Competition is the way
"When businesses compete, you win," is true for consumers in every industry in America. From cell phones to computers, quality is improving and costs are shrinking as companies fight to offer the public the best product at the best price. But this philosophy is sadly missing from our health-care insurance system.
Health care comprises nearly 20 percent of our national economy, but outdated bureaucracy and red tape have stifled competition and raised costs. As a result, today more than 45 million are without any health coverage.
As President Bush and many others have noted, our third-party payer health-care system was built for the world of yesterday, not the opportunities of tomorrow. The current patchwork of state regulationhascreated50 mini-monopolies that are driving up costs for everyone, and no one bears this burden more than the ill, the elderly, and the working poor. New regulations cannot solve the problem, because excessive and unnecessary regulations are the problem.
In the past 30 years, state governments have instituted more than 1,500 mandated benefits. According to the Council for Affordable Health Insurance, these mandates have increased the cost of individual health insurance by as much as 45 percent in some markets. Some people may not want or need health insurance coverage for drug abuse treatment, hair pieces, or acupuncture -- but if the state they live in mandates it, they can only buy policies with that coverage. You can be sure the policies are more expensive as a result. Speaker Dennis Hastert likened the situation to requiring everyone to purchase a Cadillac when all they want or need is a Chevy.
To address this problem, we have introduced the Health Care Choice Act, which would break down these state-imposed barriers to affordable insurance. Under the Health Care Choice Act, individuals would continue to shop for health insurance as they do now -- in consultation with an insurance agent in their hometown, online, by mail or over the phone. But consumers would no longer be limited only to policies that meet their state's regulations and mandated benefits. Instead, they would be able to select from a wide array of insurance policies that are qualified in one state and offered for sale in multiple states, thus allowing them to choose the policy that best suits their needs -- and their budget.
For example, families could choose between similar policies with a $500 deductible that cost $3,780 in New Jersey, $1,471 in Maine, $466 in Wisconsin, or $355 in Arizona. With this huge variation in price, it's clear that consumers who already have health insurance -- especially those in excessively regulated states like New Jersey -- would see substantial savings. Plus small-business owners, young people and low-income working families who are currently priced out of the market could afford health insurance.
Additionally, this bill would allow insurance companies to consolidate administrative functions by making them comply with only a single state's review of coverage and qualifications, as opposed to 50. The savings would invariably find their way back to consumers as insurance companies lowered premiums to compete for business.
Not surprisingly, this bill faces opposition from lobbyists who have a vested interest in protecting the current monopoly system. Naysayers have already started claiming the sick will be left with skyrocketing premiums and unwitting consumers will be preyed upon by unprincipled insurers in under-regulated states. Scare tactics are always a predictable last resort of monopolies.
The good news is, Americans know firsthand the benefits of a free market -- more choices, lower prices, higher quality -- and there is no reason why we cannot help them see these same benefits in health care. This includes high-risk consumers, who would even have the option to decline coverage they don't truly need, thus increasing their savings even more. And states, currently charged with protecting their residents, will still have the capability and responsibility to go after insurance carriers that victimize consumers. Under this bill, states will simply be held accountable to reconcile their regulatory policies with the realities of a competitive market -- something they already successfully do in nearly every other sector of our economy.
The choice for the future of American health care is clear. Either we continue to allow bureaucrats and regulators to call all the shots and watch costs and the number of uninsured surge or we take steps to create a bold new patient-centered health-care system that puts Americans back in charge.
With the nation's health on the line, Congress must rise to the challenge and empower consumers,offerthem choices, and restore affordability. In doing so, we can insure that America's health care slogan for the 21st century will be "When insurance providers compete, patients win."
Source
Another abuse from the nasty Queensland government health system
David Gray's experience would be many people's worst nightmare. He went to a hospital for help with depression - and was locked up in a mental health ward without explanation under an Involuntary Treatment Order. During his 11 days in the ward, neither he nor his wife, Yvonne, was given any reason for his detention - or for the ITO. Under Queensland's mental health laws, Mr Gray could have been detained for two months until an independent Mental Health Review Tribunal was required to review the ITO. However, more than 80 per cent of ITOs are revoked before a patient is put before the tribunal, preventing many ITOs from being independently reviewed.
Until he went to Brisbane's Princess Alexandra Hospital three weeks ago, Mr Gray said he had no history of mental health, no history of violence, and no history of trying to harm himself. The 50-year-old builder admits he has been suffering from depression and has been on a variety of medication over the past five years to try to control it. Recently he said he was tired of the side-effects of the medication and wanted to see if counselling could help him to manage his illness without medication. He and his wife agreed he should go to the Community Mental Health service at Annerley to discuss what was available.
"My depression hit me after I stopped taking medication. I knew I was going to go down with my depression. I had been off them (depression medication) just over two weeks. It started to level off and I was coming out of my depression two days before my interview at Annerley," Mr Gray said. "I went to the interview in excellent spirits as I was looking forward to being able to speak to a psychiatrist to help me." Mr Gray said he talked to a nurse, who recommended that he go to PA Hospital where he could voluntarily admit himself into its mental health unit if he felt he needed to.
Soon after arriving at PA Hospital, Mr Gray found himself being escorted to its mental health unit by an orderly and two security guards. "I was starting to smell a rat. I thought: 'I am still in a hospital - they have professional staff here that will take care of me.' "At that stage I did not know they had made an assessment and put an ITO (Involuntary Treatment Order) on me." "It was not until the next day I knew this was not a hospital, it was a prison. And these are not nurses, these are jailers." After 11 days of incarceration, Mr Gray managed to escape from the mental health unit.
He says the entire saga has done more to damage his health than the original depression he wanted treated. A Queensland Health spokeswoman said the Health Services Act 1991 provided for the protection of patient confidentiality, and the department could not comment on individual patient matters. "A patient can be admitted voluntarily but changed to involuntary if they are assessed by the treating doctors as meeting the criteria for involuntary treatment under the Mental Health Act 2000," the spokeswoman 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.
***************************
Tuesday, May 16, 2006
Monday, May 15, 2006
Medical charity illegal, insane U.S. government agency says
"Thou shall not commit charity." So decrees the federal government, under the 1996 HIPAA and other laws and regulations. In Western Civilization, ethical requirement for personal fulfillment once included charity and charitable action. How did this ethic get turned on its head?
Once again, incompletely-considered intentions have gone awry. And this particular awryness goes back at least 40 years, when the federal government got into the business of paying for medical care big time, with the Medicare and Medicaid programs. In addition to politicians garnering political points, votes and political campaign contributions, another intention was to help older Americans get medical and hospital coverage. These government officials have been worried that doctors might inflate charges for patients covered by Medicare. So, the bureaucrats and Congress made rules limiting what doctors could charge for services rendered to Medicare recipients. Government bureaucrats allowed the small fries (such as doctors and hospitals) to collect only their lowest price for goods and services.
From the beginning, doctors had trouble keeping up with government regulations and filling out the claim forms. This paperwork is like having to fill out an individual income tax return to the IRS for every patient. The doctor is responsible for coming up with politically-correct patient information, code numbers, modifiers and other minutiae lest he be convicted of insurance fraud and sent to jail for five years. Oh, I almost forgot to mention, the degree of fraud has to be significant, defined as at least $100, under the 1996 HIPAA Law.
In the late 1960s, Dr. James Baker of Aberdeen WA charged $8.00 for a standard office consultation. But when a patient on blood pressure medicine came in to have blood pressure checked, Dr. Baker couldn't justify charging the full $8.00 so he charged a more charitable $4.00 instead. Because the government had to get the best price, the Medicare bureaucrats informed the doctor that as far as the Medicare program was concerned his fee for his standard office consultation was actually $4.00, not $8. So, the government would pay him or reimburse patients the usual 80 percent, or $3.20.
Oh, yes, and he better try really hard to collect that other 80 cents or the government would conclude that his usual fee was actually only $3.20, and the government would pay 80 percent of that, or $2.56; the formula spirals downward from there. So, if a doctor charitably charged less to poor patients, the government paid the doctor no more than the fee paid by these charity patients. Some doctors became charity cases themselves. Of course, there could be exceptions, if you knew your way through the Magic Code Book and kept bureaucratic-style records meeting the bureaucratic requirements du jour. If some doctor or hospital was rash enough to treat charity patients for free, the government would conclude that was the usual fee and pay nothing for services rendered to government patients.
Indeed, this seems to be the approach to several charity hospitals that had the gall to continue their charitable mission. They get into trouble when they only give charity to human beings and not to Medicare apparatchiks. This is exactly happened to the 161 bed Deborah Hospital in New Jersey. The hospital never charges patients for medical services. But the hospital did collect from Medicare when patients had Medicare coverage.
As medical lawyer Madeline P. Cosman, Ph.D., writes "the U.S. Department of Health and Human Services prosecuted Deborah over the course of four years because Deborah accepts Medicare payments without requiring patient copayments and therefore violates a slew of civil and criminal laws. "By following its own three-quarter-century-old mandate to never charge patients, Deborah Hospital was accused of granting incentives for referrals, submitting false claims to the government, unfairly competing with community and other specialty hospitals, and generally flouting White Coat Crime laws ... Medicare has no obligation to pay for hospital care that the patient gets as a free gift."
The "false claims" charge alone carries a $10,000 fine, per incident, plus triple damages. Each patient charge can be prosecuted as a separate false claim. "Deborah's refusal to violate its free care mandate that defies medical law nearly forced the generous doors and charity operating rooms to close shut. In 2003, Deborah Hospital finally got a reprieve, a waiver enabling them to continue their tradition of not charging copayments" writes Cosman.
Deborah Hospital was presumed guilty, until proven innocent or granted a waiver from the boss. So, in order to keep government prosecutors at bay, doctors and hospitals who have contracts with Medicare or private insurance companies are essentially forced to charge their highest fees so that the government can't accuse them of cheating. These fees are like the "rack rate" room charges posted in hotel rooms. In our experience, these posted hotel charges are always a lot higher than what you actually pay and are apparently posted because of some "consumer protection" regulation. Just as individuals, travel agents and businesses negotiate lower rates for hotel rooms, insurance companies and individuals negotiate lower rates for hospital rooms, at least with some hospitals.
At least this bureaucratic inversion of charity is now coming to public attention. The Robert Wood Johnson Foundation paid for a study of 6,600 physicians that found that 68 percent of doctors now say they deliver any free or discounted assistance to low-income patients. This is down from 76 percent a mere 10 years earlier according to Donald Devine, former director of the Federal Employees Health Benefits and Civil Service Retirement programs in an article published in the Washington Times two days after April Fools Day.
It took a study to find out what doctors have been experiencing for several decades. Although Devine "had managed the largest employer health insurance plan in the nation and written often on health matters" this problem had escaped his notice, he writes. "When one reads about doctors being hauled off to jail for fraud, odds are this is the cause: Guilty not of fraud but of charity."
Source
More on Queensland's crooked health bureaucrats
But the government is still lying
The State Government has released the names of three senior bureaucrats suspended in the wake of the latest Queensland Health bungle. The three are being investigated by the Crime and Misconduct Commission for their role in the appointment of a nurse with false qualifications and subsequent disciplining of a doctor who complained. The three were identified as Prince Charles Hospital acting district manager Michael Cleary, Statewide Health Services executive director Linda Dawson and Gloria Wallace, general manager of Central Health Area Services.
A spokesman for Health Minister Stephen Robertson said Ms Wallace was flying back from a private trip to Britain. The Government strenuously denied she was part of the British recruitment team headed by Premier Peter Beattie. But sources told The Sunday Mail Ms Wallace had been in Britain in an official capacity.
It has been revealed Health officials were warned more than a year ago about the threat of a Jayant Patel-like situation after the nurse's appointment. A confidential email that expressed concern about the risk to patient safety was ignored.
The State Government this week was forced to apologise to Dr Chris Davis, head of rehabilitation and aged care at Brisbane's Prince Charles Hospital, after he was ignored, then disciplined, for raising concerns about the nurse. Dr Davis sent an email to two senior health officials in April last year dealing with the performance of new nursing manager Virginia Hancl. He had spoken to Ms Hancl's former manager, who was surprised she had been appointed without any reference checks. Queensland Health had only called her boyfriend, listed as a referee. Dr Davis warned that trying to manage someone who should not have been appointed was like "trying to improve the performance of Dr Patel".
Opposition health spokesman Bruce Flegg slammed Queensland Health for the cover-up. "These revelations make a mockery of the Government's claims things are getting better," 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.
***************************
"Thou shall not commit charity." So decrees the federal government, under the 1996 HIPAA and other laws and regulations. In Western Civilization, ethical requirement for personal fulfillment once included charity and charitable action. How did this ethic get turned on its head?
Once again, incompletely-considered intentions have gone awry. And this particular awryness goes back at least 40 years, when the federal government got into the business of paying for medical care big time, with the Medicare and Medicaid programs. In addition to politicians garnering political points, votes and political campaign contributions, another intention was to help older Americans get medical and hospital coverage. These government officials have been worried that doctors might inflate charges for patients covered by Medicare. So, the bureaucrats and Congress made rules limiting what doctors could charge for services rendered to Medicare recipients. Government bureaucrats allowed the small fries (such as doctors and hospitals) to collect only their lowest price for goods and services.
From the beginning, doctors had trouble keeping up with government regulations and filling out the claim forms. This paperwork is like having to fill out an individual income tax return to the IRS for every patient. The doctor is responsible for coming up with politically-correct patient information, code numbers, modifiers and other minutiae lest he be convicted of insurance fraud and sent to jail for five years. Oh, I almost forgot to mention, the degree of fraud has to be significant, defined as at least $100, under the 1996 HIPAA Law.
In the late 1960s, Dr. James Baker of Aberdeen WA charged $8.00 for a standard office consultation. But when a patient on blood pressure medicine came in to have blood pressure checked, Dr. Baker couldn't justify charging the full $8.00 so he charged a more charitable $4.00 instead. Because the government had to get the best price, the Medicare bureaucrats informed the doctor that as far as the Medicare program was concerned his fee for his standard office consultation was actually $4.00, not $8. So, the government would pay him or reimburse patients the usual 80 percent, or $3.20.
Oh, yes, and he better try really hard to collect that other 80 cents or the government would conclude that his usual fee was actually only $3.20, and the government would pay 80 percent of that, or $2.56; the formula spirals downward from there. So, if a doctor charitably charged less to poor patients, the government paid the doctor no more than the fee paid by these charity patients. Some doctors became charity cases themselves. Of course, there could be exceptions, if you knew your way through the Magic Code Book and kept bureaucratic-style records meeting the bureaucratic requirements du jour. If some doctor or hospital was rash enough to treat charity patients for free, the government would conclude that was the usual fee and pay nothing for services rendered to government patients.
Indeed, this seems to be the approach to several charity hospitals that had the gall to continue their charitable mission. They get into trouble when they only give charity to human beings and not to Medicare apparatchiks. This is exactly happened to the 161 bed Deborah Hospital in New Jersey. The hospital never charges patients for medical services. But the hospital did collect from Medicare when patients had Medicare coverage.
As medical lawyer Madeline P. Cosman, Ph.D., writes "the U.S. Department of Health and Human Services prosecuted Deborah over the course of four years because Deborah accepts Medicare payments without requiring patient copayments and therefore violates a slew of civil and criminal laws. "By following its own three-quarter-century-old mandate to never charge patients, Deborah Hospital was accused of granting incentives for referrals, submitting false claims to the government, unfairly competing with community and other specialty hospitals, and generally flouting White Coat Crime laws ... Medicare has no obligation to pay for hospital care that the patient gets as a free gift."
