor's task force to urge them to repeal mandates. Employers have complained about the more than 50 mandates since 1999, when Gov. Gray Davis signed health care legislation requiring HMOs to offer a host of treatment and preventive care services. Included are coverage for a variety of mental illnesses, including anorexia and bulimia, cancer screenings and contraception. Employers blame the mandates for contributing to the 55 percent rise in insurance premiums in the last five years alone.
Schwarzenegger has said that reducing the ranks of the more than 6 million uninsured people in California will be one of his top priorities in the coming year. "We feel we shouldn't have 6 million people uninsured," the governor said last week. "We maybe cannot solve the whole problem, but we definitely can cut it in half and do something that really is impressive and shows the rest of the nation that it can be done."
But Beth Capell, a spokeswoman for Health Access, a coalition of more than 200 consumer and community groups that lobby for increased health care coverage for Californians, said she hoped the administration would come up with better proposals. "The idea that eliminating such basic care as Pap smears, mammograms and childhood immunizations saves money has been disproved by study after study," Capell said. "What's the point of having health insurance if it doesn't get you any health care?" Schwarzenegger aides did not specify which mandates would be under consideration for repeal.
Shaw, whose organization represents 35,000 employers in the state, said that because group insurance plans are required to provide more benefits than individual plans, many small business have been priced out of the market. "So we want to create a set of rules for all plans that treat individuals equally but do not cost people the ability to afford health care," he said. Shaw said single men, for example, should not be forced to pay for maternity care "simply because the state determined that it should be part of health coverage."
But state Sen. Sheila Kuehl, who as a member of the Assembly was involved in the crafting of the HMO mandates, said repealing some of the requirements would not improve health care in California. Kuehl, D-Santa Monica, this year wrote a bill that would have insured all Californians and abolished the role of private insurance companies in California, instead setting up a single-payer system in which the state would take over the role of insurers. Schwarzenegger vetoed the measure, Senate Bill 840, saying he opposes "government-run" health care.
"I think (eliminating mandates) is the least desirable way to lower the cost of health care for people in California because it does nothing to address the record profits of the for-profit insurance companies," Kuehl said.
The administration has said the governor's plan will include several measures designed to squeeze cost savings out of the health care system, including reining in overuse of services. A possible model is a program in Illinois that would require doctors to file prescriptions electronically rather than filling them out by hand.
Source
Pennypinching Australian State government tries to cut back on medical training
And Leftists say that private business is characterized by short-term thinking!
A group of the state's most senior emergency doctors has resigned en masse from a high-level government committee, signalling worsening relations between the Iemma Government and its frontline physicians. The doctors say the Government is forcing them to halve the time they spend teaching registrars, which would result in hospitals losing their accreditation to train doctors in emergency medicine. The end result, they warned, was an exodus of young doctors from the NSW health system and dangerously understaffed emergency departments.
In an open letter to the Premier, Morris Iemma, the doctors say NSW Health's plans would result in an unsafe level of care for patients and, as emergency medicine was a compulsory rotation, it would prevent interns from becoming registered. They note that even at current staffing levels not one NSW public hospital met the minimum specialist staffing requirements endorsed by state and territory health ministers.
The dispute began, the doctors say, when they learnt that NSW Health was reneging on a pay deal struck in April that gave a 25 per cent allowance for city-based emergency specialists filling shifts in rural and regional hospitals. The department said it would pay the allowance only if the doctors reduced their clinical support duties such as registrar training, further education and taking part in quality improvement programs. Any reduction in these duties would breach guidelines set by the Australasian College of Emergency Medicine - 75 per cent clinical work and 25 per cent clinical support work - the doctors say.
The executive director of the Australian Salaried Medical Officers Federation, Sim Mead, said NSW Health was pushing for clinical support work to be limited to 10 per cent of doctors' time. "If they move to 10 per cent, the accreditation for all emergency departments for registrar training in NSW will be withdrawn and the registrar workforce would be completely destroyed. "Why would a registrar want to work in a hospital without a training program, if their aim was to become a qualified specialist?"
After months of talks, the specialists have resigned from the Government's emergency advisory committee, the Emergency Care Taskforce. Rod Bishop is a senior emergency physician and was, until he resigned, co-chair of the taskforce. Dedicated to the specialty for 17 years, he is deeply frustrated and disappointed at the attitude of NSW Health. "There is a terrible workforce issue - no emergency department in the state meets the minimum staff specialist requirements . nor do we have the supply of registrars . to meet predicted future needs." If NSW Health did not offer emergency specialists a reasonable employment package, doctors would leave and the losers would be the patients, he said.
