ISRAELI HOSPITAL TOLERATES MURDEROUS DOCTOR
The bureaucrats just turned a blind eye
In the worst-ever case of medical malpractice in Israel, Yakirevich, who was the head of Ichilov's cardiac surgery department from 1990 to 1996, was found guilty of the manslaughter of two 80-year-old patients he treated. In the first case, Yakirevich hastened his patient's death by stopping the balloon pump in her heart. In the second case he was found guilty of killing through malpractice a patient who was recovering from an operation. After being informed that the patient, semi-conscious and who was suffering from severe respiratory and blood pressure problems, was in a critical state, Yakirevich ordered the medical staff not to use a life-support system.
Following his orders, the medical staff didn't try to resuscitate the patient, who died several hours later from asphyxiation. The judge ruled that the doctor knew his orders would lead to the death or the hastening of the patient's death. The judge said that the doctor "Acted out of insensitivity as though he possessed unlimited power. He decided who could live or die."
The Tel-Aviv District Court also slammed Ichilov hospital's management and conduct of the case. The hospital showed, according to the verdict, "a lenient and ingratiating attitude" towards Yakirevich "despite being aware of part of his acts." The hospital, he continues, "decided to leave the doctor in his position because it needed his expertise and experience, which no one could doubt."
This criticism follows one raised in Judge Kara's verdict from January, according to which the hospital's management, under Professor Gabi Barbesh did not pay heed to serious complaints put forward by patients and staff against Dr. Yakirevich, and did not report them to the Health Ministry.
In addition to manslaughter charges, Yakirevich was also found guilty of a number of financial offenses, such as "accepting illegal and immoral payments," to the tune of thousands of dollars, from patients and their families, fraudulent deception, and, in one case, extorting money from the daughter of a patient he had operated on at another Tel Aviv hospital.
More here.
CANCEROUS GROWTH IN THE COST OF GOVERNMENT-FUNDED "FREEBIES"
How unsurprising!
"Medicaid will become the No. 1 cost facing U.S. state governments in 2004, beating out elementary and secondary education for the first time ever, according to a report from state budget officers on Tuesday. The cost of providing health services under the federal-state program for the poor and disabled climbed 8 percent in fiscal 2003 and came within a hair of overtaking elementary and secondary education as the top expenditure. Medicaid accounted for 21.4 percent of all state spending while elementary and secondary education took 21.7 percent of state spending in 2003, according to the National Association of State Budget Officers' annual State Expenditure Report.
In 1987, the program accounted for only 10.2 percent of total state spending compared with the 22.8 percent of spending allocated to education, the budget officers' group said. When final results are tallied for fiscal 2004, the budget officers group expects Medicaid to top states' list of expenses, said Scott Pattison, executive director of the group. "It's amazing," Pattison said. "Based on the projections for the (fiscal year) 2004 data, we would expect that it has surpassed the (kindergarten through grade 12) figure." Fiscal 2004 ended June 30 for most states. The expenditures data lags by about a year.
Raymond Scheppach, executive director of the National Governors Association, said federal requirements mandating Medicaid coverage would force states to cut back on other services. "Since Medicaid is a federal entitlement and education is discretionary, Medicaid will trump education going forward," Scheppach said. State budget and Medicaid officials, as well as health advocates, have warned for years that growth in Medicaid costs was unsustainable. Rising prescription drug costs, increasing enrollment and costly nursing home care have been cited throughout the country as the program's main cost drivers.
The Kaiser Commission on Medicaid and the Uninsured last week said Medicaid costs would continue to squeeze state governments in fiscal 2005 despite rising revenue collections and improving economies.
***************************
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.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, October 14, 2004
Wednesday, October 13, 2004
DOCTORS REPLACED BY NURSES IN BRITAIN
Doctors are to be instructed to make evening home visits following a surge in the number of patients being forced to use hospital casualty departments at night. Hospital staff say they are struggling to cope with the increasing workload created by patients who find it difficult to see their family doctor. Almost half a million extra patients were treated in accident and emergency departments this summer, compared with the same period in 2003.