The "false claims" charge alone carries a $10,000 fine, per incident, plus triple damages. Each patient charge can be prosecuted as a separate false claim. "Deborah's refusal to violate its free care mandate that defies medical law nearly forced the generous doors and charity operating rooms to close shut. In 2003, Deborah Hospital finally got a reprieve, a waiver enabling them to continue their tradition of not charging copayments" writes Cosman.
Deborah Hospital was presumed guilty, until proven innocent or granted a waiver from the boss. So, in order to keep government prosecutors at bay, doctors and hospitals who have contracts with Medicare or private insurance companies are essentially forced to charge their highest fees so that the government can't accuse them of cheating. These fees are like the "rack rate" room charges posted in hotel rooms. In our experience, these posted hotel charges are always a lot higher than what you actually pay and are apparently posted because of some "consumer protection" regulation. Just as individuals, travel agents and businesses negotiate lower rates for hotel rooms, insurance companies and individuals negotiate lower rates for hospital rooms, at least with some hospitals.
At least this bureaucratic inversion of charity is now coming to public attention. The Robert Wood Johnson Foundation paid for a study of 6,600 physicians that found that 68 percent of doctors now say they deliver any free or discounted assistance to low-income patients. This is down from 76 percent a mere 10 years earlier according to Donald Devine, former director of the Federal Employees Health Benefits and Civil Service Retirement programs in an article published in the Washington Times two days after April Fools Day.
It took a study to find out what doctors have been experiencing for several decades. Although Devine "had managed the largest employer health insurance plan in the nation and written often on health matters" this problem had escaped his notice, he writes. "When one reads about doctors being hauled off to jail for fraud, odds are this is the cause: Guilty not of fraud but of charity."
Source
More on Queensland's crooked health bureaucrats
But the government is still lying
The State Government has released the names of three senior bureaucrats suspended in the wake of the latest Queensland Health bungle. The three are being investigated by the Crime and Misconduct Commission for their role in the appointment of a nurse with false qualifications and subsequent disciplining of a doctor who complained. The three were identified as Prince Charles Hospital acting district manager Michael Cleary, Statewide Health Services executive director Linda Dawson and Gloria Wallace, general manager of Central Health Area Services.
A spokesman for Health Minister Stephen Robertson said Ms Wallace was flying back from a private trip to Britain. The Government strenuously denied she was part of the British recruitment team headed by Premier Peter Beattie. But sources told The Sunday Mail Ms Wallace had been in Britain in an official capacity.
It has been revealed Health officials were warned more than a year ago about the threat of a Jayant Patel-like situation after the nurse's appointment. A confidential email that expressed concern about the risk to patient safety was ignored.
The State Government this week was forced to apologise to Dr Chris Davis, head of rehabilitation and aged care at Brisbane's Prince Charles Hospital, after he was ignored, then disciplined, for raising concerns about the nurse. Dr Davis sent an email to two senior health officials in April last year dealing with the performance of new nursing manager Virginia Hancl. He had spoken to Ms Hancl's former manager, who was surprised she had been appointed without any reference checks. Queensland Health had only called her boyfriend, listed as a referee. Dr Davis warned that trying to manage someone who should not have been appointed was like "trying to improve the performance of Dr Patel".
Opposition health spokesman Bruce Flegg slammed Queensland Health for the cover-up. "These revelations make a mockery of the Government's claims things are getting better," 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.
***************************
Sunday, May 14, 2006
THE AUSTRALIAN PUBLIC MEDICINE MELTDOWN CONTINUES
Three more reports below on government control of medicine:
Universities producing doctors trained as social workers
University medical schools have filled their curriculums with "soft" subjects to such an extent they are now busy turning out a generation of "medical social workers and medical psychologists" instead of doctors. One of the country's top neurosurgeons warned that the decline of anatomy teaching was "a growing cause of concern, to the point of panic" among many surgeons, who felt powerless to stop the universities cutting traditional science subjects.
Leigh Atkinson, associate professor of neurosurgery at the University of Queensland, said the downgrading of science in favour of soft topics such as communication skills meant young doctors "haven't got the basics they have to build their medical thinking on". Professor Atkinson said junior doctors' understanding of anatomy was "very poor". "I think the people running the medical schools have to justify to the profession why they are changing direction, and what are the benefits of changing direction," he said. "It would seem they are trying to turn our medical students into glorified social workers... we are going to be producing medical social workers and medical psychologists."
Professor Atkinson said senior doctors "do not feel the universities are listening to the clinical colleges" about what skills medical students needed. "There's this big rush to see how much money they can get ... I think they are forgetting the basic principles."
The Weekend Australian on Saturday revealed widespread alarm among senior doctors over the decline in anatomy training to make way for "touchy-feely" subjects such as "cultural sensitivity". One group, the Australian Doctors' Fund, sent a dossier to the federal Government last week detailing its concerns.
Final-year Monash University medical student Michael Gardner said up to 25 per cent of his course was now focused on cultural sensitivity and other subjects such as ethics, law and "personal development". Sensitivity training taught students that some ethnic groups had "different expectations" of doctors, and that they should "be aware that things you say may be viewed in a different way than how you intend". A smaller module on personal development focused on "relaxation techniques" and "how to manage stress".
Education Minister Julie Bishop said she was "concerned by the issues raised" in the ADF submission, which will be considered in a current review of medical education.
Source
Medical schools in new alert on anatomy teaching
Three more doctors' colleges have raised concerns about the standard of teaching in medical schools, with one warning that doctors' skills risk being taken "back to the Middle Ages" by cutbacks to the basic sciences. Amid a continuing row over the downgrading of anatomy teaching, the Royal College of Pathologists of Australasia has opened a new front, warning that the problem extends to other basic sciences such as pharmacology and pathology, the study of the disease process. Anaesthetists, obstetricians and gynaecologists have added their voices to the concerns, saying the gaps now evident in junior doctors' knowledge raise questions over the extent to which they could practise safely if they did not do further training after university.
RCPA president Stewart Bryant said universities had slashed pathology tuition so much that many newly graduated doctors were "often quite unsure" what pathology tests they should order to confirm or exclude a diagnosis. "That's another fallout of this - it's something we are observing routinely," Dr Bryant said. "If you go back to the origins of the names of diseases, malaria means 'bad air'. Do we want to go back to believing malaria is caused by bad air, when modern medicine shows us it's caused by a parasite in the blood? "Pathology started 250 years ago and has taught us this basic information about the disease process - and we risk losing that, we risk going back to the Middle Ages."
The Weekend Australian last week revealed a coalition of senior doctors and academics had called on the federal Government to step in to sort out the "appalling" state of medical education. But the deans of the nation's 17 medical schools have strenuously denied their courses are failing to equip medical students with essential knowledge, and have accused critics of resisting necessary change. The Royal Australasian College of Surgeons is in talks to arrange remedial training courses in anatomy for junior doctors entering its own specialist training program, saying their anatomical knowledge was "unacceptably low".
The president of the Australian and New Zealand College of Anaesthetists, Michael Cousins, said the teaching of communication skills was important, but that graduates "need to have a fundamental knowledge of the major structures in the human body". "We are finding we have to do more work with students, especially those coming out of four-year programs, in bringing them up to speed," Professor Cousins said. "It raises some concern, I suppose, with us that the people who aren't coming to us for further education, but go out practising as doctors or GPs, may not necessarily have as much knowledge as they should have."
John Svigos, chairman of the training and accreditation committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said almost all the colleges shared the concerns and would discuss them when college presidents meet later this month. John Carmody, who taught physiology and pharmacology at the University of NSW for more than 40 years, said many medical courses had now changed the sequence of education in a way that made it harder for students to apply the knowledge.
Source
Health bureaucrats at last get some blame
The Queensland Government has suspended three senior health bureaucrats, pending the outcome of an investigation by the Crime and Misconduct Commission (CMC). The Director-General of Queensland Health Uschi Schreiber referred the matters to the CMC last week after receiving new information from a doctor that raised concerns about possible misconduct. The Queensland Government was forced yesterday to apologise to Dr Chris Davis after he was disciplined for raising concerns about a nurse hired on fake qualifications and recommendations of her boyfriend. Health Minister Stephen Robertson said he had personally apologised to Dr Davis, who heads the rehabilitation and geriatric unit at Brisbane's Prince Charles Hospital. Mr Robertson said based on new information, Dr Davis had been given whistleblower status and his disciplinary record cleared.
A decision today by a delegate of the Public Service Commissioner found that Queensland Health had denied natural justice to the senior doctor as he was not given an opportunity to respond to a charge against him. Dr Davis was disciplined last September after raising concerns about the abilities of a nurse employed in a senior role in his unit. The nurse's competence also was questioned in a written document by 18 other staff members in the unit. The Opposition revealed yesterday the nurse had been hired despite presenting fake qualifications of a masters degree from a university in Tasmania where she had nursed in an old age home. It also said Queensland Health had failed to question the nurse's previous employer, interviewing only one referee who turned out to be her boyfriend.
Opposition health spokesman Dr Bruce Flegg said Dr Davis was "very distressed". "All his hard work to build the rehabilitation unit has been blown out of the water," Dr Flegg said. "Three-quarters of the staff has left and the unit is in disarray." The future of the nurse in question, who has been on leave without pay since last August, will be determined following the CMC report.
The case raises fresh concerns of bullying in Queensland Health, following the case of Bundaberg nurse Toni Hoffman whose complaints about rogue surgeon Jayant Patel were initially ignored....
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.
***************************
Three more reports below on government control of medicine:
Universities producing doctors trained as social workers
University medical schools have filled their curriculums with "soft" subjects to such an extent they are now busy turning out a generation of "medical social workers and medical psychologists" instead of doctors. One of the country's top neurosurgeons warned that the decline of anatomy teaching was "a growing cause of concern, to the point of panic" among many surgeons, who felt powerless to stop the universities cutting traditional science subjects.
Leigh Atkinson, associate professor of neurosurgery at the University of Queensland, said the downgrading of science in favour of soft topics such as communication skills meant young doctors "haven't got the basics they have to build their medical thinking on". Professor Atkinson said junior doctors' understanding of anatomy was "very poor". "I think the people running the medical schools have to justify to the profession why they are changing direction, and what are the benefits of changing direction," he said. "It would seem they are trying to turn our medical students into glorified social workers... we are going to be producing medical social workers and medical psychologists."
Professor Atkinson said senior doctors "do not feel the universities are listening to the clinical colleges" about what skills medical students needed. "There's this big rush to see how much money they can get ... I think they are forgetting the basic principles."
The Weekend Australian on Saturday revealed widespread alarm among senior doctors over the decline in anatomy training to make way for "touchy-feely" subjects such as "cultural sensitivity". One group, the Australian Doctors' Fund, sent a dossier to the federal Government last week detailing its concerns.
Final-year Monash University medical student Michael Gardner said up to 25 per cent of his course was now focused on cultural sensitivity and other subjects such as ethics, law and "personal development". Sensitivity training taught students that some ethnic groups had "different expectations" of doctors, and that they should "be aware that things you say may be viewed in a different way than how you intend". A smaller module on personal development focused on "relaxation techniques" and "how to manage stress".
Education Minister Julie Bishop said she was "concerned by the issues raised" in the ADF submission, which will be considered in a current review of medical education.
Source
Medical schools in new alert on anatomy teaching
Three more doctors' colleges have raised concerns about the standard of teaching in medical schools, with one warning that doctors' skills risk being taken "back to the Middle Ages" by cutbacks to the basic sciences. Amid a continuing row over the downgrading of anatomy teaching, the Royal College of Pathologists of Australasia has opened a new front, warning that the problem extends to other basic sciences such as pharmacology and pathology, the study of the disease process. Anaesthetists, obstetricians and gynaecologists have added their voices to the concerns, saying the gaps now evident in junior doctors' knowledge raise questions over the extent to which they could practise safely if they did not do further training after university.
RCPA president Stewart Bryant said universities had slashed pathology tuition so much that many newly graduated doctors were "often quite unsure" what pathology tests they should order to confirm or exclude a diagnosis. "That's another fallout of this - it's something we are observing routinely," Dr Bryant said. "If you go back to the origins of the names of diseases, malaria means 'bad air'. Do we want to go back to believing malaria is caused by bad air, when modern medicine shows us it's caused by a parasite in the blood? "Pathology started 250 years ago and has taught us this basic information about the disease process - and we risk losing that, we risk going back to the Middle Ages."
The Weekend Australian last week revealed a coalition of senior doctors and academics had called on the federal Government to step in to sort out the "appalling" state of medical education. But the deans of the nation's 17 medical schools have strenuously denied their courses are failing to equip medical students with essential knowledge, and have accused critics of resisting necessary change. The Royal Australasian College of Surgeons is in talks to arrange remedial training courses in anatomy for junior doctors entering its own specialist training program, saying their anatomical knowledge was "unacceptably low".
The president of the Australian and New Zealand College of Anaesthetists, Michael Cousins, said the teaching of communication skills was important, but that graduates "need to have a fundamental knowledge of the major structures in the human body". "We are finding we have to do more work with students, especially those coming out of four-year programs, in bringing them up to speed," Professor Cousins said. "It raises some concern, I suppose, with us that the people who aren't coming to us for further education, but go out practising as doctors or GPs, may not necessarily have as much knowledge as they should have."
John Svigos, chairman of the training and accreditation committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said almost all the colleges shared the concerns and would discuss them when college presidents meet later this month. John Carmody, who taught physiology and pharmacology at the University of NSW for more than 40 years, said many medical courses had now changed the sequence of education in a way that made it harder for students to apply the knowledge.
Source
Health bureaucrats at last get some blame
The Queensland Government has suspended three senior health bureaucrats, pending the outcome of an investigation by the Crime and Misconduct Commission (CMC). The Director-General of Queensland Health Uschi Schreiber referred the matters to the CMC last week after receiving new information from a doctor that raised concerns about possible misconduct. The Queensland Government was forced yesterday to apologise to Dr Chris Davis after he was disciplined for raising concerns about a nurse hired on fake qualifications and recommendations of her boyfriend. Health Minister Stephen Robertson said he had personally apologised to Dr Davis, who heads the rehabilitation and geriatric unit at Brisbane's Prince Charles Hospital. Mr Robertson said based on new information, Dr Davis had been given whistleblower status and his disciplinary record cleared.
A decision today by a delegate of the Public Service Commissioner found that Queensland Health had denied natural justice to the senior doctor as he was not given an opportunity to respond to a charge against him. Dr Davis was disciplined last September after raising concerns about the abilities of a nurse employed in a senior role in his unit. The nurse's competence also was questioned in a written document by 18 other staff members in the unit. The Opposition revealed yesterday the nurse had been hired despite presenting fake qualifications of a masters degree from a university in Tasmania where she had nursed in an old age home. It also said Queensland Health had failed to question the nurse's previous employer, interviewing only one referee who turned out to be her boyfriend.
Opposition health spokesman Dr Bruce Flegg said Dr Davis was "very distressed". "All his hard work to build the rehabilitation unit has been blown out of the water," Dr Flegg said. "Three-quarters of the staff has left and the unit is in disarray." The future of the nurse in question, who has been on leave without pay since last August, will be determined following the CMC report.
The case raises fresh concerns of bullying in Queensland Health, following the case of Bundaberg nurse Toni Hoffman whose complaints about rogue surgeon Jayant Patel were initially ignored....
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.
