Medical errors in U.S. lead in poll
Ho Hum! We don't count illness and death from MRSA or bureaucratic denial of life-saving drugs or waiting years for surgery as "errors", do we? In fact the less we treat patients the fewer "errors" we will make. And denying treatment is what socialized medicine is best at. Isn't that a good system?
Out-of-pocket medical expenses and medical errors were higher for patients in the United States than for those in countries that have state-funded health care systems, according to a new report. The study, which was released yesterday by the Commonwealth Fund, surveyed nearly 7,000 patients from March to June in the United States, Britain, Canada, Australia, Germany and New Zealand.
Roughly 34 percent of U.S. patients encountered a medical mistake in the past two years, followed by 30 percent of Canadian patients, said the New York health research organization, which promotes universal health care coverage through government and corporate initiatives.
A lack of coordination among health care providers, from hospitals to diagnostic laboratories, contributed to the error rate, said Cathy Schoen, an author of the study. "Many of those patients were seeing multiple physicians and taking four or more prescriptions," she said yesterday at an international health policy conference in Washington.
Additionally, 34 percent of U.S. patients paid more than $1,000 in out-of-pocket medical expenses in the past year while only 14 percent of Canadian and Australian patients paid that much in the same period, the report said.
The U.S. Agency for Healthcare Research and Quality said the effort to set up a nationwide electronic network of medical records may ease coordination problems and costs and reduce medical errors. "These records are likely to be very effective for some individuals," Dr. Carolyn Clancy, the federal agency's director, said at the conference.
While medical errors and out-of-pocket expenses were higher, more than half of U.S. patients received the appropriate care for chronic conditions like hypertension and diabetes.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, November 06, 2005
Saturday, November 05, 2005
Why Employer-Based Health Insurance Is Unraveling
GM is stuck with follies from its past but other employers could move to a more flexible system that offered employees a choice
In a September 13 statement, the CEO of Starbucks Corp. announced his company will spend more on health insurance for its employees this year than on coffee beans. Howard Schultz, meeting with Sen. Patty Murray (D-WA) and Rep. Adam Smith (D-WA) and other Seattle business leaders, said his firm provides health care coverage to Starbucks employees who work at least 20 hours a week. Schultz is not alone in his concern about employee health care costs. General Motors spends more on health insurance than on steel. For GM, the cost amounts to $1,525 per car produced.
However, it is misleading to compare the $200 million Starbucks spends on its 80,000 U.S. employees, or the $5.6 billion GM expects to spend on its 1.1 million workers and retirees this year, to the cost of a cup of coffee or an automobile. Health coverage is not a direct input into the production of either coffee or cars. Coffee beans and steel are direct inputs, as is labor. Health coverage is simply a form of noncash compensation for the labor input. According to Michael Cannon, director of health policy at the Cato Institute, "an employee health plan is merely a way to pay for a portion of the labor provided by workers. The problem is that employers have agreed to compensate workers in part by giving them health care, the cost of which keeps increasing."
Responding to the fact that Starbucks' health coverage costs have increased at double-digit rates during the past four years, Schultz told the Associated Press, "It's completely non-sustainable." Some industry experts argue the high prices will force employers to change the way they calculate compensation. According to compensation and benefits expert Richard A. Matthews of the Michigan-based firm Desjardins Matthews & Company, "when insurance costs were 2 percent of payroll no one cared. Now that they approach 33 percent for family coverage everyone cares. Driven by the huge annual increases in the cost of health insurance premiums, I believe it is inevitable that all employers, including Starbucks, will go to some form of 'total compensation.'"
The exorbitant amount GM pays to cover its workers, their families, and retirees has little to do with building cars. GM made the decision decades ago to offer generous health coverage and deferred benefits (such as retiree health care) in lieu of higher cash wages. That made sense at the time because health coverage was relatively inexpensive and the liability created by deferring compensation in this way did not have to be charged against revenue until it occurred. The bill for that decision was not likely to come due for decades. By deferring the cost of compensation to future years, GM gambled that its market share and profitability would not significantly change. But it did. Competition from Europe and Asia reduced the funds GM has available to pay medical bills that have now come due.
The company also gambled that the cost of health benefits would not rise significantly. But as technology evolved and third-party payment for medical care became common, the prices for health services rose at three times the rate of inflation. GM's gamble, combined with a health benefit package lacking the incentive for workers and retirees to be wise consumers of health care, proved to be a very poor bet. In retrospect, the business decision to defer compensation in order to reduce short-term labor costs threatens to bankrupt the automaker. If costs continue to increase at recent double-digit rates, eventually all of GM's assets will be required to pay for health care commitments made long ago.
The situation Starbucks faces is different from GM's. Starbucks is a service business dishing out expensive cups of coffee and related goods. The value of coffee beans that Starbucks roasts for retail sale pales in comparison to the revenue raised from selling cups of espresso and café latté. Starbucks pays about $2,500 for health coverage for each U.S. employee, including part-timers, and about two-thirds of its employees are part-time workers.
According to the Bureau of Labor Statistics (BLS), total hourly compensation in the service industry averages $12.09 per hour--$9.17 in (cash) wages and the remainder in fringe benefits (some of which are mandatory). Average spending on health insurance per hour in the service industry is $0.72, or about 6 percent of total employee compensation. At this rate the average cost of health coverage in the service industry is $1,500 per full-time employee. If we assume Starbucks baristas (servers) receive a similar base pay for entry-level positions, it appears health benefits are a much larger proportion of Starbucks employees' compensation than the industry norm.
What firms pay workers, of course, is a function of labor market conditions--the supply of eligible workers and the demand for their services. The optimal proportion of a worker's pay that is received in the form of noncash benefits depends on the individual worker's preference. The reason the average service industry firm spends less on health coverage than Starbucks does is because few part-time workers earning $10 per hour feel they can afford to forgo $2,500 in wages per year for health benefits. Starbucks provides lavish health benefits to encourage employee retention and productivity. Schultz thinks that strategy is successful. Labor economists, however, note that providing workers with a fringe benefit they would not purchase on their own is not an efficient form of compensation. If workers prefer a dollar of cash to a dollar of health coverage, an employer is better served to give the dollar of cash.
If done correctly, the amount Starbucks pays for health coverage should not increase its cost of employing workers, and it therefore should not affect the cost of its coffee. It is merely an aspect of the company's business model and reflects how its workers choose to be paid. If the cost of health coverage has raised Starbucks' cost of keeping workers, as Schultz appears to be suggesting, it means Starbucks has misjudged its workers' preferences and is wasting money.
Here's a solution both Starbucks and its employees might agree on. According to Robert Hopper, a California insurance agent and author of a forthcoming book on health savings accounts, "instead of paying additional premiums to the insurance company for low deductibles, and copays for office visits and prescription drugs, employers can deposit that cash tax-free in a health savings account. That's fiscally responsible, since most employees will prefer cash instead of copays they rarely use."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
GM is stuck with follies from its past but other employers could move to a more flexible system that offered employees a choice
In a September 13 statement, the CEO of Starbucks Corp. announced his company will spend more on health insurance for its employees this year than on coffee beans. Howard Schultz, meeting with Sen. Patty Murray (D-WA) and Rep. Adam Smith (D-WA) and other Seattle business leaders, said his firm provides health care coverage to Starbucks employees who work at least 20 hours a week. Schultz is not alone in his concern about employee health care costs. General Motors spends more on health insurance than on steel. For GM, the cost amounts to $1,525 per car produced.
However, it is misleading to compare the $200 million Starbucks spends on its 80,000 U.S. employees, or the $5.6 billion GM expects to spend on its 1.1 million workers and retirees this year, to the cost of a cup of coffee or an automobile. Health coverage is not a direct input into the production of either coffee or cars. Coffee beans and steel are direct inputs, as is labor. Health coverage is simply a form of noncash compensation for the labor input. According to Michael Cannon, director of health policy at the Cato Institute, "an employee health plan is merely a way to pay for a portion of the labor provided by workers. The problem is that employers have agreed to compensate workers in part by giving them health care, the cost of which keeps increasing."
Responding to the fact that Starbucks' health coverage costs have increased at double-digit rates during the past four years, Schultz told the Associated Press, "It's completely non-sustainable." Some industry experts argue the high prices will force employers to change the way they calculate compensation. According to compensation and benefits expert Richard A. Matthews of the Michigan-based firm Desjardins Matthews & Company, "when insurance costs were 2 percent of payroll no one cared. Now that they approach 33 percent for family coverage everyone cares. Driven by the huge annual increases in the cost of health insurance premiums, I believe it is inevitable that all employers, including Starbucks, will go to some form of 'total compensation.'"
The exorbitant amount GM pays to cover its workers, their families, and retirees has little to do with building cars. GM made the decision decades ago to offer generous health coverage and deferred benefits (such as retiree health care) in lieu of higher cash wages. That made sense at the time because health coverage was relatively inexpensive and the liability created by deferring compensation in this way did not have to be charged against revenue until it occurred. The bill for that decision was not likely to come due for decades. By deferring the cost of compensation to future years, GM gambled that its market share and profitability would not significantly change. But it did. Competition from Europe and Asia reduced the funds GM has available to pay medical bills that have now come due.
The company also gambled that the cost of health benefits would not rise significantly. But as technology evolved and third-party payment for medical care became common, the prices for health services rose at three times the rate of inflation. GM's gamble, combined with a health benefit package lacking the incentive for workers and retirees to be wise consumers of health care, proved to be a very poor bet. In retrospect, the business decision to defer compensation in order to reduce short-term labor costs threatens to bankrupt the automaker. If costs continue to increase at recent double-digit rates, eventually all of GM's assets will be required to pay for health care commitments made long ago.
The situation Starbucks faces is different from GM's. Starbucks is a service business dishing out expensive cups of coffee and related goods. The value of coffee beans that Starbucks roasts for retail sale pales in comparison to the revenue raised from selling cups of espresso and café latté. Starbucks pays about $2,500 for health coverage for each U.S. employee, including part-timers, and about two-thirds of its employees are part-time workers.
According to the Bureau of Labor Statistics (BLS), total hourly compensation in the service industry averages $12.09 per hour--$9.17 in (cash) wages and the remainder in fringe benefits (some of which are mandatory). Average spending on health insurance per hour in the service industry is $0.72, or about 6 percent of total employee compensation. At this rate the average cost of health coverage in the service industry is $1,500 per full-time employee. If we assume Starbucks baristas (servers) receive a similar base pay for entry-level positions, it appears health benefits are a much larger proportion of Starbucks employees' compensation than the industry norm.
What firms pay workers, of course, is a function of labor market conditions--the supply of eligible workers and the demand for their services. The optimal proportion of a worker's pay that is received in the form of noncash benefits depends on the individual worker's preference. The reason the average service industry firm spends less on health coverage than Starbucks does is because few part-time workers earning $10 per hour feel they can afford to forgo $2,500 in wages per year for health benefits. Starbucks provides lavish health benefits to encourage employee retention and productivity. Schultz thinks that strategy is successful. Labor economists, however, note that providing workers with a fringe benefit they would not purchase on their own is not an efficient form of compensation. If workers prefer a dollar of cash to a dollar of health coverage, an employer is better served to give the dollar of cash.
If done correctly, the amount Starbucks pays for health coverage should not increase its cost of employing workers, and it therefore should not affect the cost of its coffee. It is merely an aspect of the company's business model and reflects how its workers choose to be paid. If the cost of health coverage has raised Starbucks' cost of keeping workers, as Schultz appears to be suggesting, it means Starbucks has misjudged its workers' preferences and is wasting money.
Here's a solution both Starbucks and its employees might agree on. According to Robert Hopper, a California insurance agent and author of a forthcoming book on health savings accounts, "instead of paying additional premiums to the insurance company for low deductibles, and copays for office visits and prescription drugs, employers can deposit that cash tax-free in a health savings account. That's fiscally responsible, since most employees will prefer cash instead of copays they rarely use."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, November 04, 2005
BIG SCOTTISH COVERUP
Scottish hospitals are hiding blunders by making millions of pounds’ worth of secret payments to victims of negligence, it has been claimed. In one case, NHS Tayside paid out a Scottish record of £3 million to a family without telling health board members employed to scrutinise expenditure. Despite the huge sums of public money involved, officials involved in out-of-court settlements have refused to provide details of what went wrong and who was to blame. Politicians and patient groups are demanding an end to the culture of secrecy surrounding medical compensation amid fears that lack of accountability puts patients at risk.
Figures released under the Freedom of Information Act show that Scotland’s 15 health boards have paid out a total of £16.3 million in the past two years. Under current rules, the health boards are allowed to hide details of the cases. NHS Tayside paid £3 million last year to the family of a 10-year-old girl left with cerebral palsy after errors made during her birth. NHS Argyll and Clyde paid £1 million to another family in similar circumstances. But neither board would say if staff had been disciplined or whether they had changed hospital practice. One NHS Tayside board member was told details of the case were confidential after spotting the £3 million in a financial report.
Shona Robison, SNP Shadow Health Minister, said: “The Executive must be concerned that the current system breeds secretive medicine and extends the harrowing experiences of patients and their families.” A leading lawyer said these two tragic cases were “the tip of the iceberg”. The lawyer, who did not want to be named, added: “There are usually one or two of these sizeable payouts each year. We are approached with dozens of cases every year but many don’t ever come to a conclusion as the health board drags the process out so long. They are hugely difficult and complex cases and many families don’t have the means to see it through all the way.”
