Comment from a senior American anesthesiologist about yesterday's post
The scenario sounds to me like the sinus infection had spread beyond the eye socket, perhaps downward into the pharynx (behind the tongue), making inserting a breathing tube more difficult, perhaps stirring up bleeding or pus, which would make visualizing the airway more difficult or impossible. If Ms Bromiley was overweight, the large tongue might make intubation difficult. With repeated attempts at intubation, the airway may become swollen. Awakening the patient before this point may have saved her; we have done this on occasion; inconvenient, but life-saving. Careful preoperative examination of the airway may have alerted the anesthesiologist to the precarious conditions present.
Actually, a tracheostomy is NOT the preferred treatment - this takes several minutes. A "cricothyrotomy" - a needle through a membrane, takes seconds, and the patient can be ventilated for a while before a better airway is established. We practice doing cricothyrotomy on dummies.
Of course, if the infection extends all the way to the throat, a tracheostomy or cricothyrotomy may not be possible. For such cases, a flexible fiberoptic device may enable the anesthesiologist to see around corners, and place the breatihing tube. Again, careful preoperative discussion between anesthesiologist and surgeons may make for better planning.
Here in the USA, we have a "difficult airway algorithm". See here
We drill our trainees (and ourselves) many times about these guidelines, on paper, with test questions, and on an electronic simulator (PC verson, and life size rubber dummy connected to a computer). This is standard practice here. This pilot would be stunned if he could see the level of our training on this issue. We have airway workshops where we can practice fiberoptic intubation on dummies, and we do it on patients as well. See here
Having a TV screen is a giant step forward (our institution is too cheap) - it allows the instructor to see what the trainee sees, and speeds up the teaching process.
ASA has close claims data, the best source of complications. I believe there has not been a case (or, more likely, too few to count) of airway disasters where a difficult airway has been diagnosed preoperatively; such cases alert the anesthesiologists to use more care or special methods (like fiberoptic). The most litigation is in emergency C-sections in (usually morbidly obese) where the airway is lost. This is why regional (spinal, epidural) anesthesia is so popular (but there are times and conditions where regional anesthesia is not possible. Hopefully, if intubation is abandoned after multiple attempts, the "cannot intubate cannot ventilate" scenario will never occur; if it does, surgical airway is a no brainer.
Pulse oximeters are a standard of care. When the oxygen in the skin drops, we are alerted that something must be done - NOW. One recently developed device is the Laryngeal Mask airway (LMA). This device allows maintaining an airway in a patient where the larynx cannot be visualized; it has been a lifesaver.
I had a recent emergency C-section in a fat lady where I couldn't intubate her. I could have maintained ventilation, but that would not protect her from vomiting and aspiration. All contraindications are relative; I used a LMA because I believed the small risk of vomiting and aspiration was less than the risk of airway obstruction from further attempts at intubation.
The anesthesiologist is normally in charge of the airway. If we must, WE request the surgeon to establish a surgical airway. The senior anesthesiologist is "in charge". Unfortunately, nervous surgeons may confuse the issue at times. I believe the British pilot would be pleasantly surprised at the level American doctors do such things. There is ACLS (advanced cardiac life support, both for adults and children); ATLS (advanced trauma life support) courses, exams, computer drills, ethc.
I am amused at nurses who claim an exclusive as "patient advocates". I am very proud what anesthesiologists have done to improbe patient safety. We are "patient advocates" as well. It was anesthesiologists who raised hell with hospital administrations to buy equipment to make anesthesia safer. Much of our improvement in safety has been with the initiatives of anesthesiologists, not Government mandates. When the Government demands better safety, then we must begin to worry.
***************************
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 18, 2006
Sunday, December 17, 2006
Robust NHS patient killed by disorganized and poorly-trained doctors
Elaine Bromiley kissed her husband Martin and their children Victoria, then six, and Adam, five. "Bye-ee," she called to them, waving as she was wheeled down the corridor towards the operating theatre. The otherwise healthy 37-year-old had suffered for years from chronic sinusitis, an inflammation of the nasal passages. Then, early in 2005, one of her eye sockets became infected. The threat of permanent damage to the optic nerve led her surgeon to recommend a minor operation to straighten the inside of the nose - a possible contributory factor.
Once they'd said their goodbyes, Martin and the children went home to wait for word that Elaine was awake and ready to see them all again. It never came. Two hours after she'd gone into theatre, Martin received a call from the Ear, Nose and Throat (ENT) surgeon to say Elaine was having difficulty waking up. Even then, Martin wasn't unduly worried. But when he arrived at the hospital, he was told Elaine was in intensive care, and, because she'd been deprived of oxygen during the operation, there was a risk of significant brain damage. The next few days were a blur as, numb with shock, Martin, with the help of friends, did his best to care for his family. Desperately anxious about his wife, he tried to maintain as normal a life as possible for the children, who continued going to school.
Meanwhile, Elaine was put into a medically-induced coma for three days to give her swollen brain a chance to recover. "I spent every minute I could with Elaine, holding her hand and telling her how much I loved her," says Martin. "The day after the operation was the 21st anniversary of our first date. I was told that the eventual outcome could be a full recovery, or that my wife could be alive but in a vegetative state - or any point between the two extremes. "My head was spinning. I couldn't grasp how life could change so quickly and in such a devastating way. I really couldn't see past the next day and had no idea what the future held for us."
Five days after the operation, a brain scan indicated little if any activity and Martin was told Elaine had suffered brain death. "It was like a TV screen covered in static: no shape, no texture, no colour to show that anything was working," he recalls. "Years ago, Elaine had told me that she did not wish to live as a vegetable. I made the decision that life support should be withdrawn and I prepared myself for a life without Elaine that I could not begin to imagine." Mrs Bromiley was observed for three days and then taken off life support. She survived for another four days, dying in the middle of the night when Martin was at home with the children. "I'd decided that they were the priority now," he says.
He had kept the children informed of their mother's progress, telling them "first that Mummy was going to be ill, just like Granny was when she had a stroke, but that she will get better". Then he had to explain that "Mummy wasn't going to wake up, she was going to die". Martin recalls those desolate days. "I just couldn't imagine how life would go on," he says. What Martin hung on to, he says, was his professional work ethic as a pilot. He took it for granted that - as is routine in aviation - an investigation would automatically be carried out. His hope was that at the very least lessons would be learnt to protect other patients in the future. He felt, if anything, comradeship with the operating team responsible. "I was 99.9 per cent sure that what had happened to Elaine could not have been predicted and that when the emergency occurred, the team did what they believed to be right but things just didn't work out."
When he discovered that no inquiry would be carried out unless he sued or made a complaint, he walked into the hospital chief executive's office to insist there was one. The subsequent investigation was headed by Professor Michael Harmer, a former president of the Association of Anaesthetists. The inquiry revealed that Elaine's operation was a textbook example of how surgery, carried out by technically proficient professionals, can go horribly wrong. The cause: human error. So much is made of the latest medical advances that it comes as something of a shock to learn that human error still figures significantly in modern healthcare.
Yet last month, the Chief Medical Officer, Sir Liam Donaldson, warned that the odds of dying as a result of clinical error in hospital are 33,000 times higher than those of dying in an air crash. "In the airline industry, the risk of death is one in 10 million. If you go into a hospital, the risk of death from a medical error is one in 300," he said. And yet it seems little is being done to improve those odds. Five years after chairing the inquiry into the deaths of 29 babies during heart surgery at Bristol Royal Infirmary, Sir Ian Kennedy, now chairman of the Health Commission, drew attention to the lack of progress. "It is almost as though avoidable deaths and injuries are accepted as part of the risk of care and treatment," he told a meeting of clinicians in London in July.
And it gets worse: the National Patient Safety Agency (NPSA), which was set up by the Government in response to the Bristol inquiry, with a brief to ensure that patient safety was a priority within the NHS, was recently described as "dysfunctional" by the National Audit Office. The agency has no idea how many people die each year as a result of medical error. It is currently under investigation, with a report on its future due out this week. The National Audit Office estimates that there may be up to 34,000 deaths annually as a result of patient safety incidents. But in reality the NHS simply does not know.
Contrast this with the approach taken by other high-risk industries. For years, businesses from motor racing to oil refining have recognised the dangers of human error, and the importance of communication and teamwork in dealing with emergencies. They have introduced what is known as Human Factors (HF) training, which teaches basic skills designed to promote safety. While much-prized technical skills are essential, they are not always enough in a fast-moving, high-risk situation. At critical moments, organisational and social skills are just as important. This means good communication and an ability to work together with each member of the team.
It appears that moments after being sedated, Elaine's airway collapsed, preventing adequate levels of oxygen from reaching her brain. Though potentially an emergency, the event is a recognised risk during an anaesthetic and, as such, should be manageable. Surgeons and anaesthetists are drilled to follow a series of steps at this point - beginning with a non-invasive attempt to get the patient breathing normally, and ending, as a last resort, with an emergency surgical procedure. This is usually a tracheotomy - where the surgeon cuts through the windpipe, inserting a tube directly into the airway through the throat.
At first the drill was followed impeccably. But then a problem arose: the surgical team tried to get a tube into the airway to help Elaine breathe, but encountered some kind of blockage. According to the drill, this was the time to consider doing a tracheotomy. Elaine, by this point, was turning blue in the face and one of the nurses fetched tracheotomy equipment. A second nurse phoned through to the intensive care unit to check there was a spare bed available.
But the three consultants appear to have made the sort of human error that is horribly common in crisis situations. They became fixated on what they were doing. The consultants also appear to have ignored the junior staff and remained intent on finding a way to insert a tube into the airway. The minutes ticked by. After 25 minutes, they were finally able to get a tube into her airway -but even then, the team failed to secure the tube and it was a full 35 minutes before adequate oxygen levels to the brain were restored.
At the inquest, held in October last year, the lead anaesthetist admitted that he had lost control and there was a dispute over exactly who was in charge of the procedure, making life-and-death decisions.
All of which could have been the end of the investigation. But Martin Bromiley had an unusual insight into the factors that led to his wife's death. He is both a pilot and a specialist in HF training, which has been mandatory for British pilots and crew since the mid-1990s. "Fixation is a normal reaction to stress. HF training teaches people that it's normal to carry on trying to take the usual action, even when it's clearly not working," he says. "But at some point, a decision has to be made to break out of that pattern of behaviour. The way to ensure that happens is for all members of the team to see it as their duty to speak out to keep the patient safe." There was no comfort in knowing that two of the nurses knew how to save his wife's life. "What they didn't know - and what HF would have taught them - is how to broach the subject with their bosses," he says.
"The same problem used to exist in aviation. It was common for the evidence from black boxes to show that junior members of staff had been aware that a mistake had been made and had either kept quiet or been ignored." Clinicians tended to view human error as a sign of weakness or the result of poor performance, says Martin. "Yet high-risk industries have shown that by accepting that it is normal to make mistakes, it becomes the team's responsibility to watch out for errors and catch them before they cause significant harm."
Martin began to ask questions and soon found that he was not the only person to be concerned about the risks of modern surgery. Indeed, for the past year the Royal College of Surgeons has been developing HF training courses in which surgeons have worked with experts from the aviation industry. Last month, it also organised a conference where leading doctors, nurses and managers heard speakers from the military, the oil industry and motor racing, among others, all described the dramatic impact on safety levels following the introduction of HF training. Martin himself also addressed the conference. "Patients want surgeons who can communicate well with them and effectively with members of the team,' says Tony Giddings, the Royal College of Surgeons council member responsible for patient safety issues and a former surgeon and trained pilot. "And there is a growing understanding of their importance within the profession. These skills are not unique to medicine; they are skills for life itself. They enable people to be confident and self-assured yet acknowledge they are not infallible. "Unless people have these skills intuitively, they need to be trained. Surgeons, anaesthetists, nurses and other members of the team can be trained together to develop these essential skills."
However, unless such training is mandatory, the surgeons who need it most won't participate, says Mr Giddings. It also needs funding. HF training could save thousands of lives every year, yet he says there is a reluctance at government level to commit resources to a scheme which could cost millions of pounds every year. "But however expensive mandatory training is, there is considerable evidence that human error in medicine is far more costly, both in human and financial terms." For Roger Goss, co-director of campaign group Patient Concern, there is no question that HF training must be implemented. "If the aviation industry uses this type of training, then that's good enough for me: flying is the safest mode of transport," he says. "Patient safety must become a priority in health care. It's not at the moment. Chief executives are constantly being criticised for failing to make it a priority, and instead focusing on keeping within their budget. The NHS has a moral obligation to do anything humanly possible to minimise the risks of surgery."
This week, Martin is meeting the Deputy Chief Medical Officer to discuss a number of initiatives. As he approaches a second Christmas without his wife, he is determined that his family's terrible experience will have a positive impact on the culture of surgery. "There is no question in my mind that Elaine's death will bring enormous change to clinical practice," he says with quiet determination
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.
***************************
Elaine Bromiley kissed her husband Martin and their children Victoria, then six, and Adam, five. "Bye-ee," she called to them, waving as she was wheeled down the corridor towards the operating theatre. The otherwise healthy 37-year-old had suffered for years from chronic sinusitis, an inflammation of the nasal passages. Then, early in 2005, one of her eye sockets became infected. The threat of permanent damage to the optic nerve led her surgeon to recommend a minor operation to straighten the inside of the nose - a possible contributory factor.
Once they'd said their goodbyes, Martin and the children went home to wait for word that Elaine was awake and ready to see them all again. It never came. Two hours after she'd gone into theatre, Martin received a call from the Ear, Nose and Throat (ENT) surgeon to say Elaine was having difficulty waking up. Even then, Martin wasn't unduly worried. But when he arrived at the hospital, he was told Elaine was in intensive care, and, because she'd been deprived of oxygen during the operation, there was a risk of significant brain damage. The next few days were a blur as, numb with shock, Martin, with the help of friends, did his best to care for his family. Desperately anxious about his wife, he tried to maintain as normal a life as possible for the children, who continued going to school.
Meanwhile, Elaine was put into a medically-induced coma for three days to give her swollen brain a chance to recover. "I spent every minute I could with Elaine, holding her hand and telling her how much I loved her," says Martin. "The day after the operation was the 21st anniversary of our first date. I was told that the eventual outcome could be a full recovery, or that my wife could be alive but in a vegetative state - or any point between the two extremes. "My head was spinning. I couldn't grasp how life could change so quickly and in such a devastating way. I really couldn't see past the next day and had no idea what the future held for us."
Five days after the operation, a brain scan indicated little if any activity and Martin was told Elaine had suffered brain death. "It was like a TV screen covered in static: no shape, no texture, no colour to show that anything was working," he recalls. "Years ago, Elaine had told me that she did not wish to live as a vegetable. I made the decision that life support should be withdrawn and I prepared myself for a life without Elaine that I could not begin to imagine." Mrs Bromiley was observed for three days and then taken off life support. She survived for another four days, dying in the middle of the night when Martin was at home with the children. "I'd decided that they were the priority now," he says.
He had kept the children informed of their mother's progress, telling them "first that Mummy was going to be ill, just like Granny was when she had a stroke, but that she will get better". Then he had to explain that "Mummy wasn't going to wake up, she was going to die". Martin recalls those desolate days. "I just couldn't imagine how life would go on," he says. What Martin hung on to, he says, was his professional work ethic as a pilot. He took it for granted that - as is routine in aviation - an investigation would automatically be carried out. His hope was that at the very least lessons would be learnt to protect other patients in the future. He felt, if anything, comradeship with the operating team responsible. "I was 99.9 per cent sure that what had happened to Elaine could not have been predicted and that when the emergency occurred, the team did what they believed to be right but things just didn't work out."
When he discovered that no inquiry would be carried out unless he sued or made a complaint, he walked into the hospital chief executive's office to insist there was one. The subsequent investigation was headed by Professor Michael Harmer, a former president of the Association of Anaesthetists. The inquiry revealed that Elaine's operation was a textbook example of how surgery, carried out by technically proficient professionals, can go horribly wrong. The cause: human error. So much is made of the latest medical advances that it comes as something of a shock to learn that human error still figures significantly in modern healthcare.