A letter to the director-general of NSW Health, Robyn Kruk, sent 18 days ago, has gone unanswered, and the NSW Industrial Relations Commission is trying to resolve the matter through conciliation. The chairman of the NSW Faculty of the Australasian College of Emergency Medicine, Tony Joseph, also a senior emergency specialist in one of the state's largest public hospitals, said NSW Health did not appear to care that hospitals would lose their training accreditation if its plan was implemented. It preferred to rely on locums paid up to $200 an hour to staff emergency departments, rather than increasing its workforce of emergency specialists, who were paid half that amount. A spokeswoman for NSW Health said the department would conduct a work study and liaise with the college and the union on the matter.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Monday, November 20, 2006
IMPENDING DRUGS BUNGLE BY THE DIM DEMOCRATS
Nancy Pelosi has promised that when the Democrats come into control of the House, they will repeal the ban preventing Medicare from negotiating directly with pharmaceutical companies, within the first 100 hours. She must expect that this legislation will bring down drug prices dramatically. In fact, it is not obvious that allowing the government to negotiate with pharmaceutical companies will lead to lower prices than those achieved by private drug plans. There are several good reasons that government negotiations may not decrease drug costs.
First, negotiations are a bargaining process. The relative balance of bargaining power determines at which price the deal is struck. People often confuse market power with bargaining power. The thinking goes, the larger the share of the market the buyer represents, the greater the bargaining power and thus the lower the prices negotiated. That line of reasoning fails with drugs, however, because the seller is frequently a monopolist so it cannot be threatened with replacement by a substitute. Instead, the only threat is exclusion from the market.
Rather than market share, a party's bargaining power is determined simply by its ability to say no, to walk away from the table without an agreement. Whether the government or a private drug plan has greater bargaining power is not clear. Which can walk away more easily and declare that some brand-name drug will not be covered on the formulary? Private plans like Kaiser or United are able to negotiate deep discounts with pharmaceutical companies precisely because of the plans' ability to say no -- the ability to include some drugs and to exclude others, allowing the market to judge the resulting formulary. On the other hand, when the government negotiates, its hands are tied because there are few drugs it can exclude without facing political backlash from doctors and the Medicare population, a very influential group of voters.
In fact, the government negotiating on behalf of Medicare beneficiaries may lead to some unintended adverse consequences. Since direct-to-consumer advertising is legal in the U.S., there is nothing preventing pharmaceutical companies from funding a torrent of advertisements for the "latest and greatest" drug, thereby creating a strong demand within the Medicare population for coverage of the drug. How firm can the government stand when negotiating for a drug being clamored for? This is not the sort of bargaining power that will lead to lower prices.
Secondly, by acting as one large buyer, the government will cause price discounts to become more expensive for pharmaceutical companies. In other words, the minimum price that the pharmaceutical company is able to accept increases. All else equal, this will lead to higher, not lower, prices. When private drug plans are negotiating individually with pharmaceutical companies, those companies have the power to "price discriminate," meaning they can charge lower prices to some drug plans and higher prices to others. This ability allows for large discounts. If Pfizer is able to give a deep discount to Kaiser without giving a similar discount to United, then it is less costly for Pfizer to give Kaiser that discount. If, however, Pfizer can give a deep discount to Kaiser only if the same discount is granted to all other Medicare drug plans, then the discount becomes very expensive.
Experience with the Medicaid best-price rule, passed as part of OBRA '90, provides both empirical and anecdotal evidence of price discounts becoming more expensive when buyers' discounts are forcibly linked together. The best-price rule states roughly that Medicaid will be granted a price for a drug that is the lowest price offered to any buyer of that drug. If that price is not low enough, Medicaid receives a fixed discount off the average price. In effect, the best-price rule transforms all private discounts negotiated between a pharmaceutical company and a drug plan into public discounts for Medicaid. Research by academics, along with a slew of anecdotal evidence reported in the press, suggests that after passage of the Medicaid best-price rule, the days of deep discounts to private drug plans have been numbered. Instead, for most drugs the dispersion in prices has declined significantly and the overall level of prices has increased. Even with products for which there are therapeutic substitutes available, price competition has become less intense.
All that aside, many will argue that, clearly, government negotiations lead to lower prices -- just look at Canada, or Britain, or France. True, those governments may obtain lower prices than the public pays in the U.S., but the real question is: Do those governments negotiate lower prices than what would be negotiated were smaller groups of buyers able to deal individually with pharmaceutical companies? Moreover, a great advantage that governments in other countries have over the U.S. government is the ability to control entry. Without direct-to-consumer advertising, citizens in other countries don't even hear about new drugs until the government has approved the drug and negotiated an amenable price. Interestingly, with the expansion of the Internet and unrestrained information flow, other governments have been facing new challenges. Earlier this year, a well-publicized legal battle brought by a U.K. woman against the NHS's decision not to cover Herceptin for early-stage breast cancer has compelled the NHS to reverse its original decision and to offer coverage for that drug.
Finally, there is the familiar economic argument that the market-determined price is the only fair price. How can the government determine what price is "fair," what price appropriately reimburses pharmaceutical companies for all their research and development efforts? How can the government determine what prices will encourage the right levels of future innovation? The government negotiating prices only leaves room for additional gains through political lobbying and campaigning, activities at which pharmaceutical companies have proven themselves rather adept.