NHS Tayside said: “In settling claims there is a duty of confidentiality implicit in the procedure and NHS Tayside will not breach this. Where such claims have been settled in court then these will already be in the public domain. Those settled out of court will remain confidential.” Argyll and Clyde refused to comment.
The Department of Health announced last month that it was to introduce a method of small negligence claims of up to £20,000 to cut back on legal costs. But Andy Kerr, Executive Health Minister, ruled out any changes to the compensation procedure in Scotland. “There is a long standing agreement around confidentiality in cases like this, which we do not propose to break,” he said
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Scottish hospitals are hiding blunders by making millions of pounds’ worth of secret payments to victims of negligence, it has been claimed. In one case, NHS Tayside paid out a Scottish record of £3 million to a family without telling health board members employed to scrutinise expenditure. Despite the huge sums of public money involved, officials involved in out-of-court settlements have refused to provide details of what went wrong and who was to blame. Politicians and patient groups are demanding an end to the culture of secrecy surrounding medical compensation amid fears that lack of accountability puts patients at risk.
Figures released under the Freedom of Information Act show that Scotland’s 15 health boards have paid out a total of £16.3 million in the past two years. Under current rules, the health boards are allowed to hide details of the cases. NHS Tayside paid £3 million last year to the family of a 10-year-old girl left with cerebral palsy after errors made during her birth. NHS Argyll and Clyde paid £1 million to another family in similar circumstances. But neither board would say if staff had been disciplined or whether they had changed hospital practice. One NHS Tayside board member was told details of the case were confidential after spotting the £3 million in a financial report.
Shona Robison, SNP Shadow Health Minister, said: “The Executive must be concerned that the current system breeds secretive medicine and extends the harrowing experiences of patients and their families.” A leading lawyer said these two tragic cases were “the tip of the iceberg”. The lawyer, who did not want to be named, added: “There are usually one or two of these sizeable payouts each year. We are approached with dozens of cases every year but many don’t ever come to a conclusion as the health board drags the process out so long. They are hugely difficult and complex cases and many families don’t have the means to see it through all the way.”
NHS Tayside said: “In settling claims there is a duty of confidentiality implicit in the procedure and NHS Tayside will not breach this. Where such claims have been settled in court then these will already be in the public domain. Those settled out of court will remain confidential.” Argyll and Clyde refused to comment.
The Department of Health announced last month that it was to introduce a method of small negligence claims of up to £20,000 to cut back on legal costs. But Andy Kerr, Executive Health Minister, ruled out any changes to the compensation procedure in Scotland. “There is a long standing agreement around confidentiality in cases like this, which we do not propose to break,” he said
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, November 03, 2005
SURPRISE: BRITISH GOVERNMENT HOSPITALS DON'T CARE ABOUT COMPLAINTS
A third of all complaints made by patients against the National Health Service are having to be sent back because hospitals are failing to deal with them properly. Figures released today by the Healthcare Commission reveal that the number of people demanding an independent review of their NHS complaint has more than doubled in a year, after inadequate action by health trusts. The commission, which handles complaints that local trusts fail to resolve, said that it had received more than 8,000 requests in the year to August from people who wanting their matter to be reviewed independently. This compared with 3,700 requests in 2003-04, when the health service was responsible for dealing with the second stage of the complaints process itself.
The commission is now urging the NHS to improve its dealings with dissatisfied patients by resolving more cases at a local level. It also said that trusts needed to provide vital information to the commission more promptly. Fewer than 10 per cent were found to provide annual complaints reports to the commission, as they are required to do by statute. The Healthcare Commission is currently sending one in three cases back to the NHS because it has not dealt with the issue well enough. This figure increased from 27 per cent of complaints at the end of May to 32 per cent by the end of September.
NHS trusts have to file annual reports on complaints to their strategic health authority and the commission, showing how they are resolving them. But the commission said that it had received reports from only 46 out of 597 trusts in England for the financial year 2004-05. It also said that some trusts had failed to send complaints information, slowing down the review process. Current figures show that the commission is investigating 4,500 complaints with about 1,600 of these with them for more than six months. In 25 per cent of the cases that have been waiting six months, it is still waiting for more information from NHS providers.
Marcia Fry, head of operational development at the Healthcare Commission, said that the procedural failures were unacceptable. “The number of NHS complaints referred for independent review has gone up dramatically,” she said. “We have been working as hard as we can to get as many NHS complaints resolved as quickly as possible and those efforts are now bearing fruit. “However, all trusts must also play their part. Patients want complaints resolved quickly and locally, so NHS trusts need to be good at this. “It is worrying that so many of the NHS complaints that come to us — one in three — are having to go back to the NHS to be put right.”
The majority of complaints (53 per cent) were about acute hospital trusts, including foundation trusts. Complaints about GPs, primary care trusts and dentists, made up a third of complaints and 13 per cent related to mental health trusts. The most common complaints seen by the Healthcare Commission concerned poor communication and information for patients, and safe and effective clinical practice.
The commission is now producing a good-practice guide on complaints management — including what it would expect to see in a complaints file. It is also working with trusts that have the highest numbers of unresolved complaints, offering training and advice. The commission also said that it had to improve its processes because some people were waiting too long to have their complaint dealt with
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
A third of all complaints made by patients against the National Health Service are having to be sent back because hospitals are failing to deal with them properly. Figures released today by the Healthcare Commission reveal that the number of people demanding an independent review of their NHS complaint has more than doubled in a year, after inadequate action by health trusts. The commission, which handles complaints that local trusts fail to resolve, said that it had received more than 8,000 requests in the year to August from people who wanting their matter to be reviewed independently. This compared with 3,700 requests in 2003-04, when the health service was responsible for dealing with the second stage of the complaints process itself.
The commission is now urging the NHS to improve its dealings with dissatisfied patients by resolving more cases at a local level. It also said that trusts needed to provide vital information to the commission more promptly. Fewer than 10 per cent were found to provide annual complaints reports to the commission, as they are required to do by statute. The Healthcare Commission is currently sending one in three cases back to the NHS because it has not dealt with the issue well enough. This figure increased from 27 per cent of complaints at the end of May to 32 per cent by the end of September.
NHS trusts have to file annual reports on complaints to their strategic health authority and the commission, showing how they are resolving them. But the commission said that it had received reports from only 46 out of 597 trusts in England for the financial year 2004-05. It also said that some trusts had failed to send complaints information, slowing down the review process. Current figures show that the commission is investigating 4,500 complaints with about 1,600 of these with them for more than six months. In 25 per cent of the cases that have been waiting six months, it is still waiting for more information from NHS providers.
Marcia Fry, head of operational development at the Healthcare Commission, said that the procedural failures were unacceptable. “The number of NHS complaints referred for independent review has gone up dramatically,” she said. “We have been working as hard as we can to get as many NHS complaints resolved as quickly as possible and those efforts are now bearing fruit. “However, all trusts must also play their part. Patients want complaints resolved quickly and locally, so NHS trusts need to be good at this. “It is worrying that so many of the NHS complaints that come to us — one in three — are having to go back to the NHS to be put right.”
The majority of complaints (53 per cent) were about acute hospital trusts, including foundation trusts. Complaints about GPs, primary care trusts and dentists, made up a third of complaints and 13 per cent related to mental health trusts. The most common complaints seen by the Healthcare Commission concerned poor communication and information for patients, and safe and effective clinical practice.
The commission is now producing a good-practice guide on complaints management — including what it would expect to see in a complaints file. It is also working with trusts that have the highest numbers of unresolved complaints, offering training and advice. The commission also said that it had to improve its processes because some people were waiting too long to have their complaint dealt with
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, November 02, 2005
REGULATION MADNESS IN BRITAIN
Britain will be unable to use a flu treatment that could be critical to fighting a pandemic because of strict rules designed to prevent transmission of the human form of mad cow disease, The Times has learnt. Scientists believe that antibodies taken from the blood of recovered flu patients could be used to treat others who develop the disease, providing a third line of defence against a pandemic after vaccines and antiviral drugs such as Tamiflu. The technique, however, could not be used in the UK because of a ban on British blood products in medical therapies, introduced seven years ago to tackle a theoretical risk of spreading new variant Creutzfeldt-Jakob disease (vCJD).
Sir Peter Lachmann, Emeritus Professor of Immunology at the University of Cambridge and a past president of the Academy of Medical Sciences, said that the minuscule chance of contracting vCJD from antibody treatments was far outweighed by their potential benefit in a pandemic. “Compared to flu, it is a trivial risk, and it can be reduced,” he said. “Preparedness for a pandemic means doing something about these regulations, so we don’t have any obstacles when the time comes.”
Treatments and vaccines based on antibodies, known as immunoglobulins, are already used widely against diseases such as hepatitis A, chicken pox and measles. Blood is removed from a patient who has recovered and the liquid plasma part is mixed with alcohol and separated into its components by fractionation. One of the resulting fractions is rich in immunoglobulins that the immune system has made to fight the pathogen in question, and these can then be given to other patients exposed to the disease, either to prevent it from developing or to assist recovery. The approach has not yet been used against flu in humans, largely because existing vaccines and antivirals are more effective and less risky for ordinary seasonal strains of the virus. Research in mice, however, suggests that immunoglobulins would be an effective way of alleviating symptoms. Immunoglobulins would also be a vital alternative to Tamiflu if a pandemic strain developed resistance to the antiviral drug, as experts predict.
“This is an option,” Robin Thorpe, head of immunology at the National Institute for Biological Standards and Control (NIBSC) in Potters Bar, Hertfordshire, said. “It really needs to be thought through as early as possible. If it is deemed to be a way forward, we’ll need time to do it properly.”
Stephen Inglis, director of the NIBSC, said: “It is clearly part of our armoury and there isn’t any reason to think it shouldn’t work. The problem though is that you would have to wait until you had patients who had recovered. There may also be practical problems with obtaining immunoglobulin and ensuring it is safe to give to other patients.”
Under regulations introduced in 1998, immunoglobulins and other plasma products cannot be made from British blood because of the risk of vCJD. A spokeswoman for the Department of Health said that it was aware of the potential role of immunoglobulins, but the approach was not yet considered a frontline pandemic defence.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Britain will be unable to use a flu treatment that could be critical to fighting a pandemic because of strict rules designed to prevent transmission of the human form of mad cow disease, The Times has learnt. Scientists believe that antibodies taken from the blood of recovered flu patients could be used to treat others who develop the disease, providing a third line of defence against a pandemic after vaccines and antiviral drugs such as Tamiflu. The technique, however, could not be used in the UK because of a ban on British blood products in medical therapies, introduced seven years ago to tackle a theoretical risk of spreading new variant Creutzfeldt-Jakob disease (vCJD).
Sir Peter Lachmann, Emeritus Professor of Immunology at the University of Cambridge and a past president of the Academy of Medical Sciences, said that the minuscule chance of contracting vCJD from antibody treatments was far outweighed by their potential benefit in a pandemic. “Compared to flu, it is a trivial risk, and it can be reduced,” he said. “Preparedness for a pandemic means doing something about these regulations, so we don’t have any obstacles when the time comes.”
Treatments and vaccines based on antibodies, known as immunoglobulins, are already used widely against diseases such as hepatitis A, chicken pox and measles. Blood is removed from a patient who has recovered and the liquid plasma part is mixed with alcohol and separated into its components by fractionation. One of the resulting fractions is rich in immunoglobulins that the immune system has made to fight the pathogen in question, and these can then be given to other patients exposed to the disease, either to prevent it from developing or to assist recovery. The approach has not yet been used against flu in humans, largely because existing vaccines and antivirals are more effective and less risky for ordinary seasonal strains of the virus. Research in mice, however, suggests that immunoglobulins would be an effective way of alleviating symptoms. Immunoglobulins would also be a vital alternative to Tamiflu if a pandemic strain developed resistance to the antiviral drug, as experts predict.
“This is an option,” Robin Thorpe, head of immunology at the National Institute for Biological Standards and Control (NIBSC) in Potters Bar, Hertfordshire, said. “It really needs to be thought through as early as possible. If it is deemed to be a way forward, we’ll need time to do it properly.”
Stephen Inglis, director of the NIBSC, said: “It is clearly part of our armoury and there isn’t any reason to think it shouldn’t work. The problem though is that you would have to wait until you had patients who had recovered. There may also be practical problems with obtaining immunoglobulin and ensuring it is safe to give to other patients.”
Under regulations introduced in 1998, immunoglobulins and other plasma products cannot be made from British blood because of the risk of vCJD. A spokeswoman for the Department of Health said that it was aware of the potential role of immunoglobulins, but the approach was not yet considered a frontline pandemic defence.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, November 01, 2005
DRUGGIE DOCTOR OK WITH THE GOVERNMENT
Disgraced brain surgeon Tim Steel has been cleared to return to work just weeks after being caught with cocaine in Queensland. The NSW Medical Board last week declared Steel fit to work provided he undergoes regular drug tests in the next 18 months. But the Sydney hospitals Steel worked at - St Vincent's public and private hospitals and Concord Hospital - are still considering whether to reinstate him.