Yet last month, the Chief Medical Officer, Sir Liam Donaldson, warned that the odds of dying as a result of clinical error in hospital are 33,000 times higher than those of dying in an air crash. "In the airline industry, the risk of death is one in 10 million. If you go into a hospital, the risk of death from a medical error is one in 300," he said. And yet it seems little is being done to improve those odds. Five years after chairing the inquiry into the deaths of 29 babies during heart surgery at Bristol Royal Infirmary, Sir Ian Kennedy, now chairman of the Health Commission, drew attention to the lack of progress. "It is almost as though avoidable deaths and injuries are accepted as part of the risk of care and treatment," he told a meeting of clinicians in London in July.
And it gets worse: the National Patient Safety Agency (NPSA), which was set up by the Government in response to the Bristol inquiry, with a brief to ensure that patient safety was a priority within the NHS, was recently described as "dysfunctional" by the National Audit Office. The agency has no idea how many people die each year as a result of medical error. It is currently under investigation, with a report on its future due out this week. The National Audit Office estimates that there may be up to 34,000 deaths annually as a result of patient safety incidents. But in reality the NHS simply does not know.
Contrast this with the approach taken by other high-risk industries. For years, businesses from motor racing to oil refining have recognised the dangers of human error, and the importance of communication and teamwork in dealing with emergencies. They have introduced what is known as Human Factors (HF) training, which teaches basic skills designed to promote safety. While much-prized technical skills are essential, they are not always enough in a fast-moving, high-risk situation. At critical moments, organisational and social skills are just as important. This means good communication and an ability to work together with each member of the team.
It appears that moments after being sedated, Elaine's airway collapsed, preventing adequate levels of oxygen from reaching her brain. Though potentially an emergency, the event is a recognised risk during an anaesthetic and, as such, should be manageable. Surgeons and anaesthetists are drilled to follow a series of steps at this point - beginning with a non-invasive attempt to get the patient breathing normally, and ending, as a last resort, with an emergency surgical procedure. This is usually a tracheotomy - where the surgeon cuts through the windpipe, inserting a tube directly into the airway through the throat.
At first the drill was followed impeccably. But then a problem arose: the surgical team tried to get a tube into the airway to help Elaine breathe, but encountered some kind of blockage. According to the drill, this was the time to consider doing a tracheotomy. Elaine, by this point, was turning blue in the face and one of the nurses fetched tracheotomy equipment. A second nurse phoned through to the intensive care unit to check there was a spare bed available.
But the three consultants appear to have made the sort of human error that is horribly common in crisis situations. They became fixated on what they were doing. The consultants also appear to have ignored the junior staff and remained intent on finding a way to insert a tube into the airway. The minutes ticked by. After 25 minutes, they were finally able to get a tube into her airway -but even then, the team failed to secure the tube and it was a full 35 minutes before adequate oxygen levels to the brain were restored.
At the inquest, held in October last year, the lead anaesthetist admitted that he had lost control and there was a dispute over exactly who was in charge of the procedure, making life-and-death decisions.
All of which could have been the end of the investigation. But Martin Bromiley had an unusual insight into the factors that led to his wife's death. He is both a pilot and a specialist in HF training, which has been mandatory for British pilots and crew since the mid-1990s. "Fixation is a normal reaction to stress. HF training teaches people that it's normal to carry on trying to take the usual action, even when it's clearly not working," he says. "But at some point, a decision has to be made to break out of that pattern of behaviour. The way to ensure that happens is for all members of the team to see it as their duty to speak out to keep the patient safe." There was no comfort in knowing that two of the nurses knew how to save his wife's life. "What they didn't know - and what HF would have taught them - is how to broach the subject with their bosses," he says.
"The same problem used to exist in aviation. It was common for the evidence from black boxes to show that junior members of staff had been aware that a mistake had been made and had either kept quiet or been ignored." Clinicians tended to view human error as a sign of weakness or the result of poor performance, says Martin. "Yet high-risk industries have shown that by accepting that it is normal to make mistakes, it becomes the team's responsibility to watch out for errors and catch them before they cause significant harm."
Martin began to ask questions and soon found that he was not the only person to be concerned about the risks of modern surgery. Indeed, for the past year the Royal College of Surgeons has been developing HF training courses in which surgeons have worked with experts from the aviation industry. Last month, it also organised a conference where leading doctors, nurses and managers heard speakers from the military, the oil industry and motor racing, among others, all described the dramatic impact on safety levels following the introduction of HF training. Martin himself also addressed the conference. "Patients want surgeons who can communicate well with them and effectively with members of the team,' says Tony Giddings, the Royal College of Surgeons council member responsible for patient safety issues and a former surgeon and trained pilot. "And there is a growing understanding of their importance within the profession. These skills are not unique to medicine; they are skills for life itself. They enable people to be confident and self-assured yet acknowledge they are not infallible. "Unless people have these skills intuitively, they need to be trained. Surgeons, anaesthetists, nurses and other members of the team can be trained together to develop these essential skills."
However, unless such training is mandatory, the surgeons who need it most won't participate, says Mr Giddings. It also needs funding. HF training could save thousands of lives every year, yet he says there is a reluctance at government level to commit resources to a scheme which could cost millions of pounds every year. "But however expensive mandatory training is, there is considerable evidence that human error in medicine is far more costly, both in human and financial terms." For Roger Goss, co-director of campaign group Patient Concern, there is no question that HF training must be implemented. "If the aviation industry uses this type of training, then that's good enough for me: flying is the safest mode of transport," he says. "Patient safety must become a priority in health care. It's not at the moment. Chief executives are constantly being criticised for failing to make it a priority, and instead focusing on keeping within their budget. The NHS has a moral obligation to do anything humanly possible to minimise the risks of surgery."
This week, Martin is meeting the Deputy Chief Medical Officer to discuss a number of initiatives. As he approaches a second Christmas without his wife, he is determined that his family's terrible experience will have a positive impact on the culture of surgery. "There is no question in my mind that Elaine's death will bring enormous change to clinical practice," he says with quiet determination
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 16, 2006
NHS spend 7 billion pounds of taxpayer's money on 'private consultants'
And it's not medical consultants we are talking about
More than 7 billion pounds [Yes. That's billions, not millions] of taxpayers' money was lavished on private consultants in the public services over the last three years - thanks to soaring costs in the NHS. Spending on consultants in the Health Service has increased 18 fold in just two years, from 31million in 2004 to a staggering 578m in the 12 months to April - partly thanks to the spiralling costs of the new NHS computer system. That raised the total bill for consultants in the public services to 2.8bn last year - a rise of a third over the last two years.
The National Audit Office warned there is no evidence at all that taxpapyers have got value for money because Whitehall departments keep such poor records. A hard hitting report by the government spending watchdog found that ministers could save more than 1billion over three years if they put in place even basic controls to cut the number of consultants and get better value from their contracts.
The company cashing in the most is computer firm IBM, with contracts worth 275m pounds last year, while Accenture - the management company who have worked for Labour since before the 1997 election - raked in 175m. PA Consulting, who are presiding over the controversial ID card scheme, pocketed 102million last year.
The report slams government departments for paying consultants millions on a daily 'time and materials' rate which encourages them to spin out contracts to milk money from the public purse, rather making payments dependent on delivering successful projects. The worst offender is the Department of Education and Skills, which receives four 'red lights' for its failure to get a grip on consultant spending. After the NHS, the biggest slice of the bill comes from local government, where consultants earned 386m last year. The Department for International Development, despite being a small ministry, ran up a gigantic bill of 255m. The Ministry of Defence spent 213m and the Environment department 160m.
Among the contracts singled out for criticism is the Home Office's ID cards project, where more than 2m a month was being funnelled to PA Consulting last year. The report complains that the department rather than the consultants 'bear the costs for increases in project duration', which have exceeded original estimates. The NAO concluded that most departments do not bother to 'make a proper assessment of whether internal resources could have been used instead of consultants' or 'collect adequate information on their use of consultants'. Crucially their report said that departments do not talk to each other about which consulting firms and partners at those firms do a good job, nor do they make sure consultants train up civil servants to do the job once they have left. It concludes: 'Fewer than half of central government organisations collect information on how the consultants have performed against what they were intended to do.'
Keith Davis, director of the NAO efficiency centre which compiled the report, said: 'The way that Government is managing consultants doesn't represent value for money. Part of the problem is there is no clear information.' Edward Leigh, chairman of the Public Accounts Committee, said: 'Today's report from the NAO confirms what many of us have long suspected: the external consultancy gravy train continues full steam ahead, courtesy if the public purse. 'In the past three years, 7.3bn of taxpayers' money has gone to big consultancy firms. Too often departments hand over a signed cheque to consultants without first looking to see what skills they have in-house. 'Perhaps the most damning finding is that, time and again, departments fail to keep an eye on how these companies perform or if they are delivering.'
Sir John Bourn, head of the National Audit Office, branded progress in government 'disappointing'. He said: 'Departments need to think ahead about what skills they should have, so they don't have to rely on consultants year after year. Peter Hill, chief executive of the Management Consultancies Association said: 'The increase in the use of management consultants is against a background of unprecedented public sector reform which requires skills and competency not available in sufficient numbers in the public sector.' CBI director of public services Dr Neil Bentley said: 'Consultants offer expertise and experience often not found in the public sector, but government departments need to make a clear business case for using them if the taxpayer is to get value for money. 'As the NAO rightly suggests, this does not always happen.'
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 it's not medical consultants we are talking about
More than 7 billion pounds [Yes. That's billions, not millions] of taxpayers' money was lavished on private consultants in the public services over the last three years - thanks to soaring costs in the NHS. Spending on consultants in the Health Service has increased 18 fold in just two years, from 31million in 2004 to a staggering 578m in the 12 months to April - partly thanks to the spiralling costs of the new NHS computer system. That raised the total bill for consultants in the public services to 2.8bn last year - a rise of a third over the last two years.
The National Audit Office warned there is no evidence at all that taxpapyers have got value for money because Whitehall departments keep such poor records. A hard hitting report by the government spending watchdog found that ministers could save more than 1billion over three years if they put in place even basic controls to cut the number of consultants and get better value from their contracts.
The company cashing in the most is computer firm IBM, with contracts worth 275m pounds last year, while Accenture - the management company who have worked for Labour since before the 1997 election - raked in 175m. PA Consulting, who are presiding over the controversial ID card scheme, pocketed 102million last year.
The report slams government departments for paying consultants millions on a daily 'time and materials' rate which encourages them to spin out contracts to milk money from the public purse, rather making payments dependent on delivering successful projects. The worst offender is the Department of Education and Skills, which receives four 'red lights' for its failure to get a grip on consultant spending. After the NHS, the biggest slice of the bill comes from local government, where consultants earned 386m last year. The Department for International Development, despite being a small ministry, ran up a gigantic bill of 255m. The Ministry of Defence spent 213m and the Environment department 160m.
Among the contracts singled out for criticism is the Home Office's ID cards project, where more than 2m a month was being funnelled to PA Consulting last year. The report complains that the department rather than the consultants 'bear the costs for increases in project duration', which have exceeded original estimates. The NAO concluded that most departments do not bother to 'make a proper assessment of whether internal resources could have been used instead of consultants' or 'collect adequate information on their use of consultants'. Crucially their report said that departments do not talk to each other about which consulting firms and partners at those firms do a good job, nor do they make sure consultants train up civil servants to do the job once they have left. It concludes: 'Fewer than half of central government organisations collect information on how the consultants have performed against what they were intended to do.'
Keith Davis, director of the NAO efficiency centre which compiled the report, said: 'The way that Government is managing consultants doesn't represent value for money. Part of the problem is there is no clear information.' Edward Leigh, chairman of the Public Accounts Committee, said: 'Today's report from the NAO confirms what many of us have long suspected: the external consultancy gravy train continues full steam ahead, courtesy if the public purse. 'In the past three years, 7.3bn of taxpayers' money has gone to big consultancy firms. Too often departments hand over a signed cheque to consultants without first looking to see what skills they have in-house. 'Perhaps the most damning finding is that, time and again, departments fail to keep an eye on how these companies perform or if they are delivering.'
Sir John Bourn, head of the National Audit Office, branded progress in government 'disappointing'. He said: 'Departments need to think ahead about what skills they should have, so they don't have to rely on consultants year after year. Peter Hill, chief executive of the Management Consultancies Association said: 'The increase in the use of management consultants is against a background of unprecedented public sector reform which requires skills and competency not available in sufficient numbers in the public sector.' CBI director of public services Dr Neil Bentley said: 'Consultants offer expertise and experience often not found in the public sector, but government departments need to make a clear business case for using them if the taxpayer is to get value for money. 'As the NAO rightly suggests, this does not always happen.'
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 15, 2006
PLENTY OF MONEY FOR NHS LOGO -- TOO BAD ABOUT PATIENT WAITING LISTS
As always, "administration" (the bureaucracy) comes first in a call on funds
Hundreds of thousands of pounds of taxpayers' money is being spent on 'managing' the NHS logo despite the cash crisis gripping the Health Service. Official figures reveal that the bill for protecting and promoting the 'NHS identity' has more than doubled in the last four years - reaching almost 334,000 pounds last year. The money would have paid for 75 extra hip replacements - or the salaries of 15 nurses.
Instead, a special website has been set up setting out the 'core identity guidelines' on use of the NHS logo - three simple white letters set against a blue background. It advises hospitals and other NHS bodies to ensure it is printed in 'NHS Blue - Pantone 300' and 'always positioned in the top right corner' of stationery. The NHS 'official typeface' - called Frutiger - should always be used where possible, it insists, while a strict 'exclusion zone' should be observed around the edge of the logo. An NHS 'branding team' is on hand to offer advice, and an NHS 'identity helpline' has been set up.
Health Minister Ivan Lewis revealed in a written Parliamentary answer yesterday the total cost of the project since the NHS logo was developed and introduced in 1999. In 2001-02, it was 179,807, but by last year it had risen to 333,996, he revealed.
The Tories said the rising bill was extraordinary given the financial pressures facing NHS trusts across the country, which have let to job cuts and closures. Shadow Health Secretary Andrew Lansley, whose questions uncovered the figures, said: "While the NHS brand is important and has value the last thing it needs is over 300,000 to be spent on it. "The NHS needs every penny it has to spend on patient care. "I have asked the Government to explain why - like many things in the central administration of the NHS - spending has more than doubled.'
The NHS branding website insists the organisation's identity is 'important'. It adds: "It is largely formed by what we do - treating illness and promoting health. As the NHS is changing, it is vitally important to use our identity consistently and correctly. "We need to help the public and patients navigate a more diverse healthcare system, whilst maintaining their confidence that NHS values and quality will still be observed." The NHS logo has a '90 per cent spontaneous recognition rate' among the public, it adds - suggesting money has been spent on surveys to test reactions to the branding.
In the past, different NHS organisations had around 600 logos. The Health Department believes many patients were confused by some of the individual logos and could not tell if hospitals were part of the NHS. Only hospitals with a logo that pre-dated the foundation of the Health Service in 1948 were allowed to retain their brand. The department insists that 'millions of pounds' have been saved by the single branding system for letterheads, signs, uniforms and offices. A Health Department spokesman insisted: "This is not a waste of money. "The spending on the logo safeguards one of the world's most recognised and trusted brands, and stops people not allowed to use the NHS logo from using it, therefore protecting patients from organisations who may fraudulently purport to provide NHS care."
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.
***************************
As always, "administration" (the bureaucracy) comes first in a call on funds
Hundreds of thousands of pounds of taxpayers' money is being spent on 'managing' the NHS logo despite the cash crisis gripping the Health Service. Official figures reveal that the bill for protecting and promoting the 'NHS identity' has more than doubled in the last four years - reaching almost 334,000 pounds last year. The money would have paid for 75 extra hip replacements - or the salaries of 15 nurses.
Instead, a special website has been set up setting out the 'core identity guidelines' on use of the NHS logo - three simple white letters set against a blue background. It advises hospitals and other NHS bodies to ensure it is printed in 'NHS Blue - Pantone 300' and 'always positioned in the top right corner' of stationery. The NHS 'official typeface' - called Frutiger - should always be used where possible, it insists, while a strict 'exclusion zone' should be observed around the edge of the logo. An NHS 'branding team' is on hand to offer advice, and an NHS 'identity helpline' has been set up.