***************************
Saturday, May 13, 2006
Study: Four out of 10 Medical Malpractice Cases Are Groundless
About 40 percent of the medical malpractice cases filed in the United States are groundless, according to a Harvard analysis of the hotly debated issue that pits trial lawyers against doctors, with lawmakers in the middle. Many of the lawsuits analyzed contained no evidence that a medical error was committed or that the patient suffered any injury, the researchers reported. The vast majority of those dubious cases were dismissed with no payout to the patient. However, groundless lawsuits still accounted for 15 percent of the money paid out in settlements or verdicts.
The study's lead researcher, David Studdert of the Harvard School of Public Health, said the findings challenge the view among tort reform supporters that the legal system is riddled with frivolous claims that lead to exorbitant payouts. "We found the system did reasonably well in sorting the good claims from the bad ones, but there were problems," he said.
However, the American Medical Association, which favors caps on malpractice awards, called the study proof that a substantial number of meritless claims continue to slip through the cracks, "clogging the courts" and forcing doctors to waste time defending them, association board member Dr. Cecil Wilson said in a statement.
The findings were published in Thursday's New England Journal of Medicine. The study found 3 percent of claims analyzed were filed by patients who had no injury. Of the claims that involved injuries, two-thirds were caused by medical error. But the remaining injury claims, or 37 percent, lacked evidence of a medical mistake, and most of those -- 72 percent -- were thrown out or otherwise resolved without a payout to the patient. Altogether, the Harvard researchers reviewed 1,452 malpractice claims randomly selected from five insurance companies. The cases were resolved -- meaning they ended in a verdict, a settlement or a dismissal -- between 1984 and 2004. The claims resulted in a combined $449 million in verdicts and settlements. The researchers examined medical records, depositions and court transcripts to determine if the patients were injured and whether the injury was due to a medical error.
In one instance, a young woman with no family history of breast cancer underwent routine breast exams for four years and came back with a clean bill of health. But doctors later found she had breast cancer that had spread to other parts of the body. The researchers determined the case did not involve medical error because proper procedures were followed. The woman filed a malpractice claim and received an undisclosed settlement.
The study also confirmed that defending a claim is expensive and long, taking an average of five years to resolve. It also found that for every dollar awarded to patients, about half went to cover lawyer fees and other expenses. Chris Mather, a spokeswoman for the Association of Trial Lawyers for America, said the study was biased because data was taken from insurers, which sometimes are the defendants in malpractice suits.
The debate over malpractice litigation simmered in Congress this week when Senate Democrats defeated a pair of Republican-backed bills aimed at limiting how much pain-and-suffering damages juries can award in malpractice cases. Similar legislation already passed the House.
George Annas, a Boston University bioethicist who had no role in the study, said he was not surprised by the findings. Many personal injury attorneys receive a contingency fee -- meaning they get paid only if they win -- and will not go to court with a baseless lawsuit, Annas said. "There's really no motivation to bring a frivolous lawsuit," he said. "It's not worth their time and effort." Among the findings:
* An overwhelming number of malpractice claims (97 percent) involved a severe disability or death. Seventy-three percent of all of the injury claims that were due to medical error were settled with a payment.
* In about a quarter of cases where a groundless claim was settled, the average payout was lower than that given to a legitimate claim ($313,000 versus $521,000).
Source
THE STEADY DECLINE OF AUSTRALIAN PUBLIC MEDICINE CONTINUES
Three stories from one day below:
Queensland Health: Nurse-hiring as incompetent as its doctor-hiring
Queensland Health appointed a senior nurse with false qualifications and called her boyfriend as her principal referee, State Parliament was told yesterday. The three-year-old blunder is now under investigation by the Crime and Misconduct Commission after it was revealed that a senior doctor who raised concerns about the appointment was disciplined and ignored by the department.
The Opposition yesterday issued a list of allegations against Prince Charles Hospital nursing manager Virginia Hancl, suggesting she was removed from clinical duties in her previous job because of concerns about her nursing skills. It was also alleged she falsified her master's degree in public administration from the University of Tasmania and the doctor discovered her past employer had not been contacted about a reference. The Opposition said the fiasco bore striking similarities to the Jayant Patel scandal, where nurse Toni Hoffman was ignored after complaining about the surgeon's ability, and accused the Government of attempting to cover up the matter.
After uncovering the concerns last year, doctor Chris Davis sought a review of Ms Hancl's appointment and applied for whistleblower protection, but instead was disciplined for breaching her privacy. Yesterday, Health Minister Stephen Robertson admitted the reference check had not been thorough and involved someone close to the nurse. "In terms of the referee that was contacted, that referee did not disclose the personal relationship he had with Hancl at that point in time," he said.
Defending yet another Queensland Health bungle, Premier Peter Beattie said the matter was a product of "the old" Queensland Health. "What you've got . . . is the legacy of the bad old days of Health - the new days are on the way," he said. Mr Beattie said any staff found to have erred would have "the book thrown at them". The department where the woman worked at Prince Charles will be reviewed to decide whether her appointment and the ensuing staff concerns resulted in reduced services.
The admissions are in stark contrast to comments last November when Mr Robertson said two internal reviews had found no problem with her appointment, her reference checks were "appropriate" and she was fully qualified. Yesterday, Mr Robertson said he had acted "decisively and transparently" when the real facts of the matter came to light in May, when the department prepared documents before an industrial relations hearing into Dr Davis's appeal for whistleblower protection. Since then, Mr Robertson has apologised to the doctor, offered to pay his legal fees, strike the disciplinary action from his record and give him whistleblower protection.
Ms Hancl is still employed by Queensland Health but has been on unpaid leave for several months. Mr Robertson said there was no evidence that any patients had experienced adverse outcomes as a result of her appointment.
Source
Resigning surgeons 'had no choice': "One of four urological surgeons, who have resigned from Sir Charles Gardiner Hospital, says they had no choice but to quit in protest over delays in treating patients and ever-increasing waiting lists. Robert Davies and three other specialists will leave the hospital within six weeks. He says surgeons, nurses and other medical workers at the coal face feel disenfranchised with the health system. "We don't feel as though we have control or any real input into the way the system is organised and run," Dr Davies said. "What we see at the end of the line is a diminishing resources in the face of increased demands."
Superbug link to 103 deaths in Victoria's public hospitals: "A deadly superbug has been linked to 103 Victorian deaths in public hospitals. The MRSA superbug, a multi-antibiotic-resistant golden staph, has infected 1447 Victorians who were admitted to Melbourne hospitals last year. Department of Human Services figures show Bayside Health, which oversees the Alfred hospital, had the highest number of MRSA cases of all Melbourne health networks. More than 530 patients admitted to Bayside hospitals had MRSA -- 29 of them died. At Southern Health, which includes the Monash Medical Centre and Casey and Dandenong hospitals, 17 patients with MRSA died. And 11 patients died at Northern Health, which runs the Northern Hospital in Epping. MRSA, or methicillin-resistant staphylococcus aureus, is spread by doctors and nurses who have not washed their hands properly, and by dirty hospital equipment. The bug can be found in harmless levels on the skin, but once it enters the bloodstream it can become lethal... Department of Human Services acting director of quality and safety Alison McMillan said 75 per cent of Victoria's MRSA cases caught the superbug in hospitals. Ms McMillan said MRSA rates had improved since the introduction of a hand hygiene program in all Victorian hospitals last year, but there was still a lot of work to be done. "It's not an easy area to tackle, it's an enormous challenge," she said. "We've got this rolling program of educating hospitals, setting up systems to encourage people to use the hand gel, but that's going to take some time because there are a lot of hospitals in Victoria."
***************************
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.
***************************
About 40 percent of the medical malpractice cases filed in the United States are groundless, according to a Harvard analysis of the hotly debated issue that pits trial lawyers against doctors, with lawmakers in the middle. Many of the lawsuits analyzed contained no evidence that a medical error was committed or that the patient suffered any injury, the researchers reported. The vast majority of those dubious cases were dismissed with no payout to the patient. However, groundless lawsuits still accounted for 15 percent of the money paid out in settlements or verdicts.
The study's lead researcher, David Studdert of the Harvard School of Public Health, said the findings challenge the view among tort reform supporters that the legal system is riddled with frivolous claims that lead to exorbitant payouts. "We found the system did reasonably well in sorting the good claims from the bad ones, but there were problems," he said.
However, the American Medical Association, which favors caps on malpractice awards, called the study proof that a substantial number of meritless claims continue to slip through the cracks, "clogging the courts" and forcing doctors to waste time defending them, association board member Dr. Cecil Wilson said in a statement.
The findings were published in Thursday's New England Journal of Medicine. The study found 3 percent of claims analyzed were filed by patients who had no injury. Of the claims that involved injuries, two-thirds were caused by medical error. But the remaining injury claims, or 37 percent, lacked evidence of a medical mistake, and most of those -- 72 percent -- were thrown out or otherwise resolved without a payout to the patient. Altogether, the Harvard researchers reviewed 1,452 malpractice claims randomly selected from five insurance companies. The cases were resolved -- meaning they ended in a verdict, a settlement or a dismissal -- between 1984 and 2004. The claims resulted in a combined $449 million in verdicts and settlements. The researchers examined medical records, depositions and court transcripts to determine if the patients were injured and whether the injury was due to a medical error.
In one instance, a young woman with no family history of breast cancer underwent routine breast exams for four years and came back with a clean bill of health. But doctors later found she had breast cancer that had spread to other parts of the body. The researchers determined the case did not involve medical error because proper procedures were followed. The woman filed a malpractice claim and received an undisclosed settlement.
The study also confirmed that defending a claim is expensive and long, taking an average of five years to resolve. It also found that for every dollar awarded to patients, about half went to cover lawyer fees and other expenses. Chris Mather, a spokeswoman for the Association of Trial Lawyers for America, said the study was biased because data was taken from insurers, which sometimes are the defendants in malpractice suits.
The debate over malpractice litigation simmered in Congress this week when Senate Democrats defeated a pair of Republican-backed bills aimed at limiting how much pain-and-suffering damages juries can award in malpractice cases. Similar legislation already passed the House.
George Annas, a Boston University bioethicist who had no role in the study, said he was not surprised by the findings. Many personal injury attorneys receive a contingency fee -- meaning they get paid only if they win -- and will not go to court with a baseless lawsuit, Annas said. "There's really no motivation to bring a frivolous lawsuit," he said. "It's not worth their time and effort." Among the findings:
* An overwhelming number of malpractice claims (97 percent) involved a severe disability or death. Seventy-three percent of all of the injury claims that were due to medical error were settled with a payment.
* In about a quarter of cases where a groundless claim was settled, the average payout was lower than that given to a legitimate claim ($313,000 versus $521,000).
Source
THE STEADY DECLINE OF AUSTRALIAN PUBLIC MEDICINE CONTINUES
Three stories from one day below:
Queensland Health: Nurse-hiring as incompetent as its doctor-hiring
Queensland Health appointed a senior nurse with false qualifications and called her boyfriend as her principal referee, State Parliament was told yesterday. The three-year-old blunder is now under investigation by the Crime and Misconduct Commission after it was revealed that a senior doctor who raised concerns about the appointment was disciplined and ignored by the department.
The Opposition yesterday issued a list of allegations against Prince Charles Hospital nursing manager Virginia Hancl, suggesting she was removed from clinical duties in her previous job because of concerns about her nursing skills. It was also alleged she falsified her master's degree in public administration from the University of Tasmania and the doctor discovered her past employer had not been contacted about a reference. The Opposition said the fiasco bore striking similarities to the Jayant Patel scandal, where nurse Toni Hoffman was ignored after complaining about the surgeon's ability, and accused the Government of attempting to cover up the matter.
After uncovering the concerns last year, doctor Chris Davis sought a review of Ms Hancl's appointment and applied for whistleblower protection, but instead was disciplined for breaching her privacy. Yesterday, Health Minister Stephen Robertson admitted the reference check had not been thorough and involved someone close to the nurse. "In terms of the referee that was contacted, that referee did not disclose the personal relationship he had with Hancl at that point in time," he said.
Defending yet another Queensland Health bungle, Premier Peter Beattie said the matter was a product of "the old" Queensland Health. "What you've got . . . is the legacy of the bad old days of Health - the new days are on the way," he said. Mr Beattie said any staff found to have erred would have "the book thrown at them". The department where the woman worked at Prince Charles will be reviewed to decide whether her appointment and the ensuing staff concerns resulted in reduced services.
The admissions are in stark contrast to comments last November when Mr Robertson said two internal reviews had found no problem with her appointment, her reference checks were "appropriate" and she was fully qualified. Yesterday, Mr Robertson said he had acted "decisively and transparently" when the real facts of the matter came to light in May, when the department prepared documents before an industrial relations hearing into Dr Davis's appeal for whistleblower protection. Since then, Mr Robertson has apologised to the doctor, offered to pay his legal fees, strike the disciplinary action from his record and give him whistleblower protection.
Ms Hancl is still employed by Queensland Health but has been on unpaid leave for several months. Mr Robertson said there was no evidence that any patients had experienced adverse outcomes as a result of her appointment.
Source
Resigning surgeons 'had no choice': "One of four urological surgeons, who have resigned from Sir Charles Gardiner Hospital, says they had no choice but to quit in protest over delays in treating patients and ever-increasing waiting lists. Robert Davies and three other specialists will leave the hospital within six weeks. He says surgeons, nurses and other medical workers at the coal face feel disenfranchised with the health system. "We don't feel as though we have control or any real input into the way the system is organised and run," Dr Davies said. "What we see at the end of the line is a diminishing resources in the face of increased demands."
Superbug link to 103 deaths in Victoria's public hospitals: "A deadly superbug has been linked to 103 Victorian deaths in public hospitals. The MRSA superbug, a multi-antibiotic-resistant golden staph, has infected 1447 Victorians who were admitted to Melbourne hospitals last year. Department of Human Services figures show Bayside Health, which oversees the Alfred hospital, had the highest number of MRSA cases of all Melbourne health networks. More than 530 patients admitted to Bayside hospitals had MRSA -- 29 of them died. At Southern Health, which includes the Monash Medical Centre and Casey and Dandenong hospitals, 17 patients with MRSA died. And 11 patients died at Northern Health, which runs the Northern Hospital in Epping. MRSA, or methicillin-resistant staphylococcus aureus, is spread by doctors and nurses who have not washed their hands properly, and by dirty hospital equipment. The bug can be found in harmless levels on the skin, but once it enters the bloodstream it can become lethal... Department of Human Services acting director of quality and safety Alison McMillan said 75 per cent of Victoria's MRSA cases caught the superbug in hospitals. Ms McMillan said MRSA rates had improved since the introduction of a hand hygiene program in all Victorian hospitals last year, but there was still a lot of work to be done. "It's not an easy area to tackle, it's an enormous challenge," she said. "We've got this rolling program of educating hospitals, setting up systems to encourage people to use the hand gel, but that's going to take some time because there are a lot of hospitals in Victoria."
***************************
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, May 12, 2006
Australia: Public medicine demands coverups
There is so much failure to conceal
Specialist doctors say governments are gagging them from speaking out about serious flaws in the public hospital system that are costing lives and harming their patients. Members of the Royal Australasian College of Physicians (RACP) have complained they are being forced to sign public hospital contracts preventing them from telling the public about major problems affecting health care Australia-wide.
They said a 30 per cent drop in the number of hospital paediatric wards since 1992 had resulted in children being placed alongside adults who were sometimes psychiatrically disturbed or dying. "I know of children having adult emergency patients in the adjacent bed," Melbourne-based physician Peter Lazzari said in Cairns, where he was attending the RACP's annual scientific conference. "That adult emergency may be a death or a cardiac arrest or a massive haemorrhage, and you can imagine the trauma to the child as a result of that deliberate exposure by the government of children to adult illness," Dr Lazzari said.