David Faktor, a spokesman for St Vincent's public and private hospitals, confirmed a letter received from the Medical Board said Steel could be "reinstated without restrictions". "That means he can consult and treat patients and perform surgery," Mr Faktor said. "St Vincent's Public Hospital is going to meet with Dr Steel soon to discuss the letter. "Dr Steel will have to meet a unique set of principles before he can be reinstated."
A spokeswoman for Concord Hospital, where Steel is a visiting medical officer, said: "Dr Steel's return, and the terms of that return, are still under consideration."
The 41-year-old socialite was arrested during a police raid on a Surfers Paradise nightclub on September 18. He pleaded guilty and was allowed to walk free on condition he attended drug counselling or forfeit a $500 surety. Steel, who had been on the Gold Coast for a meeting of brain and spinal surgeons, is considered one of Australia's best neurosurgeons. Last weekend, he was photographed at his luxury Woollahra mansion with new flame Emma-Kate Sullivan. Ms Sullivan, a former Sale Of The Century glamour girl, is the former wife ofHong Kong-based jockey Shane Dye. Steel was formerly married to model Donnah Wise, but they spit about two years ago.
Source
THE BRITS ARE GETTING DESPERATE
Supermarkets and high-street chemists could be asked to provide NHS services, Health Secretary Patricia Hewitt said. Ms Hewitt said GPs in London were sending patients to a weight-loss programme run by a chemist. She said she would look to see if the idea could be expanded to other areas.
Speaking at a health conference in Birmingham Ms Hewitt told the BBC: "One of the ideas that came up in one of the earlier consultations was exactly that - could you have Boots or a supermarket or whoever, some other organisation or a charity or voluntary group providing more services for NHS patients and on the NHS."
Ms Hewitt's comments will cause concern among some in the Labour Party and trade unions. There was anger at this year's Labour Party conference over plans to give private firms a greater role in the NHS.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Disgraced brain surgeon Tim Steel has been cleared to return to work just weeks after being caught with cocaine in Queensland. The NSW Medical Board last week declared Steel fit to work provided he undergoes regular drug tests in the next 18 months. But the Sydney hospitals Steel worked at - St Vincent's public and private hospitals and Concord Hospital - are still considering whether to reinstate him.
David Faktor, a spokesman for St Vincent's public and private hospitals, confirmed a letter received from the Medical Board said Steel could be "reinstated without restrictions". "That means he can consult and treat patients and perform surgery," Mr Faktor said. "St Vincent's Public Hospital is going to meet with Dr Steel soon to discuss the letter. "Dr Steel will have to meet a unique set of principles before he can be reinstated."
A spokeswoman for Concord Hospital, where Steel is a visiting medical officer, said: "Dr Steel's return, and the terms of that return, are still under consideration."
The 41-year-old socialite was arrested during a police raid on a Surfers Paradise nightclub on September 18. He pleaded guilty and was allowed to walk free on condition he attended drug counselling or forfeit a $500 surety. Steel, who had been on the Gold Coast for a meeting of brain and spinal surgeons, is considered one of Australia's best neurosurgeons. Last weekend, he was photographed at his luxury Woollahra mansion with new flame Emma-Kate Sullivan. Ms Sullivan, a former Sale Of The Century glamour girl, is the former wife ofHong Kong-based jockey Shane Dye. Steel was formerly married to model Donnah Wise, but they spit about two years ago.
Source
THE BRITS ARE GETTING DESPERATE
Supermarkets and high-street chemists could be asked to provide NHS services, Health Secretary Patricia Hewitt said. Ms Hewitt said GPs in London were sending patients to a weight-loss programme run by a chemist. She said she would look to see if the idea could be expanded to other areas.
Speaking at a health conference in Birmingham Ms Hewitt told the BBC: "One of the ideas that came up in one of the earlier consultations was exactly that - could you have Boots or a supermarket or whoever, some other organisation or a charity or voluntary group providing more services for NHS patients and on the NHS."
Ms Hewitt's comments will cause concern among some in the Labour Party and trade unions. There was anger at this year's Labour Party conference over plans to give private firms a greater role in the NHS.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, October 31, 2005
FEDS IGNORE MALPRACTICE LAW
Negligence by government doctors obviously has to be shielded where possible
Federal health agencies routinely flout a requirement to report any cases in which they pay medical malpractice claims against the government, federal investigators said Tuesday. Such reports are meant to protect the public against incompetent doctors. Hospitals and health plans check such information before hiring doctors or granting them privileges. Under a 1986 law, insurance companies, hospitals and others who pay malpractice claims on behalf of doctors must report the information to a federal clearinghouse known as the National Practitioner Data Bank. Under a 1990 policy directive, federal health agencies are supposed to report the same type of information within 30 days after a court judgment is awarded or a case is settled.
But the new inspector general of the Department of Health and Human Services, Daniel R. Levinson, found that the department itself had repeatedly ignored this requirement. From 1997 to 2004, Mr. Levinson said, 474 cases "should have been reported to the National Practitioner Data Bank," but were not. This failure, he said, deprives state licensing boards of information they need when they decide to grant, restrict or revoke doctors' licenses. Moreover, he said, "underreporting of the department's own medical malpractice cases lessens the usefulness of the National Practitioner Data Bank and undermines departmental efforts to regulate private and public sector compliance" with the reporting requirements.
Senator Ron Wyden, Democrat of Oregon, author of the law that created the databank, said: "It is imperative that the federal government fully comply with the reporting requirements. The National Practitioner Data Bank is only as good as the information it contains."
Federal health officials told the inspector general that they did not want to be bound by certain requirements that applied to insurers and hospitals in the private sector. Specifically, they said, they did not want to report payments if they believed that the care provided by a doctor measured up to an appropriate standard of care. But Mr. Levinson said, "The private sector is required to report all medical malpractice settlements and judgments" to the databank, regardless of whether they believed that the doctors had been negligent.
State medical boards use information in the databank to evaluate the performance of doctors. In at least 19 states, consumers can obtain information about malpractice payments made by or on behalf of doctors.
Mr. Levinson said the National Institutes of Health and the Indian Health Service did not want to report malpractice payments when, in their judgment, government doctors had provided acceptable care. Payment of claims does not prove that a doctor is bad, but it may prompt consumers and hospitals to examine a doctor's record more closely. In some cases, government lawyers, like insurance companies, settle claims to avoid the costs of litigation. Doctors often have little say over whether the Justice Department or an insurer decides to settle.
Senator Wyden said that "a pattern of six or seven malpractice payments on behalf of a doctor should set off bells," even if the doctor has not been formally found to be negligent. In choosing a doctor, he said, many consumers would want to know such information.
Federal agencies told the inspector general that they had failed to report some malpractice payments because they could not find the case files. Thus, for example, one agency in the department, the Health Resources and Services Administration, said that "in many instances, relevant data or records were misplaced or lost." The health services agency operates the databank and finances community health centers around the country. The federal government serves as the primary insurer for such health centers and pays malpractice claims on their behalf, as if their employees were working directly for the government. Such payments are supposed to be reported to the databank.
Betty James Duke, administrator of the health services agency, said she would soon recommend changes to "ensure greater compliance" with the reporting requirements. But in discussions with the inspector general's staff, federal agencies did not make any firm commitments. "It was not clear whether they would fully comply," Mr. Levinson wrote
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Negligence by government doctors obviously has to be shielded where possible
Federal health agencies routinely flout a requirement to report any cases in which they pay medical malpractice claims against the government, federal investigators said Tuesday. Such reports are meant to protect the public against incompetent doctors. Hospitals and health plans check such information before hiring doctors or granting them privileges. Under a 1986 law, insurance companies, hospitals and others who pay malpractice claims on behalf of doctors must report the information to a federal clearinghouse known as the National Practitioner Data Bank. Under a 1990 policy directive, federal health agencies are supposed to report the same type of information within 30 days after a court judgment is awarded or a case is settled.
But the new inspector general of the Department of Health and Human Services, Daniel R. Levinson, found that the department itself had repeatedly ignored this requirement. From 1997 to 2004, Mr. Levinson said, 474 cases "should have been reported to the National Practitioner Data Bank," but were not. This failure, he said, deprives state licensing boards of information they need when they decide to grant, restrict or revoke doctors' licenses. Moreover, he said, "underreporting of the department's own medical malpractice cases lessens the usefulness of the National Practitioner Data Bank and undermines departmental efforts to regulate private and public sector compliance" with the reporting requirements.
Senator Ron Wyden, Democrat of Oregon, author of the law that created the databank, said: "It is imperative that the federal government fully comply with the reporting requirements. The National Practitioner Data Bank is only as good as the information it contains."
Federal health officials told the inspector general that they did not want to be bound by certain requirements that applied to insurers and hospitals in the private sector. Specifically, they said, they did not want to report payments if they believed that the care provided by a doctor measured up to an appropriate standard of care. But Mr. Levinson said, "The private sector is required to report all medical malpractice settlements and judgments" to the databank, regardless of whether they believed that the doctors had been negligent.
State medical boards use information in the databank to evaluate the performance of doctors. In at least 19 states, consumers can obtain information about malpractice payments made by or on behalf of doctors.
Mr. Levinson said the National Institutes of Health and the Indian Health Service did not want to report malpractice payments when, in their judgment, government doctors had provided acceptable care. Payment of claims does not prove that a doctor is bad, but it may prompt consumers and hospitals to examine a doctor's record more closely. In some cases, government lawyers, like insurance companies, settle claims to avoid the costs of litigation. Doctors often have little say over whether the Justice Department or an insurer decides to settle.
Senator Wyden said that "a pattern of six or seven malpractice payments on behalf of a doctor should set off bells," even if the doctor has not been formally found to be negligent. In choosing a doctor, he said, many consumers would want to know such information.
Federal agencies told the inspector general that they had failed to report some malpractice payments because they could not find the case files. Thus, for example, one agency in the department, the Health Resources and Services Administration, said that "in many instances, relevant data or records were misplaced or lost." The health services agency operates the databank and finances community health centers around the country. The federal government serves as the primary insurer for such health centers and pays malpractice claims on their behalf, as if their employees were working directly for the government. Such payments are supposed to be reported to the databank.
Betty James Duke, administrator of the health services agency, said she would soon recommend changes to "ensure greater compliance" with the reporting requirements. But in discussions with the inspector general's staff, federal agencies did not make any firm commitments. "It was not clear whether they would fully comply," Mr. Levinson wrote
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, October 30, 2005
A LITTLE BIT OF STATE-FREE MEDICINE COMING UP?
Take a sample of saliva from inside your mouth. Put it into a vial of test fluid, and 20 minutes later you will learn whether you are infected with the virus that causes AIDS. The OraQuick Advance test is widely available in health clinics and doctors' offices, and the Food and Drug Administration (FDA) is considering permitting it to be sold over the counter. Supporters of home kits say they will spur more people to be tested and get treatment sooner if infected. However, concerns have been raised about whether a doctor or counselor should be nearby when people find out they are HIV-positive.
If approved, OraQuick Advance would become the first FDA-approved test that a person can take without the presence of a health care worker, or the requirement of mailing a sample to a lab.
The maker, OraSure Technologies of Bethlehem, Pa., has not decided how much it will charge consumers for the kit, said Ron Spair, the company's chief financial officer. The company sells the kits for between $12 and $17 to clinics and doctors, he said. The test is accurate more than 99 percent of the time, Mr. Spair said. Still, a positive result from the test should be confirmed through an additional test by doctors or public health officials, he said.
To take the test, a person swabs the inside of his mouth between the cheek and gum, and inserts the saliva into a vial of fluid that comes with the kit. Twenty minutes later, an indicator will light up if the test detects the presence of HIV-1 or HIV-2 antibodies. Those antibodies become present in the body several weeks after a person acquires HIV; the test will not detect the virus if it was acquired more recently.
Next Thursday, the FDA's Blood Products Advisory Committee will consider whether to recommend the product for over-the-counter sales. The FDA has the final say; it usually follows the advice of its advisory committees.
The kits are a good idea, said Terje Anderson, executive director of the National Association of People with AIDS. He said he doubts they will be as popular as at-home pregnancy-test kits, suggesting most people who want an HIV test would prefer to be with a doctor when they are tested. Use of the kits also may depend on their price. "Overall, I would say they are a step forward," he said. "Anything that helps more people learn their status is a good thing." ....
About 1 million people in the United States are thought to have HIV. The Centers for Disease Control and Prevention estimates nearly 300,000 people have the virus but do not know it.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Take a sample of saliva from inside your mouth. Put it into a vial of test fluid, and 20 minutes later you will learn whether you are infected with the virus that causes AIDS. The OraQuick Advance test is widely available in health clinics and doctors' offices, and the Food and Drug Administration (FDA) is considering permitting it to be sold over the counter. Supporters of home kits say they will spur more people to be tested and get treatment sooner if infected. However, concerns have been raised about whether a doctor or counselor should be nearby when people find out they are HIV-positive.
If approved, OraQuick Advance would become the first FDA-approved test that a person can take without the presence of a health care worker, or the requirement of mailing a sample to a lab.