Health Minister Ivan Lewis revealed in a written Parliamentary answer yesterday the total cost of the project since the NHS logo was developed and introduced in 1999. In 2001-02, it was 179,807, but by last year it had risen to 333,996, he revealed.
The Tories said the rising bill was extraordinary given the financial pressures facing NHS trusts across the country, which have let to job cuts and closures. Shadow Health Secretary Andrew Lansley, whose questions uncovered the figures, said: "While the NHS brand is important and has value the last thing it needs is over 300,000 to be spent on it. "The NHS needs every penny it has to spend on patient care. "I have asked the Government to explain why - like many things in the central administration of the NHS - spending has more than doubled.'
The NHS branding website insists the organisation's identity is 'important'. It adds: "It is largely formed by what we do - treating illness and promoting health. As the NHS is changing, it is vitally important to use our identity consistently and correctly. "We need to help the public and patients navigate a more diverse healthcare system, whilst maintaining their confidence that NHS values and quality will still be observed." The NHS logo has a '90 per cent spontaneous recognition rate' among the public, it adds - suggesting money has been spent on surveys to test reactions to the branding.
In the past, different NHS organisations had around 600 logos. The Health Department believes many patients were confused by some of the individual logos and could not tell if hospitals were part of the NHS. Only hospitals with a logo that pre-dated the foundation of the Health Service in 1948 were allowed to retain their brand. The department insists that 'millions of pounds' have been saved by the single branding system for letterheads, signs, uniforms and offices. A Health Department spokesman insisted: "This is not a waste of money. "The spending on the logo safeguards one of the world's most recognised and trusted brands, and stops people not allowed to use the NHS logo from using it, therefore protecting patients from organisations who may fraudulently purport to provide NHS care."
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, December 14, 2006
Not enough nurses in NSW (Australia) hospitals
Note how the Left-leaning newspaper quoted below tries with its opening words to let a Leftist State government off the hook
Caught in the midst of a worldwide nursing shortage, the [NSW] Government has been forced to close hospital beds and defer elective surgery because there are too few staff to care for patients, a NSW Auditor-General's report says. [Getting nurses to nurse instead of doing "administration" (paperwork) all the time will not be considered of course] At the same time, an ageing population and a surge in chronic health conditions such as diabetes, obesity and heart disease is placing enormous strain on hospitals, it says.
Although the number of nurses had increased by 5500 in the past four years and resignation rates had fallen from 16 per cent to 14 per cent, there was still a chronic shortage, said Peter Achterstraat in his performance audit of NSW Health. [Because they are all busy doing paperwork.]
The report acknowledges NSW Health has used a number of successful strategies to increase nurse numbers, and overall has "done well to attract and retain nurses". "The department improved nurses' wages to make them the highest paid in Australia, recruited over 1000 nurses from overseas and attracted nearly 1500 ex-nurses back to the public health sector," it says. "These are all positive initiatives, but it is too early to judge whether they will ensure that the nursing workforce in public hospitals will be adequate in the future." While more nurses have been employed, 45 per cent of them work part-time, forcing the department to rely on overtime and agency nurses to fill the gaps, the report says.
The general secretary of the NSW Nurses' Association, Brett Holmes, said the Government was seeking to recruit 1200 nurses to fill vacancies. "Thirty per cent of our nursing workforce are over 50, so there needs to be a long-term plan for their replacement and a large proportion . need to be registered nurses," he said. "We can further improve recruitment. There are clearly still more nurses who have maintained their enrolment but who aren't working. The Government has been successful in getting more than 1500 of those back already."
The Minister for Health, John Hatzistergos, laid the blame at the feet of the Federal Government, saying more than 2000 extra university places were needed to keep pace with demand. "We are going to be substantially short on nursing numbers, and we will have to go overseas to recruit," Mr Hatzistergos said. He dismissed claims by the Opposition health spokeswoman, Jillian Skinner, that the Government had inflated the increase in nurse numbers by double counting agency staff. Only permanent full- and part-time staff had been included in the figures, he said.
Problems in recruiting and retaining nurses would remain difficult to resolve unless both federal and state governments reviewed the role of all health-care workers, including nurses, doctors and allied health workers, said the executive director of the College of Nursing, Professor Judy Lumby. She said other health sectors had been affected, indicating a need to move away from old structures and divides. "We have to rethink the way in which we care for people, with more focus on primary care and preventative health," Professor Lumby said. The Auditor-General recommended NSW Health improve its monitoring of the nursing shortage, reduce reliance on overtime and agency nurses and develop better plans to manage its nursing workforce.
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.
***************************
Note how the Left-leaning newspaper quoted below tries with its opening words to let a Leftist State government off the hook
Caught in the midst of a worldwide nursing shortage, the [NSW] Government has been forced to close hospital beds and defer elective surgery because there are too few staff to care for patients, a NSW Auditor-General's report says. [Getting nurses to nurse instead of doing "administration" (paperwork) all the time will not be considered of course] At the same time, an ageing population and a surge in chronic health conditions such as diabetes, obesity and heart disease is placing enormous strain on hospitals, it says.
Although the number of nurses had increased by 5500 in the past four years and resignation rates had fallen from 16 per cent to 14 per cent, there was still a chronic shortage, said Peter Achterstraat in his performance audit of NSW Health. [Because they are all busy doing paperwork.]
The report acknowledges NSW Health has used a number of successful strategies to increase nurse numbers, and overall has "done well to attract and retain nurses". "The department improved nurses' wages to make them the highest paid in Australia, recruited over 1000 nurses from overseas and attracted nearly 1500 ex-nurses back to the public health sector," it says. "These are all positive initiatives, but it is too early to judge whether they will ensure that the nursing workforce in public hospitals will be adequate in the future." While more nurses have been employed, 45 per cent of them work part-time, forcing the department to rely on overtime and agency nurses to fill the gaps, the report says.
The general secretary of the NSW Nurses' Association, Brett Holmes, said the Government was seeking to recruit 1200 nurses to fill vacancies. "Thirty per cent of our nursing workforce are over 50, so there needs to be a long-term plan for their replacement and a large proportion . need to be registered nurses," he said. "We can further improve recruitment. There are clearly still more nurses who have maintained their enrolment but who aren't working. The Government has been successful in getting more than 1500 of those back already."
The Minister for Health, John Hatzistergos, laid the blame at the feet of the Federal Government, saying more than 2000 extra university places were needed to keep pace with demand. "We are going to be substantially short on nursing numbers, and we will have to go overseas to recruit," Mr Hatzistergos said. He dismissed claims by the Opposition health spokeswoman, Jillian Skinner, that the Government had inflated the increase in nurse numbers by double counting agency staff. Only permanent full- and part-time staff had been included in the figures, he said.
Problems in recruiting and retaining nurses would remain difficult to resolve unless both federal and state governments reviewed the role of all health-care workers, including nurses, doctors and allied health workers, said the executive director of the College of Nursing, Professor Judy Lumby. She said other health sectors had been affected, indicating a need to move away from old structures and divides. "We have to rethink the way in which we care for people, with more focus on primary care and preventative health," Professor Lumby said. The Auditor-General recommended NSW Health improve its monitoring of the nursing shortage, reduce reliance on overtime and agency nurses and develop better plans to manage its nursing workforce.
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 13, 2006
NOW IT'S THREATS (EMPTY THOUGH) BEING USED TO MAKE THE NHS WORK
Hospitals will face renewed pressure to save money, cut waiting times and tackle superbugs under new performance targets to be set today by the Government. In his first report as chief exective of the NHS, David Nicholson has compiled a list of priorities for the next financial year, including a target for a 250 million pound budget surplus by March 2008. He will also demand faster access to treatment and less of a “postcode lottery” of health inequalities. A new benchmark is to be set for the 18-week waiting times target — widely regarded as the most ambitious of all NHS targets — that almost all hospitals will treat patients within that time by March 2008. The Government has pledged to have all patients treated within 18 weeks of a doctor’s referral by the end of that year.
Mr Nicholson’s target for a 250 million surplus comes amid rising levels of debt in the NHS. Funding has more than doubled in ten years, but the total NHS deficit has also risen. Thousands of job losses and other cost-cutting measures have already been announced to make savings, but Patricia Hewitt, the Health Secretary, said yesterday that hospitals that did not meet the 18-week target could be penalised with further financial sanctions. About half of all hospital patients are currently treated within 18 weeks, but further progress has been limited by bottlenecks of patients waiting weeks for scans or test results.
Meanwhile, nearly a third of hospitals and a quarter of all 570 NHS organisations failed to balance their books in 2005-06, leaving the NHS with a net deficit of 547 million pounds. The latest figures show that 120 of 548 NHS organisations are now predicting deficits for the current financial year, with 90 per cent of the estimated gross deficit originating from 71 trusts. Despite this, ministers are confident that the NHS will generate a profit by next year, but that will become even more difficult to achieve after 2008 when extra funding supplied by the Treasury is due to dry up.
John Appleby, chief economist at the King’s Fund, the health think-tank, said that the new surplus target was intended to provide a “buffer” to the anticipated drop in the rate of growth, from a 10 per cent year-on-year cash increase to between 2.5 to 3.5 per cent by 2008-09, he said. “There’s a paradox of lots of money going into the NHS but trusts still overspending and going into debt. It is possible that across the NHS the system can generate a surplus by 2008, but whether the system can meet that at the same time as meeting other performance targets is open to question.”
A Department of Health spokesman said: “Only by managing finances efficiently can NHS organisations develop and improve services. The majority of organisations are delivering on finance and patient care, but more need to generate surpluses to recover historic overspending.” Hospitals affected by the latest superbug, Clostridium difficile, will be able to bid for grants of up to 350,000 pounds each from a 50 million fund to combat infection rates. The grants could pay for measures such as extra basins for hand-washing in an attempt to stop the spread of C. difficile — which kills three times as many patients as the better-known MRSA, Ms Hewitt said.
“MRSA has been coming down, thanks in part to the target we set some years ago,” she told The Sunday Edition on ITV. “C. difficile, this new and very nasty bug, is bad in some hospitals but not in others. “So we want local hospitals to look at their own performance and, where they are not doing well enough, to set a local target agreed publicly with their local NHS. We are backing them up with more money — up to £350,000 for each hospital organisation.”
Source
Reality debunks myths about Australian private health insurance
Some comments by a health insurance spokesman. Health insurance is normally taken out by individuals directly in Australia -- rather than through the employer, as in the USA
With the introduction to Parliament on Thursday of the Government's legislative changes aimed at broadening the scope of care for which private health insurance funds can pay, it is a good time to reflect on what benefits broader health care may provide, and why things need to change.
The National Health Act was introduced 50 years ago, but medical practice has altered dramatically (for the better) over those 50 years. However, until now this Act has constrained the health funds from providing some of the most appropriate care options for members. People who are opposed to improvements in the system are acting against the interests of those 10.2 million Australians who have chosen to take out private health insurance. The consumer expects to receive the most appropriate health care in the most appropriate setting. It is common sense that expanding the opportunity for an efficient private health insurance industry to cover the full range of modern treatments will result in improvements in clinical outcomes. Innovative care options, offering perhaps a substitute for expensive hospital care, or a shortened length of time spent in hospital - or even preventing people from going to hospital in the first place - could be introduced.
The truth is that the proposed private health insurance legislation allows for all these options, thus providing a modernised framework to deliver the most exciting advances in health care in 50 years. However, myths abound, which promote a different story. So, what are these myths about the present and the proposed systems?
The first, and most common, myth about the present system is that the 30 per cent rebate offered to Australians who have taken out private health insurance is a waste of public money, providing no benefit to the public system. The facts tell a different story. Figures showing the number of public beds available per 1000 uninsured Australians (ie those Australians reliant on Medicare), indicate that the 30 per cent rebate has freed up 1.3 beds per 1000 people (see chart). These "extra" beds are now available in the public system for Australians without private health insurance to use -- a direct benefit flowing from the 30 per cent rebate.
Equally, those Australians who have chosen to take out private health insurance in fact are utilising their insurance (thus relieving pressure on the public system), with an additional 900,000 operations per annum being performed in private hospitals since 2000 (the year the rebate was introduced). All Australians know the public system could not cope with another 900,000 admissions each year.
Another myth is, of course, that those people having private insurance, and undergoing treatment in the private system, don't really need that treatment. In fact, private health funds pay for more than 50 per cent of the surgical procedures performed in Australia. This includes 54 per cent of major procedures for malignant breast conditions, 55 per cent of chemotherapy treatment, 64 per cent of major joint replacements and 68 per cent of same-day mental health treatment - procedures that can be life-saving. Without the 30 per cent rebate, there would be an immediate influx of these non-discretionary surgical procedures into the public system.
In the face of criticism as to whether the "value proposition" of private health insurance is accepted by Australians, one needs only to realise that over the last 12 months the number of Australians taking out private health insurance has grown by 220,000. Pleasingly, the most recent figures show the percentage of 20 to 35-year-olds with private health insurance (traditionally a market regarded as rejecting private cover) has grown by 2.1 per cent in the September quarter. Another myth debunked.
So, what of criticism - such as that from Stephen Leeder (Weekend Health, November 25) - that the broader health care legislation will advantage those with private health insurance over those without? This is another myth ripe for debunking. Leeder and other critics of private health insurance would be interested to know that the Advanced Community Care Association of South Australia (an organisation delivering excellent out-of-hospital care in the public system) spoke at the annual conference of the Australian Health Insurance Association, and it was lauded for its initiative. There is a strong possibility that a model used in the private sector may emulate a model such as this from the public system. The fact that such a system is already operating successfully in South Australia's public hospitals is not only a credit to the organisation, but also a direct rebuttal to the claim that such options will be available only in the private sector.
However, if such an innovative program were implemented, allowing privately insured patients being treated in public hospitals to be treated in a more appropriate setting under a broader health care initiative - and in the process, freeing up resources and beds for other public patients with myriad other illnesses - most would judge this to be a good thing, both for the privately insured patients and for the public system which will have more resources available. To suggest otherwise seems perverse. Via these newly introduced legislative reforms, private health insurance will be provided with a great opportunity to advance the health care of Australians, and the benefits will flow to both components of the mixed health care system that operates in Australia. The private health insurance industry is excited about the possibilities. The changes are positive, and are worthy of widespread support. If people look past the rhetoric of the myths they will find a private health insurance industry which is capable of, and intent on, delivering improved health outcomes for consumers.
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.
***************************
Hospitals will face renewed pressure to save money, cut waiting times and tackle superbugs under new performance targets to be set today by the Government. In his first report as chief exective of the NHS, David Nicholson has compiled a list of priorities for the next financial year, including a target for a 250 million pound budget surplus by March 2008. He will also demand faster access to treatment and less of a “postcode lottery” of health inequalities. A new benchmark is to be set for the 18-week waiting times target — widely regarded as the most ambitious of all NHS targets — that almost all hospitals will treat patients within that time by March 2008. The Government has pledged to have all patients treated within 18 weeks of a doctor’s referral by the end of that year.
Mr Nicholson’s target for a 250 million surplus comes amid rising levels of debt in the NHS. Funding has more than doubled in ten years, but the total NHS deficit has also risen. Thousands of job losses and other cost-cutting measures have already been announced to make savings, but Patricia Hewitt, the Health Secretary, said yesterday that hospitals that did not meet the 18-week target could be penalised with further financial sanctions. About half of all hospital patients are currently treated within 18 weeks, but further progress has been limited by bottlenecks of patients waiting weeks for scans or test results.
Meanwhile, nearly a third of hospitals and a quarter of all 570 NHS organisations failed to balance their books in 2005-06, leaving the NHS with a net deficit of 547 million pounds. The latest figures show that 120 of 548 NHS organisations are now predicting deficits for the current financial year, with 90 per cent of the estimated gross deficit originating from 71 trusts. Despite this, ministers are confident that the NHS will generate a profit by next year, but that will become even more difficult to achieve after 2008 when extra funding supplied by the Treasury is due to dry up.