Rural Victoria-based paediatrician Peter Goss said he risked the sack for speaking out, but could no longer continue to remain silent when children's welfare was at stake. "It's the first time in a year that I've said anything because speaking out in public prior to that caused me such significant emotional stress from the harassment," Dr Goss said. "These sorts of scandals would not be propagated if the medical staff were allowed to openly ... tell the general population what's going on. "Children will get better more quickly in an environment which is child-friendly and will be cared for more safely if we retain nurses with paediatric experience. "Over the last three years across Victoria, there are multiple examples of hospitals who have downsized children's wards and co-located adults in those wards. "An entire children's ward in Ballarat was closed last year."
Dr Lazzari said governments, both state and federal, had forced medical practitioners to become unwilling jailers and executioners, having to tell patients they might have to wait years in pain for necessary surgery and might even die waiting. "Instead of a diagnosis and an operation, we're actually ... giving those patients who can't get through the waiting list system a sentence," he said. "We say 'yes, you need that hip operated on otherwise your health is going to continue to deteriorate. "'You're going to have continuing pain, continuing suffering, your weight's going to become more of a problem, your exercise program is going to become more of a problem, and you may well die because it's going to be five or six years before you get your operation. "'We're giving you a term of imprisonment with your illness and ultimately you may well die'. "It's a disgrace," he said.
Dr Lazzari said he had decided to speak out because he believed doctors had a major democratic responsibility to raise issues of concern with public health. "We need to be able to speak up freely, but accurately and fairly," he said.
Source
One Australian coverup comes unglued
Queensland Health has been forced into another embarrassing backdown after admitting it wrongly disciplined a whistleblower doctor. The doctor had exposed serious concerns about a senior manager at the Prince Charles Hospital. The man was disciplined last year after checking into the background of a woman appointed to a senior nursing position at the hospital when he had concerns about her ability and referees.
However, the department has now been forced into an about-face, admitting it was wrong, and the matter has been referred to the Crime and Misconduct Commission for investigation. Health Minister Stephen Robertson yesterday told State Parliament that at a May 5 meeting, he personally apologised to the doctor and offered to pay his legal fees and strike the disciplinary action from his record. "We also accorded the doctor with whistleblower status, and the director-general of Queensland Health has taken steps to ensure that he will not be disadvantaged because of the disclosures he has made," Mr Robertson told Parliament.
The doctor first raised concerns about the woman's ability to manage her position and the process of her appointment with hospital management in April last year. He asked for a review of the appointment process, saying her former supervisor had not been contacted as a referee by the hospital before the woman was hired in 2003. Despite the doctor seeking whistleblower protection in May last year, Queensland Health took disciplinary action against the doctor in September for breaching the woman's privacy. He appealed against the action.
Mr Robertson said the incident demonstrated the importance of the soon-to-be-established independent Health Quality and Complaints Commission, which would ensure the concerns of staff and the public were properly managed. The issue was first raised in State Parliament last November by Liberal Party health spokesman Bruce Flegg, who accused the department of ignoring complaints from 18 staff about the woman's appointment and shredding documents relating to the issue.
At the time, the hospital said the appointment had been endorsed by two external reviews. Yesterday, Dr Flegg said the incident had all the hallmarks of poor Queensland Health management including staff bullying and decisions by bureaucrats not clinicians. "This was an appalling episode in the management of a critically important clinical unit," 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.
***************************
There is so much failure to conceal
Specialist doctors say governments are gagging them from speaking out about serious flaws in the public hospital system that are costing lives and harming their patients. Members of the Royal Australasian College of Physicians (RACP) have complained they are being forced to sign public hospital contracts preventing them from telling the public about major problems affecting health care Australia-wide.
They said a 30 per cent drop in the number of hospital paediatric wards since 1992 had resulted in children being placed alongside adults who were sometimes psychiatrically disturbed or dying. "I know of children having adult emergency patients in the adjacent bed," Melbourne-based physician Peter Lazzari said in Cairns, where he was attending the RACP's annual scientific conference. "That adult emergency may be a death or a cardiac arrest or a massive haemorrhage, and you can imagine the trauma to the child as a result of that deliberate exposure by the government of children to adult illness," Dr Lazzari said.
Rural Victoria-based paediatrician Peter Goss said he risked the sack for speaking out, but could no longer continue to remain silent when children's welfare was at stake. "It's the first time in a year that I've said anything because speaking out in public prior to that caused me such significant emotional stress from the harassment," Dr Goss said. "These sorts of scandals would not be propagated if the medical staff were allowed to openly ... tell the general population what's going on. "Children will get better more quickly in an environment which is child-friendly and will be cared for more safely if we retain nurses with paediatric experience. "Over the last three years across Victoria, there are multiple examples of hospitals who have downsized children's wards and co-located adults in those wards. "An entire children's ward in Ballarat was closed last year."
Dr Lazzari said governments, both state and federal, had forced medical practitioners to become unwilling jailers and executioners, having to tell patients they might have to wait years in pain for necessary surgery and might even die waiting. "Instead of a diagnosis and an operation, we're actually ... giving those patients who can't get through the waiting list system a sentence," he said. "We say 'yes, you need that hip operated on otherwise your health is going to continue to deteriorate. "'You're going to have continuing pain, continuing suffering, your weight's going to become more of a problem, your exercise program is going to become more of a problem, and you may well die because it's going to be five or six years before you get your operation. "'We're giving you a term of imprisonment with your illness and ultimately you may well die'. "It's a disgrace," he said.
Dr Lazzari said he had decided to speak out because he believed doctors had a major democratic responsibility to raise issues of concern with public health. "We need to be able to speak up freely, but accurately and fairly," he said.
Source
One Australian coverup comes unglued
Queensland Health has been forced into another embarrassing backdown after admitting it wrongly disciplined a whistleblower doctor. The doctor had exposed serious concerns about a senior manager at the Prince Charles Hospital. The man was disciplined last year after checking into the background of a woman appointed to a senior nursing position at the hospital when he had concerns about her ability and referees.
However, the department has now been forced into an about-face, admitting it was wrong, and the matter has been referred to the Crime and Misconduct Commission for investigation. Health Minister Stephen Robertson yesterday told State Parliament that at a May 5 meeting, he personally apologised to the doctor and offered to pay his legal fees and strike the disciplinary action from his record. "We also accorded the doctor with whistleblower status, and the director-general of Queensland Health has taken steps to ensure that he will not be disadvantaged because of the disclosures he has made," Mr Robertson told Parliament.
The doctor first raised concerns about the woman's ability to manage her position and the process of her appointment with hospital management in April last year. He asked for a review of the appointment process, saying her former supervisor had not been contacted as a referee by the hospital before the woman was hired in 2003. Despite the doctor seeking whistleblower protection in May last year, Queensland Health took disciplinary action against the doctor in September for breaching the woman's privacy. He appealed against the action.
Mr Robertson said the incident demonstrated the importance of the soon-to-be-established independent Health Quality and Complaints Commission, which would ensure the concerns of staff and the public were properly managed. The issue was first raised in State Parliament last November by Liberal Party health spokesman Bruce Flegg, who accused the department of ignoring complaints from 18 staff about the woman's appointment and shredding documents relating to the issue.
At the time, the hospital said the appointment had been endorsed by two external reviews. Yesterday, Dr Flegg said the incident had all the hallmarks of poor Queensland Health management including staff bullying and decisions by bureaucrats not clinicians. "This was an appalling episode in the management of a critically important clinical unit," 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, May 11, 2006
IN SOCIALIZED MEDICINE, TREATMENT IS A PRIVILEGE THAT CAN BE WITHDRAWN, NOT A RIGHT
A pro-life campaigner who sent hospital staff pictures of mutilated and aborted foetuses has been denied hip treatment. Edward Atkinson, 74, was jailed for 28 days and given a five-year antisocial behaviour order for sending offensive photographs to the Queen Elizabeth Hospital in King's Lynn, Norfolk. The pensioner has been taken off a waiting list for an assessment for a hip operation and banned from treatment for anything other than life-threatening conditions.
The move was criticised yesterday by an anti-abortion group backing Atkinson. James Dowson, the national co-ordinator of the UK Life League, said: "It is ridiculous. I think it is completely unfair. They are refusing to treat him. Would they refuse a murderer or a paedophile? "He has paid his taxes, he is entitled to that treatment, who are they to withhold it from him?"
Atkinson, of Hilgay, Norfolk, was jailed at Swaffham Magistrates' Court on Thursday last week after he was convicted of three counts of sending offensive literature or material to staff at the hospital between January and April this year. A hospital spokesman said that the pensioner had been on a waiting list for an assessment for a hip operation when he started sending in pictures of aborted foetuses. The NHS trust wrote to him asking him not to send such material to the hospital as it was distressing staff. When he continued, the trust said he had broken its "Zero Tolerance" policy with regards to staff. Ruth May, chief executive of the Queen Elizabeth Hospital, said: "The trust's view is that we have a duty of care to our staff." [But no duty to people who have paid for care?]
Source
U.K.: 340 MILLION POUNDS FOR NOTHING
A new contract for hospital consultants cost at least 340 million pounds in its first two years but offered patients few improvements in care, a report has found. The King's Fund, an influential health think-tank, says that rushed implementation, a failure to cost the contract properly and a preoccupation with other problems mean that hospitals, the NHS and patients have failed to get much benefit. The result is that consultants are being paid more money for doing the same work as previously, while hospitals are running deficits caused, in part, by the cost of paying them.
Despite promises by Alan Milburn, then Health Secretary, that the new contract would reduce moonlighting by consultants, private work may actually have increased. Mr Milburn claimed that the contract, the first change in consultants' terms and conditions since 1948, was a "something for something" deal. But the King's Fund concludes that it was closer to something for nothing. Niall Dickson, the chief executive of the charity, said: "Consultants are at the core of the NHS and deserve to be paid well for the work they do. However, the Government promised that this contract would also bring benefits to patients and so far that does not appear to have materialised. This is a limited study and these are early days, but it raises profound questions about the effectiveness of the deal and what now needs to be done to ensure that it delivers greater productivity."
Paul Miller, chairman of the BMA consultants' committee, said that the report was limited, inaccurate and based on a small sample of senior managers in five London trusts. "Blaming the consultant contract for the financial crisis facing the NHS is an easy option," he said. "Many NHS trusts are in debt because they are struggling to shake off years of under-investment. They also face rising drug costs and an ever-increasing number of patients. The blame for the NHS funding crisis lies with an incoherent and inconsistent health policy, riddled with errors and misjudgments."
The consultants' contract, which was finally agreed in 2003, aimed to give management greater control over doctors' activities in return for better pay. The report says that, under the old contract, hospitals and consultants had colluded in a deal that meant consultants worked very long hours. In return for this, managements allowed them to "do their own thing". The consultants worked hard, but wrote their own rules. The new contract aimed to define their work much more precisely, and was based on ten four-hour sessions, called programmed activities, a week. Consultants could do private work only if they offered their NHS hospitals an extra weekly session. In practice this lever proved worthless. There is so much work that the average consultant does more than eleven sessions a week, not the ten envisaged.
The contract cost the NHS 90 million pounds more than expected, in part because nobody in the Department of Health believed what the consultants told them about the hours they worked. Pay increased substantially, with starting salaries rising by 36 per cent since 2001 to 69,298 pounds in 2005. But corresponding improvements in productivity have been lacking, largely because managers have seen the contract as "a box to be ticked" rather than an opportunity for change. "There needs to be more emphasis at both national and local levels on how the contract can be used as a tool to benefit patients," Professor James Buchan, co- author of the report, said.
A spokeswoman for the Department of Health said: "NHS pay reform, including the consultant contract, has been part of a significant success story in the NHS. "There is still some way to go before we realise the full benefits of its implementation, but increasing pay rates is only one small part of the new contract." Alastair Henderson, deputy director of NHS Employers, said: "The focus is now turning to realising the benefits that can be provided for patients."
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 pro-life campaigner who sent hospital staff pictures of mutilated and aborted foetuses has been denied hip treatment. Edward Atkinson, 74, was jailed for 28 days and given a five-year antisocial behaviour order for sending offensive photographs to the Queen Elizabeth Hospital in King's Lynn, Norfolk. The pensioner has been taken off a waiting list for an assessment for a hip operation and banned from treatment for anything other than life-threatening conditions.
The move was criticised yesterday by an anti-abortion group backing Atkinson. James Dowson, the national co-ordinator of the UK Life League, said: "It is ridiculous. I think it is completely unfair. They are refusing to treat him. Would they refuse a murderer or a paedophile? "He has paid his taxes, he is entitled to that treatment, who are they to withhold it from him?"
Atkinson, of Hilgay, Norfolk, was jailed at Swaffham Magistrates' Court on Thursday last week after he was convicted of three counts of sending offensive literature or material to staff at the hospital between January and April this year. A hospital spokesman said that the pensioner had been on a waiting list for an assessment for a hip operation when he started sending in pictures of aborted foetuses. The NHS trust wrote to him asking him not to send such material to the hospital as it was distressing staff. When he continued, the trust said he had broken its "Zero Tolerance" policy with regards to staff. Ruth May, chief executive of the Queen Elizabeth Hospital, said: "The trust's view is that we have a duty of care to our staff." [But no duty to people who have paid for care?]
Source
U.K.: 340 MILLION POUNDS FOR NOTHING
A new contract for hospital consultants cost at least 340 million pounds in its first two years but offered patients few improvements in care, a report has found. The King's Fund, an influential health think-tank, says that rushed implementation, a failure to cost the contract properly and a preoccupation with other problems mean that hospitals, the NHS and patients have failed to get much benefit. The result is that consultants are being paid more money for doing the same work as previously, while hospitals are running deficits caused, in part, by the cost of paying them.
Despite promises by Alan Milburn, then Health Secretary, that the new contract would reduce moonlighting by consultants, private work may actually have increased. Mr Milburn claimed that the contract, the first change in consultants' terms and conditions since 1948, was a "something for something" deal. But the King's Fund concludes that it was closer to something for nothing. Niall Dickson, the chief executive of the charity, said: "Consultants are at the core of the NHS and deserve to be paid well for the work they do. However, the Government promised that this contract would also bring benefits to patients and so far that does not appear to have materialised. This is a limited study and these are early days, but it raises profound questions about the effectiveness of the deal and what now needs to be done to ensure that it delivers greater productivity."
Paul Miller, chairman of the BMA consultants' committee, said that the report was limited, inaccurate and based on a small sample of senior managers in five London trusts. "Blaming the consultant contract for the financial crisis facing the NHS is an easy option," he said. "Many NHS trusts are in debt because they are struggling to shake off years of under-investment. They also face rising drug costs and an ever-increasing number of patients. The blame for the NHS funding crisis lies with an incoherent and inconsistent health policy, riddled with errors and misjudgments."
The consultants' contract, which was finally agreed in 2003, aimed to give management greater control over doctors' activities in return for better pay. The report says that, under the old contract, hospitals and consultants had colluded in a deal that meant consultants worked very long hours. In return for this, managements allowed them to "do their own thing". The consultants worked hard, but wrote their own rules. The new contract aimed to define their work much more precisely, and was based on ten four-hour sessions, called programmed activities, a week. Consultants could do private work only if they offered their NHS hospitals an extra weekly session. In practice this lever proved worthless. There is so much work that the average consultant does more than eleven sessions a week, not the ten envisaged.