The maker, OraSure Technologies of Bethlehem, Pa., has not decided how much it will charge consumers for the kit, said Ron Spair, the company's chief financial officer. The company sells the kits for between $12 and $17 to clinics and doctors, he said. The test is accurate more than 99 percent of the time, Mr. Spair said. Still, a positive result from the test should be confirmed through an additional test by doctors or public health officials, he said.
To take the test, a person swabs the inside of his mouth between the cheek and gum, and inserts the saliva into a vial of fluid that comes with the kit. Twenty minutes later, an indicator will light up if the test detects the presence of HIV-1 or HIV-2 antibodies. Those antibodies become present in the body several weeks after a person acquires HIV; the test will not detect the virus if it was acquired more recently.
Next Thursday, the FDA's Blood Products Advisory Committee will consider whether to recommend the product for over-the-counter sales. The FDA has the final say; it usually follows the advice of its advisory committees.
The kits are a good idea, said Terje Anderson, executive director of the National Association of People with AIDS. He said he doubts they will be as popular as at-home pregnancy-test kits, suggesting most people who want an HIV test would prefer to be with a doctor when they are tested. Use of the kits also may depend on their price. "Overall, I would say they are a step forward," he said. "Anything that helps more people learn their status is a good thing." ....
About 1 million people in the United States are thought to have HIV. The Centers for Disease Control and Prevention estimates nearly 300,000 people have the virus but do not know it.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, October 29, 2005
Fatal Flows - Doctors on the Move
The article below is from one of the world's most prestigious medical journals but displays a grade-school level of thinking. Their solution to the problem of third-world doctors migrating to richer countreies? More aid! Throw dollars at it! It shows how cretinous people can be when speaking outside their own narrow field of expertise. That the USA and other Western countries could improve their educational systems so that they themselves trained all the doctors they need is glided over. That aid will only buy golden bedsteads and Swiss bank accounts for the corrupt ruling elites of the poor countries concerned is CERTAINLY not mentioned
"The movement of physicians from poor to rich countries is a growing obstacle to global health. Ghana, with 0.09 physician per thousand population, sends doctors to the United Kingdom, which has 18 times as many physicians per capita. The United States, with 5 percent of the world's population, employs 11 percent of the globe's physicians, and its demand is growing. As underscored in the article by Mullan in this issue of the Journal, today, 25 percent of U.S. physicians are international medical graduates, and the number is even higher in the United Kingdom, Canada, and Australia. Many of these graduates come from poor countries with high disease burdens - precisely those nations that can least afford to lose their professionals.
The plain truth is that medical systems in the United States and other wealthy countries are heavily dependent on imported workers - for hospital staffing, coverage of underserved areas, and meeting gaps in skill levels. U.S. medical schools turn out a relatively stable 17,000 graduates annually, but the demand for residency staffing exceeds this number by 30 percent. This gap is filled by international medical graduates, most of whom will attain citizenship or permanent residence and remain in the United States to practice medicine. Medical coverage of disadvantaged Americans also depends on U.S. federal waivers for international medical graduates to enter primary care practice in underserved areas. The dependence is not confined to doctors, since nurses and other medically skilled workers are in equally high demand.
International professional mobility is inevitable when persons have skills they can sell in a global marketplace. The migration of medical professionals reflects a balance of supply and demand - but it has ethical implications, too. Demand in affluent countries pulls health care workers from poor countries as low salaries, limited career prospects, poor working environments, family aspirations, and political insecurity push them out. The beneficiaries are the importing countries and, of course, the migrants themselves. Countries that intentionally export skilled workers tolerate "brain drain" in exchange for financial remittances, relief from high unemployment rates, and the possibility of scientific connections. Markets for medical labor operate in and across all of the major world regions, with Asians moving into North America, Egyptians into countries with oil-exporting economies, and Eastern Europeans into an expanding European Union.4 South Africa exports health professionals to wealthier countries while simultaneously importing them from neighboring African nations.
Emigration from the poorest countries is unquestionably damaging. More than a dozen countries in sub-Saharan Africa have plummeting life expectancies mostly as a result of the epidemic of human immunodeficiency virus infection and AIDS.5 With just 600,000 doctors, nurses, and midwives for 600 million people, African countries need the equivalent of at least 1 million additional workers in order to offer basic services consistent with the United Nations Millennium Development Goals. Instead, these countries are moving backward, with the hemorrhaging of clinical and professional leaders crippling the already fragile health care systems. These failures have been characterized as "fatal flows," because poor people are left vulnerable to devastating diseases and avoidable death. The exodus also constitutes a silent theft from the poorest countries through the loss of public subsidies for medical education, estimated at $500 million annually for all emigrating skilled workers from Africa.
Moral outrage over the "poaching" behavior on the part of rich countries has reached a crescendo. Yet simply blocking migration is neither effective nor ethical, since freedom of movement is a basic human right. The challenge is to advance human health while protecting health workers' rights to seek gainful employment. The first responsibility for action belongs with each country to "train, retain, and sustain" its workforces through national plans that improve salaries and working conditions, revitalize education, and mobilize paraprofessional and community workers whose services are demonstrably more cost-effective and who are less likely to emigrate. Since such urgent actions must be pursued in the world's poorest nations, much will depend on the global community's provision of appropriate financial and technical aid".
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The article below is from one of the world's most prestigious medical journals but displays a grade-school level of thinking. Their solution to the problem of third-world doctors migrating to richer countreies? More aid! Throw dollars at it! It shows how cretinous people can be when speaking outside their own narrow field of expertise. That the USA and other Western countries could improve their educational systems so that they themselves trained all the doctors they need is glided over. That aid will only buy golden bedsteads and Swiss bank accounts for the corrupt ruling elites of the poor countries concerned is CERTAINLY not mentioned
"The movement of physicians from poor to rich countries is a growing obstacle to global health. Ghana, with 0.09 physician per thousand population, sends doctors to the United Kingdom, which has 18 times as many physicians per capita. The United States, with 5 percent of the world's population, employs 11 percent of the globe's physicians, and its demand is growing. As underscored in the article by Mullan in this issue of the Journal, today, 25 percent of U.S. physicians are international medical graduates, and the number is even higher in the United Kingdom, Canada, and Australia. Many of these graduates come from poor countries with high disease burdens - precisely those nations that can least afford to lose their professionals.
The plain truth is that medical systems in the United States and other wealthy countries are heavily dependent on imported workers - for hospital staffing, coverage of underserved areas, and meeting gaps in skill levels. U.S. medical schools turn out a relatively stable 17,000 graduates annually, but the demand for residency staffing exceeds this number by 30 percent. This gap is filled by international medical graduates, most of whom will attain citizenship or permanent residence and remain in the United States to practice medicine. Medical coverage of disadvantaged Americans also depends on U.S. federal waivers for international medical graduates to enter primary care practice in underserved areas. The dependence is not confined to doctors, since nurses and other medically skilled workers are in equally high demand.
International professional mobility is inevitable when persons have skills they can sell in a global marketplace. The migration of medical professionals reflects a balance of supply and demand - but it has ethical implications, too. Demand in affluent countries pulls health care workers from poor countries as low salaries, limited career prospects, poor working environments, family aspirations, and political insecurity push them out. The beneficiaries are the importing countries and, of course, the migrants themselves. Countries that intentionally export skilled workers tolerate "brain drain" in exchange for financial remittances, relief from high unemployment rates, and the possibility of scientific connections. Markets for medical labor operate in and across all of the major world regions, with Asians moving into North America, Egyptians into countries with oil-exporting economies, and Eastern Europeans into an expanding European Union.4 South Africa exports health professionals to wealthier countries while simultaneously importing them from neighboring African nations.
Emigration from the poorest countries is unquestionably damaging. More than a dozen countries in sub-Saharan Africa have plummeting life expectancies mostly as a result of the epidemic of human immunodeficiency virus infection and AIDS.5 With just 600,000 doctors, nurses, and midwives for 600 million people, African countries need the equivalent of at least 1 million additional workers in order to offer basic services consistent with the United Nations Millennium Development Goals. Instead, these countries are moving backward, with the hemorrhaging of clinical and professional leaders crippling the already fragile health care systems. These failures have been characterized as "fatal flows," because poor people are left vulnerable to devastating diseases and avoidable death. The exodus also constitutes a silent theft from the poorest countries through the loss of public subsidies for medical education, estimated at $500 million annually for all emigrating skilled workers from Africa.
Moral outrage over the "poaching" behavior on the part of rich countries has reached a crescendo. Yet simply blocking migration is neither effective nor ethical, since freedom of movement is a basic human right. The challenge is to advance human health while protecting health workers' rights to seek gainful employment. The first responsibility for action belongs with each country to "train, retain, and sustain" its workforces through national plans that improve salaries and working conditions, revitalize education, and mobilize paraprofessional and community workers whose services are demonstrably more cost-effective and who are less likely to emigrate. Since such urgent actions must be pursued in the world's poorest nations, much will depend on the global community's provision of appropriate financial and technical aid".
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, October 28, 2005
DODGING A PROBLEM RATHER THAN SOLVING IT
But better than nothing, I suppose
The first state subsidies to help doctors worst hit by rising medical malpractice premiums are being distributed, the New Jersey Department of Banking and Insurance said Monday. Payments of nearly $11,000 each are being made to about 1,200 medical specialists: neurosurgeons, obstetricians and radiologists who read mammograms. The subsidy payments are being made under a 2004 law, the New Jersey Medical Care Access and Responsibility and Patients First Act, intended to ensure there are enough of certain specialists to treat patients in the state.
The three specialist groups are among those that took the worst hit when malpractice insurance premiums began spiking a few years ago. Doctors' groups say many specialists retired or moved to states with lower malpractice premiums to avoid high insurance costs in New Jersey.
Donald Bryan, acting commissioner of banking and insurance, said in a prepared statement that the subsidy is a key component of state legislation to address cost and availability of medical malpractice insurance. The payments are the first in a three-year program, he said. The subsidies come from the state's Medical Malpractice Liability Insurance Premium Assistance Fund. It is funded by $75-a-year fees paid by practicing doctors, dentists, chiropractors, podiatrists, optometrists and attorneys, as well as a $3-per-employee annual fee collected from most businesses.
According to the department, 65 percent of money in the fund goes for premium subsidies. The rest is split among the New Jersey FamilyCare health insurance program, hospital charity care reimbursements and reimbursement of student loans for obstetricians and gynecologists who agree to practice in New Jersey.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
But better than nothing, I suppose
The first state subsidies to help doctors worst hit by rising medical malpractice premiums are being distributed, the New Jersey Department of Banking and Insurance said Monday. Payments of nearly $11,000 each are being made to about 1,200 medical specialists: neurosurgeons, obstetricians and radiologists who read mammograms. The subsidy payments are being made under a 2004 law, the New Jersey Medical Care Access and Responsibility and Patients First Act, intended to ensure there are enough of certain specialists to treat patients in the state.
The three specialist groups are among those that took the worst hit when malpractice insurance premiums began spiking a few years ago. Doctors' groups say many specialists retired or moved to states with lower malpractice premiums to avoid high insurance costs in New Jersey.
Donald Bryan, acting commissioner of banking and insurance, said in a prepared statement that the subsidy is a key component of state legislation to address cost and availability of medical malpractice insurance. The payments are the first in a three-year program, he said. The subsidies come from the state's Medical Malpractice Liability Insurance Premium Assistance Fund. It is funded by $75-a-year fees paid by practicing doctors, dentists, chiropractors, podiatrists, optometrists and attorneys, as well as a $3-per-employee annual fee collected from most businesses.
According to the department, 65 percent of money in the fund goes for premium subsidies. The rest is split among the New Jersey FamilyCare health insurance program, hospital charity care reimbursements and reimbursement of student loans for obstetricians and gynecologists who agree to practice in New Jersey.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, October 27, 2005
YOUR REGULATORS WILL PROTECT YOU -- NOT
I think a $1,000 fine for killing a baby is a bit light. Don't you?
Because of the lack of information available to the public about our doctor's malpractice history, what my wife, Christine, and I didn't know could have saved our son Ian's life.
When our doctor gave Christine a small brown envelope of pills, with handwritten instructions to "take every four hours," it was impossible to know he had eight previous malpractice claims and restricted privileges at the local hospital. We later discovered this drug was not approved for this use. If we had been given the drugs at the pharmacy it would been boldly labeled explicitly stating it was not to be taken by a pregnant woman.
The drug caused violent, extreme contractions, smothering Ian. After hours of suffering, he was born blue and lifeless -- not breathing and without a hearbeat. Ian was revived and lived, but with severe injuries. He required around-the-clock care and ate through a feeding tube. His mind would never develop beyond that of a 6-month-old infant. Ian died at age 4, due to complications from his preventable injuries.
We filed a complaint with the state medical board. After a two-year wait, the board finally agreed with our accusation. But while the board found the doctor guilty of malpractice and misconduct, it simply issued a $1,000 fine. This obstetrician, who has injured at least two other babies after Ian, continues to practice.
Because of what happened to our son, I helped draft Initiative 336 -- a measure that will hold doctors, lawyers and the insurance industry accountable. It puts patients first by implementing measures that would allow them to know their doctors' complete malpractice history. Had this been in place when Ian was born, we certainly would have selected a different obstetrician.....