John Appleby, chief economist at the King’s Fund, the health think-tank, said that the new surplus target was intended to provide a “buffer” to the anticipated drop in the rate of growth, from a 10 per cent year-on-year cash increase to between 2.5 to 3.5 per cent by 2008-09, he said. “There’s a paradox of lots of money going into the NHS but trusts still overspending and going into debt. It is possible that across the NHS the system can generate a surplus by 2008, but whether the system can meet that at the same time as meeting other performance targets is open to question.”
A Department of Health spokesman said: “Only by managing finances efficiently can NHS organisations develop and improve services. The majority of organisations are delivering on finance and patient care, but more need to generate surpluses to recover historic overspending.” Hospitals affected by the latest superbug, Clostridium difficile, will be able to bid for grants of up to 350,000 pounds each from a 50 million fund to combat infection rates. The grants could pay for measures such as extra basins for hand-washing in an attempt to stop the spread of C. difficile — which kills three times as many patients as the better-known MRSA, Ms Hewitt said.
“MRSA has been coming down, thanks in part to the target we set some years ago,” she told The Sunday Edition on ITV. “C. difficile, this new and very nasty bug, is bad in some hospitals but not in others. “So we want local hospitals to look at their own performance and, where they are not doing well enough, to set a local target agreed publicly with their local NHS. We are backing them up with more money — up to £350,000 for each hospital organisation.”
Source
Reality debunks myths about Australian private health insurance
Some comments by a health insurance spokesman. Health insurance is normally taken out by individuals directly in Australia -- rather than through the employer, as in the USA
With the introduction to Parliament on Thursday of the Government's legislative changes aimed at broadening the scope of care for which private health insurance funds can pay, it is a good time to reflect on what benefits broader health care may provide, and why things need to change.
The National Health Act was introduced 50 years ago, but medical practice has altered dramatically (for the better) over those 50 years. However, until now this Act has constrained the health funds from providing some of the most appropriate care options for members. People who are opposed to improvements in the system are acting against the interests of those 10.2 million Australians who have chosen to take out private health insurance. The consumer expects to receive the most appropriate health care in the most appropriate setting. It is common sense that expanding the opportunity for an efficient private health insurance industry to cover the full range of modern treatments will result in improvements in clinical outcomes. Innovative care options, offering perhaps a substitute for expensive hospital care, or a shortened length of time spent in hospital - or even preventing people from going to hospital in the first place - could be introduced.
The truth is that the proposed private health insurance legislation allows for all these options, thus providing a modernised framework to deliver the most exciting advances in health care in 50 years. However, myths abound, which promote a different story. So, what are these myths about the present and the proposed systems?
The first, and most common, myth about the present system is that the 30 per cent rebate offered to Australians who have taken out private health insurance is a waste of public money, providing no benefit to the public system. The facts tell a different story. Figures showing the number of public beds available per 1000 uninsured Australians (ie those Australians reliant on Medicare), indicate that the 30 per cent rebate has freed up 1.3 beds per 1000 people (see chart). These "extra" beds are now available in the public system for Australians without private health insurance to use -- a direct benefit flowing from the 30 per cent rebate.
Equally, those Australians who have chosen to take out private health insurance in fact are utilising their insurance (thus relieving pressure on the public system), with an additional 900,000 operations per annum being performed in private hospitals since 2000 (the year the rebate was introduced). All Australians know the public system could not cope with another 900,000 admissions each year.
Another myth is, of course, that those people having private insurance, and undergoing treatment in the private system, don't really need that treatment. In fact, private health funds pay for more than 50 per cent of the surgical procedures performed in Australia. This includes 54 per cent of major procedures for malignant breast conditions, 55 per cent of chemotherapy treatment, 64 per cent of major joint replacements and 68 per cent of same-day mental health treatment - procedures that can be life-saving. Without the 30 per cent rebate, there would be an immediate influx of these non-discretionary surgical procedures into the public system.
In the face of criticism as to whether the "value proposition" of private health insurance is accepted by Australians, one needs only to realise that over the last 12 months the number of Australians taking out private health insurance has grown by 220,000. Pleasingly, the most recent figures show the percentage of 20 to 35-year-olds with private health insurance (traditionally a market regarded as rejecting private cover) has grown by 2.1 per cent in the September quarter. Another myth debunked.
So, what of criticism - such as that from Stephen Leeder (Weekend Health, November 25) - that the broader health care legislation will advantage those with private health insurance over those without? This is another myth ripe for debunking. Leeder and other critics of private health insurance would be interested to know that the Advanced Community Care Association of South Australia (an organisation delivering excellent out-of-hospital care in the public system) spoke at the annual conference of the Australian Health Insurance Association, and it was lauded for its initiative. There is a strong possibility that a model used in the private sector may emulate a model such as this from the public system. The fact that such a system is already operating successfully in South Australia's public hospitals is not only a credit to the organisation, but also a direct rebuttal to the claim that such options will be available only in the private sector.
However, if such an innovative program were implemented, allowing privately insured patients being treated in public hospitals to be treated in a more appropriate setting under a broader health care initiative - and in the process, freeing up resources and beds for other public patients with myriad other illnesses - most would judge this to be a good thing, both for the privately insured patients and for the public system which will have more resources available. To suggest otherwise seems perverse. Via these newly introduced legislative reforms, private health insurance will be provided with a great opportunity to advance the health care of Australians, and the benefits will flow to both components of the mixed health care system that operates in Australia. The private health insurance industry is excited about the possibilities. The changes are positive, and are worthy of widespread support. If people look past the rhetoric of the myths they will find a private health insurance industry which is capable of, and intent on, delivering improved health outcomes for consumers.
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, December 12, 2006
Solving the health-care "crisis" means not more government involvement but less
About 10 years ago, I broke my leg playing basketball. After I came out of surgery, with a cast stretching from my ankle to the top of my leg, an orderly asked me whether I had ever used crutches before. I hadn't, so he showed me what to do, swinging through them from one end of the room to the other. The whole lesson lasted about 90 seconds. When I got my hospital bill, I saw that I had been charged $150 for "gait training on crutches." I did what all insured Americans do: I forwarded the bill to my insurance company. Why should I care? I wasn't paying for it.
One of the problems with American health care, as David Gratzer notes in "The Cure," is precisely a payment system that takes the patient out of the equation. In the early 1960s, the average American paid out of pocket one of every two dollars that he spent on health care; today the figure is one dollar in seven. The inevitable effect is hugely wasteful spending (and inflated hospital bills like mine). In fact, per-patient costs have gone up almost exactly in inverse proportion to the share of spending borne by the consumer.
Dr. Gratzer cites a remarkable Rand Corp. study that tracked health-care spending by 2,000 families over eight years. The families who got free health care spent 40% more than the families with cost-sharing arrangements. And yet the health outcomes for the two groups were the same. The lesson: Market-based health insurance systems, such as health savings accounts, cut out inefficiencies and lower costs without compromising quality.
Dr. Gratzer, a physician from Canada and a fellow at the Manhattan Institute, is painfully aware, thanks to Canada's single-payer government system, of how inefficient and limited health care can be when the market is kept almost completely out of the calculation. He has seen the effects firsthand. In Canada, the average wait between a doctor visit and prescribed surgery is 17 weeks. American patients are twice as likely as Canadians to get lifesaving treatments like dialysis, three times more likely to get a coronary bypass and four times more likely to get coronary angioplasty. The survival rate for leukemia, breast cancer, colon cancer and heart disease is much higher if you are treated in a U.S. hospital than in a Canadian one or, for that matter, in a European one.
And it isn't only health-care "delivery" that is affected by suppressing market forces. Dr. Gratzer rightly spends part of "The Cure" celebrating the medical marvels that a dynamic, capitalist economy has helped to make possible by allowing capital to flow in productive directions. "Death due to cardiac disease has fallen by nearly two-thirds in the past five decades," he writes. "Polio is confined to the history books. Childhood leukemia, once a death sentence, is now almost always curable. Depression and mental illness are now treatable. . . . The death rate from heart attack and heart failure has fallen by more than half since 1950." In short, the medical progress of the past 50 years has been breathtaking.
For some, including Dr. Gratzer, the costs are breathtaking, too, even when they are corrected for the payment dysfunctions that he analyzes so well. Are we suffering from a kind of runaway health-care inflation, as Dr. Gratzer at times suggests? Perhaps. But it can easily be argued that medicine, because it is subject to hyper-technological change, is hard to gauge by traditional inflation measures. The current treatments for disease aren't really comparable with those of a quarter-century ago.
To complain about the cost of heart surgery or cancer treatment by comparing it to the inflation-adjusted price in the 1960s or '70s is to miss the point: You died 30 years ago, and you live today. The cost of my leg surgery would have been a lot cheaper in the 1960s, but I wouldn't be able to play tennis or even run after the surgical repair was done, as I can now. How much is it worth to a family with a child who has leukemia to be able to treat her and give her a full life? The families I know who have seen their children recover say that they would have given up everything they own for today's miracle cures. Yet it's become a great American pastime for patients and politicians to whine about the "high cost of drugs" and other treatments that save lives.
All of which can lead to demagoguery and calls for a nationalized health insurance system of the sort that Hillary Clinton and Howard Dean are always so keen to recommend. Such calls may grow louder soon: America is clearly at a crossroads in medical care. Within the next decade we will get either some version of Hillary-care or more free-market medicine, starting with universally available health savings accounts. Let's hope that our nation's policy makers read "The Cure" before they decide. They will learn that the government route flattens costs only by holding back the pace of technology, artificially controlling its price and rationing its use. That is not a prescription for better health.
Source
South Australian public hospitals failing too
The rot is not confined to Queensland, New South Wales and Victoria
An extra 80 patients a day were admitted to public hospitals in the past year while more people were forced to wait longer in emergency departments as health system demands intensified. The Health Department's annual report, tabled in Parliament this week, shows on a daily average 1035 patients were admitted to hospitals, up from 955 in the previous financial year. Thirty-seven per cent of patients waited more than four hours in emergency departments before being seen, up from 30 per cent in 2004-05.
Each day, an average 1358 people were treated in accident and emergency departments, compared with 1300 the year before. A total of 328,572 people attended emergency departments, up from 310,661 in 2904-05. There were 896 on an elective surgery waiting list for more than 12 months, down from 1045 in 2004-05.
Health Minister John Hill said the demands on public hospitals were at "their greatest level", mainly because of SA's ageing population. Opposition health spokeswoman Vickie Chapman, who is waiting on Freedom of Information data on each hospital, said it was "pointless to conceal individual hospital information when it is important to identify which of the hospitals are really struggling".
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.
***************************
About 10 years ago, I broke my leg playing basketball. After I came out of surgery, with a cast stretching from my ankle to the top of my leg, an orderly asked me whether I had ever used crutches before. I hadn't, so he showed me what to do, swinging through them from one end of the room to the other. The whole lesson lasted about 90 seconds. When I got my hospital bill, I saw that I had been charged $150 for "gait training on crutches." I did what all insured Americans do: I forwarded the bill to my insurance company. Why should I care? I wasn't paying for it.
One of the problems with American health care, as David Gratzer notes in "The Cure," is precisely a payment system that takes the patient out of the equation. In the early 1960s, the average American paid out of pocket one of every two dollars that he spent on health care; today the figure is one dollar in seven. The inevitable effect is hugely wasteful spending (and inflated hospital bills like mine). In fact, per-patient costs have gone up almost exactly in inverse proportion to the share of spending borne by the consumer.
Dr. Gratzer cites a remarkable Rand Corp. study that tracked health-care spending by 2,000 families over eight years. The families who got free health care spent 40% more than the families with cost-sharing arrangements. And yet the health outcomes for the two groups were the same. The lesson: Market-based health insurance systems, such as health savings accounts, cut out inefficiencies and lower costs without compromising quality.
Dr. Gratzer, a physician from Canada and a fellow at the Manhattan Institute, is painfully aware, thanks to Canada's single-payer government system, of how inefficient and limited health care can be when the market is kept almost completely out of the calculation. He has seen the effects firsthand. In Canada, the average wait between a doctor visit and prescribed surgery is 17 weeks. American patients are twice as likely as Canadians to get lifesaving treatments like dialysis, three times more likely to get a coronary bypass and four times more likely to get coronary angioplasty. The survival rate for leukemia, breast cancer, colon cancer and heart disease is much higher if you are treated in a U.S. hospital than in a Canadian one or, for that matter, in a European one.
And it isn't only health-care "delivery" that is affected by suppressing market forces. Dr. Gratzer rightly spends part of "The Cure" celebrating the medical marvels that a dynamic, capitalist economy has helped to make possible by allowing capital to flow in productive directions. "Death due to cardiac disease has fallen by nearly two-thirds in the past five decades," he writes. "Polio is confined to the history books. Childhood leukemia, once a death sentence, is now almost always curable. Depression and mental illness are now treatable. . . . The death rate from heart attack and heart failure has fallen by more than half since 1950." In short, the medical progress of the past 50 years has been breathtaking.
For some, including Dr. Gratzer, the costs are breathtaking, too, even when they are corrected for the payment dysfunctions that he analyzes so well. Are we suffering from a kind of runaway health-care inflation, as Dr. Gratzer at times suggests? Perhaps. But it can easily be argued that medicine, because it is subject to hyper-technological change, is hard to gauge by traditional inflation measures. The current treatments for disease aren't really comparable with those of a quarter-century ago.
To complain about the cost of heart surgery or cancer treatment by comparing it to the inflation-adjusted price in the 1960s or '70s is to miss the point: You died 30 years ago, and you live today. The cost of my leg surgery would have been a lot cheaper in the 1960s, but I wouldn't be able to play tennis or even run after the surgical repair was done, as I can now. How much is it worth to a family with a child who has leukemia to be able to treat her and give her a full life? The families I know who have seen their children recover say that they would have given up everything they own for today's miracle cures. Yet it's become a great American pastime for patients and politicians to whine about the "high cost of drugs" and other treatments that save lives.
All of which can lead to demagoguery and calls for a nationalized health insurance system of the sort that Hillary Clinton and Howard Dean are always so keen to recommend. Such calls may grow louder soon: America is clearly at a crossroads in medical care. Within the next decade we will get either some version of Hillary-care or more free-market medicine, starting with universally available health savings accounts. Let's hope that our nation's policy makers read "The Cure" before they decide. They will learn that the government route flattens costs only by holding back the pace of technology, artificially controlling its price and rationing its use. That is not a prescription for better health.
Source
South Australian public hospitals failing too
The rot is not confined to Queensland, New South Wales and Victoria
An extra 80 patients a day were admitted to public hospitals in the past year while more people were forced to wait longer in emergency departments as health system demands intensified. The Health Department's annual report, tabled in Parliament this week, shows on a daily average 1035 patients were admitted to hospitals, up from 955 in the previous financial year. Thirty-seven per cent of patients waited more than four hours in emergency departments before being seen, up from 30 per cent in 2004-05.
Each day, an average 1358 people were treated in accident and emergency departments, compared with 1300 the year before. A total of 328,572 people attended emergency departments, up from 310,661 in 2904-05. There were 896 on an elective surgery waiting list for more than 12 months, down from 1045 in 2004-05.
Health Minister John Hill said the demands on public hospitals were at "their greatest level", mainly because of SA's ageing population. Opposition health spokeswoman Vickie Chapman, who is waiting on Freedom of Information data on each hospital, said it was "pointless to conceal individual hospital information when it is important to identify which of the hospitals are really struggling".
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 11, 2006
ANOTHER LAWSUIT TO CHALLENGE CANADIAN BASTARDRY
Even with a brain tumour, it's "wait your turn" in Canada -- even if the wait could kill you. The only thing Canada is quick with is promises
Timely Medical Alternatives Inc., a leading Canadian medical broker, today announced that it intends to launch a lawsuit against the Ontario Provincial government on behalf of a 66-year-old Newmarket resident, Lindsay McCreith. Seeking damages as well as reimbursement for medical, travel and rehabilitation costs, the decision to launch a lawsuit comes after the Provincial government refused to pay the costs for private magnetic resonance imaging (MRI) and subsequent surgery to remove a cancerous tumour in Mr. McCreith's brain at a Buffalo hospital on March 6, 2006. The Ontario Health Insurance Plan informed Mr. McCreith that since he didn't get pre-approval for his out-of-country procedure, they would not reimburse him for the services he received. The "catch 22 "is that the pre-approval process routinely takes significantly longer than the four and half weeks between Mr. McCreith's initial MRI and his life saving surgery.