The contract cost the NHS 90 million pounds more than expected, in part because nobody in the Department of Health believed what the consultants told them about the hours they worked. Pay increased substantially, with starting salaries rising by 36 per cent since 2001 to 69,298 pounds in 2005. But corresponding improvements in productivity have been lacking, largely because managers have seen the contract as "a box to be ticked" rather than an opportunity for change. "There needs to be more emphasis at both national and local levels on how the contract can be used as a tool to benefit patients," Professor James Buchan, co- author of the report, said.
A spokeswoman for the Department of Health said: "NHS pay reform, including the consultant contract, has been part of a significant success story in the NHS. "There is still some way to go before we realise the full benefits of its implementation, but increasing pay rates is only one small part of the new contract." Alastair Henderson, deputy director of NHS Employers, said: "The focus is now turning to realising the benefits that can be provided for patients."
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, May 10, 2006
THE BRITISH DENTAL DISASTER
It takes socialism to send people back to the Dark Ages
"I snapped it out myself," said William Kelly, 43, describing his most recent dental procedure, the autoextraction of one of his upper teeth. Now it is a jagged black stump, and the pain gnawing at Mr. Kelly's mouth has transferred itself to a different tooth, mottled and rickety, on the other side of his mouth. "I'm in the middle of pulling that one out, too," he said.
It is easy to be mean about British teeth. Mike Myers's mouth is a joke in itself in the "Austin Powers" movies. In a "Simpsons" episode, dentalphobic children are shown "The Big Book of British Smiles," cautionary photographs of hideously snaggletoothed Britons. In Mexico, protruding, discolored and generally unfortunate teeth are known as "dientes de ingles."
But the problem is serious. Mr. Kelly's predicament is not just a result of cigarettes and possibly indifferent oral hygiene; he is careful to brush once a day, he said. Instead, it is due in large part to the deficiencies in Britain's state-financed dental service, which, stretched beyond its limit, no longer serves everyone and no longer even pretends to try. Mr. Kelly, interviewed in a health clinic here as he waited for his son to see a doctor, last visited a dentist six years ago, in Sussex. Since moving to Rochdale, a working-class suburb of Manchester, he has been unable to find a National Health Service dentist willing to take him on. Every time he has tried to sign up, lining up with hundreds of others from the ranks of the desperate and the hurting - "I've seen people with bleeding gums where they've ripped their teeth out," he said grimly - he has arrived too late and missed the cutoff.
"You could argue that Britain has not seen lines like this since World War II," said Mark Pritchard, a member of Parliament who represents part of Shropshire, where the situation is just as grim. "Churchill once said that the British are great queuers, but I don't think he meant that in connection to dental care." Britain has too few public dentists for too many people. At the beginning of the year, just 49 percent of the adults and 63 percent of the children in England and Wales were registered with public dentists.
And now, discouraged by what they say is the assembly-line nature of the job and by a new contract that pays them to perform a set number of "units of dental activity" per year, even more dentists are abandoning the health service and going into private practice - some 2,000 in April alone, the British Dental Association says.
How does this affect the teeth of the nation? "People are not registered with dentists, they can't afford to go private and therefore their teeth are going rotten," said Paul Rowen, the member of Parliament for Rochdale. Rotting teeth and no one to treat them are among his constituents' biggest complaints, up there with gas prices and shrinking pensions. Just 33 percent of the Rochdale population is signed up with a state dentist, down from 58 percent in 1997.
Nor is the level of care what it might be. The system, critics say, encourages state dentists to see too many patients in too short a time and to cut corners by, for instance, extracting teeth rather than performing root canals. Claire Dacey, a nurse for a private dentist, said that when she worked in the National Health Service one dentist in the practice performed cleanings in five minutes flat. Moreover, she said, by the time patients got in to see a dentist, many were in terrible shape. "I had a lady who was in so much pain and had to wait so long that she got herself drunk and had her friend take out her tooth with a pair of pliers," Ms. Dacey said.....
In Rochdale, people who have no dentist but who are in dire straits can visit an emergency clinic that very day - provided they can get an appointment. The phones open at 8 a.m.; the books are closed by about 8:10. "We see toothaches through trauma, toothaches through neglect, dental caries, dental abscesses, gum disease," said Dr. Khalid Anis, the clinical leader for the emergency facility, the Dental Access Center. "What we see is shocking." Dr. Anis enumerated some positive dental developments in Rochdale: a second, soon-to-be-opened clinic; an aggressive community-health program; a political push, finally, to fluoridate the water. But, he said, "sometimes I feel as if I'm hitting my head against a brick wall."
The waiting room at the center was a testament to his concerns. Sitting by the window was George Glasper, 81. One of Mr. Glasper's teeth had broken off a week earlier, but when he called his dentist, he was told the practice had become a private one. Efforts to sign up with four other dentists failed, he said. Nearby sat Shahana Begum, 27, a Bangladeshi immigrant with a bad toothache and no dentist. Her stepdaughter, Sanya Karim, 16, said her family had been trying to find a health service dentist for six years, since moving to Rochdale from Birmingham. Occasionally, Miss Karim says, she feels a twinge or an ache, but she tries to ignore it. "It normally goes away in a couple of days," she said.
In extremis, Britons can always buy dental emergency supplies made by a company called Passion for Health DenTek. These include materials that allow people to replace lost fillings, treat gum pain or reattach cracked crowns "until they can actually get in and see a dentist," said Jennifer Stone, the company's sales and marketing director. Sales in Britain have increased by 40 percent in the last year, Ms. Stone said. A recent Guardian newspaper article about the company titled "D.I.Y. Dentistry" (meaning Do It Yourself) said that the previous week British drugstores had sold 6,000 jars of the filling replacement, and 6,000 of the crown-and-cap replacement.
Ms. Stone, an American, says she is struck by the profound differences in attitudes about dental care in Britain and the United States. "Prevention and having nice white shiny teeth is a huge priority for us from the moment we're born," she said. "That doesn't seem to be the culture here. You've got a lot of tea drinkers; you've got a lot of staining. In the U.S., we go through a spool of dental floss in six weeks, on average. Here it's a year and a half." Back in Rochdale clinic, Dr. Anis laughed hollowly when the word came up in connection with his patients, who come from some of the area's most deprived neighborhoods. "Floss?" he said. "That's a good one."
Source
ROMNEYCARE'S RECIPE FOR UNEMPLOYMENT
The following post is lifted from Powerline. The major conclusion to be drawn from its revelations seems to be that the Massachusetts law substantially raises the cost of employing people
Last week the Wall Street Journal published a column by Elizabeth McCaughey on the fine print in the new Massachusetts law providing for compulsory health insurance. Governor Romney exercised a line item veto over one provision that would have required employers with 10 or more employees who don't provide insurance to start offering it or pay fees of $295 per employee. The Massachusetts legislature nevertheless overrode the veto, and Governor Romney appears to have been straining at gnats while swallowing camels. In her column McCaughey observes:
McCaughey's column is unavailable to nonsubscribers. Brendan Miniter draws what appearst to me to be the appropriate conclusion in an OpinionJournal column that is accessible: "RomneyCare will turn out to be not only expensive but also a mandate for more government spending and more government intrusion."
***************************
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.
***************************
It takes socialism to send people back to the Dark Ages
"I snapped it out myself," said William Kelly, 43, describing his most recent dental procedure, the autoextraction of one of his upper teeth. Now it is a jagged black stump, and the pain gnawing at Mr. Kelly's mouth has transferred itself to a different tooth, mottled and rickety, on the other side of his mouth. "I'm in the middle of pulling that one out, too," he said.
It is easy to be mean about British teeth. Mike Myers's mouth is a joke in itself in the "Austin Powers" movies. In a "Simpsons" episode, dentalphobic children are shown "The Big Book of British Smiles," cautionary photographs of hideously snaggletoothed Britons. In Mexico, protruding, discolored and generally unfortunate teeth are known as "dientes de ingles."
But the problem is serious. Mr. Kelly's predicament is not just a result of cigarettes and possibly indifferent oral hygiene; he is careful to brush once a day, he said. Instead, it is due in large part to the deficiencies in Britain's state-financed dental service, which, stretched beyond its limit, no longer serves everyone and no longer even pretends to try. Mr. Kelly, interviewed in a health clinic here as he waited for his son to see a doctor, last visited a dentist six years ago, in Sussex. Since moving to Rochdale, a working-class suburb of Manchester, he has been unable to find a National Health Service dentist willing to take him on. Every time he has tried to sign up, lining up with hundreds of others from the ranks of the desperate and the hurting - "I've seen people with bleeding gums where they've ripped their teeth out," he said grimly - he has arrived too late and missed the cutoff.
"You could argue that Britain has not seen lines like this since World War II," said Mark Pritchard, a member of Parliament who represents part of Shropshire, where the situation is just as grim. "Churchill once said that the British are great queuers, but I don't think he meant that in connection to dental care." Britain has too few public dentists for too many people. At the beginning of the year, just 49 percent of the adults and 63 percent of the children in England and Wales were registered with public dentists.
And now, discouraged by what they say is the assembly-line nature of the job and by a new contract that pays them to perform a set number of "units of dental activity" per year, even more dentists are abandoning the health service and going into private practice - some 2,000 in April alone, the British Dental Association says.
How does this affect the teeth of the nation? "People are not registered with dentists, they can't afford to go private and therefore their teeth are going rotten," said Paul Rowen, the member of Parliament for Rochdale. Rotting teeth and no one to treat them are among his constituents' biggest complaints, up there with gas prices and shrinking pensions. Just 33 percent of the Rochdale population is signed up with a state dentist, down from 58 percent in 1997.
Nor is the level of care what it might be. The system, critics say, encourages state dentists to see too many patients in too short a time and to cut corners by, for instance, extracting teeth rather than performing root canals. Claire Dacey, a nurse for a private dentist, said that when she worked in the National Health Service one dentist in the practice performed cleanings in five minutes flat. Moreover, she said, by the time patients got in to see a dentist, many were in terrible shape. "I had a lady who was in so much pain and had to wait so long that she got herself drunk and had her friend take out her tooth with a pair of pliers," Ms. Dacey said.....
In Rochdale, people who have no dentist but who are in dire straits can visit an emergency clinic that very day - provided they can get an appointment. The phones open at 8 a.m.; the books are closed by about 8:10. "We see toothaches through trauma, toothaches through neglect, dental caries, dental abscesses, gum disease," said Dr. Khalid Anis, the clinical leader for the emergency facility, the Dental Access Center. "What we see is shocking." Dr. Anis enumerated some positive dental developments in Rochdale: a second, soon-to-be-opened clinic; an aggressive community-health program; a political push, finally, to fluoridate the water. But, he said, "sometimes I feel as if I'm hitting my head against a brick wall."
The waiting room at the center was a testament to his concerns. Sitting by the window was George Glasper, 81. One of Mr. Glasper's teeth had broken off a week earlier, but when he called his dentist, he was told the practice had become a private one. Efforts to sign up with four other dentists failed, he said. Nearby sat Shahana Begum, 27, a Bangladeshi immigrant with a bad toothache and no dentist. Her stepdaughter, Sanya Karim, 16, said her family had been trying to find a health service dentist for six years, since moving to Rochdale from Birmingham. Occasionally, Miss Karim says, she feels a twinge or an ache, but she tries to ignore it. "It normally goes away in a couple of days," she said.
In extremis, Britons can always buy dental emergency supplies made by a company called Passion for Health DenTek. These include materials that allow people to replace lost fillings, treat gum pain or reattach cracked crowns "until they can actually get in and see a dentist," said Jennifer Stone, the company's sales and marketing director. Sales in Britain have increased by 40 percent in the last year, Ms. Stone said. A recent Guardian newspaper article about the company titled "D.I.Y. Dentistry" (meaning Do It Yourself) said that the previous week British drugstores had sold 6,000 jars of the filling replacement, and 6,000 of the crown-and-cap replacement.
Ms. Stone, an American, says she is struck by the profound differences in attitudes about dental care in Britain and the United States. "Prevention and having nice white shiny teeth is a huge priority for us from the moment we're born," she said. "That doesn't seem to be the culture here. You've got a lot of tea drinkers; you've got a lot of staining. In the U.S., we go through a spool of dental floss in six weeks, on average. Here it's a year and a half." Back in Rochdale clinic, Dr. Anis laughed hollowly when the word came up in connection with his patients, who come from some of the area's most deprived neighborhoods. "Floss?" he said. "That's a good one."
Source
ROMNEYCARE'S RECIPE FOR UNEMPLOYMENT
The following post is lifted from Powerline. The major conclusion to be drawn from its revelations seems to be that the Massachusetts law substantially raises the cost of employing people
Last week the Wall Street Journal published a column by Elizabeth McCaughey on the fine print in the new Massachusetts law providing for compulsory health insurance. Governor Romney exercised a line item veto over one provision that would have required employers with 10 or more employees who don't provide insurance to start offering it or pay fees of $295 per employee. The Massachusetts legislature nevertheless overrode the veto, and Governor Romney appears to have been straining at gnats while swallowing camels. In her column McCaughey observes:
Everyone should have access to health care. Massachusetts aims to achieve this goal with a double mandate: All residents must have health coverage (Section 12) and all employers with more than 10 workers must assume ultimate financial responsibility if employees or their immediate family members need expensive medical care and can't pay for it (Sections 32, 44).
What is the impact on individuals? The state will offer subsidies to help low income residents pay for coverage (Section 19), but most of the uninsured earn too much to be eligible. An individual making $29,000 or more would probably have to pay the full cost or find a job that provides health insurance. Individual coverage costs about $3,600 in Massachusetts -- a hefty bill. Moreover, under the new law, individuals purchasing their own insurance must buy HMO policies. Preferred provider plans (PPOs) -- which give you more ability to choose your own doctors and treatments -- are not allowed (Section 65).
The impact of this law on employers is substantial. The original bill required employers with more than 10 full-time workers to provide all of them (and their families) with health insurance or to opt out of that requirement by paying a $295 annual tax per worker into a state fund. This modest penalty was highly publicized by the bill's supporters as proof that the bill would not be a heavy burden on businesses. Nevertheless, Gov. Romney vetoed it, perhaps to display his Republican credentials as a tax-cutter.
The Massachusetts House of Representatives overrode the veto -- but the reality is that the $295 penalty is small potatoes compared with the other obligations in the law. Say, for example, you open a restaurant and don't provide health coverage. If the chef's spouse or child is rushed to the hospital and can't pay because they don't have insurance, you -- the employer -- are responsible for up to 100% of the cost of that medical care. There is no cap on your obligation. Once the costs reach $50,000, the state will start billing you and fine you $5,000 a week for every week you are late in filling out the paperwork on your uncovered employees (Section 44). These provisions are onerous enough to motivate the owners of small businesses to limit their full-time workforce to 10 people, or even to lay employees off.
What else is surprising about this new law? Union shops are exempt (Section 32).
***
People should be allowed to buy basic, high deductible insurance without costly extras. The new Massachusetts law allows only people under age 27 to buy such policies (Section 90).
McCaughey's column is unavailable to nonsubscribers. Brendan Miniter draws what appearst to me to be the appropriate conclusion in an OpinionJournal column that is accessible: "RomneyCare will turn out to be not only expensive but also a mandate for more government spending and more government intrusion."
***************************
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, May 09, 2006
Toxic fungus found at La Jolla hospital
The headline above is taken from the "Sacramento Bee" of California. In the body of the article we read of the fungus concerned: "It is harmless to healthy people". So much for "toxic". Most things are toxic in some dose and to some people, of course. Are peanuts "toxic"? They kill a lot of people who are allergic to them. Even common salt can kill you if you eat enough of it.