Congressional Democrats need to be careful in making the logical leap from market share to bargaining power. Empowering the government to negotiate with pharmaceutical companies is not necessarily equivalent to achieving lower drug prices. In fact, neither economic theory nor historical experience suggests that will be the outcome. Members should think carefully before jumping on the bandwagon -- this promise may bring just the opposite of what was ordered
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
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Nancy Pelosi has promised that when the Democrats come into control of the House, they will repeal the ban preventing Medicare from negotiating directly with pharmaceutical companies, within the first 100 hours. She must expect that this legislation will bring down drug prices dramatically. In fact, it is not obvious that allowing the government to negotiate with pharmaceutical companies will lead to lower prices than those achieved by private drug plans. There are several good reasons that government negotiations may not decrease drug costs.
First, negotiations are a bargaining process. The relative balance of bargaining power determines at which price the deal is struck. People often confuse market power with bargaining power. The thinking goes, the larger the share of the market the buyer represents, the greater the bargaining power and thus the lower the prices negotiated. That line of reasoning fails with drugs, however, because the seller is frequently a monopolist so it cannot be threatened with replacement by a substitute. Instead, the only threat is exclusion from the market.
Rather than market share, a party's bargaining power is determined simply by its ability to say no, to walk away from the table without an agreement. Whether the government or a private drug plan has greater bargaining power is not clear. Which can walk away more easily and declare that some brand-name drug will not be covered on the formulary? Private plans like Kaiser or United are able to negotiate deep discounts with pharmaceutical companies precisely because of the plans' ability to say no -- the ability to include some drugs and to exclude others, allowing the market to judge the resulting formulary. On the other hand, when the government negotiates, its hands are tied because there are few drugs it can exclude without facing political backlash from doctors and the Medicare population, a very influential group of voters.
In fact, the government negotiating on behalf of Medicare beneficiaries may lead to some unintended adverse consequences. Since direct-to-consumer advertising is legal in the U.S., there is nothing preventing pharmaceutical companies from funding a torrent of advertisements for the "latest and greatest" drug, thereby creating a strong demand within the Medicare population for coverage of the drug. How firm can the government stand when negotiating for a drug being clamored for? This is not the sort of bargaining power that will lead to lower prices.
Secondly, by acting as one large buyer, the government will cause price discounts to become more expensive for pharmaceutical companies. In other words, the minimum price that the pharmaceutical company is able to accept increases. All else equal, this will lead to higher, not lower, prices. When private drug plans are negotiating individually with pharmaceutical companies, those companies have the power to "price discriminate," meaning they can charge lower prices to some drug plans and higher prices to others. This ability allows for large discounts. If Pfizer is able to give a deep discount to Kaiser without giving a similar discount to United, then it is less costly for Pfizer to give Kaiser that discount. If, however, Pfizer can give a deep discount to Kaiser only if the same discount is granted to all other Medicare drug plans, then the discount becomes very expensive.
Experience with the Medicaid best-price rule, passed as part of OBRA '90, provides both empirical and anecdotal evidence of price discounts becoming more expensive when buyers' discounts are forcibly linked together. The best-price rule states roughly that Medicaid will be granted a price for a drug that is the lowest price offered to any buyer of that drug. If that price is not low enough, Medicaid receives a fixed discount off the average price. In effect, the best-price rule transforms all private discounts negotiated between a pharmaceutical company and a drug plan into public discounts for Medicaid. Research by academics, along with a slew of anecdotal evidence reported in the press, suggests that after passage of the Medicaid best-price rule, the days of deep discounts to private drug plans have been numbered. Instead, for most drugs the dispersion in prices has declined significantly and the overall level of prices has increased. Even with products for which there are therapeutic substitutes available, price competition has become less intense.
All that aside, many will argue that, clearly, government negotiations lead to lower prices -- just look at Canada, or Britain, or France. True, those governments may obtain lower prices than the public pays in the U.S., but the real question is: Do those governments negotiate lower prices than what would be negotiated were smaller groups of buyers able to deal individually with pharmaceutical companies? Moreover, a great advantage that governments in other countries have over the U.S. government is the ability to control entry. Without direct-to-consumer advertising, citizens in other countries don't even hear about new drugs until the government has approved the drug and negotiated an amenable price. Interestingly, with the expansion of the Internet and unrestrained information flow, other governments have been facing new challenges. Earlier this year, a well-publicized legal battle brought by a U.K. woman against the NHS's decision not to cover Herceptin for early-stage breast cancer has compelled the NHS to reverse its original decision and to offer coverage for that drug.
Finally, there is the familiar economic argument that the market-determined price is the only fair price. How can the government determine what price is "fair," what price appropriately reimburses pharmaceutical companies for all their research and development efforts? How can the government determine what prices will encourage the right levels of future innovation? The government negotiating prices only leaves room for additional gains through political lobbying and campaigning, activities at which pharmaceutical companies have proven themselves rather adept.
Congressional Democrats need to be careful in making the logical leap from market share to bargaining power. Empowering the government to negotiate with pharmaceutical companies is not necessarily equivalent to achieving lower drug prices. In fact, neither economic theory nor historical experience suggests that will be the outcome. Members should think carefully before jumping on the bandwagon -- this promise may bring just the opposite of what was ordered
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
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