McCreith, a retired small business owner, is seeking a larger role for private health care in Canada: "I had hoped that the Government would carefully consider my case. I didn't feel I had an option to wait for my medical treatment, given the possibility the tumour was malignant, and had to pay out of pocket to have my brain surgery. The health system has let me down and I don't want to see other individuals go through the pain and anguish I have suffered," said McCreith.
Timely Medical Alternatives, which will lead fundraising efforts for the court challenge, said that Canadians are still not receiving timely health care despite record levels of health spending and numerous commitments made by provincial and federal governments. Richard Baker, President of Timely Medical Alternatives, said: "This case is not about creating a second tier of health care. Instead, it's about the provincial government's refusal to provide timely medical treatment for Mr. McCreith, as well as the restrictions on private insurance. In Mr. McCreith's case, it really was a life or death situation."
In the opinion of Dr. Gary Magee, Mr. McCreith's family physician of 35 years, Mr. McCreith could not afford to wait to receive treatment: "Brain surgery needed to be expedited. Lindsay might not have made it if he had to wait the likely eight months it would have taken him to have a MRI, see a specialist and have surgery."
Timely Medical Alternatives is asking Ontario patients who have been adversely affected by waiting for medically necessary services as well as by restrictions on private insurance and have had to pay for their own medical treatment to contact the Company as soon as possible to be considered as part of the lawsuit.
Like the landmark Chaoulli case in 2005 when Montreal patient George Zeliotis and physician Jacques Chaoulli won a Supreme Court of Canada battle for the right to buy private medical insurance, Timely Medical Alternatives' lawsuit will argue that the provincial government's actions violate the Canadian Charter of Rights.
News of the Timely Medical Alternatives lawsuit could ignite a political debate over long waiting times for medically necessary services, a debate which would be welcomed by Ontario patients as a call to action for the government.
Mrs. Mariana Rosero, a 56 year old Ontario patient whose debilitating back pain grew so severe she could no longer walk as she waited to see a specialist, finally chose to have immediate surgery in Buffalo, again with the help of Timely Medical Alternatives. She hopes the lawsuit will generate changes: "This is a David versus Goliath struggle. If filing a lawsuit on behalf of Mr. McCreith is what it takes to get the government's attention and make timely medical treatment a priority, then I fully support it and hope the government does something to fix the system."
Timely Medical Alternative President, Richard Baker, added: "The Canada Health Act is arguably responsible for more misery, suffering and even death, than any other domestic legislation in Canadian history. It's time that Canadians no longer be asked to sacrifice their health in the name of supporting this Act."
Backgrounder: Lindsay McCreith's Medical History
- In January 2006, Mr. McCreith suffered his first seizure. The Newmarket Hospital diagnoses his seizure as epileptic and prescribes anti-seizure drugs. Mr. McCreith has a MRI scheduled for May 27, 2006.
- During the month of January 2006, Mr. McCreith continues to suffer from headaches and seizures on an almost daily basis. Mr. McCreith decides to seek a second opinion.
- On February 2, 2006, Mr. McCreith contacts Timely Medical Alternatives and the next day has an MRI in Buffalo and is diagnosed with a brain tumour.
- On February 13, 2006, Mr. McCreith returns to Buffalo for a specialist consultation.
- On March 6, 2006, Mr. McCreith returns again to Buffalo for a scheduled biopsy, during which time doctors decide immediately to perform surgery and remove tumour.
- On March 14, the pathology report concludes that Mr. McCreith's tumour was malignant.
- On May 23, 2006, OHIP rejects Mr. McCreith's application for refund of medical costs of $27,600 ($US) that he paid out of pocket to the Buffalo hospital.
- In November 2006, Mr. McCreith is cancer-free and agrees to begin process of filing lawsuit against Ontario provincial government.
Source. A video interview with the people involved is here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Even with a brain tumour, it's "wait your turn" in Canada -- even if the wait could kill you. The only thing Canada is quick with is promises
Timely Medical Alternatives Inc., a leading Canadian medical broker, today announced that it intends to launch a lawsuit against the Ontario Provincial government on behalf of a 66-year-old Newmarket resident, Lindsay McCreith. Seeking damages as well as reimbursement for medical, travel and rehabilitation costs, the decision to launch a lawsuit comes after the Provincial government refused to pay the costs for private magnetic resonance imaging (MRI) and subsequent surgery to remove a cancerous tumour in Mr. McCreith's brain at a Buffalo hospital on March 6, 2006. The Ontario Health Insurance Plan informed Mr. McCreith that since he didn't get pre-approval for his out-of-country procedure, they would not reimburse him for the services he received. The "catch 22 "is that the pre-approval process routinely takes significantly longer than the four and half weeks between Mr. McCreith's initial MRI and his life saving surgery.
McCreith, a retired small business owner, is seeking a larger role for private health care in Canada: "I had hoped that the Government would carefully consider my case. I didn't feel I had an option to wait for my medical treatment, given the possibility the tumour was malignant, and had to pay out of pocket to have my brain surgery. The health system has let me down and I don't want to see other individuals go through the pain and anguish I have suffered," said McCreith.
Timely Medical Alternatives, which will lead fundraising efforts for the court challenge, said that Canadians are still not receiving timely health care despite record levels of health spending and numerous commitments made by provincial and federal governments. Richard Baker, President of Timely Medical Alternatives, said: "This case is not about creating a second tier of health care. Instead, it's about the provincial government's refusal to provide timely medical treatment for Mr. McCreith, as well as the restrictions on private insurance. In Mr. McCreith's case, it really was a life or death situation."
In the opinion of Dr. Gary Magee, Mr. McCreith's family physician of 35 years, Mr. McCreith could not afford to wait to receive treatment: "Brain surgery needed to be expedited. Lindsay might not have made it if he had to wait the likely eight months it would have taken him to have a MRI, see a specialist and have surgery."
Timely Medical Alternatives is asking Ontario patients who have been adversely affected by waiting for medically necessary services as well as by restrictions on private insurance and have had to pay for their own medical treatment to contact the Company as soon as possible to be considered as part of the lawsuit.
Like the landmark Chaoulli case in 2005 when Montreal patient George Zeliotis and physician Jacques Chaoulli won a Supreme Court of Canada battle for the right to buy private medical insurance, Timely Medical Alternatives' lawsuit will argue that the provincial government's actions violate the Canadian Charter of Rights.
News of the Timely Medical Alternatives lawsuit could ignite a political debate over long waiting times for medically necessary services, a debate which would be welcomed by Ontario patients as a call to action for the government.
Mrs. Mariana Rosero, a 56 year old Ontario patient whose debilitating back pain grew so severe she could no longer walk as she waited to see a specialist, finally chose to have immediate surgery in Buffalo, again with the help of Timely Medical Alternatives. She hopes the lawsuit will generate changes: "This is a David versus Goliath struggle. If filing a lawsuit on behalf of Mr. McCreith is what it takes to get the government's attention and make timely medical treatment a priority, then I fully support it and hope the government does something to fix the system."
Timely Medical Alternative President, Richard Baker, added: "The Canada Health Act is arguably responsible for more misery, suffering and even death, than any other domestic legislation in Canadian history. It's time that Canadians no longer be asked to sacrifice their health in the name of supporting this Act."
Backgrounder: Lindsay McCreith's Medical History
- In January 2006, Mr. McCreith suffered his first seizure. The Newmarket Hospital diagnoses his seizure as epileptic and prescribes anti-seizure drugs. Mr. McCreith has a MRI scheduled for May 27, 2006.
- During the month of January 2006, Mr. McCreith continues to suffer from headaches and seizures on an almost daily basis. Mr. McCreith decides to seek a second opinion.
- On February 2, 2006, Mr. McCreith contacts Timely Medical Alternatives and the next day has an MRI in Buffalo and is diagnosed with a brain tumour.
- On February 13, 2006, Mr. McCreith returns to Buffalo for a specialist consultation.
- On March 6, 2006, Mr. McCreith returns again to Buffalo for a scheduled biopsy, during which time doctors decide immediately to perform surgery and remove tumour.
- On March 14, the pathology report concludes that Mr. McCreith's tumour was malignant.
- On May 23, 2006, OHIP rejects Mr. McCreith's application for refund of medical costs of $27,600 ($US) that he paid out of pocket to the Buffalo hospital.
- In November 2006, Mr. McCreith is cancer-free and agrees to begin process of filing lawsuit against Ontario provincial government.
Source. A video interview with the people involved is here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Sunday, December 10, 2006
The Leftist "Big Pharma" myth
It is a Leftist kneejerk to hate any big business
The winds of political fortune have brought the Democrats into power in both houses of Congress, and high on their 2007 agenda is tightening the regulatory screws on the pharmaceutical industry. It seems highly likely that the new Congress will seek to intervene on such hot-button issues as FDA oversight of drug safety, patent protection, and drug pricing. The implicit premise behind this looming regulatory offensive is that Big Pharma (an epithet) is a 900-pound gorilla in need of domestication. In recent years, notable authors such as Arnold Relman, Marcia Angell, and Jerome Kassirer -- all former editors in chief of the New England Journal of Medicine -- have penned searing indictments of the industry.
These and other critics treat the industry's multibillion dollar profits as a sure sign of its permanent robust economic status. But those numbers conceal deep vulnerabilities. It is no accident that the shares of major pharmaceutical houses have been hammered over the past three of four years, even as profits appear to be at record highs. Wall Street values companies not only on current earnings, but also on long-term prospects, which are cloudy at best for research pharmaceutical firms. Just this past week, for example, Pfizer announced plans to cut one-fifth of its United States sales force, with a promise of further restructuring in January.
We shouldn't be surprised. The huge profits of major drug firms are often tied to one or two drugs, such as Pfizer's Lipitor or Viagra -- profits that evaporate when their patents expire and generics enter the marketplace. The Standard & Poor's review of pharmaceuticals thus starts somberly, noting that products with $21 billion in US drug sales are going off patent in 2006, with another $24 billion to follow over the next three years -- a sharp dent for an industry that today generates about $250 billion in revenue. All the while, the pharmaceutical houses also must absorb the legal and business risks needed to identify, patent, test, license, and market any new drug.
These trends should worry us all. Pharmaceuticals are not tobacco. There is no reason to rejoice in putting pharma on the ropes if its business reversals hurt the very consumers they are trying to serve. The medical advances of the past 30 years are not just a matter of dumb luck. They are very heavily dependent on the patent law, pricing freedom, and marketing strategies that have allowed these firms to bring a wide variety of vital products to market.
The champions of further regulation argue that their efforts won't limit innovations or curtail the widespread use of new drugs. But there are no free fixes. Too often ill-designed regulation gives us the worst of both worlds -- slower innovation and more limited drug use. We have much to fear in any new round of regulation. Bringing a new drug to market is already an arduous task. The FDA has consistently upped the number and type of clinical trials for companies seeking approval of new drugs, so that today as many as 60 separate trials are often required. Fewer drugs make it through these hurdles, and those that survive the ordeal cost ever more to bring to market.
Firms are thus caught in a two-way vise. They have to spend more to reach the market, yet once there they have a shorter period of patent exclusivity in which to recover their extensive front-end costs. (One consequence is that it has become ever harder to persuade companies to invest in drugs that attack diseases or conditions that afflict small populations -- thus exposing companies to the charge that they heartlessly put profits before patient health.)
The risks of marketing a new drug have been further compounded as the FDA has become more willing to remove drugs from markets at the first sign of any real or imagined dangerous side effects. But while such FDA actions often lead to accusations that drug companies have not come clean about a product's risks, it is usually the FDA that makes the incorrect risk calculation. Last year, for example, early clinical trials showed great promise for a cancer drug called Iressa, which was used with success by many patients. After the early successes were not replicated in further clinical studies, the FDA adopted a Solomon-like solution: It allowed current users to continue receiving the drug, but otherwise took it off the market. The FDA's rationale was that a new drug, Tarceva, worked better. Yet it could never explain why patients for whom all other therapies had failed should prefer one last-ditch option to two. What is needed is good information about Iressa's successes and failures. If that is supplied, surely oncologists can do a better job calculating the odds than the FDA, which has to deal with averages, not individual cases.
With other established drugs, like the antidepressants Zoloft and Prozac, the FDA leaves them on the market, but requires they be sold with severe "black-box" warnings that overstate the risks (in the case of Zoloft and Prozac, of suicide). Fearful physicians thus shy away from prescribing such drugs -- not because of the dangers the drugs pose, but because they fear the warnings expose them to greater risk of medical malpractice suits.
Pharmaceutical companies meanwhile have their own lawsuits to worry about. The liability risks of mass-marketed drugs have increased significantly in recent years. Consumer fraud class actions, now common, arise after drugs have been withdrawn for some adverse side effect. Nonetheless, litigants are often allowed to sue for refunds not only for unused drugs, but also for the drugs that were successfully used, on the grounds that if the truth about the side effects had not been concealed (itself a debatable proposition), the pills would never have been purchased in the first place. The resulting loss in revenue leaves drug companies with even fewer resources to cover the thousands of suits for compensatory and punitive damages for drug-related injuries, like the multiple suits brought against Merck for its drug Vioxx.
Personal injury claims are immensely expensive to defend individually and their outcomes are fraught with error. Often they are propelled by inflammatory trial techniques that obscure the scientific evidence, which lay juries find hard to assess in the first place. It is stark evidence of how dire the situation is for pharmaceutical companies that the FDA, typically no friend of the drug companies on safety issues, has now actively intervened on their side in personal injury suits that attack the adequacy of FDA approved warnings.
The common judicial refrain in tort litigation has long been that FDA oversight, no matter how comprehensive, supplies only a "minimum" set of warnings. In reality, however, excessive warning is the greater peril. The FDA faces fierce criticism from Congress, the medical profession, and the popular press whenever any approved drug exhibits adverse side effects. Yet these watchdogs offer little or no outcry when the FDA keeps a new drug off the market. Visible injuries are easier to track than lost opportunities for cure.
Perhaps the biggest threat on the horizon for the drug industry is mounting pressure to submit to price controls. One possibility is that the government will set uniform prices for all drugs. Another is that it would require a company to sell to all customers at the lowest price charged to any customer within the past year. But no matter how such controls are calculated, they could devastate the business. What's more, they're just not necessary.
Traditionally, patent holders could decide how much to charge for their wares. Public protection against excessive profits for drug companies came from three sources. First, the patent period is limited to 20 years, with about half that time used to shepherd a new drug through the FDA approval process. Once the patent expires, the entry of low-cost generics sharply reduces the cost of proven drugs. Second, the rapid pace of invention means that consumers frequently can choose between two or more patented drugs in the same class (Lipitor, Crestor, and Zocor, for example, are three statins used to lower cholesterol), effectively blunting the monopoly power of all patent holders. Third, antitrust laws make it illegal for any makers of the same or similar drugs to conspire to raise prices or reduce output.
Within these constraints, of course, the research pharmaceutical firms still must recover their huge front-end costs, which can run over $1 billion for a new drug, over an ever shorter useful patent life. In addition, their successful drugs must generate additional revenues to cover the predictable flops. Yet companies need to charge someone for the initial costs of production, not just for the small cost of producing additional pills.
One common argument for price controls is that drug companies should only spend money for research but not for lavish marketing. Yet that short-sighted argument assumes that pharmaceutical companies could sell the same quantities of drugs without advertising them. Of course, the cost of marketing raises the total cost of production, but by expanding the consumer base, it lowers the average costs consumers pay per unit. Any system of direct price controls would thus play havoc with both research and marketing, drying up the capital needed for innovation.
The overall picture today shows a research drug industry under constant pressure from all sides. Industry critics greatly fear letting bad drugs on the market, while simultaneously underestimating the real costs (in the form of forgone health benefits) of keeping good drugs off the market. In reality any sound risk assessment, whether by regulation or litigation, should take into account both kinds of error.