So why the scare headline? Why not, (say) "problem fungus"? Easy. Because it was a private hospital concerned -- and a Leftist rag that often puts up very cautious headlines (See e.g. here or here) could not resist letting their socialist hatreds out.
Aspergillus is of course an extremely common fungus in the environment and hence both difficult to eliminate and much less important to eliminate than many less common but highly virulent hospital-borne organisms.
Australian junior doctors to catch up on anatomy
Remedial courses in anatomy are being considered for junior doctors following complaints their anatomical knowledge upon graduation from medical school is "unacceptably low". Amid a push by senior doctors to increase the amount of anatomical teaching in universities, the Royal Australasian College of Surgeons says it is negotiating directly with university anatomy departments to provide extra tuition to get junior doctors up to speed before they enter surgical training.
Julian Smith, a member of the anatomy committee of the Royal Australasian College of Surgeons, said the "basic anatomical knowledge amongst graduating medical students at many universities is unacceptably low". Professor Smith -- a heart surgeon and professor of surgery at Monash University -- said he had some final-year medical students in his operating theatre to watch a live cardiac operation. "The heart was exposed and I pointed to a part of the heart and asked them to name it. They said 'the liver'. That was in my own university. "There are some fairly ugly anecdotes. I don't think too many of them are as bad as that, but it's a big worry."
RACS executive director for surgical affairs John Quinn said the college was "concerned about the level of anatomical knowledge of those wanting to enter the (RACS) training program". "That knowledge is much less than it used to be," he said. The college had already tried persuading medical schools to increase the anatomy training they provided, but the "community is demanding more from their doctor". "As many (medical school) courses have moved from being six years to four years postgraduate, the time is less and the demands are more and something has to give," Dr Quinn said. "The rationale (for cutting anatomy teaching) is that the only doctors who need to know anatomy are surgeons. That's rubbish, but it's the justification."
The Weekend Australian reported a coalition of concerned doctors had sent a 70-page submission to the federal Department of Education, Science and Training, calling for benchmarks on medical training and mandatory minimum standards for science teaching.
Professor Smith said when students encountered patients "their anatomical knowledge is often very weak and makes it difficult for them to appreciate many of the clinical conditions they might encounter". "If they don't know the normal, how can they understand the abnormal?" he said.
The Australian Medical Council accredits Australia's 17 medical schools and approves their curricula. Chief executive officer Ian Frank said the AMC set "general requirements" about the knowledge, skills and attributes that graduating doctors were expected to have after their education. "We have stopped short of saying that means you have to have done X-hundred hours of such-and-such, because there really isn't any evidence ... that says that 500 hours (of anatomy teaching) is better than 300 hours, or 100 hours," he said. "The studies that have been done here and elsewhere show the guys coming out (of Australian medical schools) are at least the equal of those from more traditional courses, and superior in some areas, such as interpersonal skills and capacity to work in collaboration."
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 headline above is taken from the "Sacramento Bee" of California. In the body of the article we read of the fungus concerned: "It is harmless to healthy people". So much for "toxic". Most things are toxic in some dose and to some people, of course. Are peanuts "toxic"? They kill a lot of people who are allergic to them. Even common salt can kill you if you eat enough of it.
So why the scare headline? Why not, (say) "problem fungus"? Easy. Because it was a private hospital concerned -- and a Leftist rag that often puts up very cautious headlines (See e.g. here or here) could not resist letting their socialist hatreds out.
Aspergillus is of course an extremely common fungus in the environment and hence both difficult to eliminate and much less important to eliminate than many less common but highly virulent hospital-borne organisms.
Australian junior doctors to catch up on anatomy
Remedial courses in anatomy are being considered for junior doctors following complaints their anatomical knowledge upon graduation from medical school is "unacceptably low". Amid a push by senior doctors to increase the amount of anatomical teaching in universities, the Royal Australasian College of Surgeons says it is negotiating directly with university anatomy departments to provide extra tuition to get junior doctors up to speed before they enter surgical training.
Julian Smith, a member of the anatomy committee of the Royal Australasian College of Surgeons, said the "basic anatomical knowledge amongst graduating medical students at many universities is unacceptably low". Professor Smith -- a heart surgeon and professor of surgery at Monash University -- said he had some final-year medical students in his operating theatre to watch a live cardiac operation. "The heart was exposed and I pointed to a part of the heart and asked them to name it. They said 'the liver'. That was in my own university. "There are some fairly ugly anecdotes. I don't think too many of them are as bad as that, but it's a big worry."
RACS executive director for surgical affairs John Quinn said the college was "concerned about the level of anatomical knowledge of those wanting to enter the (RACS) training program". "That knowledge is much less than it used to be," he said. The college had already tried persuading medical schools to increase the anatomy training they provided, but the "community is demanding more from their doctor". "As many (medical school) courses have moved from being six years to four years postgraduate, the time is less and the demands are more and something has to give," Dr Quinn said. "The rationale (for cutting anatomy teaching) is that the only doctors who need to know anatomy are surgeons. That's rubbish, but it's the justification."
The Weekend Australian reported a coalition of concerned doctors had sent a 70-page submission to the federal Department of Education, Science and Training, calling for benchmarks on medical training and mandatory minimum standards for science teaching.
Professor Smith said when students encountered patients "their anatomical knowledge is often very weak and makes it difficult for them to appreciate many of the clinical conditions they might encounter". "If they don't know the normal, how can they understand the abnormal?" he said.
The Australian Medical Council accredits Australia's 17 medical schools and approves their curricula. Chief executive officer Ian Frank said the AMC set "general requirements" about the knowledge, skills and attributes that graduating doctors were expected to have after their education. "We have stopped short of saying that means you have to have done X-hundred hours of such-and-such, because there really isn't any evidence ... that says that 500 hours (of anatomy teaching) is better than 300 hours, or 100 hours," he said. "The studies that have been done here and elsewhere show the guys coming out (of Australian medical schools) are at least the equal of those from more traditional courses, and superior in some areas, such as interpersonal skills and capacity to work in collaboration."
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, May 08, 2006
MEDICAL POLITICS
A letter from a reader on the unwisdom of battles against bureaucracy such as that undertaken by Dr. Szabo in California -- a case referred to here yesterday:
"While I was an anesthesiologist at a major teaching hospital, the hospital administration hired a surgical specialist. The hospital paid good money to a search firm to find this doctor. But he had been at his last job less than a year.
Things went very wrong with this man from the start. He threw bags of IV fluids at anesthesiologists. He did a number of strange things, and behaved in a bizarre manner. A colleague found out all he needed to know with a few phone calls to those who had worked with him. Others discovered that he had been the same since his training. One by one, the anesthesia staff formally refused to work with this surgeon. Only I and two others (including the Chairman) would work with him after a few months.
On the day after I wrote a letter to the Chairman saying that I would no longer work with this man, the Chairman gave me a letter saying he would not renew my contract. He backed down when I said I would work with this surgeon. If I knew what I know now, I wouldn't have done so.
A few years passed, and I was again given a letter of non-renewal. I filed an appeal with the Medical School, with hearings and an attorney, etc. But, predictably, I was turned down by the Dean. [Of course, knowing what I know now, the Dean has only 2 options - fire me or the Chairman. Firing me was much less costly to him]
Fortunately, my attorney convinced me NOT to pursue this further. The case was much too complex for a jury. On the other hand, if I had filed an appeal immediately after the letter that I received one day after refusing to work with this incompetent surgeon (who was eventually removed from the staff -- in under a year. He had 7 lawsuits against him by this time), this would have been a "smoking gun" and would have been much easier to litigate. In addition, my attorney convinced me that, if I filed a lawsuit, I would be a "marked man' and likely unable to get a good job in medical schools.
And why, I asked myself, should I make life miserable for myself and others by forcing those who didn't want me to keep me on their staff? I took his advice, and got a better job. And no one has tried to fire me for the last 14 years".
DANGEROUSLY INSANE IRISH REGULATIONS
And there's no move to change anything, either
The life of a Newbridge baby was put at risk recently because of a restrictor device that limits an army ambulance to speeds of just 55 miles per hour. The 14-month-old baby had reportedly slipped into unconsciousness following a seizure, but when the anguished parents called 999 it transpired that all the ambulances at Naas General Hospital were out on call.
The emergency protocol then kicked in and the Eastern Health Board Regional Area (EHRA) called for backup from the Defence Forces at the Curragh Camp. In February, the army had bought a new 250,000 Euro state-of-theart Emergency Rescue vehicle as a back-up resource for the county. As this new ambulance was on stand-by in the army barracks on the Curragh, it was closer to Newbridge than any other ambulance that could be dispatched from Naas.
The parents, who were relieved that the medical experts were on hand to deal with their little boy, were unaware that the paramedics were secretly panicking. On the way to the hospital, the condition of the baby worsened, but instead of racing even faster the ambulance crew made a decision that baffled everyone. They pulled over and called Naas General Hospital to dispatch a different ambulance to collect the child.
The reason was that they didn't trust their own vehicle to save the child's life as a restrictor had been put on the engine. This meant that the highest speed the ambulance could reach was 90kmh (around 55mph); the speed limit on the motorway to Tallaght hospital is 120kmh.
Emergency response vehicles regularly break the speed limits to save lives, but if this ambulance had tried to rush the child to hospital the journey would have taken three times as long as it should. Since the incident, Naas General Hospital has not called on the services of the Curragh ambulance as emergency back up. The restrictor remains in place on that vehicle.
Over a typical weekend, the previous Military Medical Facility, which is no longer considered reliable or roadworthy, would have responded to up to 25 calls, but now people have to rely on back-up from Athy, which is at least 20 minutes away from Newbridge.
A spokesperson for the army said that the restrictor was a manufacturing design. He said: "It is a legal requirement to do with the weight of the vehicle, and is actually set higher than the legal speed limit for army vehicles." He was keen to point out that the ambulance was for military use only and was only a back-up service for the EHRA.
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 letter from a reader on the unwisdom of battles against bureaucracy such as that undertaken by Dr. Szabo in California -- a case referred to here yesterday:
"While I was an anesthesiologist at a major teaching hospital, the hospital administration hired a surgical specialist. The hospital paid good money to a search firm to find this doctor. But he had been at his last job less than a year.
Things went very wrong with this man from the start. He threw bags of IV fluids at anesthesiologists. He did a number of strange things, and behaved in a bizarre manner. A colleague found out all he needed to know with a few phone calls to those who had worked with him. Others discovered that he had been the same since his training. One by one, the anesthesia staff formally refused to work with this surgeon. Only I and two others (including the Chairman) would work with him after a few months.
On the day after I wrote a letter to the Chairman saying that I would no longer work with this man, the Chairman gave me a letter saying he would not renew my contract. He backed down when I said I would work with this surgeon. If I knew what I know now, I wouldn't have done so.
A few years passed, and I was again given a letter of non-renewal. I filed an appeal with the Medical School, with hearings and an attorney, etc. But, predictably, I was turned down by the Dean. [Of course, knowing what I know now, the Dean has only 2 options - fire me or the Chairman. Firing me was much less costly to him]
Fortunately, my attorney convinced me NOT to pursue this further. The case was much too complex for a jury. On the other hand, if I had filed an appeal immediately after the letter that I received one day after refusing to work with this incompetent surgeon (who was eventually removed from the staff -- in under a year. He had 7 lawsuits against him by this time), this would have been a "smoking gun" and would have been much easier to litigate. In addition, my attorney convinced me that, if I filed a lawsuit, I would be a "marked man' and likely unable to get a good job in medical schools.
And why, I asked myself, should I make life miserable for myself and others by forcing those who didn't want me to keep me on their staff? I took his advice, and got a better job. And no one has tried to fire me for the last 14 years".
DANGEROUSLY INSANE IRISH REGULATIONS
And there's no move to change anything, either
The life of a Newbridge baby was put at risk recently because of a restrictor device that limits an army ambulance to speeds of just 55 miles per hour. The 14-month-old baby had reportedly slipped into unconsciousness following a seizure, but when the anguished parents called 999 it transpired that all the ambulances at Naas General Hospital were out on call.
The emergency protocol then kicked in and the Eastern Health Board Regional Area (EHRA) called for backup from the Defence Forces at the Curragh Camp. In February, the army had bought a new 250,000 Euro state-of-theart Emergency Rescue vehicle as a back-up resource for the county. As this new ambulance was on stand-by in the army barracks on the Curragh, it was closer to Newbridge than any other ambulance that could be dispatched from Naas.
The parents, who were relieved that the medical experts were on hand to deal with their little boy, were unaware that the paramedics were secretly panicking. On the way to the hospital, the condition of the baby worsened, but instead of racing even faster the ambulance crew made a decision that baffled everyone. They pulled over and called Naas General Hospital to dispatch a different ambulance to collect the child.
The reason was that they didn't trust their own vehicle to save the child's life as a restrictor had been put on the engine. This meant that the highest speed the ambulance could reach was 90kmh (around 55mph); the speed limit on the motorway to Tallaght hospital is 120kmh.
Emergency response vehicles regularly break the speed limits to save lives, but if this ambulance had tried to rush the child to hospital the journey would have taken three times as long as it should. Since the incident, Naas General Hospital has not called on the services of the Curragh ambulance as emergency back up. The restrictor remains in place on that vehicle.
Over a typical weekend, the previous Military Medical Facility, which is no longer considered reliable or roadworthy, would have responded to up to 25 calls, but now people have to rely on back-up from Athy, which is at least 20 minutes away from Newbridge.
A spokesperson for the army said that the restrictor was a manufacturing design. He said: "It is a legal requirement to do with the weight of the vehicle, and is actually set higher than the legal speed limit for army vehicles." He was keen to point out that the ambulance was for military use only and was only a back-up service for the EHRA.
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, May 07, 2006
Tort reform brings doctors back to Texas
The Senate is once again taking up the issue of medical justice reform. If senators want to expand access to health care by increasing the number of physicians and lowering costs, they need to look at Texas. In the summer of 2003 the Texas Legislature enacted important medical litigation reform. A voter-approved constitutional amendment, Proposition 12, followed later that year to solidify the changes. As a result, physicians are returning to the state, particularly in underserved specialties and counties. Insurance premiums to protect against frivolous lawsuits have declined dramatically, with the state's largest carrier reporting declines up to 22% and other carriers reducing premiums by an average of 13%. The number of lawsuits filed against doctors has been cut almost in half.
Prior to the successful reform effort, personal injury lawyers had put Texas doctors on the run. According to the Texas Department of Insurance, the frequency of claims was increasing at a rate of 4.6% annually--between 1996 and 2000 alone, one out of four doctors was sued. These surging legal and insurance bills reduced patient access to health care. Texas fell to 48th out of 50 in physician manpower. There were 152 medical doctors per 100,000 citizens, well below the U.S. average of 196. Some 158 counties had no obstetrician. Good, competent doctors were closing their doors, unable to afford the cost of insurance.
Other industry players suffered as well. Hospital premiums to protect against the onslaught of lawsuits more than doubled between 2000 and 2003. From 1999 to 2002, the annual per-bed cost of litigation-protection insurance in nursing homes increased from $250 to $5,000--a factor of 20! Texas seniors were being displaced and deprived of care, as nursing homes closed, unable to afford the cost of escalating insurance premiums.
At the core of House Bill 4, led with remarkable courage and dedication by state Rep. Joe Nixon and state Sen. Jane Nelson, was a hard $250,000 cap on noneconomic damages for all physicians, with a separate $250,000 cap on noneconomic damages payable by hospitals and other providers. The law keeps doctors, hospitals and nursing homes liable for all economic damages assessed by a jury. HB 4 was modeled on California's successful 1975 Micra law, still on the books, keeping litigation-related costs under control and allowing competent doctors and hospitals to continue providing care.