Less than half -- 44.7 percent -- of doctors with five or more malpractice payouts have been disciplined by Washington authorities or a state medical board, according to a recent Public Citizen study. Currently, the few bad doctors who cause the majority of medical malpractice incidents have no incentive to change their ways. I-336 will make this small population of bad doctors accountable for their actions.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
I think a $1,000 fine for killing a baby is a bit light. Don't you?
Because of the lack of information available to the public about our doctor's malpractice history, what my wife, Christine, and I didn't know could have saved our son Ian's life.
When our doctor gave Christine a small brown envelope of pills, with handwritten instructions to "take every four hours," it was impossible to know he had eight previous malpractice claims and restricted privileges at the local hospital. We later discovered this drug was not approved for this use. If we had been given the drugs at the pharmacy it would been boldly labeled explicitly stating it was not to be taken by a pregnant woman.
The drug caused violent, extreme contractions, smothering Ian. After hours of suffering, he was born blue and lifeless -- not breathing and without a hearbeat. Ian was revived and lived, but with severe injuries. He required around-the-clock care and ate through a feeding tube. His mind would never develop beyond that of a 6-month-old infant. Ian died at age 4, due to complications from his preventable injuries.
We filed a complaint with the state medical board. After a two-year wait, the board finally agreed with our accusation. But while the board found the doctor guilty of malpractice and misconduct, it simply issued a $1,000 fine. This obstetrician, who has injured at least two other babies after Ian, continues to practice.
Because of what happened to our son, I helped draft Initiative 336 -- a measure that will hold doctors, lawyers and the insurance industry accountable. It puts patients first by implementing measures that would allow them to know their doctors' complete malpractice history. Had this been in place when Ian was born, we certainly would have selected a different obstetrician.....
Less than half -- 44.7 percent -- of doctors with five or more malpractice payouts have been disciplined by Washington authorities or a state medical board, according to a recent Public Citizen study. Currently, the few bad doctors who cause the majority of medical malpractice incidents have no incentive to change their ways. I-336 will make this small population of bad doctors accountable for their actions.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, October 26, 2005
A little perspective on the avian flu panic
Some reasons not to bow down before the government as our saviour. See also my post of 24th.
Okay, by now we have all about had our fill of hearing about the impending “bird flu pandemic” that is going to destroy half the population if we don’t jump into line for vaccinations and allow our civil liberties to be entirely ignored (instead of just mostly, as has been the case for years now) as “martial law” is imposed around us. I am in no sense of the word an expert on this subject, although I’ve been writing news blurbs on this and related matters for several weeks now. But in the process I’ve encountered enough ambiguity on the topic to make me at least skeptical about the warnings and the pending proscriptions.....
* Thus far, the evidence of human-to-human transmission of the “avian flu” virus is both sparse and anecdotal. The vast majority of reports can be traced to chicken-farmers, regularly inhaling the infected air around their diseased flocks, and/or contracting the virus directly from handling the chickens. The few exceptions may not even be the same ailment, as it turns out. Meanwhile, the continued reports of “bird flu sightings” in other countries besides Southeast Asia turn out to be BIRDS showing some sortr of disease, not HUMANS diagnosed with the specific H5N1 virus that has everyone so concerned. In short, as one story (Human bird flu: “science fiction”) puts it, the whole thing (like so many anxieties) may be just another “debt that may never come due.”
* Meanwhile, the reports that keep circulating in the news are doing very little to clarify the fact that the outbreaks being reported around the world are in birds, not humans. When you see a headlline like the one in today’s papers, “Bird Flu Arrives In England,” take note of the fact that it is about a parrot, which was quarantined alongside birds of other species that already had the H5N1 virus. We already know this thing is deadly to birds, of a variety of species; we still have no reported cases of a human being, taken completely away from the infected birds, passing the disease to another human being, who had not already been exposed to a diseased bird!
* There is as yet no “vaccine” developed for the human strain – and there cannot be, at least until a “human strain” is detected, extracted, experimented on and then diluted, so a vaccine can be prepared from allegedly weakened and/or denatured cultures. (Meanwhile, CDC labs around the country are doing experiments to recreate the KNOWN deadly virus of the 1918 Spanish Influenza, with some misguided idea that they might be able to create a vaccine from that pathogen that would combat this one, while pharmaceutical companies seek a shield against potential lawsuits. We should be far more concerned about that full-strength disease being released, accidentally or otherwise, in the wake of the present hysteria.)
* Meanwhile, the history of influenza epidemics may hold more warnings about “vaccination programs” than about successful cures. The very concept of vaccination still requires that the first step be a virulent killer virus, from with you then make a denatured or weakened version. And if that particular killer virus does not exist, you have to create it! Does that really make sense in this case?
* There is also at least one theory that the problem behind nearly all systemic illness is the indiscriminate taking of aspirin to hold down a fever. The fever is treated as part of the illness, when it is in fact the body’s defense mechanism to fight it; if you suppress the fever at the wrong stage of recovery, all you do is allow a virus to propagate in peace, and then it comes back in fuller force. There’s even a rather long webpage that outlines the effects of widespread use of aspirin (for fever reduction) explaining how and why the 1918 Flu was so devastating, and how we might avoid a repeat, simply by letting the fever perform its proper role in healing.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Some reasons not to bow down before the government as our saviour. See also my post of 24th.
Okay, by now we have all about had our fill of hearing about the impending “bird flu pandemic” that is going to destroy half the population if we don’t jump into line for vaccinations and allow our civil liberties to be entirely ignored (instead of just mostly, as has been the case for years now) as “martial law” is imposed around us. I am in no sense of the word an expert on this subject, although I’ve been writing news blurbs on this and related matters for several weeks now. But in the process I’ve encountered enough ambiguity on the topic to make me at least skeptical about the warnings and the pending proscriptions.....
* Thus far, the evidence of human-to-human transmission of the “avian flu” virus is both sparse and anecdotal. The vast majority of reports can be traced to chicken-farmers, regularly inhaling the infected air around their diseased flocks, and/or contracting the virus directly from handling the chickens. The few exceptions may not even be the same ailment, as it turns out. Meanwhile, the continued reports of “bird flu sightings” in other countries besides Southeast Asia turn out to be BIRDS showing some sortr of disease, not HUMANS diagnosed with the specific H5N1 virus that has everyone so concerned. In short, as one story (Human bird flu: “science fiction”) puts it, the whole thing (like so many anxieties) may be just another “debt that may never come due.”
* Meanwhile, the reports that keep circulating in the news are doing very little to clarify the fact that the outbreaks being reported around the world are in birds, not humans. When you see a headlline like the one in today’s papers, “Bird Flu Arrives In England,” take note of the fact that it is about a parrot, which was quarantined alongside birds of other species that already had the H5N1 virus. We already know this thing is deadly to birds, of a variety of species; we still have no reported cases of a human being, taken completely away from the infected birds, passing the disease to another human being, who had not already been exposed to a diseased bird!
* There is as yet no “vaccine” developed for the human strain – and there cannot be, at least until a “human strain” is detected, extracted, experimented on and then diluted, so a vaccine can be prepared from allegedly weakened and/or denatured cultures. (Meanwhile, CDC labs around the country are doing experiments to recreate the KNOWN deadly virus of the 1918 Spanish Influenza, with some misguided idea that they might be able to create a vaccine from that pathogen that would combat this one, while pharmaceutical companies seek a shield against potential lawsuits. We should be far more concerned about that full-strength disease being released, accidentally or otherwise, in the wake of the present hysteria.)
* Meanwhile, the history of influenza epidemics may hold more warnings about “vaccination programs” than about successful cures. The very concept of vaccination still requires that the first step be a virulent killer virus, from with you then make a denatured or weakened version. And if that particular killer virus does not exist, you have to create it! Does that really make sense in this case?
* There is also at least one theory that the problem behind nearly all systemic illness is the indiscriminate taking of aspirin to hold down a fever. The fever is treated as part of the illness, when it is in fact the body’s defense mechanism to fight it; if you suppress the fever at the wrong stage of recovery, all you do is allow a virus to propagate in peace, and then it comes back in fuller force. There’s even a rather long webpage that outlines the effects of widespread use of aspirin (for fever reduction) explaining how and why the 1918 Flu was so devastating, and how we might avoid a repeat, simply by letting the fever perform its proper role in healing.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, October 25, 2005
MORE USELESS BUREAUCACY PUSHING U.S. HEALTHCARE COSTS UP EVEN FURTHER
Health care costs continue to skyrocket nationwide, driving up government spending at double digit rates and hurting American economic competitiveness. But, instead of addressing this crisis head on by passing medical malpractice tort reform and pro-competition policies like medical savings accounts, the federal health care bureaucracy is getting ready to add new mandates and regulations that will further drive up the cost of providing health care.
The latest onerous regulation is Hospital CAHPS (HCAPHS), which will pile unnecessary new burdens on our nation's hospitals with no discernable benefit. HCAHPS is a survey on hospital care dreamed up by Medicare and the Agency for Healthcare Research and Quality (AHRQ). Bureaucrats at these two departments have decided that all hospitals participating in Medicare—virtually every one in the nation—should "voluntarily" post patient responses to a new quality survey on the Medicare website. It is an exercise in regulatory overkill that expert after expert has indicated will actually hinder its supposed goal.
HCAPHS ignores that about 80 percent of our nation's hospitals already survey a percentage of patients upon discharge. Hospitals already spend a lot of money on surveys because they want to improve the quality of care they provide, and the results speak for themselves. For example, all four hospitals that have been awarded the federal government's prestigious Malcolm Baldrige National Quality Award are aggressive users of private sector survey products, and are outspoken advocates of quality initiatives. Hospitals as a group support public reporting of patient satisfaction data and have said they will voluntarily participate, but only if the government would not add a cost burden to their operations.
Unfortunately, HCAPHS does little or nothing to reinforce these ongoing quality programs. Despite a well-functioning private sector, Medicare and AHRQ bureaucrats have spent three-plus years developing a laundry list of ultra-specific questions for patients, including a pair about bed pan usage. The many incarnations of the HCAHPS questionnaire have ranged from 66 questions to 25; the present version is 27. During two separate comment periods, more than 1,900 hospital officials have recommended keeping the number of HCAHPS questions to between eight and ten, a range that would enable hospitals to include the government-sponsored questions in their own surveys and collect results at less of an added cost. Otherwise, existing data collection efforts will suffer and hospitals will have to engage in costly new practices—such as multiple mailings and telephone surveys—just to acquire enough feedback to keep federal regulators happy.
A shorter and simpler HCAHPS might be easier for patients, but the tremendous cost burden that will be placed on hospitals comes from simply having to send and collect data from two separate surveys. Studies by leading economists have concluded that the nationwide burden on hospitals of a lengthy HCAHPS could range from $100 million to over a half billion dollars over the next five years alone. Those millions of dollars are added to the bottom line of America’s health care bill.
Not surprisingly, the forces pushing for HCAHPS are the same forces that want to control and socialize private sector health care: the AARP and AFL-CIO. The union agenda is to force hospitals to adopt centralized systems of management that employ legions of (unionized) workers, and the AARP is a consistent supporter of the expansion of federal involvement in our health care system. HCAHPS questions can and will be designed to advance their specific left-wing policy goals. That is why, for example, we see two questions on labor-intensive bed pan performance, which is hardly an urgent measure of health care quality. The other group that loves a lengthy and invasive HCAHPS is the trial bar, a group already hard at work diminishing the quality and increasing the cost of American health care. The trial bar will surely distort the results of a complicated HCAHPS and use it to advance their organized fleecing of hospitals that are serving poorer and higher-risk patient populations.
The stakes, then, are huge. FreedomWorks expects the Department of Health and Human Services (HHS) to make a final decision on HCAHPS in the next few weeks. The Bush administration has a chance to stand up for common sense and limited government by ensuring the federal hospital survey known as HCAHPS does no harm to America’s health care providers.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Health care costs continue to skyrocket nationwide, driving up government spending at double digit rates and hurting American economic competitiveness. But, instead of addressing this crisis head on by passing medical malpractice tort reform and pro-competition policies like medical savings accounts, the federal health care bureaucracy is getting ready to add new mandates and regulations that will further drive up the cost of providing health care.
The latest onerous regulation is Hospital CAHPS (HCAPHS), which will pile unnecessary new burdens on our nation's hospitals with no discernable benefit. HCAHPS is a survey on hospital care dreamed up by Medicare and the Agency for Healthcare Research and Quality (AHRQ). Bureaucrats at these two departments have decided that all hospitals participating in Medicare—virtually every one in the nation—should "voluntarily" post patient responses to a new quality survey on the Medicare website. It is an exercise in regulatory overkill that expert after expert has indicated will actually hinder its supposed goal.
HCAPHS ignores that about 80 percent of our nation's hospitals already survey a percentage of patients upon discharge. Hospitals already spend a lot of money on surveys because they want to improve the quality of care they provide, and the results speak for themselves. For example, all four hospitals that have been awarded the federal government's prestigious Malcolm Baldrige National Quality Award are aggressive users of private sector survey products, and are outspoken advocates of quality initiatives. Hospitals as a group support public reporting of patient satisfaction data and have said they will voluntarily participate, but only if the government would not add a cost burden to their operations.