Critics also naively assume that investors and firms will continue to make huge investments in new products without any assurance of recouping their costs in the marketplace. But the drug business is too vast and complex to depend on individual altruism or government bureaucrats to fuel medical advances. As Adam Smith recognized long ago, the profit motive is the only constant and reliable spur to making the major investments on which the prosperity (and health) of any nation depends. Today's pharmaceutical industry is not exempt from that enduring insight.
Source
Australia: Useless government "child welfare" bureaucracy again
A malnourished baby girl died while under an intense supervision order of the Department of Child Safety. The child's mother, 35, will appear in the Brisbane Magistrate's Court today charged with the manslaughter of the four-month-old girl on the grounds of parental negligence for failing to provide adequate care and nourishment. Police will allege the baby gained only 500g in her four-month life and weighed 3300g when she died from bronchopneumonia at her mother's Brisbane home in July 2004. Her death was believed to be have been the result of complications from being malnourished.
The baby was underweight when she was born at 2800g and suffering from methadone withdrawal among other medical problems. She gained the 500g in the first five weeks of her life in hospital and did not put on any more weight while living with her mother under departmental supervision, government sources said yesterday. Upper Mt Gravatt detectives also charged the baby's father, 39, with her manslaughter and he will face court later this month.
Medical experts contacted by The Courier-Mail said the average growth rate of a normal baby was between 150g and 160g a week. It is understood police will seek a meeting with the Crime and Misconduct Commission over the Department of Child Safety's handling of the case. The department had left the baby in the care of her mother, who was placed under an intensive management plan and the supervision of a case worker. Government sources told The Courier-Mail last night that, under the plan, case workers were supposed to conduct random weekly visits, ensure the mother maintained medical appointments, as well as involve a community health worker. It is understood case workers instead often made pre-arranged visits with the baby's mother and, in the weeks when they could not attend, spoke to her over the telephone.
The sources said the mother had allegedly failed to keep some medical appointments and the department's last contact with her was a telephone call in the week before the baby died. They said a case worker's file notes show she had recorded the baby as "thriving" but they did not contain any information that showed the baby had ever been weighed. A spokesperson for Child Safety Minister Desley Boyle said an external review found no reason to conclude the department's actions in any way impacted on the child's death. He said allegations made to The Courier-Mail were at odds with departmental information.
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.
***************************
It is a Leftist kneejerk to hate any big business
The winds of political fortune have brought the Democrats into power in both houses of Congress, and high on their 2007 agenda is tightening the regulatory screws on the pharmaceutical industry. It seems highly likely that the new Congress will seek to intervene on such hot-button issues as FDA oversight of drug safety, patent protection, and drug pricing. The implicit premise behind this looming regulatory offensive is that Big Pharma (an epithet) is a 900-pound gorilla in need of domestication. In recent years, notable authors such as Arnold Relman, Marcia Angell, and Jerome Kassirer -- all former editors in chief of the New England Journal of Medicine -- have penned searing indictments of the industry.
These and other critics treat the industry's multibillion dollar profits as a sure sign of its permanent robust economic status. But those numbers conceal deep vulnerabilities. It is no accident that the shares of major pharmaceutical houses have been hammered over the past three of four years, even as profits appear to be at record highs. Wall Street values companies not only on current earnings, but also on long-term prospects, which are cloudy at best for research pharmaceutical firms. Just this past week, for example, Pfizer announced plans to cut one-fifth of its United States sales force, with a promise of further restructuring in January.
We shouldn't be surprised. The huge profits of major drug firms are often tied to one or two drugs, such as Pfizer's Lipitor or Viagra -- profits that evaporate when their patents expire and generics enter the marketplace. The Standard & Poor's review of pharmaceuticals thus starts somberly, noting that products with $21 billion in US drug sales are going off patent in 2006, with another $24 billion to follow over the next three years -- a sharp dent for an industry that today generates about $250 billion in revenue. All the while, the pharmaceutical houses also must absorb the legal and business risks needed to identify, patent, test, license, and market any new drug.
These trends should worry us all. Pharmaceuticals are not tobacco. There is no reason to rejoice in putting pharma on the ropes if its business reversals hurt the very consumers they are trying to serve. The medical advances of the past 30 years are not just a matter of dumb luck. They are very heavily dependent on the patent law, pricing freedom, and marketing strategies that have allowed these firms to bring a wide variety of vital products to market.
The champions of further regulation argue that their efforts won't limit innovations or curtail the widespread use of new drugs. But there are no free fixes. Too often ill-designed regulation gives us the worst of both worlds -- slower innovation and more limited drug use. We have much to fear in any new round of regulation. Bringing a new drug to market is already an arduous task. The FDA has consistently upped the number and type of clinical trials for companies seeking approval of new drugs, so that today as many as 60 separate trials are often required. Fewer drugs make it through these hurdles, and those that survive the ordeal cost ever more to bring to market.
Firms are thus caught in a two-way vise. They have to spend more to reach the market, yet once there they have a shorter period of patent exclusivity in which to recover their extensive front-end costs. (One consequence is that it has become ever harder to persuade companies to invest in drugs that attack diseases or conditions that afflict small populations -- thus exposing companies to the charge that they heartlessly put profits before patient health.)
The risks of marketing a new drug have been further compounded as the FDA has become more willing to remove drugs from markets at the first sign of any real or imagined dangerous side effects. But while such FDA actions often lead to accusations that drug companies have not come clean about a product's risks, it is usually the FDA that makes the incorrect risk calculation. Last year, for example, early clinical trials showed great promise for a cancer drug called Iressa, which was used with success by many patients. After the early successes were not replicated in further clinical studies, the FDA adopted a Solomon-like solution: It allowed current users to continue receiving the drug, but otherwise took it off the market. The FDA's rationale was that a new drug, Tarceva, worked better. Yet it could never explain why patients for whom all other therapies had failed should prefer one last-ditch option to two. What is needed is good information about Iressa's successes and failures. If that is supplied, surely oncologists can do a better job calculating the odds than the FDA, which has to deal with averages, not individual cases.
With other established drugs, like the antidepressants Zoloft and Prozac, the FDA leaves them on the market, but requires they be sold with severe "black-box" warnings that overstate the risks (in the case of Zoloft and Prozac, of suicide). Fearful physicians thus shy away from prescribing such drugs -- not because of the dangers the drugs pose, but because they fear the warnings expose them to greater risk of medical malpractice suits.
Pharmaceutical companies meanwhile have their own lawsuits to worry about. The liability risks of mass-marketed drugs have increased significantly in recent years. Consumer fraud class actions, now common, arise after drugs have been withdrawn for some adverse side effect. Nonetheless, litigants are often allowed to sue for refunds not only for unused drugs, but also for the drugs that were successfully used, on the grounds that if the truth about the side effects had not been concealed (itself a debatable proposition), the pills would never have been purchased in the first place. The resulting loss in revenue leaves drug companies with even fewer resources to cover the thousands of suits for compensatory and punitive damages for drug-related injuries, like the multiple suits brought against Merck for its drug Vioxx.
Personal injury claims are immensely expensive to defend individually and their outcomes are fraught with error. Often they are propelled by inflammatory trial techniques that obscure the scientific evidence, which lay juries find hard to assess in the first place. It is stark evidence of how dire the situation is for pharmaceutical companies that the FDA, typically no friend of the drug companies on safety issues, has now actively intervened on their side in personal injury suits that attack the adequacy of FDA approved warnings.
The common judicial refrain in tort litigation has long been that FDA oversight, no matter how comprehensive, supplies only a "minimum" set of warnings. In reality, however, excessive warning is the greater peril. The FDA faces fierce criticism from Congress, the medical profession, and the popular press whenever any approved drug exhibits adverse side effects. Yet these watchdogs offer little or no outcry when the FDA keeps a new drug off the market. Visible injuries are easier to track than lost opportunities for cure.
Perhaps the biggest threat on the horizon for the drug industry is mounting pressure to submit to price controls. One possibility is that the government will set uniform prices for all drugs. Another is that it would require a company to sell to all customers at the lowest price charged to any customer within the past year. But no matter how such controls are calculated, they could devastate the business. What's more, they're just not necessary.
Traditionally, patent holders could decide how much to charge for their wares. Public protection against excessive profits for drug companies came from three sources. First, the patent period is limited to 20 years, with about half that time used to shepherd a new drug through the FDA approval process. Once the patent expires, the entry of low-cost generics sharply reduces the cost of proven drugs. Second, the rapid pace of invention means that consumers frequently can choose between two or more patented drugs in the same class (Lipitor, Crestor, and Zocor, for example, are three statins used to lower cholesterol), effectively blunting the monopoly power of all patent holders. Third, antitrust laws make it illegal for any makers of the same or similar drugs to conspire to raise prices or reduce output.
Within these constraints, of course, the research pharmaceutical firms still must recover their huge front-end costs, which can run over $1 billion for a new drug, over an ever shorter useful patent life. In addition, their successful drugs must generate additional revenues to cover the predictable flops. Yet companies need to charge someone for the initial costs of production, not just for the small cost of producing additional pills.
One common argument for price controls is that drug companies should only spend money for research but not for lavish marketing. Yet that short-sighted argument assumes that pharmaceutical companies could sell the same quantities of drugs without advertising them. Of course, the cost of marketing raises the total cost of production, but by expanding the consumer base, it lowers the average costs consumers pay per unit. Any system of direct price controls would thus play havoc with both research and marketing, drying up the capital needed for innovation.
The overall picture today shows a research drug industry under constant pressure from all sides. Industry critics greatly fear letting bad drugs on the market, while simultaneously underestimating the real costs (in the form of forgone health benefits) of keeping good drugs off the market. In reality any sound risk assessment, whether by regulation or litigation, should take into account both kinds of error.
Critics also naively assume that investors and firms will continue to make huge investments in new products without any assurance of recouping their costs in the marketplace. But the drug business is too vast and complex to depend on individual altruism or government bureaucrats to fuel medical advances. As Adam Smith recognized long ago, the profit motive is the only constant and reliable spur to making the major investments on which the prosperity (and health) of any nation depends. Today's pharmaceutical industry is not exempt from that enduring insight.
Source
Australia: Useless government "child welfare" bureaucracy again
A malnourished baby girl died while under an intense supervision order of the Department of Child Safety. The child's mother, 35, will appear in the Brisbane Magistrate's Court today charged with the manslaughter of the four-month-old girl on the grounds of parental negligence for failing to provide adequate care and nourishment. Police will allege the baby gained only 500g in her four-month life and weighed 3300g when she died from bronchopneumonia at her mother's Brisbane home in July 2004. Her death was believed to be have been the result of complications from being malnourished.
The baby was underweight when she was born at 2800g and suffering from methadone withdrawal among other medical problems. She gained the 500g in the first five weeks of her life in hospital and did not put on any more weight while living with her mother under departmental supervision, government sources said yesterday. Upper Mt Gravatt detectives also charged the baby's father, 39, with her manslaughter and he will face court later this month.
Medical experts contacted by The Courier-Mail said the average growth rate of a normal baby was between 150g and 160g a week. It is understood police will seek a meeting with the Crime and Misconduct Commission over the Department of Child Safety's handling of the case. The department had left the baby in the care of her mother, who was placed under an intensive management plan and the supervision of a case worker. Government sources told The Courier-Mail last night that, under the plan, case workers were supposed to conduct random weekly visits, ensure the mother maintained medical appointments, as well as involve a community health worker. It is understood case workers instead often made pre-arranged visits with the baby's mother and, in the weeks when they could not attend, spoke to her over the telephone.
The sources said the mother had allegedly failed to keep some medical appointments and the department's last contact with her was a telephone call in the week before the baby died. They said a case worker's file notes show she had recorded the baby as "thriving" but they did not contain any information that showed the baby had ever been weighed. A spokesperson for Child Safety Minister Desley Boyle said an external review found no reason to conclude the department's actions in any way impacted on the child's death. He said allegations made to The Courier-Mail were at odds with departmental information.
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 09, 2006
FDA restrictions hurting sick babies
Like thousands of children in the U.S., Maggie Leaver has short bowel syndrome. These children can't absorb enough nutrients from food, and some need intravenous feedings to survive.
A baby's digestive system can adapt over time, but that may take months or years. Many of these babies can't wait. For reasons not fully understood, children put on intravenous nutrition may suffer liver damage. Some require liver and small bowel transplants, risky procedures that don't always work. Others die waiting for a transplant.
In July, in a paper in the scientific journal Pediatrics, researchers at Children's Hospital Boston reported on a small study that suggested a promising treatment. They found that by switching from the standard intravenous formula to a different kind -- called Omegaven -- babies weren't progressing to liver failure. Omegaven, used in Europe for adults, isn't approved in the U.S. and is considered experimental treatment. "The kids aren't dying anymore," says Mark Puder, a pediatric surgeon who was lead investigator on the study. "We think we have a good treatment."
But Dr. Puder's effort to get Omegaven widely used in babies has put him in an unusual conflict with the German company that developed the drug. Fresenius Kabi AG, which makes Omegaven, says it isn't interested in bringing the drug to the U.S. market. The company says it doesn't agree that Omegaven is the best drug for these babies and has a new product that it believes is better.
In 28 of 29 babies treated with Omegaven so far at Children's Hospital, Dr. Puder says they were able to stop further liver damage -- and damage that children already incurred seemed to improve. Some babies who were switched to Omegaven rebounded enough that they were taken off the waiting list for an organ transplant. At one point, Maggie Leaver's condition deteriorated so much that her surgeon thought she was going to die. Now the 18-month-old is thriving at home in Hingham, Mass.
. . .
Mr. Ducker says the company's new product, called SMOFlipid, "presents a better option for pediatric feeding." The company believes the new product does contain all the essential fatty acids babies need and can be used on its own. Fresenius Kabi says it doesn't want to invest the resources required to test both products for approval by the U.S. Food and Drug Administration. It hopes to eventually sell the new product in the U.S., Mr. Ducker says, although no timetable has been set and no trials are under way.
. . .
Because Omegaven is considered experimental in the U.S., if hospitals want to try it, they have to ask permission from the FDA for each individual patient. The FDA has regulations that enable doctors to use experimental drugs in certain (p. A15) emergency situations. If hospitals obtain the required permissions, they must then find a way to buy the drug on their own, since insurers typically won't cover Omegaven because it's experimental. The cost can run from $50 to $100 a day per patient. At Children's Hospital Boston, the surgical department has already spent close to $100,000 to buy Omegaven for babies.
. . .
Dr. Mooney says he wrestled almost from the beginning about whether to put Maggie on Omegaven. He knew about Dr. Puder's results, which he calls "amazingly great," but the number of children treated was still small. He worried about adverse effects. "It is so easy to get caught in the hype of new things," Dr. Mooney says. Maggie was already fragile. What if he put her on Omegaven, he says, "and there was a horrible side effect that could tip her over the edge?"
But when standard therapies failed, he felt "there was nothing else to do." Given that the treatment is experimental, Dr. Mooney says he believes it was right to wait. But he also feels Omegaven has made a difference. "Five years ago, every single one of the kids taking Omegaven would be dead by now, Maggie included," he says.
Source
UNIVERSAL HEALTH CARE GOES TO WASHINGTON
Newly elected Democrats and America's Health Insurance Plans (AHIP), the industry's trade association, have put universal health care at the top of their legislative agenda, says Investor's Business Daily (IBD). While Democrats have not developed a comprehensive plan, AHIP has outlined its formal strategy:
* The group wants the federal government to spend $300 billion over 10 years on the plan, which would expand federal-state programs -- including Medicaid -- to insure below-poverty-line children and adults.
* The organization also wants individuals to buy coverage through universal health accounts paid for with pretax dollars, with federal matching funds for working families.
But John C. Goodman, president of the National Center for Policy Analysis has his doubts: "There is no way to make health insurance really universal in the United States. To do that would mean everybody is in the same system, and you couldn't do that unless you make it free. A free system would mean runaway costs and reduction in quality," he explains.
Goodman's solution: Personal and portable insurance, similar to health savings accounts, which are engineered like the 401(k) retirement savings program, and allow individuals to buy their insurance with tax-free dollars and take it from job to job, city to city and state to state.
Source: Peter Benesh, "U.S. Health Insurers Expect Quick Action From Dem Congress," Investor's Business Daily, November 24, 2006.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Like thousands of children in the U.S., Maggie Leaver has short bowel syndrome. These children can't absorb enough nutrients from food, and some need intravenous feedings to survive.