Health minister John Hutton will this week give patients a guarantee that they can have a home visit from a GP if their condition requires it - although it may not be their own family doctor. A Department of Health source said: 'Ministers are adamant that, should the clinical need arise, patients should be able to see a GP around the clock. The guidance will show exactly what ministers expect the NHS to deliver for patients in the evenings and weekends.'
Under the new GP contract introduced earlier this year, doctors can take a small pay cut and opt out of providing care between 11pm and 6am, and at weekends. It is now up to primary care trusts to provide cover at night, using nurses, locum doctors and other staff to deal with calls. When the change comes into full force in December, it is expected that nine out of 10 family doctors will choose not to offer night cover.
There are growing concerns about the burden this is placing on A & E departments. They are partly a victim of their own success because the four-hour waiting time target means more people are seen more quickly, but the burden has been exacerbated by difficulties across England in accessing care from GPs. Martin Shalley, president of the British Association of Emergency Medicine and a consultant in Birmingham, said: 'We see an awful lot [of patients] who cannot get in to see their GP with non-emergency problems.'
Casualty nurses take the brunt of the extra work. Some say they have seen a 20 per cent rise in attendance in the last two years, and a 13 per cent rise this year alone. Earlier this year, Northumbria Healthcare Trust was warned by its nurses that they could be forced to quit, so great was the burden of work at night in its overstretched A & E department. Sue Burt, a sister in the casualty department at Norfolk and Norwich Hospital Trust, told the Nursing Times that her department had seen a 13 per cent rise in attendances since January alone, mostly at night. 'People tell me they are here because it is convenient and because they cannot get an appointment with their GP. We are struggling to cope with the onslaught.'
More here:
AUSTRALIA'S MOST LEFTIST STATE CANNOT TREAT THE SICK
"Three thousand people have joined elective surgery waiting lists in the past year and thousands more waited too long in emergency departments, according to a new report on Victoria's public hospitals. The latest quarterly report on the state's public hospitals yesterday painted a grim picture, with most major performance measures pointing to a system unable to cope with growing patient demand. The number of people waiting in emergency for more than 12 hours shot up by 36 per cent, up from 4784 in the first three months of this year to 6547 in April, May and June. Elective surgery waiting lists also rose sharply, increasing by 3486 on the same time last year to 42,120, according to the report. Victoria's hospitals were forced to turn ambulances away 238 times in the three months to the end of June this year, 60 times more than in the same period last year.
Opposition health spokesman David Davis said the State Government had deliberately withheld the figures to avoid embarrassment before the federal election. "These figures should have been out some time ago. Steve Bracks decided to sit on these figures because they are disastrous," he said. Mr Davis said the poor results were due to a decision to close hospital beds and not a nurses' strike earlier this year. "The Bracks Government has to open beds and manage our system better," Mr Davis said....
A decline in performance at The Alfred hospital, where more than one in three patients waited for more than 12 hours on a trolley, would be addressed. "The Alfred hospital, as a major trauma centre, has some challenges," Ms Pike said...... "
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.
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.
***************************
Doctors are to be instructed to make evening home visits following a surge in the number of patients being forced to use hospital casualty departments at night. Hospital staff say they are struggling to cope with the increasing workload created by patients who find it difficult to see their family doctor. Almost half a million extra patients were treated in accident and emergency departments this summer, compared with the same period in 2003.
Health minister John Hutton will this week give patients a guarantee that they can have a home visit from a GP if their condition requires it - although it may not be their own family doctor. A Department of Health source said: 'Ministers are adamant that, should the clinical need arise, patients should be able to see a GP around the clock. The guidance will show exactly what ministers expect the NHS to deliver for patients in the evenings and weekends.'