Unfortunately, HCAPHS does little or nothing to reinforce these ongoing quality programs. Despite a well-functioning private sector, Medicare and AHRQ bureaucrats have spent three-plus years developing a laundry list of ultra-specific questions for patients, including a pair about bed pan usage. The many incarnations of the HCAHPS questionnaire have ranged from 66 questions to 25; the present version is 27. During two separate comment periods, more than 1,900 hospital officials have recommended keeping the number of HCAHPS questions to between eight and ten, a range that would enable hospitals to include the government-sponsored questions in their own surveys and collect results at less of an added cost. Otherwise, existing data collection efforts will suffer and hospitals will have to engage in costly new practices—such as multiple mailings and telephone surveys—just to acquire enough feedback to keep federal regulators happy.
A shorter and simpler HCAHPS might be easier for patients, but the tremendous cost burden that will be placed on hospitals comes from simply having to send and collect data from two separate surveys. Studies by leading economists have concluded that the nationwide burden on hospitals of a lengthy HCAHPS could range from $100 million to over a half billion dollars over the next five years alone. Those millions of dollars are added to the bottom line of America’s health care bill.
Not surprisingly, the forces pushing for HCAHPS are the same forces that want to control and socialize private sector health care: the AARP and AFL-CIO. The union agenda is to force hospitals to adopt centralized systems of management that employ legions of (unionized) workers, and the AARP is a consistent supporter of the expansion of federal involvement in our health care system. HCAHPS questions can and will be designed to advance their specific left-wing policy goals. That is why, for example, we see two questions on labor-intensive bed pan performance, which is hardly an urgent measure of health care quality. The other group that loves a lengthy and invasive HCAHPS is the trial bar, a group already hard at work diminishing the quality and increasing the cost of American health care. The trial bar will surely distort the results of a complicated HCAHPS and use it to advance their organized fleecing of hospitals that are serving poorer and higher-risk patient populations.
The stakes, then, are huge. FreedomWorks expects the Department of Health and Human Services (HHS) to make a final decision on HCAHPS in the next few weeks. The Bush administration has a chance to stand up for common sense and limited government by ensuring the federal hospital survey known as HCAHPS does no harm to America’s health care providers.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, October 24, 2005
Don't put your faith in a central Tamiflu stockpile
Countries around the world are stockpiling Tamiflu, in anticipation of a possible avian flu pandemic. This is better than doing nothing, but Tamiflu is unlikely to protect most of us, should a pandemic arrive. Here are a few reasons why:
1. Tamiflu must be taken within the first two days of symptoms. Your chance of getting some Tamiflu that quickly, in a pandemic, will not be great (of course you could buy some on your own).
2. Tamiflu, if taken preventively, can prevent you from getting sick in the first place. But you would need two tablets each day. Only essential medical personnel, and select politicians, are likely to receive such treatments.
3. You show up at the emergency room with avian flu, and then they have to decide where you stand on the priority list. Will the hospital fear a lawsuit? How long will this take? Will it require federal or regulatory clearance?
4. Given the crush of the infected, will you be afraid to show up at the emergency room in the first place? Maybe you just have the common cold. See point #1.
5. Many Tamiflu supplies will be exhausted on false alarms, such as colds and other flus.
6. A Tamiflu stockpile is only good for a few years. If avian flu does not come soon, do you expect the stockpile to be replenished? Or would avian flu become the new "swine flu", never to be uttered by politicians again? The avian flu threat will likely be with us for at least ten years, in the form of a bird "flu reservoir" for possible mutation.
7. There is some chance that the virus will develop Tamiflu immunity over time, especially if Tamiflu is applied indiscriminately at the early stages of a pandemic.
8. Let's say the virus arrives first in California. Will Tamiflu supplies all be sent that way at first? Will they ever later be shipped back to Kansas? How much of the stockpile -- an inevitable political football -- will be available at any point in time?
Did I mention that the U.S. won't be getting any more new Tamiflu for at least two years? Right now we only have 4.3 million courses.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Countries around the world are stockpiling Tamiflu, in anticipation of a possible avian flu pandemic. This is better than doing nothing, but Tamiflu is unlikely to protect most of us, should a pandemic arrive. Here are a few reasons why:
1. Tamiflu must be taken within the first two days of symptoms. Your chance of getting some Tamiflu that quickly, in a pandemic, will not be great (of course you could buy some on your own).
2. Tamiflu, if taken preventively, can prevent you from getting sick in the first place. But you would need two tablets each day. Only essential medical personnel, and select politicians, are likely to receive such treatments.
3. You show up at the emergency room with avian flu, and then they have to decide where you stand on the priority list. Will the hospital fear a lawsuit? How long will this take? Will it require federal or regulatory clearance?
4. Given the crush of the infected, will you be afraid to show up at the emergency room in the first place? Maybe you just have the common cold. See point #1.
5. Many Tamiflu supplies will be exhausted on false alarms, such as colds and other flus.
6. A Tamiflu stockpile is only good for a few years. If avian flu does not come soon, do you expect the stockpile to be replenished? Or would avian flu become the new "swine flu", never to be uttered by politicians again? The avian flu threat will likely be with us for at least ten years, in the form of a bird "flu reservoir" for possible mutation.
7. There is some chance that the virus will develop Tamiflu immunity over time, especially if Tamiflu is applied indiscriminately at the early stages of a pandemic.
8. Let's say the virus arrives first in California. Will Tamiflu supplies all be sent that way at first? Will they ever later be shipped back to Kansas? How much of the stockpile -- an inevitable political football -- will be available at any point in time?
Did I mention that the U.S. won't be getting any more new Tamiflu for at least two years? Right now we only have 4.3 million courses.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, October 23, 2005
DISGRACEFUL BRITISH HOSPITAL CLOSURES
At a time when there is a vast unmet demand for medical services in Britain. A private business would be EXPANDING facilities to cope with rising demand
If we had any proper democracy in this country, Patricia Hewitt would now be explaining to Parliament and the public why there is an undeclared war on local community hospitals, everywhere from Yorkshire to Suffolk to Wiltshire to Hampshire to, yes, Oxfordshire. Now that the election is over, and now that Gordon Brown is running out of money, we find that in towns across England, the Government is threatening to close local hospitals, in defiance of every promise they have made.
Did I say the Government? Forgive me: of course, the Government, when asked about this, denies all responsibility. Not me guv, say ministers, when you inquire why a loved and valued community hospital faces closure. It is, say ministers, entirely a decision for the local strategic health authority, or the primary care trust, and so the Labour people wash their hands of it.
It will not do. It is in the first place wrong that these hospitals are facing closure, when we all know that the biggest problem in the NHS is the waiting lists, made far worse by bed-blocking in the acute sector.
Why on earth are we proposing to close community hospitals, when they are not only relied upon for immediate treatment by local people, but when they also provide a place for recuperation, and so relieve the pressure on big general hospitals?
And then there is the second and more important point. Even if there were a case for closing these hospitals — which there is not — it should be made by Patricia Hewitt. It should not be the job of some worthy health service hierarch, some beleaguered quangocrat, to explain this baffling and outrageous decision. These hospitals were, by and large, built and funded by local people. They have been loved and used by local people for generations.
They were nationalised by the Labour Government in 1948; in other words they were taken away from the care and control of local people, to be run by national politicians. It is not good enough for those national politicians now to say that they have no responsibility for whether those hospitals stay open, especially since they have created the quangos.
It is not good enough for them to direct angry locals to write letters of protest to the strategic health authority, or to invite MPs to get in touch with the primary care trust. Apart from anything else, the Labour Government, having created the primary care trusts only three years ago, now proposes to abolish half of them. With whom are we supposed to be dealing, if we want to keep a hospital open?
No one seems to be in charge. No one is accountable. It is infamous. Instead of wasting everybody’s time and money with politically correct gerrymandering of public sector appointments, Patricia Hewitt should recognise that she is presiding over a massacre of local hospitals, and that it is her job — and her job alone — to justify the actions of her appointees
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
At a time when there is a vast unmet demand for medical services in Britain. A private business would be EXPANDING facilities to cope with rising demand
If we had any proper democracy in this country, Patricia Hewitt would now be explaining to Parliament and the public why there is an undeclared war on local community hospitals, everywhere from Yorkshire to Suffolk to Wiltshire to Hampshire to, yes, Oxfordshire. Now that the election is over, and now that Gordon Brown is running out of money, we find that in towns across England, the Government is threatening to close local hospitals, in defiance of every promise they have made.
Did I say the Government? Forgive me: of course, the Government, when asked about this, denies all responsibility. Not me guv, say ministers, when you inquire why a loved and valued community hospital faces closure. It is, say ministers, entirely a decision for the local strategic health authority, or the primary care trust, and so the Labour people wash their hands of it.
It will not do. It is in the first place wrong that these hospitals are facing closure, when we all know that the biggest problem in the NHS is the waiting lists, made far worse by bed-blocking in the acute sector.
Why on earth are we proposing to close community hospitals, when they are not only relied upon for immediate treatment by local people, but when they also provide a place for recuperation, and so relieve the pressure on big general hospitals?
And then there is the second and more important point. Even if there were a case for closing these hospitals — which there is not — it should be made by Patricia Hewitt. It should not be the job of some worthy health service hierarch, some beleaguered quangocrat, to explain this baffling and outrageous decision. These hospitals were, by and large, built and funded by local people. They have been loved and used by local people for generations.
They were nationalised by the Labour Government in 1948; in other words they were taken away from the care and control of local people, to be run by national politicians. It is not good enough for those national politicians now to say that they have no responsibility for whether those hospitals stay open, especially since they have created the quangos.
It is not good enough for them to direct angry locals to write letters of protest to the strategic health authority, or to invite MPs to get in touch with the primary care trust. Apart from anything else, the Labour Government, having created the primary care trusts only three years ago, now proposes to abolish half of them. With whom are we supposed to be dealing, if we want to keep a hospital open?
No one seems to be in charge. No one is accountable. It is infamous. Instead of wasting everybody’s time and money with politically correct gerrymandering of public sector appointments, Patricia Hewitt should recognise that she is presiding over a massacre of local hospitals, and that it is her job — and her job alone — to justify the actions of her appointees
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, October 22, 2005
THE ATTACK ON OUR GUARDIANS AGAINST DISEASE
In the wake of the management snafus of Katrina, President Bush was asked about the avian flu threat at his October 4 press conference; he offered a thoughtful answer which shows, at least, that no hapless Michael Browns will be in charge of a Viral Big One.
Yet once again, we don't know the future; we don't know whether the US government's response will be equal to the challenge. But some distant early warning indicators are not so promising; one of Uncle Sam's scenarios envisions shortages of food, medicine and electricity, followed by mass riots and the ultimate death of 1.9 million Americans. In other words, as we stare into the tiny grains of the flu virus, we could be looking at Katrina multiplied by a thousand. This is the best we can do? The richest country in the world? Clearly, what we have seen over the past few decades hasn't been management, but rather malpractice.
But even before we get to the management blame game, we should be looking toward the manufacture of a cure. Unfortunately a cure doesn't exist -- a future action item if there ever was one, which we will come back to later. For now, we do have an anti-viral medicine, called Tamiflu, but we don't have enough. Indeed, at present, so parlous is our condition that even if we wanted to start manufacturing more right away, it would still take years to build up an adequate stockpile.
What's more, as Waldemar Ingdahl has noted here at TCS, since 1970, the number of companies producing vaccines has fallen by 80 percent. Which is to say, while the need has been going north, the supply has been going south. What explains this wrong-way trend? One reason is that the government has practiced a kind of malign neglect toward vaccines and toward the innovative side of the pharmaceutical industry.
Consider the fate of Merck. The New Jersey-based company is currently being clobbered by costly Vioxx lawsuits, based on junk science, as the federal government watches passively. Yet even so, Merck has persevered on a vaccine for the human papilloma virus, which accounts for perhaps 70 percent of the world's cervical cancers. It would be a tragic shame if Merck were knocked out of the innovation box by big lawsuits, before its vaccine, Gardasil, ever reaches the women who need it. What national interest would that serve?
We need to rethink our approach to manufacturing, because at present, US government mismanagement -- tolerance for predatory lawsuits -- is undercutting the productive and lifesaving fundaments of the pharmaceutical industry. Indeed, motivated by a strange mix of desperation and calculation, many governments around the world are considering compounding past mismanagement with still more mismanagement. Here's how: Hans Hogerzeil, acting director of the department of essential drugs and medicines policy at the World Health Organization, demanded recently that Roche, the maker of Tamiflu, cut its price and waive its patent rights, so that anybody, anywhere, could make the drug.
Hogerzeil's comments stand in sharp contrast to those of his boss, Lee Jong-wook, who, mindful of the enormous investment needed to make medicines, has said that it is bad policy to weaken drug patents, since they are the cornerstone of production. But of course, it's Hogerzeil's flamboyantly anti-corporate populism that grabs the attention of the controversy-crazed world media.
If any of this legal-medical jousting sounds familiar, it should. Because the same Hogerzeil and the same WHO had the same bright idea about AIDS drugs. Working closely with NGO activists, the world's public health-ocracy cooked up a scheme to "pre-qualify" copycat AIDS drugs, manufactured in India, onto the market. But "pre-qualification" proved to be a synonym of "non-quality." So great was the danger of these pseudo-drugs that they had to be withdrawn from the marketplace. It was a humiliating for the neo-Naderite "H Team" of genericists, but evidently not so humiliating that the H-ers aren't up to the same trick again.....