Additional provisions of HB 4 included periodic payments for all awards greater than $100,000, procedural changes to address claim frequency, and Good Samaritan protections. This new law passed by a two-thirds majority in both chambers of the legislature and was integrated into the Texas constitution by voters later that same year. Importantly, the constitutional amendment prevents activist judges from ignoring the law and imposing a subjective opinion.
So what has happened since September of 2003, when the new law went into effect? After years of losing doctors, Texas has added nearly 4,000 since passage of Proposition 12, including 127 orthopedic surgeons, almost 300 anesthesiologists, over 200 emergency room physicians, 146 new obstetricians, 58 neurologists and 24 neurosurgeons. The Texas Medical Board is anticipating some 4,000 applicants for new physician licenses this year alone--double last year's numbers, and 30% more than the greatest growth year ever.
The threat of lawsuits has been a particular barrier to attracting and retaining pediatric specialists. Since 2003, Texas has gained 20 pediatric cardiologists, 14 pediatric oncologists, almost 50 new perinatologists (obstetricians specializing in high-risk pregnancies), 10 pediatric surgeons and 8 new pediatric endocrinologists.
Medically underserved counties in Texas are benefiting as well. Jefferson, Webb and Victoria Counties, as well as the counties of Cameron and Hidalgo in the Rio Grande Valley, have all experienced an influx of physicians. Additionally, the market for insurance to protect health-care providers against the cost of lawsuits has become more robust and competitive. In 2002 there were only four companies writing policies. Today that number has more than tripled. And all of these trends are expected to continue.
Gov. Matt Blunt and the Missouri Legislature enacted similarly tough medical liability reform in 2005. The state's citizens can expect to benefit from more doctors with lower liability premiums in the coming years as well, assuming no meddling by the courts.
The legislation to be considered by the Senate would ensure more predictability in our justice system by reining in the most egregious abuses by personal injury lawyers. In deference to states' rights, it does not pre-empt the noneconomic damage caps in place in 26 states whether they are higher or lower than the proposed federal standard. Thus, Texas, California, Missouri and Mississippi with strong caps will not be affected; similarly, a state like Nevada with weak damage caps also will not be touched. The Senate bill would apply only to states that currently have no damage caps in place.
Proper medical justice reform plays a central role in ensuring the availability and affordability of health care for families everywhere, and our elected officials should not underestimate how deeply this issue resonates with the American people. A March 2006 Gallup poll showed that "availability and affordability of health care" topped a list of 12 issues of most concern to Americans. A full 68% of respondents said they worried about this a "great deal," compared to 51% who were worried a great deal about social security, the next highest issue area.
In the coming days, our senators in Washington will have a chance to stand up with America's doctors and patients against the personal injury lawyers. Expect a brawl. On one side will be the lawyers, frantically attempting to protect and pad their wallets, while driving up costs for the American people and limiting our access to health-care providers. On the other will be the positive, pro-patient, pro-health-care story from Texas, a state which has taken an important first step toward creating a 21st-century health justice system that meets the needs of doctors and patients alike.
Source
BUREAUCRATIC NASTINESS IN CALIFORNIA PUBLIC MEDICINE
An orthopedic surgeon and tenured professor at the University of California, Davis, Medical School is suing the UC Davis chancellor and the medical school's dean emeritus, claiming he was subjected to retaliation for blowing the whistle on irregularities at a university clinic in Sacramento. In a lawsuit filed Thursday in Sacramento federal court, Dr. Robert M. Szabo alleges that a long-simmering feud between him and Dr. Joseph Silva, then the dean of the medical school, boiled over two years ago when Szabo complained about another physician's billing practices and the way Medi-Cal patients were being scheduled at the university's primary care clinic on J Street in midtown Sacramento.
On May 12, 2004, the day after Szabo was notified that his complaint was unsubstantiated, Silva ordered Szabo's academic and clinical offices moved off the UC Davis Medical Center campus to a primary care clinic in Carmichael and eliminated Szabo's block of operating-room time at the medical center, the suit alleges.
In November a three-professor panel of the university's Academic Senate, after conducting a hearing, sustained Szabo's grievance and found inappropriate conduct by Silva in retaliating against Szabo for his whistle-blower complaint, the suit alleges. It alleges that, on Feb. 9, the hearing panel reaffirmed its decision in response to the university's request for reconsideration. But, on March 29, "despite overwhelming evidence of willful misconduct and retaliation by former Dean Silva, Chancellor (Larry) Vanderhoef rejected the findings" of the hearing panel, the suit alleges.
The suit says that "power was abused by defendants Silva and Vanderhoef to punish and retaliate against Dr. Szabo for exercising his right of free speech protected" by the Constitution's First Amendment and those provisions of California's Constitution and statutes that protect whistle-blowers. Szabo is seeking $2.5 million general damages and $1 million punitive damages. "Dr. Szabo has been damaged in his reputation, professional standing, and has been subjected to emotional distress and upset and humiliation as he watched and experienced the unlawful, discriminatory and willful acts of the defendants," Szabo's attorney, Donald Heller, wrote in the complaint.
UC Davis spokeswoman Lisa Lapin said Thursday that Silva and Vanderhoef have not yet seen the complaint and would have no immediate comment.
The Academic Senate's three-member hearing panel found the evidence "supports the finding that Dean Silva acted out of personal animus toward Dr. Szabo in making the relocation decision," according to the panel's report. The report, which is attached to the complaint as an exhibit, notes that Silva claimed when he made the relocation decision that he was unaware that Szabo had made a whistle-blower complaint. However, the report states, "the very public and widespread knowledge of Dr. Szabo's complaint as early as late January and early February 2004 undermines Dean Silva's credibility on this point." "We find that, based on the totality of the circumstances, Dr. Szabo demonstrated by a preponderance of the evidence that his filing of a whistle-blower complaint was a contributing factor in Dean Silva's decision to relocate Dr. Szabo, and that the relocation was retaliatory."
The panel recommended Szabo's grievance be sustained and that he be reimbursed attorney's fees incurred pursuing the grievance. The university asked the panel to reconsider its decision, but the panel stood firm in its findings and recommendations. "Let us be clear," the panel said in its response to the university, "the consequences of the dean's decision had such a negative impact on the care of patients and the training of the fellows that animus is the only explanation the panel can come up with to explain why the dean made this change."
But Vanderhoef, in a March 29 letter to Szabo, rejected the panel's findings and recommendations and refused to uphold the doctor's grievance. "Absent findings of misconduct against Dean Silva, I do not find a preponderance of the evidence supports a conclusion that your rights and privileges as a faculty member have been violated," Vanderhoef wrote. "I find no persuasive evidence to support a conclusion that Dean Silva's actions were based on personal animus. "The factors cited by the (panel) in support of its finding are not persuasive. "I find no compelling evidence to indicate that Dean Silva was aware of your (whistle-blowing) at the time the relocation decision was being considered. Instead, only argument and inference is offered to support such a conclusion. "Further, even if Dean Silva were aware of your whistle-blower report ... there is no persuasive evidence that he had any personal animus or other motivation to retaliate against you based upon such information."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The Senate is once again taking up the issue of medical justice reform. If senators want to expand access to health care by increasing the number of physicians and lowering costs, they need to look at Texas. In the summer of 2003 the Texas Legislature enacted important medical litigation reform. A voter-approved constitutional amendment, Proposition 12, followed later that year to solidify the changes. As a result, physicians are returning to the state, particularly in underserved specialties and counties. Insurance premiums to protect against frivolous lawsuits have declined dramatically, with the state's largest carrier reporting declines up to 22% and other carriers reducing premiums by an average of 13%. The number of lawsuits filed against doctors has been cut almost in half.
Prior to the successful reform effort, personal injury lawyers had put Texas doctors on the run. According to the Texas Department of Insurance, the frequency of claims was increasing at a rate of 4.6% annually--between 1996 and 2000 alone, one out of four doctors was sued. These surging legal and insurance bills reduced patient access to health care. Texas fell to 48th out of 50 in physician manpower. There were 152 medical doctors per 100,000 citizens, well below the U.S. average of 196. Some 158 counties had no obstetrician. Good, competent doctors were closing their doors, unable to afford the cost of insurance.
Other industry players suffered as well. Hospital premiums to protect against the onslaught of lawsuits more than doubled between 2000 and 2003. From 1999 to 2002, the annual per-bed cost of litigation-protection insurance in nursing homes increased from $250 to $5,000--a factor of 20! Texas seniors were being displaced and deprived of care, as nursing homes closed, unable to afford the cost of escalating insurance premiums.
At the core of House Bill 4, led with remarkable courage and dedication by state Rep. Joe Nixon and state Sen. Jane Nelson, was a hard $250,000 cap on noneconomic damages for all physicians, with a separate $250,000 cap on noneconomic damages payable by hospitals and other providers. The law keeps doctors, hospitals and nursing homes liable for all economic damages assessed by a jury. HB 4 was modeled on California's successful 1975 Micra law, still on the books, keeping litigation-related costs under control and allowing competent doctors and hospitals to continue providing care.
Additional provisions of HB 4 included periodic payments for all awards greater than $100,000, procedural changes to address claim frequency, and Good Samaritan protections. This new law passed by a two-thirds majority in both chambers of the legislature and was integrated into the Texas constitution by voters later that same year. Importantly, the constitutional amendment prevents activist judges from ignoring the law and imposing a subjective opinion.
So what has happened since September of 2003, when the new law went into effect? After years of losing doctors, Texas has added nearly 4,000 since passage of Proposition 12, including 127 orthopedic surgeons, almost 300 anesthesiologists, over 200 emergency room physicians, 146 new obstetricians, 58 neurologists and 24 neurosurgeons. The Texas Medical Board is anticipating some 4,000 applicants for new physician licenses this year alone--double last year's numbers, and 30% more than the greatest growth year ever.
The threat of lawsuits has been a particular barrier to attracting and retaining pediatric specialists. Since 2003, Texas has gained 20 pediatric cardiologists, 14 pediatric oncologists, almost 50 new perinatologists (obstetricians specializing in high-risk pregnancies), 10 pediatric surgeons and 8 new pediatric endocrinologists.
Medically underserved counties in Texas are benefiting as well. Jefferson, Webb and Victoria Counties, as well as the counties of Cameron and Hidalgo in the Rio Grande Valley, have all experienced an influx of physicians. Additionally, the market for insurance to protect health-care providers against the cost of lawsuits has become more robust and competitive. In 2002 there were only four companies writing policies. Today that number has more than tripled. And all of these trends are expected to continue.
Gov. Matt Blunt and the Missouri Legislature enacted similarly tough medical liability reform in 2005. The state's citizens can expect to benefit from more doctors with lower liability premiums in the coming years as well, assuming no meddling by the courts.
The legislation to be considered by the Senate would ensure more predictability in our justice system by reining in the most egregious abuses by personal injury lawyers. In deference to states' rights, it does not pre-empt the noneconomic damage caps in place in 26 states whether they are higher or lower than the proposed federal standard. Thus, Texas, California, Missouri and Mississippi with strong caps will not be affected; similarly, a state like Nevada with weak damage caps also will not be touched. The Senate bill would apply only to states that currently have no damage caps in place.
Proper medical justice reform plays a central role in ensuring the availability and affordability of health care for families everywhere, and our elected officials should not underestimate how deeply this issue resonates with the American people. A March 2006 Gallup poll showed that "availability and affordability of health care" topped a list of 12 issues of most concern to Americans. A full 68% of respondents said they worried about this a "great deal," compared to 51% who were worried a great deal about social security, the next highest issue area.
In the coming days, our senators in Washington will have a chance to stand up with America's doctors and patients against the personal injury lawyers. Expect a brawl. On one side will be the lawyers, frantically attempting to protect and pad their wallets, while driving up costs for the American people and limiting our access to health-care providers. On the other will be the positive, pro-patient, pro-health-care story from Texas, a state which has taken an important first step toward creating a 21st-century health justice system that meets the needs of doctors and patients alike.
Source
BUREAUCRATIC NASTINESS IN CALIFORNIA PUBLIC MEDICINE
An orthopedic surgeon and tenured professor at the University of California, Davis, Medical School is suing the UC Davis chancellor and the medical school's dean emeritus, claiming he was subjected to retaliation for blowing the whistle on irregularities at a university clinic in Sacramento. In a lawsuit filed Thursday in Sacramento federal court, Dr. Robert M. Szabo alleges that a long-simmering feud between him and Dr. Joseph Silva, then the dean of the medical school, boiled over two years ago when Szabo complained about another physician's billing practices and the way Medi-Cal patients were being scheduled at the university's primary care clinic on J Street in midtown Sacramento.
On May 12, 2004, the day after Szabo was notified that his complaint was unsubstantiated, Silva ordered Szabo's academic and clinical offices moved off the UC Davis Medical Center campus to a primary care clinic in Carmichael and eliminated Szabo's block of operating-room time at the medical center, the suit alleges.
In November a three-professor panel of the university's Academic Senate, after conducting a hearing, sustained Szabo's grievance and found inappropriate conduct by Silva in retaliating against Szabo for his whistle-blower complaint, the suit alleges. It alleges that, on Feb. 9, the hearing panel reaffirmed its decision in response to the university's request for reconsideration. But, on March 29, "despite overwhelming evidence of willful misconduct and retaliation by former Dean Silva, Chancellor (Larry) Vanderhoef rejected the findings" of the hearing panel, the suit alleges.
The suit says that "power was abused by defendants Silva and Vanderhoef to punish and retaliate against Dr. Szabo for exercising his right of free speech protected" by the Constitution's First Amendment and those provisions of California's Constitution and statutes that protect whistle-blowers. Szabo is seeking $2.5 million general damages and $1 million punitive damages. "Dr. Szabo has been damaged in his reputation, professional standing, and has been subjected to emotional distress and upset and humiliation as he watched and experienced the unlawful, discriminatory and willful acts of the defendants," Szabo's attorney, Donald Heller, wrote in the complaint.
UC Davis spokeswoman Lisa Lapin said Thursday that Silva and Vanderhoef have not yet seen the complaint and would have no immediate comment.
The Academic Senate's three-member hearing panel found the evidence "supports the finding that Dean Silva acted out of personal animus toward Dr. Szabo in making the relocation decision," according to the panel's report. The report, which is attached to the complaint as an exhibit, notes that Silva claimed when he made the relocation decision that he was unaware that Szabo had made a whistle-blower complaint. However, the report states, "the very public and widespread knowledge of Dr. Szabo's complaint as early as late January and early February 2004 undermines Dean Silva's credibility on this point." "We find that, based on the totality of the circumstances, Dr. Szabo demonstrated by a preponderance of the evidence that his filing of a whistle-blower complaint was a contributing factor in Dean Silva's decision to relocate Dr. Szabo, and that the relocation was retaliatory."
The panel recommended Szabo's grievance be sustained and that he be reimbursed attorney's fees incurred pursuing the grievance. The university asked the panel to reconsider its decision, but the panel stood firm in its findings and recommendations. "Let us be clear," the panel said in its response to the university, "the consequences of the dean's decision had such a negative impact on the care of patients and the training of the fellows that animus is the only explanation the panel can come up with to explain why the dean made this change."