Under the new GP contract introduced earlier this year, doctors can take a small pay cut and opt out of providing care between 11pm and 6am, and at weekends. It is now up to primary care trusts to provide cover at night, using nurses, locum doctors and other staff to deal with calls. When the change comes into full force in December, it is expected that nine out of 10 family doctors will choose not to offer night cover.
There are growing concerns about the burden this is placing on A & E departments. They are partly a victim of their own success because the four-hour waiting time target means more people are seen more quickly, but the burden has been exacerbated by difficulties across England in accessing care from GPs. Martin Shalley, president of the British Association of Emergency Medicine and a consultant in Birmingham, said: 'We see an awful lot [of patients] who cannot get in to see their GP with non-emergency problems.'
Casualty nurses take the brunt of the extra work. Some say they have seen a 20 per cent rise in attendance in the last two years, and a 13 per cent rise this year alone. Earlier this year, Northumbria Healthcare Trust was warned by its nurses that they could be forced to quit, so great was the burden of work at night in its overstretched A & E department. Sue Burt, a sister in the casualty department at Norfolk and Norwich Hospital Trust, told the Nursing Times that her department had seen a 13 per cent rise in attendances since January alone, mostly at night. 'People tell me they are here because it is convenient and because they cannot get an appointment with their GP. We are struggling to cope with the onslaught.'
More here:
AUSTRALIA'S MOST LEFTIST STATE CANNOT TREAT THE SICK
"Three thousand people have joined elective surgery waiting lists in the past year and thousands more waited too long in emergency departments, according to a new report on Victoria's public hospitals. The latest quarterly report on the state's public hospitals yesterday painted a grim picture, with most major performance measures pointing to a system unable to cope with growing patient demand. The number of people waiting in emergency for more than 12 hours shot up by 36 per cent, up from 4784 in the first three months of this year to 6547 in April, May and June. Elective surgery waiting lists also rose sharply, increasing by 3486 on the same time last year to 42,120, according to the report. Victoria's hospitals were forced to turn ambulances away 238 times in the three months to the end of June this year, 60 times more than in the same period last year.
Opposition health spokesman David Davis said the State Government had deliberately withheld the figures to avoid embarrassment before the federal election. "These figures should have been out some time ago. Steve Bracks decided to sit on these figures because they are disastrous," he said. Mr Davis said the poor results were due to a decision to close hospital beds and not a nurses' strike earlier this year. "The Bracks Government has to open beds and manage our system better," Mr Davis said....
A decline in performance at The Alfred hospital, where more than one in three patients waited for more than 12 hours on a trolley, would be addressed. "The Alfred hospital, as a major trauma centre, has some challenges," Ms Pike said...... "
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.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, October 12, 2004
THE VACCINE SHORTAGE IS GOVERNMENT-CREATED
"Flu vaccine should be an attractive product for manufacturers - it is used every year, recommended for virtually everyone, and extremely safe. But like virtually all other vaccines, it isn't profitable. And that has so discouraged vaccine development that supplies of many lifesaving vaccines are in jeopardy. The fundamental problem is government policies that discourage companies from investing aggressively to develop new vaccines. Innovation has suffered, and producers have abandoned the field in droves, leaving only four major producers and a few dozen products. There are only two producers of injectable flu vaccine, for example: Chiron, unable to supply any product this year because of alleged contamination; and Aventis Pasteur, whose 54 million doses will be all that's available. (In addition, there will be another 2 million doses of FluMist, an inhalable nasal vaccine.)
This is not the first time we have had dangerous shortages of several essential vaccines. Some school systems have been forced to waive immunization requirements because there aren't enough vaccines available.
Vaccination to prevent viral and bacterial diseases is modern medicine's most cost-effective intervention. Although their social value is high, their economic value to pharmaceutical companies is low because of vaccines' low return on investment and the manufacturers' exposure to legal liability....
Federal bureaucrats, who seem not to understand the concept of carrots and sticks, can do much to encourage greater production of more and better vaccines in the long term. For example, the CDC, the largest domestic purchaser of vaccines, uses its buying clout to compel deep discounts for purchases.