A baby's digestive system can adapt over time, but that may take months or years. Many of these babies can't wait. For reasons not fully understood, children put on intravenous nutrition may suffer liver damage. Some require liver and small bowel transplants, risky procedures that don't always work. Others die waiting for a transplant.
In July, in a paper in the scientific journal Pediatrics, researchers at Children's Hospital Boston reported on a small study that suggested a promising treatment. They found that by switching from the standard intravenous formula to a different kind -- called Omegaven -- babies weren't progressing to liver failure. Omegaven, used in Europe for adults, isn't approved in the U.S. and is considered experimental treatment. "The kids aren't dying anymore," says Mark Puder, a pediatric surgeon who was lead investigator on the study. "We think we have a good treatment."
But Dr. Puder's effort to get Omegaven widely used in babies has put him in an unusual conflict with the German company that developed the drug. Fresenius Kabi AG, which makes Omegaven, says it isn't interested in bringing the drug to the U.S. market. The company says it doesn't agree that Omegaven is the best drug for these babies and has a new product that it believes is better.
In 28 of 29 babies treated with Omegaven so far at Children's Hospital, Dr. Puder says they were able to stop further liver damage -- and damage that children already incurred seemed to improve. Some babies who were switched to Omegaven rebounded enough that they were taken off the waiting list for an organ transplant. At one point, Maggie Leaver's condition deteriorated so much that her surgeon thought she was going to die. Now the 18-month-old is thriving at home in Hingham, Mass.
. . .
Mr. Ducker says the company's new product, called SMOFlipid, "presents a better option for pediatric feeding." The company believes the new product does contain all the essential fatty acids babies need and can be used on its own. Fresenius Kabi says it doesn't want to invest the resources required to test both products for approval by the U.S. Food and Drug Administration. It hopes to eventually sell the new product in the U.S., Mr. Ducker says, although no timetable has been set and no trials are under way.
. . .
Because Omegaven is considered experimental in the U.S., if hospitals want to try it, they have to ask permission from the FDA for each individual patient. The FDA has regulations that enable doctors to use experimental drugs in certain (p. A15) emergency situations. If hospitals obtain the required permissions, they must then find a way to buy the drug on their own, since insurers typically won't cover Omegaven because it's experimental. The cost can run from $50 to $100 a day per patient. At Children's Hospital Boston, the surgical department has already spent close to $100,000 to buy Omegaven for babies.
. . .
Dr. Mooney says he wrestled almost from the beginning about whether to put Maggie on Omegaven. He knew about Dr. Puder's results, which he calls "amazingly great," but the number of children treated was still small. He worried about adverse effects. "It is so easy to get caught in the hype of new things," Dr. Mooney says. Maggie was already fragile. What if he put her on Omegaven, he says, "and there was a horrible side effect that could tip her over the edge?"
But when standard therapies failed, he felt "there was nothing else to do." Given that the treatment is experimental, Dr. Mooney says he believes it was right to wait. But he also feels Omegaven has made a difference. "Five years ago, every single one of the kids taking Omegaven would be dead by now, Maggie included," he says.
Source
UNIVERSAL HEALTH CARE GOES TO WASHINGTON
Newly elected Democrats and America's Health Insurance Plans (AHIP), the industry's trade association, have put universal health care at the top of their legislative agenda, says Investor's Business Daily (IBD). While Democrats have not developed a comprehensive plan, AHIP has outlined its formal strategy:
* The group wants the federal government to spend $300 billion over 10 years on the plan, which would expand federal-state programs -- including Medicaid -- to insure below-poverty-line children and adults.
* The organization also wants individuals to buy coverage through universal health accounts paid for with pretax dollars, with federal matching funds for working families.
But John C. Goodman, president of the National Center for Policy Analysis has his doubts: "There is no way to make health insurance really universal in the United States. To do that would mean everybody is in the same system, and you couldn't do that unless you make it free. A free system would mean runaway costs and reduction in quality," he explains.
Goodman's solution: Personal and portable insurance, similar to health savings accounts, which are engineered like the 401(k) retirement savings program, and allow individuals to buy their insurance with tax-free dollars and take it from job to job, city to city and state to state.
Source: Peter Benesh, "U.S. Health Insurers Expect Quick Action From Dem Congress," Investor's Business Daily, November 24, 2006.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.
***************************
Friday, December 08, 2006
"HEALTHY" STATES -- GARBAGE IN, GARBAGE OUT
The report below claims that various "blue" States are much healthier than "Red" (GOP-voting) States. You see why when you read what counts as an index of "health": "The report is based on factors such as personal behaviors, the environment people live and work in, decisions by public and elected officials, and the quality of medical care delivered by health professionals". Note that quality of medical care is only one inclusion. The other criteria are non-health criteria and appear to reflect the degree to which the States are Leftist in their practices. The report is in other words a quite childish attempt to "load the dice" and present "blue" States in a better light
An annual report released Tuesday put Minnesota at the top of its health rankings for the fourth straight year, while concluding that the nation’s health improved slightly. The report by United Health Foundation, an independent, not-for-profit foundation funded by the health care company UnitedHealth Group, said Americans are 0.3 percent healthier than they were a year ago.
The report is based on factors such as personal behaviors, the environment people live and work in, decisions by public and elected officials, and the quality of medical care delivered by health professionals. Examples include smoking, motor vehicle deaths, high school graduation rates, children in poverty, access to care and incidence of preventable disease.
Dr. Reed Tuckson, senior vice president of the United Health Foundation, called the report a “call to action for all of us” to make the nation healthier. “We can do better and our children deserve better,” he said. Minnesota, which has held the top spot in 11 of the 17 years of the survey, was cited for, among other things, its low rate of uninsured (8.4 percent), low percentage of children in poverty (10 percent), and low infant mortality rate (5.1 deaths per 1,000 live births).
Vermont was second on the list, followed by New Hampshire, Hawaii and Connecticut. At the other end, the report listed Louisiana as the least-healthy state, followed by Mississippi, South Carolina, Tennessee and Arkansas.
The report also points out states that have made the most progress in overall health since last year, as well as those that have regressed the most. Illinois saw the biggest gain in the past year, jumping three to a ranking of 25. The report credited the state for decreasing child poverty by 13 percent and the prevalence of smoking by 10 percent. Other states saw health gains. Ohio was cited for cutting smoking statewide by 14 percent and increasing immunization coverage by six percent. Wisconsin rose three places to a ranking of 10, largely due to lowering the number of children in poverty by 24 percent, its high rate of high school graduation and low violent crime rate. Kansas was also noteworthy for a low rate of uninsured, smoking and incidence of infectious disease, the report said.
Source
THE TANGO: THE LATEST NHS PRESCRIPTION
It's a prescription that has the charm of not costing the NHS anything
The unfit, overweight and elderly will be told this week to take up the tango in the interests of their health. Caroline Flint, the Public Health Minister, is expected to publish a new report showing that prescribing exercise is a cost-effective way of improving health. She will recommend that street dancing, tango classes and trampolining should be encouraged. "Anything you enjoy that makes you more active is good thing," a spokeswoman for the Department of Health said yesterday. "People love dancing." But the actual cost of a visit to the local disco or th, dansant would not be paid by the NHS, she said. It would be more a case of GPs making clear to their patients that all forms of exercise, not just working out in a gym, have their value.
The report to be published this week is the final evaluation of pilot programmes backed by the department, Sport England and the Countryside Agency to try to encourage people with a sedentary lifestyle to take more exercise. For at least a decade the department has been promoting "exercise on prescription" in local areas and as pilot programmes. But funding has been sporadic and enthusiasm from GPs not always wholehearted. And there is little evidence that the programmes are cost-effective. The 2.5 million pound local exercise action pilots began in 2004 and have been evaluated by Leeds Metropolitan University. Its report is expected to say that GP referrals to exercise and walking classes have worked for the older adults, while swimming works better for younger people. "Different categories of intervention engage users with different demographic profiles and baseline levels of physical activity," it found.
The evidence suggests that this kind of intervention can reduce the number of inactive people by about a third. The data also indicate that all those involved increased their activity levels to some degree. Sedentary people exercised about an hour-and-a-half more each week.
Ms Flint will emphasise that activity can take many different forms. One primary care trust sent teachers into schools to encourage girls between 10 and 16 to spend time dancing. While Ms Flint will not suggest that dancing classes are the solution to Britain's obesity epidemic, they have a role.
In another programme, over-50s were encouraged to box, skip and take part in a "tango warm-down". Yet others were taken for walks in the woods where they built shelters out of sticks.
Twenty or 30 years ago, higher levels of activity would have been considered part of a normal life, but Britain has become increasingly sofa-bound. A plethora of small initiatives, such as the promise of "personal trainers" paid for by NHS, has given the impression of government activity, but the rise in obesity has not been halted. The report is expected to make a series of recommendations about how physical activity interventions should be planned and organised in future. It says that such schemes require a broad mix of skills not easily found, and that consultation with the target groups and with community groups is needed to ensure that people participate. Participants also need to know that the schemes will not last for ever, but are simply designed to give them a short-term boost. They will need then to continue without support. The report is expected to conclude that more investment would be justified, as persuading people to be more active saves money in the long run. Ms Flint will announce that GPs will be asked to discuss physical activity with their patients, and complete questionaires recording how active they are.
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.
***************************
The report below claims that various "blue" States are much healthier than "Red" (GOP-voting) States. You see why when you read what counts as an index of "health": "The report is based on factors such as personal behaviors, the environment people live and work in, decisions by public and elected officials, and the quality of medical care delivered by health professionals". Note that quality of medical care is only one inclusion. The other criteria are non-health criteria and appear to reflect the degree to which the States are Leftist in their practices. The report is in other words a quite childish attempt to "load the dice" and present "blue" States in a better light
An annual report released Tuesday put Minnesota at the top of its health rankings for the fourth straight year, while concluding that the nation’s health improved slightly. The report by United Health Foundation, an independent, not-for-profit foundation funded by the health care company UnitedHealth Group, said Americans are 0.3 percent healthier than they were a year ago.
The report is based on factors such as personal behaviors, the environment people live and work in, decisions by public and elected officials, and the quality of medical care delivered by health professionals. Examples include smoking, motor vehicle deaths, high school graduation rates, children in poverty, access to care and incidence of preventable disease.
Dr. Reed Tuckson, senior vice president of the United Health Foundation, called the report a “call to action for all of us” to make the nation healthier. “We can do better and our children deserve better,” he said. Minnesota, which has held the top spot in 11 of the 17 years of the survey, was cited for, among other things, its low rate of uninsured (8.4 percent), low percentage of children in poverty (10 percent), and low infant mortality rate (5.1 deaths per 1,000 live births).
Vermont was second on the list, followed by New Hampshire, Hawaii and Connecticut. At the other end, the report listed Louisiana as the least-healthy state, followed by Mississippi, South Carolina, Tennessee and Arkansas.
The report also points out states that have made the most progress in overall health since last year, as well as those that have regressed the most. Illinois saw the biggest gain in the past year, jumping three to a ranking of 25. The report credited the state for decreasing child poverty by 13 percent and the prevalence of smoking by 10 percent. Other states saw health gains. Ohio was cited for cutting smoking statewide by 14 percent and increasing immunization coverage by six percent. Wisconsin rose three places to a ranking of 10, largely due to lowering the number of children in poverty by 24 percent, its high rate of high school graduation and low violent crime rate. Kansas was also noteworthy for a low rate of uninsured, smoking and incidence of infectious disease, the report said.
Source
THE TANGO: THE LATEST NHS PRESCRIPTION
It's a prescription that has the charm of not costing the NHS anything
The unfit, overweight and elderly will be told this week to take up the tango in the interests of their health. Caroline Flint, the Public Health Minister, is expected to publish a new report showing that prescribing exercise is a cost-effective way of improving health. She will recommend that street dancing, tango classes and trampolining should be encouraged. "Anything you enjoy that makes you more active is good thing," a spokeswoman for the Department of Health said yesterday. "People love dancing." But the actual cost of a visit to the local disco or th, dansant would not be paid by the NHS, she said. It would be more a case of GPs making clear to their patients that all forms of exercise, not just working out in a gym, have their value.
The report to be published this week is the final evaluation of pilot programmes backed by the department, Sport England and the Countryside Agency to try to encourage people with a sedentary lifestyle to take more exercise. For at least a decade the department has been promoting "exercise on prescription" in local areas and as pilot programmes. But funding has been sporadic and enthusiasm from GPs not always wholehearted. And there is little evidence that the programmes are cost-effective. The 2.5 million pound local exercise action pilots began in 2004 and have been evaluated by Leeds Metropolitan University. Its report is expected to say that GP referrals to exercise and walking classes have worked for the older adults, while swimming works better for younger people. "Different categories of intervention engage users with different demographic profiles and baseline levels of physical activity," it found.
The evidence suggests that this kind of intervention can reduce the number of inactive people by about a third. The data also indicate that all those involved increased their activity levels to some degree. Sedentary people exercised about an hour-and-a-half more each week.
Ms Flint will emphasise that activity can take many different forms. One primary care trust sent teachers into schools to encourage girls between 10 and 16 to spend time dancing. While Ms Flint will not suggest that dancing classes are the solution to Britain's obesity epidemic, they have a role.
In another programme, over-50s were encouraged to box, skip and take part in a "tango warm-down". Yet others were taken for walks in the woods where they built shelters out of sticks.
Twenty or 30 years ago, higher levels of activity would have been considered part of a normal life, but Britain has become increasingly sofa-bound. A plethora of small initiatives, such as the promise of "personal trainers" paid for by NHS, has given the impression of government activity, but the rise in obesity has not been halted. The report is expected to make a series of recommendations about how physical activity interventions should be planned and organised in future. It says that such schemes require a broad mix of skills not easily found, and that consultation with the target groups and with community groups is needed to ensure that people participate. Participants also need to know that the schemes will not last for ever, but are simply designed to give them a short-term boost. They will need then to continue without support. The report is expected to conclude that more investment would be justified, as persuading people to be more active saves money in the long run. Ms Flint will announce that GPs will be asked to discuss physical activity with their patients, and complete questionaires recording how active they are.
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.
***************************
Thursday, December 07, 2006
Massachusetts deception
RomneyCare, Gov. Mitt Romney's "revolutionary" healthcare initiative, was introduced earlier this year to applause from the mainstream media, Senators Hillary Clinton and Teddy Kennedy, and Families USA-all wild at the idea of universal healthcare in Massachusetts. Such endorsements were not the best of signs for conservatives, but they were certainly eye-catching, especially with the hunt for future presidential talent on. And many Republicans were wondering whether RomneyCare was the conservative solution to the problem of uninsured Americans that the party was looking for.
Almost immediately after the bill creating it was signed into law, the Wall Street Journal ran an op-ed, which claimed that, under RomneyCare, "the state is forcing people to buy insurance many will need subsidies to afford, which is a recipe for higher taxes and more government intervention down the road." Not so, said Romney. Despite the potential weight of RomneyCare on the public purse -likely to be exacerbated by the plan's focus on signing up the 20% of Massachusetts' population that is eligible for Medicaid, but not enrolled-Romney said he would not need to raise taxes to pay for the program.
Of course, he was right. RomneyCare has not even been fully implemented yet, and a cost overrun of $151 million in 2007 alone is already in the cards, perhaps because the RomneyCare financial model assumed the wrong number of uninsured in Massachusetts (the Census Bureau puts it at 748,000, but RomneyCare assumes only 500,000). But any needed hike in taxes won't be pushed through by Romney -he'll be out of office when the bill comes due, and when extra federal dollars will likely have to be allocated to Massachusetts to help cover the shortfall between RomneyCare's cost and its budget.
Yes, RomneyCare is reliant on federal funds. So imagine if, as Romney hopes, it is replicated in other states. Even if we do not have federally-mandated universal healthcare a la HillaryCare, we could easily end up with that option's badly behaved little brother-"state-specific" universal healthcare, funded in large part, and at greater than current levels, by the federal government.