If it costs close to a billion dollars to make a drug, and if future profits are non-existent -- well, it doesn't take much management expertise to see that future discovering and manufacturing will be non-existent, too.
More here
Bravo! Less money for drug research and more money for lawyers: Just what the world needs: "Swiss drugmaker Serono SA has agreed to pay $704 million to settle criminal and civil charges that it illegally promoted its AIDS drug, prosecutors said yesterday, in one of the biggest sums collected in the government's growing scrutiny of pharmaceutical firms. The company's Serono Labs unit of Rockland agreed to plead guilty to charges it conspired to market Serostim by supplying doctors diagnostic software that was not fully approved by the Food and Drug Administration. The software, prosecutors said, led to an increase in demand for the drug prescribed to treat wasting in AIDS patients. The company also agreed to plead guilty to offering doctors all-expense-paid trips to a medical conference in Cannes, France, in return for writing prescriptions of Serostim, an arrangement that US Attorney General Alberto R. Gonzales blasted as 'The 'Cannes Kickback' campaign.'"
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
In the wake of the management snafus of Katrina, President Bush was asked about the avian flu threat at his October 4 press conference; he offered a thoughtful answer which shows, at least, that no hapless Michael Browns will be in charge of a Viral Big One.
Yet once again, we don't know the future; we don't know whether the US government's response will be equal to the challenge. But some distant early warning indicators are not so promising; one of Uncle Sam's scenarios envisions shortages of food, medicine and electricity, followed by mass riots and the ultimate death of 1.9 million Americans. In other words, as we stare into the tiny grains of the flu virus, we could be looking at Katrina multiplied by a thousand. This is the best we can do? The richest country in the world? Clearly, what we have seen over the past few decades hasn't been management, but rather malpractice.
But even before we get to the management blame game, we should be looking toward the manufacture of a cure. Unfortunately a cure doesn't exist -- a future action item if there ever was one, which we will come back to later. For now, we do have an anti-viral medicine, called Tamiflu, but we don't have enough. Indeed, at present, so parlous is our condition that even if we wanted to start manufacturing more right away, it would still take years to build up an adequate stockpile.
What's more, as Waldemar Ingdahl has noted here at TCS, since 1970, the number of companies producing vaccines has fallen by 80 percent. Which is to say, while the need has been going north, the supply has been going south. What explains this wrong-way trend? One reason is that the government has practiced a kind of malign neglect toward vaccines and toward the innovative side of the pharmaceutical industry.
Consider the fate of Merck. The New Jersey-based company is currently being clobbered by costly Vioxx lawsuits, based on junk science, as the federal government watches passively. Yet even so, Merck has persevered on a vaccine for the human papilloma virus, which accounts for perhaps 70 percent of the world's cervical cancers. It would be a tragic shame if Merck were knocked out of the innovation box by big lawsuits, before its vaccine, Gardasil, ever reaches the women who need it. What national interest would that serve?
We need to rethink our approach to manufacturing, because at present, US government mismanagement -- tolerance for predatory lawsuits -- is undercutting the productive and lifesaving fundaments of the pharmaceutical industry. Indeed, motivated by a strange mix of desperation and calculation, many governments around the world are considering compounding past mismanagement with still more mismanagement. Here's how: Hans Hogerzeil, acting director of the department of essential drugs and medicines policy at the World Health Organization, demanded recently that Roche, the maker of Tamiflu, cut its price and waive its patent rights, so that anybody, anywhere, could make the drug.
Hogerzeil's comments stand in sharp contrast to those of his boss, Lee Jong-wook, who, mindful of the enormous investment needed to make medicines, has said that it is bad policy to weaken drug patents, since they are the cornerstone of production. But of course, it's Hogerzeil's flamboyantly anti-corporate populism that grabs the attention of the controversy-crazed world media.
If any of this legal-medical jousting sounds familiar, it should. Because the same Hogerzeil and the same WHO had the same bright idea about AIDS drugs. Working closely with NGO activists, the world's public health-ocracy cooked up a scheme to "pre-qualify" copycat AIDS drugs, manufactured in India, onto the market. But "pre-qualification" proved to be a synonym of "non-quality." So great was the danger of these pseudo-drugs that they had to be withdrawn from the marketplace. It was a humiliating for the neo-Naderite "H Team" of genericists, but evidently not so humiliating that the H-ers aren't up to the same trick again.....
If it costs close to a billion dollars to make a drug, and if future profits are non-existent -- well, it doesn't take much management expertise to see that future discovering and manufacturing will be non-existent, too.
More here
Bravo! Less money for drug research and more money for lawyers: Just what the world needs: "Swiss drugmaker Serono SA has agreed to pay $704 million to settle criminal and civil charges that it illegally promoted its AIDS drug, prosecutors said yesterday, in one of the biggest sums collected in the government's growing scrutiny of pharmaceutical firms. The company's Serono Labs unit of Rockland agreed to plead guilty to charges it conspired to market Serostim by supplying doctors diagnostic software that was not fully approved by the Food and Drug Administration. The software, prosecutors said, led to an increase in demand for the drug prescribed to treat wasting in AIDS patients. The company also agreed to plead guilty to offering doctors all-expense-paid trips to a medical conference in Cannes, France, in return for writing prescriptions of Serostim, an arrangement that US Attorney General Alberto R. Gonzales blasted as 'The 'Cannes Kickback' campaign.'"
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, October 21, 2005
HERCEPTIN SHAKES UP THE BRITISH HEALTH BUREAUCRACY
The drug Herceptin was yesterday hailed as a potential cure for breast cancer that will revolutionise the way the disease is treated and save up to 1,500 lives a year in Britain and many tens of thousands across the world. As an editorial in the world's most authoritative medical journal spoke of the drug's "stunning" results in trials, the Prime Minister insisted that it had to be made available in Britain more quickly.
A health authority in the West Country has become the first in the NHS to say that it will make the drug available to all suitable women with early breast cancer, even before it is cleared by regulatory authorities. The cost for a year's treatment is 21,800 pounds per patient.
The publication of trial data on Herceptin in the New England Journal of Medicine was accompanied by an editorial by a top US specialist proclaiming the results as revolutionary. The most striking finding is that the peak in recurrence of the disease in the first two to three years after surgery has been eliminated in women taking Herceptin, said Dr Gabriel Hortobagyi in the editorial. "This observation suggests a dramatic and perhaps permanent perturbation of the natural history of the disease, maybe even a cure," he wrote. "Longer follow-up will determine whether this is correct." .....
Forced on to the back foot by growing clamour from patients and cancer charities, the Prime Minister yesterday conceded in the Commons that Herceptin had shown the need to speed up drug approvals. "At present, I think we all accept the procedures are too slow," Mr Blair said. "We are looking at how we can speed that process up in cases where it particularly matters to people who may be desperately ill and think there is a drug on the market that can help them."
Currently, the drug is licensed for use only in advanced breast cancer, though doctors can use their discretion to prescribe it in other exceptional cases.
More here
British woman sells her house to pay for Herceptin in India
A breast cancer sufferer is spending more than 25,000 pounds to be treated with Herceptin by a private clinic in India. Linda Vijeh, 50, of Ilminster, Somerset, is selling her 125,000 pound house to pay for the drug. She is believed to be the first British patient to travel abroad for Herceptin. Speaking from India yesterday, she said: "Herceptin is only licensed in the UK for use where cancer has spread to other parts of the body. Well it's a bit bloody late then. "It takes some leap of faith to fly to a Third World country to be treated by a doctor you've never met in a hospital you've never heard of. That is how desperate I was."
Ms Vijeh, a former chef to the British Ambassador to the UN in New York and a Tory member of South Somerset District Council, had cancer diagnosed after finding a lump in her right breast in August last year. She was tested and found to have HER-2 positive breast cancer, the form of the disease that can be treated by Herceptin. She had the tumour removed a year ago before beginning chemotherapy in March at Treliske Hospital, Cornwall. It was there that she met an Indian doctor who referred her to a consultant in India.
After flying out on September 27 she had a mastectomy and reconstruction surgery. She is receiving one course of Herceptin in India; it will be administered intravenously during two-hour sessions every two weeks. That course is costing her 1,000 pounds and she is also paying the doctors about 17,000 pounds for a year's worth of the drug to bring back to Britain. Once home, she plans to find a private clinic to administer it
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The drug Herceptin was yesterday hailed as a potential cure for breast cancer that will revolutionise the way the disease is treated and save up to 1,500 lives a year in Britain and many tens of thousands across the world. As an editorial in the world's most authoritative medical journal spoke of the drug's "stunning" results in trials, the Prime Minister insisted that it had to be made available in Britain more quickly.
A health authority in the West Country has become the first in the NHS to say that it will make the drug available to all suitable women with early breast cancer, even before it is cleared by regulatory authorities. The cost for a year's treatment is 21,800 pounds per patient.
The publication of trial data on Herceptin in the New England Journal of Medicine was accompanied by an editorial by a top US specialist proclaiming the results as revolutionary. The most striking finding is that the peak in recurrence of the disease in the first two to three years after surgery has been eliminated in women taking Herceptin, said Dr Gabriel Hortobagyi in the editorial. "This observation suggests a dramatic and perhaps permanent perturbation of the natural history of the disease, maybe even a cure," he wrote. "Longer follow-up will determine whether this is correct." .....
Forced on to the back foot by growing clamour from patients and cancer charities, the Prime Minister yesterday conceded in the Commons that Herceptin had shown the need to speed up drug approvals. "At present, I think we all accept the procedures are too slow," Mr Blair said. "We are looking at how we can speed that process up in cases where it particularly matters to people who may be desperately ill and think there is a drug on the market that can help them."
Currently, the drug is licensed for use only in advanced breast cancer, though doctors can use their discretion to prescribe it in other exceptional cases.
More here
British woman sells her house to pay for Herceptin in India
A breast cancer sufferer is spending more than 25,000 pounds to be treated with Herceptin by a private clinic in India. Linda Vijeh, 50, of Ilminster, Somerset, is selling her 125,000 pound house to pay for the drug. She is believed to be the first British patient to travel abroad for Herceptin. Speaking from India yesterday, she said: "Herceptin is only licensed in the UK for use where cancer has spread to other parts of the body. Well it's a bit bloody late then. "It takes some leap of faith to fly to a Third World country to be treated by a doctor you've never met in a hospital you've never heard of. That is how desperate I was."
Ms Vijeh, a former chef to the British Ambassador to the UN in New York and a Tory member of South Somerset District Council, had cancer diagnosed after finding a lump in her right breast in August last year. She was tested and found to have HER-2 positive breast cancer, the form of the disease that can be treated by Herceptin. She had the tumour removed a year ago before beginning chemotherapy in March at Treliske Hospital, Cornwall. It was there that she met an Indian doctor who referred her to a consultant in India.
After flying out on September 27 she had a mastectomy and reconstruction surgery. She is receiving one course of Herceptin in India; it will be administered intravenously during two-hour sessions every two weeks. That course is costing her 1,000 pounds and she is also paying the doctors about 17,000 pounds for a year's worth of the drug to bring back to Britain. Once home, she plans to find a private clinic to administer it
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, October 20, 2005
NEW YORK: GOVERNMENT MEDDLING KILLS OFF THE VERY ILL
In 1989, New York became the first state in the nation to make public the mortality rates of its heart surgeons. Report cards for two different procedures, coronary bypass and angioplasty, were chosen as the standards by which the entire profession would be judged—a sort of litmus test for the skill of a given surgeon or hospital. The mortality numbers, risk-adjusted by age and other factors, are released every year or so on the Internet and reprinted in newspapers for all to see, hospital by hospital and doctor by doctor. Ending years of private, clubby surgeon culture, the public report cards were intended to shine a light on poor surgeons and encourage a kind of best-practices ethic across the state. If the system worked, mortality rates would fall everywhere from Oswego to NYU.
At first glance, the system seems to have made an enormous difference. Although there’s no satisfying way to compare our risk-adjusted death rates with those of other states (most of which only have data from Medicare patients, who tend to be sicker and therefore skew the sample), the most recent data suggest that in the past fifteen years, New York’s coronary-bypass surgeons have improved their mortality rates to the point that they are, on average, just one-third of what they were. Sharma’s risk-adjusted mortality rate in the latest angioplasty report is an astonishing 0.1 percent, the state’s lowest. In eleven years, he has been the only doctor to have consistently earned the state’s coveted double asterisk, which designates a surgeon with numbers far below the norm. These days, plenty of his colleagues have low numbers, too; everyone has drifted downward together. Like the children of Lake Wobegon, the surgeons of New York are all, apparently, above average.
But the statisticians who devised the report cards have been tormented by a persistent, intractable glitch in the system: It involves human beings. From the start, it was clear that surgeons’ careers were on the line as well as patients’ lives, and even before the first set of data was released, leaders in the heart-surgery community warned with an air of eerie certainty that the threat of public exposure would create a chilling effect—influencing surgeons to turn their backs on the sickest patients in order to prop up their personal success records.