Arbitrary and excessive regulation also blocks progress. Consider, for instance, the FDA position on a vaccine to prevent meningitis C, a bacterial illness that infects thousands of Americans and kills hundreds each year. No state-of-the-art vaccine against this infectious disease is approved for use in the United States, although three excellent products are available in Canada and Europe. The safety and efficacy of these vaccines have been amply demonstrated, with more than 20 million doses administered. Yet the FDA refuses to recognize the foreign approvals.
Moreover, the FDA has a history of removing safe and effective vaccines from the market based merely on perceptions of excessive side effects - a prospect terrifying to manufacturers.
We need a fundamental change in mind-set: The rewards for creating, testing and producing vaccines must become commensurate with their benefits to society, as is the case for therapeutic pharmaceuticals. First, our government should accept U.S.-European Union reciprocity of vaccine regulatory approvals. This would cut development costs significantly. Second, public agencies must stop extorting huge discounts for vaccines..... And finally, a regulatory-compliance defense should be allowed so that after a manufacturer meets the rigorous regulatory requirements for vaccine approval, any mishap from use of the product is considered to be nonculpable... "
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.
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.
***************************
"Flu vaccine should be an attractive product for manufacturers - it is used every year, recommended for virtually everyone, and extremely safe. But like virtually all other vaccines, it isn't profitable. And that has so discouraged vaccine development that supplies of many lifesaving vaccines are in jeopardy. The fundamental problem is government policies that discourage companies from investing aggressively to develop new vaccines. Innovation has suffered, and producers have abandoned the field in droves, leaving only four major producers and a few dozen products. There are only two producers of injectable flu vaccine, for example: Chiron, unable to supply any product this year because of alleged contamination; and Aventis Pasteur, whose 54 million doses will be all that's available. (In addition, there will be another 2 million doses of FluMist, an inhalable nasal vaccine.)
This is not the first time we have had dangerous shortages of several essential vaccines. Some school systems have been forced to waive immunization requirements because there aren't enough vaccines available.
Vaccination to prevent viral and bacterial diseases is modern medicine's most cost-effective intervention. Although their social value is high, their economic value to pharmaceutical companies is low because of vaccines' low return on investment and the manufacturers' exposure to legal liability....
Federal bureaucrats, who seem not to understand the concept of carrots and sticks, can do much to encourage greater production of more and better vaccines in the long term. For example, the CDC, the largest domestic purchaser of vaccines, uses its buying clout to compel deep discounts for purchases.
Arbitrary and excessive regulation also blocks progress. Consider, for instance, the FDA position on a vaccine to prevent meningitis C, a bacterial illness that infects thousands of Americans and kills hundreds each year. No state-of-the-art vaccine against this infectious disease is approved for use in the United States, although three excellent products are available in Canada and Europe. The safety and efficacy of these vaccines have been amply demonstrated, with more than 20 million doses administered. Yet the FDA refuses to recognize the foreign approvals.
Moreover, the FDA has a history of removing safe and effective vaccines from the market based merely on perceptions of excessive side effects - a prospect terrifying to manufacturers.
We need a fundamental change in mind-set: The rewards for creating, testing and producing vaccines must become commensurate with their benefits to society, as is the case for therapeutic pharmaceuticals. First, our government should accept U.S.-European Union reciprocity of vaccine regulatory approvals. This would cut development costs significantly. Second, public agencies must stop extorting huge discounts for vaccines..... And finally, a regulatory-compliance defense should be allowed so that after a manufacturer meets the rigorous regulatory requirements for vaccine approval, any mishap from use of the product is considered to be nonculpable... "
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.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, October 11, 2004
GOVERNMENT IS THE PROBLEM
Politicians used to run for office promising to fix the health-care crisis, but lately they've given up pretending they have any answers. Since 2000, medical costs have soared, and the number of people without medical insurance has grown. Yet the issue has been almost invisible in this presidential campaign. We know more about the candidates' hobbies than we do about their health-care plans.