But Vanderhoef, in a March 29 letter to Szabo, rejected the panel's findings and recommendations and refused to uphold the doctor's grievance. "Absent findings of misconduct against Dean Silva, I do not find a preponderance of the evidence supports a conclusion that your rights and privileges as a faculty member have been violated," Vanderhoef wrote. "I find no persuasive evidence to support a conclusion that Dean Silva's actions were based on personal animus. "The factors cited by the (panel) in support of its finding are not persuasive. "I find no compelling evidence to indicate that Dean Silva was aware of your (whistle-blowing) at the time the relocation decision was being considered. Instead, only argument and inference is offered to support such a conclusion. "Further, even if Dean Silva were aware of your whistle-blower report ... there is no persuasive evidence that he had any personal animus or other motivation to retaliate against you based upon such information."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, May 06, 2006
U.K.: MORE FAILED GOVERNMENT MEDDLING
Don't get sick late at night in Britain!
The Government’s reorganisation of out-of-hours medical care has failed patients and cost 70 million pounds more than was expected. The nine million patients a year who use the services were kept waiting for calls to be answered and 85 per cent of out-of-hours surgeries missed targets for urgent consultations, according to the National Audit Office. Primary care trusts (PCTs), which took on the services after GPs were allowed to opt out, were given insufficient funds by the Department of Health, increasing their financial difficulties. The findings are published as NHS hospitals and PCTs — responsible for planning and commissioning healthcare — are struggling with deficits and laying off staff. Better organisation of the out-of-hours service could have saved the NHS up to 134 million pounds in 2005-06, the audit office says.
The Department of Health had drawn up a list of 13 “quality requirements” for after-hours care, hardly any of which were met. For example, only 2 per cent of PCTs were able to answer patients’ calls within 60 seconds, and only 23 per cent began clinical assessment of patients within 20 minutes of their arrival at a medical centre. Fewer than one in ten surgeries could prove that they had assessed patients within 20 minutes of their making an urgent out-of-hours call for help, and fewer than one in six could provide emergency face-to-face consultations at a centre within an hour, or an urgent consultation within two hours. As for visiting patients’ homes, only 13 per cent of out-of-hours centres were able to arrange urgent consultations within two hours, and only 25 per cent could arrange less urgent consultations within six hours. But, despite these problems, the audit office found no evidence of serious incidents or deaths and says that, a year after they took on the service, “out-of-hours providers are beginning to deliver a satisfactory standard of service”.
The changes came about in 2004 when GPs were given the right to opt out of 24-hour care. By giving up 6,000 pounds a year they could hand over responsibility for patients from 6.30pm to 8am on weekdays, and on all weekends and public holidays. Nine out of ten did so. However, 6,000 did not represent the full cost of the service — as the Government knew. It was an amount reached in negotiation with the British Medical Association (BMA). The real figure was believed to be 9,500 a GP, or a total of 322 million in 2005-06. This was the sum provided to the PCTs— but the actual cost proved to be 22 per cent higher, or 392 million. In addition, PCTs lacked the “experience, time and reliable management data” to pick up the service. It was not even clear whether out-of-hours services should be restricted to urgent care, an issue that remained unresolved.
However, direct comparisons are difficult because nobody really knew how well or badly the old system worked. Chris Shapcott, the director of value-for-money studies at the audit office, said that PCTs were dealing with numerous other issues, such as changes to GP contracts and the payment-by-results reform. “The out-of-hours system probably did not get the attention it deserved in some areas,” he said. The audit office added that there appeared to be a discrepancy between patients’ experiences and the PCTs’ views of the care that they were offering, “suggesting that providers are currently not capturing negative feedback”.
Hamish Meldrum, the chairman of the GPs committee of the BMA, said that the old service had been unsustainable. “The finding that the costs of providing out-of-hours services were higher than the Government anticipated will not be a surprise to the thousands of family doctors who, in former years, provided it on the cheap to the NHS,” he said. Lord Warner, the Health Minister, said that the report “confirms the NHS is on the right track towards providing quality round-the-clock GP services”. [Amazing! What evidence would he need that they were on the wrong track??]
Source
Stuck in HSA Denial
Consumer-driven health care is beginning to show real signs of progress. A recent survey by America's Health Insurance Plans found that the number of people with a health savings account (HSA) tripled, from 1 million to 3 million, in barely a year's time. Companies are finding that high-deductible plans coupled with an HSA cost less. In his recent visit to Milwaukee, President Bush pointed to the hamburger giant Wendy's, which saw an increase of only 1 percent in its premiums after switching to an HSA plan.
Although I haven't had much to cheer about regarding the White House as of late, health care is an exception. President Bush has released a relatively bold agenda that would add steam to consumer-driven health care. The proposals include allowing all taxes, including payroll taxes, to be deducted from HSA contributions; putting individually-purchased health insurance on a more equal footing with employer-purchased insurance by permitting those who buy an individual HSA policy to deduct the cost of the premium from their income taxes; and also putting individual-purchased insurance on an equal footing with that of large employers by allowing individuals to purchase their insurance out of state.
Despite the progress, the political left refuses to acknowledge consumer-driven health care's promise and persists in promoting misconceptions about it. Jason Furman, of the liberal Center for Budget and Policy Priorities, in a missive against HSAs, complained that:
Our nation is suffering from two chronic health challenges: spiraling insurance premiums and 46 million Americans with no coverage at all. Just since 2000, premiums have skyrocketed by 73% and 6 million more people have become uninsured. The President's Health Savings Account "solution" would likely make these problems even worse.
Actually, consumer-driven health insurance provides relief from higher premiums. The Deloitte Center for Health Solutions released a survey showing that while premiums for more traditional plans rose between 6.6 and 7.5 percent last year, premiums for consumer driven plans rose only 2.6 percent. That's lower than the 2005 inflation rate of 3.4 percent.
Furman also overlooks improvement in the insured/uninsured numbers since HSAs came on line in 2004. While Census Bureau statistics show the number of uninsured has increased by 6 million since 2000, in 2004 the growth in the uninsured slowed. In the previous three years, the growth in the uninsured had ranged from about 3.2 percent to 5.7 percent; in 2004, it was under 2 percent. Another promising development in 2004 was that the total number of privately insured and those with employer-based insurance increased for the first time in five years. The arrival of a lower cost insurance product in the form of HSAs is likely one factor leading to these positive developments.
In reaction to Bush's agenda, many liberals like Ted Kennedy trotted out the increasingly tired "only for the healthy and the wealthy" charge against HSAs. While it is tempting to go through all the evidence showing it isn't true, it may be more instructive to consider the example of Wendy's touted by Bush. The average worker at Wendy's is likely part of the "working poor." And since the health of the poor tends to be worse than that of general population, chances are that Wendy's employees are a bit sicker on average. In other words, Wendy's is an excellent example of consumer-driven plans not being primarily for the healthy and the wealthy.
Furthermore, other parts of Bush's health care agenda make HSAs more accessible for the poor and sick. Bush's agenda permits a low-income family to take a refundable tax credit to purchase an HSA. It also allows small businesses and civic and religious groups to form associations that enable them to pool their resources to purchase insurance for their members. Finally, Bush enables employers to put additional contributions in the HSA of an employee with a chronic health condition.
Despite all the promising news, the path toward a more consumer-oriented health care system will not be without some serious obstacles. Many people are still stuck in an "entitlement" mentality regarding health care, for years accustomed to employers and insurance companies picking up the tab. A recent article in the Chicago Tribune examined the experience of Lutheran Social Services, which switched to an HSA plan last July. On balance, it has not been positive:
Larry Lutey, the agency's vice president of human resources, said many employees "don't like the HSA, to be quite frank," because it's a new way of thinking about buying medical services, and workers think it costs them more. "If my position had been an elective one," he added, "I would have been voted out of office this year."
Lutey said employees are unhappy with HSAs because "it feels like they're paying more upfront. The perception is, this is a very expensive type of plan. Even though there is money in [employee] accounts to cover these expenses, people end up feeling they're paying more out of pocket."
As the example of Whole Foods shows, companies can minimize such problems if they make a serious effort to educate employees about the switch to a consumer-driven plan. Nevertheless, there will be both some resistance and resentment as people change from health-care dependents to health-care consumers.
Despite some problems, consumer-driven health care can be expected to grow as it lowers costs and gives people more control over their health care choices. Congress can move the process along even more if it acts on Bush's health care agenda.
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.
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Don't get sick late at night in Britain!
The Government’s reorganisation of out-of-hours medical care has failed patients and cost 70 million pounds more than was expected. The nine million patients a year who use the services were kept waiting for calls to be answered and 85 per cent of out-of-hours surgeries missed targets for urgent consultations, according to the National Audit Office. Primary care trusts (PCTs), which took on the services after GPs were allowed to opt out, were given insufficient funds by the Department of Health, increasing their financial difficulties. The findings are published as NHS hospitals and PCTs — responsible for planning and commissioning healthcare — are struggling with deficits and laying off staff. Better organisation of the out-of-hours service could have saved the NHS up to 134 million pounds in 2005-06, the audit office says.
The Department of Health had drawn up a list of 13 “quality requirements” for after-hours care, hardly any of which were met. For example, only 2 per cent of PCTs were able to answer patients’ calls within 60 seconds, and only 23 per cent began clinical assessment of patients within 20 minutes of their arrival at a medical centre. Fewer than one in ten surgeries could prove that they had assessed patients within 20 minutes of their making an urgent out-of-hours call for help, and fewer than one in six could provide emergency face-to-face consultations at a centre within an hour, or an urgent consultation within two hours. As for visiting patients’ homes, only 13 per cent of out-of-hours centres were able to arrange urgent consultations within two hours, and only 25 per cent could arrange less urgent consultations within six hours. But, despite these problems, the audit office found no evidence of serious incidents or deaths and says that, a year after they took on the service, “out-of-hours providers are beginning to deliver a satisfactory standard of service”.
The changes came about in 2004 when GPs were given the right to opt out of 24-hour care. By giving up 6,000 pounds a year they could hand over responsibility for patients from 6.30pm to 8am on weekdays, and on all weekends and public holidays. Nine out of ten did so. However, 6,000 did not represent the full cost of the service — as the Government knew. It was an amount reached in negotiation with the British Medical Association (BMA). The real figure was believed to be 9,500 a GP, or a total of 322 million in 2005-06. This was the sum provided to the PCTs— but the actual cost proved to be 22 per cent higher, or 392 million. In addition, PCTs lacked the “experience, time and reliable management data” to pick up the service. It was not even clear whether out-of-hours services should be restricted to urgent care, an issue that remained unresolved.
However, direct comparisons are difficult because nobody really knew how well or badly the old system worked. Chris Shapcott, the director of value-for-money studies at the audit office, said that PCTs were dealing with numerous other issues, such as changes to GP contracts and the payment-by-results reform. “The out-of-hours system probably did not get the attention it deserved in some areas,” he said. The audit office added that there appeared to be a discrepancy between patients’ experiences and the PCTs’ views of the care that they were offering, “suggesting that providers are currently not capturing negative feedback”.
Hamish Meldrum, the chairman of the GPs committee of the BMA, said that the old service had been unsustainable. “The finding that the costs of providing out-of-hours services were higher than the Government anticipated will not be a surprise to the thousands of family doctors who, in former years, provided it on the cheap to the NHS,” he said. Lord Warner, the Health Minister, said that the report “confirms the NHS is on the right track towards providing quality round-the-clock GP services”. [Amazing! What evidence would he need that they were on the wrong track??]
Source
Stuck in HSA Denial
Consumer-driven health care is beginning to show real signs of progress. A recent survey by America's Health Insurance Plans found that the number of people with a health savings account (HSA) tripled, from 1 million to 3 million, in barely a year's time. Companies are finding that high-deductible plans coupled with an HSA cost less. In his recent visit to Milwaukee, President Bush pointed to the hamburger giant Wendy's, which saw an increase of only 1 percent in its premiums after switching to an HSA plan.
Although I haven't had much to cheer about regarding the White House as of late, health care is an exception. President Bush has released a relatively bold agenda that would add steam to consumer-driven health care. The proposals include allowing all taxes, including payroll taxes, to be deducted from HSA contributions; putting individually-purchased health insurance on a more equal footing with employer-purchased insurance by permitting those who buy an individual HSA policy to deduct the cost of the premium from their income taxes; and also putting individual-purchased insurance on an equal footing with that of large employers by allowing individuals to purchase their insurance out of state.
Despite the progress, the political left refuses to acknowledge consumer-driven health care's promise and persists in promoting misconceptions about it. Jason Furman, of the liberal Center for Budget and Policy Priorities, in a missive against HSAs, complained that:
Our nation is suffering from two chronic health challenges: spiraling insurance premiums and 46 million Americans with no coverage at all. Just since 2000, premiums have skyrocketed by 73% and 6 million more people have become uninsured. The President's Health Savings Account "solution" would likely make these problems even worse.
Actually, consumer-driven health insurance provides relief from higher premiums. The Deloitte Center for Health Solutions released a survey showing that while premiums for more traditional plans rose between 6.6 and 7.5 percent last year, premiums for consumer driven plans rose only 2.6 percent. That's lower than the 2005 inflation rate of 3.4 percent.
Furman also overlooks improvement in the insured/uninsured numbers since HSAs came on line in 2004. While Census Bureau statistics show the number of uninsured has increased by 6 million since 2000, in 2004 the growth in the uninsured slowed. In the previous three years, the growth in the uninsured had ranged from about 3.2 percent to 5.7 percent; in 2004, it was under 2 percent. Another promising development in 2004 was that the total number of privately insured and those with employer-based insurance increased for the first time in five years. The arrival of a lower cost insurance product in the form of HSAs is likely one factor leading to these positive developments.
In reaction to Bush's agenda, many liberals like Ted Kennedy trotted out the increasingly tired "only for the healthy and the wealthy" charge against HSAs. While it is tempting to go through all the evidence showing it isn't true, it may be more instructive to consider the example of Wendy's touted by Bush. The average worker at Wendy's is likely part of the "working poor." And since the health of the poor tends to be worse than that of general population, chances are that Wendy's employees are a bit sicker on average. In other words, Wendy's is an excellent example of consumer-driven plans not being primarily for the healthy and the wealthy.
Furthermore, other parts of Bush's health care agenda make HSAs more accessible for the poor and sick. Bush's agenda permits a low-income family to take a refundable tax credit to purchase an HSA. It also allows small businesses and civic and religious groups to form associations that enable them to pool their resources to purchase insurance for their members. Finally, Bush enables employers to put additional contributions in the HSA of an employee with a chronic health condition.
Despite all the promising news, the path toward a more consumer-oriented health care system will not be without some serious obstacles. Many people are still stuck in an "entitlement" mentality regarding health care, for years accustomed to employers and insurance companies picking up the tab. A recent article in the Chicago Tribune examined the experience of Lutheran Social Services, which switched to an HSA plan last July. On balance, it has not been positive:
Larry Lutey, the agency's vice president of human resources, said many employees "don't like the HSA, to be quite frank," because it's a new way of thinking about buying medical services, and workers think it costs them more. "If my position had been an elective one," he added, "I would have been voted out of office this year."
Lutey said employees are unhappy with HSAs because "it feels like they're paying more upfront. The perception is, this is a very expensive type of plan. Even though there is money in [employee] accounts to cover these expenses, people end up feeling they're paying more out of pocket."
As the example of Whole Foods shows, companies can minimize such problems if they make a serious effort to educate employees about the switch to a consumer-driven plan. Nevertheless, there will be both some resistance and resentment as people change from health-care dependents to health-care consumers.
Despite some problems, consumer-driven health care can be expected to grow as it lowers costs and gives people more control over their health care choices. Congress can move the process along even more if it acts on Bush's health care agenda.
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.
***************************
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