That matters because it means more government intrusion into personal healthcare choices. Government will end up funding healthcare at a higher level, and in exchange, making mandates about the kind of coverage you must have, and who may treat you (RomneyCare mandates that individuals must purchase HMO coverage; PPO coverage, often better and more flexible, is not allowed). Moreover, government will end up dictating to businesses and requiring them to incur potentially great costs: RomneyCare mandates that employers with more than 10 workers must assume ultimate financial responsibility if employees or their immediate family members need expensive medical care, and that if such businesses do not insure their employees, they must pay a $295 per uninsured employee fee to subsidize healthcare costs. This threatens employment levels and discourages small businesses from growing.
Ultimately, the entire specter of government engagement in the realm of healthcare hits at a fundamental question. Is healthcare and health itself primarily an individual responsibility, the product of individual choices made in consideration of private matters, or is it a benefit to be assured by the government, without regard to the wishes of the individual?
Only an individual can know what their objectives are in terms of health and how best to ensure that they are met. For example, someone with a rare and difficult-to-treat illness may wish to carry PPO insurance, rather than HMO insurance. PPO insurance generally affords access to a wider range of physicians and treatments, yet RomneyCare bans taking it out. Alternatively, someone earning $30,000 a year-too much to be eligible for state-subsidized insurance under RomneyCare-might want to buy cheap, basic coverage, instead of insurance costing around $3,600 annually for an individual and $11,000 annually for a family, plus 10%-14% annual inflation on premiums. But buying cheaper, more basic insurance is not possible-RomneyCare didn't change Massachusetts' rules mandating coverage for chiropractic treatment and acupuncture, or allowing purchase on the day of diagnosis, which make insurance there so expensive, compared to less regulated states.
This is the big problem with RomneyCare. It represents an interventionist, big government approach toward what is a highly personal matter, and does virtually nothing to reform burdensome insurance regulation that is responsible for the problem of underinsurance.
Romney disagrees with this characterization. He claims that his plan (and make no mistake, he claims it as his), which is already costing more than intended, imposes criminal sanctions on individuals who do not buy what may be a totally unsuitable product, mandates significant costs and imposes obligations on businesses, and results in government guaranteeing healthcare as a virtual right, is a good, conservative initiative. He contends that there's nothing wrong with forcing people via government diktat to purchase health insurance, because states already force people to carry car insurance. But he ignores that it is not standard to require drivers to carry insurance for damage to themselves or their own cars-only for harm done to others. This may be stupid, but so is driving a Yugo, and yet we don't mandate that everyone drive a BMW, do we?
Romney also contends that, since hospitals are required to provide treatment for the uninsured irrespective of their ability to pay, underinsurance is a grave risk and government already is in the position of footing the bill for something that should be a matter of individual responsibility. Yet, as the Wall Street Journal's "RomneyCare" op-ed notes, the cost of covering the care of uninsured patients is low, and uses a very small proportion of governmental medical budgets. Plus, the uninsured that benefit from emergency-room treatment can always be pursued as debtors, just like people who default on loans.
It is a shame that Romney could identify no more market-friendly options to curb the problem of under-insurance. Surely, in a state where insurance must cover rather exotic treatments, un-mandating coverage for chiropractic treatment and acupuncture as well as in vitro fertilization, could and should have been pursued first. This would have enabled cheaper policies to be marketed in Massachusetts, the number of uninsured to be cut, and for Romney to have legitimately claimed responsibility for meaningful, market-friendly reforms in the realm of healthcare-something RomneyCare effectively prevents.
Source
BULL**** ABOUT BRITISH HOSPITAL ER CLOSURES
The closure of accident and emergency services at some hospitals is in the interests of patients, the Government said yesterday. Presenting them as part of a plan to create "super-A&Es" to deal with heart attacks, strokes, and aortic aneurysms, Patricia Hewitt, the Health Secretary, sought to halt a tide of opposition to the closures. They were not about saving money but about saving lives, she asserted.
If that were true, Andrew Lansley, her Conservative opposite number retorted, it could have been done before, not after, financial deficits in the NHS had come to light.
The Department of Health published two reports to support the claims by Ms Hewitt. They called for "reconfiguration" of A&E services, to allow specialist centres for the most serious conditions to be created, and enable more people to be treated in their homes. According to Professor Roger Boyle, the national director for heart disease and strokes, local A&E units are not the best places for providing good care for patients suffering from either of these conditions. Specialist centres might mean a longer journey for many people, but they would produce better results, saving the the lives of 500 people suffering heart attacks every year, preventing 1,000 further heart attacks and saving 1,000 more stroke victims from death and disability, he said.
Sir George Alberti, the national director for emergency access, said: "We have to be up front and tell the public that, in terms of modern medicine, some of the A&E departments that they cherish are not able to provide this type of care and cannot and will not be able to provide the degree of specialisation and specialist cover that modern medicine dictates the public deserves." It would be better, he said, for many patients to bypass the local hospital and be taken by highly trained paramedics to specialist centres. " `But won't I die on the way?' many people ask," he said. "No, you won't. Long ambulance journeys do not lead to more deaths."
Ms Hewitt said: "Whenever the A&E starts to talk about reorganising, people think it's all about money and it isn't. It's about saving more people's lives, it's about making care more convenient, it's about getting the money into the right place so that people get the best care from the right person at the right time."
The Government fears that it is losing the argument over NHS reconfigurations, which involve A&E and maternity services, among others. The reports, published yesterday, are designed to present the issue more positively, by showing that change might not mean worse care. But the argument assumes that the money saved by closing some A&Es is devoted to building others into specialised centres. That is not guaranteed. Karen Jennings, the head of health at the public sector union Unison, said: "The climate of debt in the NHS puts the development of new policy under suspicion. We are extremely concerned that these policies may be being driven by deficits, not what is best for patient care. "If we move towards more specialist units we still need to ensure that patients have access to really good local A&E departments."
Geoff Martin, of the campaign group Health Emergency, said: "Claiming that closing local A&E departments, trauma units and intensive-care facilities will improve services turns all logic on its head. People are fighting these closures in their tens of thousands up and down the country because they know that closing local services and increasing journey times puts lives at risk."
Mr Lansley did not dissent from the idea of specialist units, which he has championed for some years. But he said that the patients who would be sent to them represented, at most, 5 per cent of all A&E attenders. "I accept the need for specialisation, but this should not be used to justify taking accessible A&E departments away from district general hospitals," he said.
Ms Hewitt said that casualty services in future would divide into three kinds, with "super- A&Es" for people with the most serious conditions, local A&Es for most treatment and the A&E that "will come to you" for less serious injuries. "Financial problems are forcing people to look at changes they ought to be doing anyway, and in a few cases financial problems are driving people to make changes they should have done years ago," she said.
The report by Sir George Alberti arrives at a similar conclusion. "Finances may have been the issue that drew the media's attention, but they are not the reason for reform," it said. "Reforming emergency care is about responding to medical advances and providing new and better services in ways that allow the NHS to save more lives."
Beverly Malone, the general secretary of the Royal College of Nursing, said: "Any changes must be subject to full and proper consultation with staff, unions, patients and local communities - after all, it's our NHS and we all deserve a say in how it is run and reformed." The Government has not produced a list of trusts where A&E departments have closed or are threatened. But the Tories say they have identified hospitals in 29 NHS trusts
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.
***************************
RomneyCare, Gov. Mitt Romney's "revolutionary" healthcare initiative, was introduced earlier this year to applause from the mainstream media, Senators Hillary Clinton and Teddy Kennedy, and Families USA-all wild at the idea of universal healthcare in Massachusetts. Such endorsements were not the best of signs for conservatives, but they were certainly eye-catching, especially with the hunt for future presidential talent on. And many Republicans were wondering whether RomneyCare was the conservative solution to the problem of uninsured Americans that the party was looking for.
Almost immediately after the bill creating it was signed into law, the Wall Street Journal ran an op-ed, which claimed that, under RomneyCare, "the state is forcing people to buy insurance many will need subsidies to afford, which is a recipe for higher taxes and more government intervention down the road." Not so, said Romney. Despite the potential weight of RomneyCare on the public purse -likely to be exacerbated by the plan's focus on signing up the 20% of Massachusetts' population that is eligible for Medicaid, but not enrolled-Romney said he would not need to raise taxes to pay for the program.
Of course, he was right. RomneyCare has not even been fully implemented yet, and a cost overrun of $151 million in 2007 alone is already in the cards, perhaps because the RomneyCare financial model assumed the wrong number of uninsured in Massachusetts (the Census Bureau puts it at 748,000, but RomneyCare assumes only 500,000). But any needed hike in taxes won't be pushed through by Romney -he'll be out of office when the bill comes due, and when extra federal dollars will likely have to be allocated to Massachusetts to help cover the shortfall between RomneyCare's cost and its budget.
Yes, RomneyCare is reliant on federal funds. So imagine if, as Romney hopes, it is replicated in other states. Even if we do not have federally-mandated universal healthcare a la HillaryCare, we could easily end up with that option's badly behaved little brother-"state-specific" universal healthcare, funded in large part, and at greater than current levels, by the federal government.
That matters because it means more government intrusion into personal healthcare choices. Government will end up funding healthcare at a higher level, and in exchange, making mandates about the kind of coverage you must have, and who may treat you (RomneyCare mandates that individuals must purchase HMO coverage; PPO coverage, often better and more flexible, is not allowed). Moreover, government will end up dictating to businesses and requiring them to incur potentially great costs: RomneyCare mandates that employers with more than 10 workers must assume ultimate financial responsibility if employees or their immediate family members need expensive medical care, and that if such businesses do not insure their employees, they must pay a $295 per uninsured employee fee to subsidize healthcare costs. This threatens employment levels and discourages small businesses from growing.
Ultimately, the entire specter of government engagement in the realm of healthcare hits at a fundamental question. Is healthcare and health itself primarily an individual responsibility, the product of individual choices made in consideration of private matters, or is it a benefit to be assured by the government, without regard to the wishes of the individual?
Only an individual can know what their objectives are in terms of health and how best to ensure that they are met. For example, someone with a rare and difficult-to-treat illness may wish to carry PPO insurance, rather than HMO insurance. PPO insurance generally affords access to a wider range of physicians and treatments, yet RomneyCare bans taking it out. Alternatively, someone earning $30,000 a year-too much to be eligible for state-subsidized insurance under RomneyCare-might want to buy cheap, basic coverage, instead of insurance costing around $3,600 annually for an individual and $11,000 annually for a family, plus 10%-14% annual inflation on premiums. But buying cheaper, more basic insurance is not possible-RomneyCare didn't change Massachusetts' rules mandating coverage for chiropractic treatment and acupuncture, or allowing purchase on the day of diagnosis, which make insurance there so expensive, compared to less regulated states.
This is the big problem with RomneyCare. It represents an interventionist, big government approach toward what is a highly personal matter, and does virtually nothing to reform burdensome insurance regulation that is responsible for the problem of underinsurance.
Romney disagrees with this characterization. He claims that his plan (and make no mistake, he claims it as his), which is already costing more than intended, imposes criminal sanctions on individuals who do not buy what may be a totally unsuitable product, mandates significant costs and imposes obligations on businesses, and results in government guaranteeing healthcare as a virtual right, is a good, conservative initiative. He contends that there's nothing wrong with forcing people via government diktat to purchase health insurance, because states already force people to carry car insurance. But he ignores that it is not standard to require drivers to carry insurance for damage to themselves or their own cars-only for harm done to others. This may be stupid, but so is driving a Yugo, and yet we don't mandate that everyone drive a BMW, do we?
Romney also contends that, since hospitals are required to provide treatment for the uninsured irrespective of their ability to pay, underinsurance is a grave risk and government already is in the position of footing the bill for something that should be a matter of individual responsibility. Yet, as the Wall Street Journal's "RomneyCare" op-ed notes, the cost of covering the care of uninsured patients is low, and uses a very small proportion of governmental medical budgets. Plus, the uninsured that benefit from emergency-room treatment can always be pursued as debtors, just like people who default on loans.
It is a shame that Romney could identify no more market-friendly options to curb the problem of under-insurance. Surely, in a state where insurance must cover rather exotic treatments, un-mandating coverage for chiropractic treatment and acupuncture as well as in vitro fertilization, could and should have been pursued first. This would have enabled cheaper policies to be marketed in Massachusetts, the number of uninsured to be cut, and for Romney to have legitimately claimed responsibility for meaningful, market-friendly reforms in the realm of healthcare-something RomneyCare effectively prevents.
Source
BULL**** ABOUT BRITISH HOSPITAL ER CLOSURES
The closure of accident and emergency services at some hospitals is in the interests of patients, the Government said yesterday. Presenting them as part of a plan to create "super-A&Es" to deal with heart attacks, strokes, and aortic aneurysms, Patricia Hewitt, the Health Secretary, sought to halt a tide of opposition to the closures. They were not about saving money but about saving lives, she asserted.
If that were true, Andrew Lansley, her Conservative opposite number retorted, it could have been done before, not after, financial deficits in the NHS had come to light.
The Department of Health published two reports to support the claims by Ms Hewitt. They called for "reconfiguration" of A&E services, to allow specialist centres for the most serious conditions to be created, and enable more people to be treated in their homes. According to Professor Roger Boyle, the national director for heart disease and strokes, local A&E units are not the best places for providing good care for patients suffering from either of these conditions. Specialist centres might mean a longer journey for many people, but they would produce better results, saving the the lives of 500 people suffering heart attacks every year, preventing 1,000 further heart attacks and saving 1,000 more stroke victims from death and disability, he said.
Sir George Alberti, the national director for emergency access, said: "We have to be up front and tell the public that, in terms of modern medicine, some of the A&E departments that they cherish are not able to provide this type of care and cannot and will not be able to provide the degree of specialisation and specialist cover that modern medicine dictates the public deserves." It would be better, he said, for many patients to bypass the local hospital and be taken by highly trained paramedics to specialist centres. " `But won't I die on the way?' many people ask," he said. "No, you won't. Long ambulance journeys do not lead to more deaths."
Ms Hewitt said: "Whenever the A&E starts to talk about reorganising, people think it's all about money and it isn't. It's about saving more people's lives, it's about making care more convenient, it's about getting the money into the right place so that people get the best care from the right person at the right time."
The Government fears that it is losing the argument over NHS reconfigurations, which involve A&E and maternity services, among others. The reports, published yesterday, are designed to present the issue more positively, by showing that change might not mean worse care. But the argument assumes that the money saved by closing some A&Es is devoted to building others into specialised centres. That is not guaranteed. Karen Jennings, the head of health at the public sector union Unison, said: "The climate of debt in the NHS puts the development of new policy under suspicion. We are extremely concerned that these policies may be being driven by deficits, not what is best for patient care. "If we move towards more specialist units we still need to ensure that patients have access to really good local A&E departments."
Geoff Martin, of the campaign group Health Emergency, said: "Claiming that closing local A&E departments, trauma units and intensive-care facilities will improve services turns all logic on its head. People are fighting these closures in their tens of thousands up and down the country because they know that closing local services and increasing journey times puts lives at risk."
Mr Lansley did not dissent from the idea of specialist units, which he has championed for some years. But he said that the patients who would be sent to them represented, at most, 5 per cent of all A&E attenders. "I accept the need for specialisation, but this should not be used to justify taking accessible A&E departments away from district general hospitals," he said.
Ms Hewitt said that casualty services in future would divide into three kinds, with "super- A&Es" for people with the most serious conditions, local A&Es for most treatment and the A&E that "will come to you" for less serious injuries. "Financial problems are forcing people to look at changes they ought to be doing anyway, and in a few cases financial problems are driving people to make changes they should have done years ago," she said.
The report by Sir George Alberti arrives at a similar conclusion. "Finances may have been the issue that drew the media's attention, but they are not the reason for reform," it said. "Reforming emergency care is about responding to medical advances and providing new and better services in ways that allow the NHS to save more lives."
Beverly Malone, the general secretary of the Royal College of Nursing, said: "Any changes must be subject to full and proper consultation with staff, unions, patients and local communities - after all, it's our NHS and we all deserve a say in how it is run and reformed." The Government has not produced a list of trusts where A&E departments have closed or are threatened. But the Tories say they have identified hospitals in 29 NHS trusts
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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