As it happens, President Bush and Sen. John Kerry have some proposals, which consist mainly of measures to increase the number of Americans with medical coverage. Bush wants to rely on tax credits, while Kerry hopes to reduce insurance premiums by making the government pick up some of the costs of catastrophic illness.
Unfortunately, neither addresses the maddening dilemma we face. Anything you do to expand access to health care, like making insurance more available, increases the demand for health care and, in turn, drives up the price of health care. But if you try to control the cost of health care, you make it less accessible by discouraging hospitals and doctors from providing it. Politicians can't figure out a way to ameliorate both problems at once, so they end up doing little or nothing, or else they take steps that are likely to make things worse.
But there is a way to advance both worthy goals simultaneously--one that has been almost completely overlooked. Instead of focusing on demand, we could take steps to expand supply and promote competition. Like a glut in the gasoline market, that would allow people to consume more without all of us spending more.
Medicine is one of the most tightly regulated sectors in the entire economy, and many of the regulations limit supply. We require doctors to spend at least seven years in training after college, which deters many people from going into medicine. We impose licensing requirements that prevent some trained people from offering care. At the same time, we limit the types of treatment that other medical professionals, like physician assistants and nurses, may provide.
These policies are supposed to ensure quality, but they also deprive patients of options they might happily choose. Licensing of physicians arose in the 19th Century mainly as a way of limiting the supply of doctors and thus shielding the profession from competition.
Even now, California State University economist Shirley Svorny notes, "Many economists view licensing as a significant barrier to effective, cost-efficient health care." You might think tight regulation is needed to protect patients from quacks. But Svorny notes that while this type of regulation certainly raises costs, studies indicate that "the effect of licensure on consumption quality is ambiguous."
There is plenty of evidence that government policies reduce the availability of medical care. Though chiropractic is now widely used, the medical profession waged a long battle to prevent it from gaining acceptance. Today, the value of spinal manipulation for treating lower back pain, said a 1998 article in the New England Journal of Medicine, is "no longer in dispute." Medicare, however, still declines to cover some services that chiropractors are licensed to provide.
That experience should be a lesson about the value of expanding patient options, an approach that could lower costs while increasing satisfaction. It's not the only such lesson. Twenty years ago, midwifery was treated with scorn by medical experts. But a growing body of academic reports indicates that for normal pregnancies, deliveries can be handled as safely by nurse-midwives and lay midwives as by obstetricians.
One reason many people find health care inaccessible or too expensive is that we insist on providing so much of it through highly trained physicians. The idea of finding ways to reduce the years of training doesn't seem to have occurred to anyone. Apart from that, nurse practitioners, nurses and physician assistants could do a lot of what we now rely on doctors to do--and they could do it at a lower cost. They could also expand access to medical care in poor and rural areas that physicians shun.
It's easy to say everyone should get care from doctors. But that's like saying everyone should drive a Volvo. If we limited consumer choices to one ultrasafe nameplate, many people would not be able to afford a car at all. We let individuals make most of their own choices about safety and cost when it comes to their wheels. Why not with medical care?
For the last 40 years, every solution to our health-care problems has been a variation on the same theme: more government. Maybe the real answer is more freedom.
From the Chicago Trib.
***************************
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.
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.
***************************
Politicians used to run for office promising to fix the health-care crisis, but lately they've given up pretending they have any answers. Since 2000, medical costs have soared, and the number of people without medical insurance has grown. Yet the issue has been almost invisible in this presidential campaign. We know more about the candidates' hobbies than we do about their health-care plans.
As it happens, President Bush and Sen. John Kerry have some proposals, which consist mainly of measures to increase the number of Americans with medical coverage. Bush wants to rely on tax credits, while Kerry hopes to reduce insurance premiums by making the government pick up some of the costs of catastrophic illness.