Today, it seems clear that this prophecy has come true. Many surgeons, simply put, began gaming the system immediately and continue to do so today. “We still have people at this hospital who will not treat a high-risk patient,” says David Brown, an angioplasty cardiologist at SUNY–Stony Brook, with evident frustration. “I see a case on Monday morning with an acute myocardial infarction”—a heart attack—“that wasn’t treated. They come in and assess the patient, they think the patient’s at risk of dying no matter what they do, so they do nothing. And people admit to it.”
This isn’t just about high-risk patients. It’s about doctors playing games with practically any patient to get better scores. Some surgeons look for ways to make their easy cases seem harder. Others make their hard cases appear so difficult that they place out of the state reporting system. When it comes to the sickest patients, some surgeons simply turn them away, asserting that they’re better off getting drug treatments, or waiting in the ICU. “The cardiac surgeons refer their patients to the cardiologists, and the cardiologists refer them to the intensive-care unit,” says Joshua Burack, a SUNY–Downstate surgeon in Brooklyn who in 1999 released a study revealing that nearly two-thirds of all heart-bypass surgeons in the state anonymously admitted to refusing at least one patient for fear of tainting their mortality rates. “Everyone’s going to pass along the hot potato to the person who’s not vulnerable to reporting.”
In the past five years, no fewer than five studies have been published in reputable journals raising the possibility that New York heart surgeons are not operating on certain cases for fear of spoiling their mortality rates. The clincher came in January, when, in an anonymous survey sent out to every doctor who does angioplasty in the state, an astonishing 79 percent of the responders agreed that the public mortality statistics have discouraged them from taking on a risky patient. If you’re a hard case, in other words, four out of five doctors would think twice before operating on you.
And consider this: Research shows that New Yorkers are more prone to dying from heart attacks than people in any other state, and the death rate from heart disease in the New York metropolitan area remains disproportionately high. There could be something wrong with our diets. It could be the stress of living here. But it’s also possible that another factor plays a part: Just as more people than ever are dying of heart disease in New York, the very system designed to make heart surgery safer here may be convincing surgeons to turn patients away.
Much more here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
In 1989, New York became the first state in the nation to make public the mortality rates of its heart surgeons. Report cards for two different procedures, coronary bypass and angioplasty, were chosen as the standards by which the entire profession would be judged—a sort of litmus test for the skill of a given surgeon or hospital. The mortality numbers, risk-adjusted by age and other factors, are released every year or so on the Internet and reprinted in newspapers for all to see, hospital by hospital and doctor by doctor. Ending years of private, clubby surgeon culture, the public report cards were intended to shine a light on poor surgeons and encourage a kind of best-practices ethic across the state. If the system worked, mortality rates would fall everywhere from Oswego to NYU.
At first glance, the system seems to have made an enormous difference. Although there’s no satisfying way to compare our risk-adjusted death rates with those of other states (most of which only have data from Medicare patients, who tend to be sicker and therefore skew the sample), the most recent data suggest that in the past fifteen years, New York’s coronary-bypass surgeons have improved their mortality rates to the point that they are, on average, just one-third of what they were. Sharma’s risk-adjusted mortality rate in the latest angioplasty report is an astonishing 0.1 percent, the state’s lowest. In eleven years, he has been the only doctor to have consistently earned the state’s coveted double asterisk, which designates a surgeon with numbers far below the norm. These days, plenty of his colleagues have low numbers, too; everyone has drifted downward together. Like the children of Lake Wobegon, the surgeons of New York are all, apparently, above average.
But the statisticians who devised the report cards have been tormented by a persistent, intractable glitch in the system: It involves human beings. From the start, it was clear that surgeons’ careers were on the line as well as patients’ lives, and even before the first set of data was released, leaders in the heart-surgery community warned with an air of eerie certainty that the threat of public exposure would create a chilling effect—influencing surgeons to turn their backs on the sickest patients in order to prop up their personal success records.
Today, it seems clear that this prophecy has come true. Many surgeons, simply put, began gaming the system immediately and continue to do so today. “We still have people at this hospital who will not treat a high-risk patient,” says David Brown, an angioplasty cardiologist at SUNY–Stony Brook, with evident frustration. “I see a case on Monday morning with an acute myocardial infarction”—a heart attack—“that wasn’t treated. They come in and assess the patient, they think the patient’s at risk of dying no matter what they do, so they do nothing. And people admit to it.”
This isn’t just about high-risk patients. It’s about doctors playing games with practically any patient to get better scores. Some surgeons look for ways to make their easy cases seem harder. Others make their hard cases appear so difficult that they place out of the state reporting system. When it comes to the sickest patients, some surgeons simply turn them away, asserting that they’re better off getting drug treatments, or waiting in the ICU. “The cardiac surgeons refer their patients to the cardiologists, and the cardiologists refer them to the intensive-care unit,” says Joshua Burack, a SUNY–Downstate surgeon in Brooklyn who in 1999 released a study revealing that nearly two-thirds of all heart-bypass surgeons in the state anonymously admitted to refusing at least one patient for fear of tainting their mortality rates. “Everyone’s going to pass along the hot potato to the person who’s not vulnerable to reporting.”
In the past five years, no fewer than five studies have been published in reputable journals raising the possibility that New York heart surgeons are not operating on certain cases for fear of spoiling their mortality rates. The clincher came in January, when, in an anonymous survey sent out to every doctor who does angioplasty in the state, an astonishing 79 percent of the responders agreed that the public mortality statistics have discouraged them from taking on a risky patient. If you’re a hard case, in other words, four out of five doctors would think twice before operating on you.
And consider this: Research shows that New Yorkers are more prone to dying from heart attacks than people in any other state, and the death rate from heart disease in the New York metropolitan area remains disproportionately high. There could be something wrong with our diets. It could be the stress of living here. But it’s also possible that another factor plays a part: Just as more people than ever are dying of heart disease in New York, the very system designed to make heart surgery safer here may be convincing surgeons to turn patients away.
Much more here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, October 19, 2005
GOOD OLD BUREAUCRATIC BUCK-PASSING
Even when people are dying, nobody's to blame in a bureaucracy
BUNDABERG Hospital's top bureaucrat Peter Leck has used his return to the stand at the health inquiry to deflect some of the blame for the Jayant Patel scandal, criticising his offsider Darren Keating, Queensland Health and even hospital medical staff.
Mr Leck, who initially asked to be exempt from giving evidence on the grounds of mental illness, testified from a closed court with only audio of his testimony beamed into an adjacent room at the Brisbane Magistrate's Court.
He gave evidence to the first inquiry in May. He told commissioner Geoff Davies that because he had no medical training, he relied on his director of medical services, Dr Keating, to bring any clinical issues to his attention. He said Dr Keating had repeatedly reassured him that concerns being raised about chief surgeon Dr Patel were nothing to worry about.
Mr Leck -- suspended from his general manager's position pending the inquiry's outcome – said he was under constant pressure from Queensland Health to bring the hospital in under budget and to avoid bad publicity.
But Mr Leck, who was warned last week by Mr Davies, QC, to expect rigorous cross-examination, had his own conduct spotlighted by senior counsel assisting David Andrews, SC – particularly the failure to subject Dr Patel to credentialling and privileging checks during his two-year tenure. It is a district manager's sole responsibility to ensure such checks take place.
Mr Leck said he had delegated the credentialling process to Dr Keating and had pressed him several times about the need to get it up and running. "I kept on pressing and he became a little short with me and basically said that he had a lot on his plate and that he couldn't work the hours that I worked because he had family," Mr Leck said.
Mr Leck was also questioned about why he failed to report to his superiors the death of Gerry Kemps - one of Dr Patel's patients who died after surgery in late 2004 - which was required in the event of an unexpected death.
Late yesterday senior counsel assisting, David Andrews, SC, showed the inquiry an e-mail from Mr Leck to his director of nursing, Linda Mulligan, on January 13 this year in which he said they needed to "quieten down" any potential rumours circulating about Dr Patel. Mr Leck said he wrote the e-mail in response to a group e-mail from a staffer. Mr Leck said he assumed the first e-mail referred to Dr Patel because he had told other staff about the allegations that had been made about him.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Even when people are dying, nobody's to blame in a bureaucracy
BUNDABERG Hospital's top bureaucrat Peter Leck has used his return to the stand at the health inquiry to deflect some of the blame for the Jayant Patel scandal, criticising his offsider Darren Keating, Queensland Health and even hospital medical staff.
Mr Leck, who initially asked to be exempt from giving evidence on the grounds of mental illness, testified from a closed court with only audio of his testimony beamed into an adjacent room at the Brisbane Magistrate's Court.
He gave evidence to the first inquiry in May. He told commissioner Geoff Davies that because he had no medical training, he relied on his director of medical services, Dr Keating, to bring any clinical issues to his attention. He said Dr Keating had repeatedly reassured him that concerns being raised about chief surgeon Dr Patel were nothing to worry about.
Mr Leck -- suspended from his general manager's position pending the inquiry's outcome – said he was under constant pressure from Queensland Health to bring the hospital in under budget and to avoid bad publicity.
But Mr Leck, who was warned last week by Mr Davies, QC, to expect rigorous cross-examination, had his own conduct spotlighted by senior counsel assisting David Andrews, SC – particularly the failure to subject Dr Patel to credentialling and privileging checks during his two-year tenure. It is a district manager's sole responsibility to ensure such checks take place.
Mr Leck said he had delegated the credentialling process to Dr Keating and had pressed him several times about the need to get it up and running. "I kept on pressing and he became a little short with me and basically said that he had a lot on his plate and that he couldn't work the hours that I worked because he had family," Mr Leck said.
Mr Leck was also questioned about why he failed to report to his superiors the death of Gerry Kemps - one of Dr Patel's patients who died after surgery in late 2004 - which was required in the event of an unexpected death.
Late yesterday senior counsel assisting, David Andrews, SC, showed the inquiry an e-mail from Mr Leck to his director of nursing, Linda Mulligan, on January 13 this year in which he said they needed to "quieten down" any potential rumours circulating about Dr Patel. Mr Leck said he wrote the e-mail in response to a group e-mail from a staffer. Mr Leck said he assumed the first e-mail referred to Dr Patel because he had told other staff about the allegations that had been made about him.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, October 18, 2005
BRITAIN: ONLY 24 YEARS TO DIAGNOSE A COMMON ILLNESS
For years Nicola Howells was told her illness was "in her head". She was just 11 months old when she had her first seizure, but it was another 24 years before doctors finally diagnosed her with epilepsy. She was sent for psychiatric treatment, told she was suffering from vertigo and panic attacks, and put on anti-depressants.
But it was not until her father died from a hereditary tumour that doctors finally scanned her and diagnosed epilepsy. And it was nearly two months before she saw a specialist.
"It got to the point that they told me it was all in my head. "My teenage years and my childhood were stolen from me. If I had been diagnosed younger, I would have come to terms with it more easily and would have learnt to take my medication, but as an adult I felt that my whole world had been rocked. "They sent me to a child psychiatrist and I was told that it was all in my head. I know so many people who have gone through so many similar scenarios.
"My mum tried to fight my corner and she is riddled with guilt because when they said it was all in my mind she began to think it was."
Epilepsy experts say Nicola's story is not uncommon. They are calling for more money and expertise to be ploughed into the UK's services. National Institute for Health and Clinical Excellence (NICE) guidance states that misdiagnosis rates for epilepsy in the UK are between 20-31%.
Patients currently have to wait between eight to 10 weeks from diagnosis until their first hospital appointment. They wait about five weeks for an EEG (to monitor electrical activity in the brain) and 24 weeks for a magnetic resonance imaging scan (MRI), which can reveal structural abnormalities in the brain. NICE standards call for waiting times of no more than a month. Neurologists, nurses and epilepsy charities say the specialty needs an investment of 150 million pounds to overcome serious gaps in the service.
More here
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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For years Nicola Howells was told her illness was "in her head". She was just 11 months old when she had her first seizure, but it was another 24 years before doctors finally diagnosed her with epilepsy. She was sent for psychiatric treatment, told she was suffering from vertigo and panic attacks, and put on anti-depressants.
But it was not until her father died from a hereditary tumour that doctors finally scanned her and diagnosed epilepsy. And it was nearly two months before she saw a specialist.
"It got to the point that they told me it was all in my head. "My teenage years and my childhood were stolen from me. If I had been diagnosed younger, I would have come to terms with it more easily and would have learnt to take my medication, but as an adult I felt that my whole world had been rocked. "They sent me to a child psychiatrist and I was told that it was all in my head. I know so many people who have gone through so many similar scenarios.
"My mum tried to fight my corner and she is riddled with guilt because when they said it was all in my mind she began to think it was."
Epilepsy experts say Nicola's story is not uncommon. They are calling for more money and expertise to be ploughed into the UK's services. National Institute for Health and Clinical Excellence (NICE) guidance states that misdiagnosis rates for epilepsy in the UK are between 20-31%.
Patients currently have to wait between eight to 10 weeks from diagnosis until their first hospital appointment. They wait about five weeks for an EEG (to monitor electrical activity in the brain) and 24 weeks for a magnetic resonance imaging scan (MRI), which can reveal structural abnormalities in the brain. NICE standards call for waiting times of no more than a month. Neurologists, nurses and epilepsy charities say the specialty needs an investment of 150 million pounds to overcome serious gaps in the service.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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