Unfortunately, neither addresses the maddening dilemma we face. Anything you do to expand access to health care, like making insurance more available, increases the demand for health care and, in turn, drives up the price of health care. But if you try to control the cost of health care, you make it less accessible by discouraging hospitals and doctors from providing it. Politicians can't figure out a way to ameliorate both problems at once, so they end up doing little or nothing, or else they take steps that are likely to make things worse.
But there is a way to advance both worthy goals simultaneously--one that has been almost completely overlooked. Instead of focusing on demand, we could take steps to expand supply and promote competition. Like a glut in the gasoline market, that would allow people to consume more without all of us spending more.
Medicine is one of the most tightly regulated sectors in the entire economy, and many of the regulations limit supply. We require doctors to spend at least seven years in training after college, which deters many people from going into medicine. We impose licensing requirements that prevent some trained people from offering care. At the same time, we limit the types of treatment that other medical professionals, like physician assistants and nurses, may provide.
These policies are supposed to ensure quality, but they also deprive patients of options they might happily choose. Licensing of physicians arose in the 19th Century mainly as a way of limiting the supply of doctors and thus shielding the profession from competition.
Even now, California State University economist Shirley Svorny notes, "Many economists view licensing as a significant barrier to effective, cost-efficient health care." You might think tight regulation is needed to protect patients from quacks. But Svorny notes that while this type of regulation certainly raises costs, studies indicate that "the effect of licensure on consumption quality is ambiguous."
There is plenty of evidence that government policies reduce the availability of medical care. Though chiropractic is now widely used, the medical profession waged a long battle to prevent it from gaining acceptance. Today, the value of spinal manipulation for treating lower back pain, said a 1998 article in the New England Journal of Medicine, is "no longer in dispute." Medicare, however, still declines to cover some services that chiropractors are licensed to provide.
That experience should be a lesson about the value of expanding patient options, an approach that could lower costs while increasing satisfaction. It's not the only such lesson. Twenty years ago, midwifery was treated with scorn by medical experts. But a growing body of academic reports indicates that for normal pregnancies, deliveries can be handled as safely by nurse-midwives and lay midwives as by obstetricians.
One reason many people find health care inaccessible or too expensive is that we insist on providing so much of it through highly trained physicians. The idea of finding ways to reduce the years of training doesn't seem to have occurred to anyone. Apart from that, nurse practitioners, nurses and physician assistants could do a lot of what we now rely on doctors to do--and they could do it at a lower cost. They could also expand access to medical care in poor and rural areas that physicians shun.
It's easy to say everyone should get care from doctors. But that's like saying everyone should drive a Volvo. If we limited consumer choices to one ultrasafe nameplate, many people would not be able to afford a car at all. We let individuals make most of their own choices about safety and cost when it comes to their wheels. Why not with medical care?
For the last 40 years, every solution to our health-care problems has been a variation on the same theme: more government. Maybe the real answer is more freedom.
From the Chicago Trib.
***************************
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.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, October 10, 2004
INDIAN HOSPITALS BEAT BRITISH ONES
"BBC Radio Four (indeed any part of the B.B.C.) is not where one would expect to find support for liberty, but a few a days ago I heard, on the Radio 4 Today Program, a report on medical care.
According to the report private hospitals in India (including in Calcutta) offer British people medical care at least as good as that provided by the NHS, and in wonderful conditions (marble floors, everything clean rather than the dirt, and decay one finds in British government hospitals - thousands of people die every year in Britain from infections they pick up whilst in government hospitals) and at a small fraction of the cost of the (highly regulated) British private hospitals.
The Labour MP Frank Field (a man known for his honesty - hard to believe in a politician, but it is true in his case) came on to the program and claimed that a constituent of his was being left to go blind by the NHS, people are normally left to rot for long periods of time by the government medical service, but his sight was saved by sending him to an Indian hospital. The price of his medical care (not including the cost of flying to India, I admit) was œ50 - in Britain the medical care would have cost (according to Mr Field) œ3000.
So the choices were - go to a highly regulated British private hospital (if you happen to have œ3000), rely on government medical care (and go blind), or go overseas. Being a Labour MP Mr Field wanted the NHS to pay to send people to private hospitals in India (they put administrative barriers in the way of this ["it is too far"] - although they are willing to spend far more money sending people to European hospitals), but this was the closest I have ever come to hearing both the BBC and a Labour MP condemn statism in health care."
From Samizdata.
UNAFFORDABLE INSURANCE
"Doctors at Montgomery General Hospital are asking administrators to let them work without malpractice insurance because they cannot afford a statewide 33 percent increase in premiums. The doctors say the rates are so high now that they also are considering whether to discontinue high-risk procedures or to close or move practices out of state. "I look at these options myself," said Dr. Brian Avin, a neurologist with admitting privileges at Montgomery General. "I don't go to the emergency room anymore. I've cut back on treating the indigent. We've cut back on Medicaid. That hurts. I went into medicine to do all of those things."
Gov. Robert L. Ehrlich Jr., a Republican, yesterday described the price of medical-malpractice insurance in Maryland as a "very serious" issue. He also said that without reform, the state could lose its "very best medical providers." However, Mr. Ehrlich and state lawmakers have been unable to strike a deal to address the cost of malpractice premiums.
Meanwhile, the Maryland State Medical Society said this week that as many as 40 percent of the state's physicians will close or relocate if premiums are not reduced. Dr. Avin said he supports the Montgomery General doctors who are asking the medical staff's executive committee if they can practice without insurance, although he was not at the meeting on Tuesday night, when they voted on the plan. Montgomery General does not give admitting privileges to physicians unless they have malpractice insurance. But doctors want the hospital to drop the requirement because, they say, high malpractice-insurance rates are driving them out of business.
Doctors complained about malpractice premiums last month after insurance regulators approved a 33 percent rate increase for Medical Mutual Liability Insurance Society of Maryland, which insures about three-fourths of the state's doctors. The increase brought the cost of premiums for some doctors to more than $150,000 a year.
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.
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.
***************************
"BBC Radio Four (indeed any part of the B.B.C.) is not where one would expect to find support for liberty, but a few a days ago I heard, on the Radio 4 Today Program, a report on medical care.
According to the report private hospitals in India (including in Calcutta) offer British people medical care at least as good as that provided by the NHS, and in wonderful conditions (marble floors, everything clean rather than the dirt, and decay one finds in British government hospitals - thousands of people die every year in Britain from infections they pick up whilst in government hospitals) and at a small fraction of the cost of the (highly regulated) British private hospitals.
The Labour MP Frank Field (a man known for his honesty - hard to believe in a politician, but it is true in his case) came on to the program and claimed that a constituent of his was being left to go blind by the NHS, people are normally left to rot for long periods of time by the government medical service, but his sight was saved by sending him to an Indian hospital. The price of his medical care (not including the cost of flying to India, I admit) was œ50 - in Britain the medical care would have cost (according to Mr Field) œ3000.
So the choices were - go to a highly regulated British private hospital (if you happen to have œ3000), rely on government medical care (and go blind), or go overseas. Being a Labour MP Mr Field wanted the NHS to pay to send people to private hospitals in India (they put administrative barriers in the way of this ["it is too far"] - although they are willing to spend far more money sending people to European hospitals), but this was the closest I have ever come to hearing both the BBC and a Labour MP condemn statism in health care."
From Samizdata.
UNAFFORDABLE INSURANCE
"Doctors at Montgomery General Hospital are asking administrators to let them work without malpractice insurance because they cannot afford a statewide 33 percent increase in premiums. The doctors say the rates are so high now that they also are considering whether to discontinue high-risk procedures or to close or move practices out of state. "I look at these options myself," said Dr. Brian Avin, a neurologist with admitting privileges at Montgomery General. "I don't go to the emergency room anymore. I've cut back on treating the indigent. We've cut back on Medicaid. That hurts. I went into medicine to do all of those things."
Gov. Robert L. Ehrlich Jr., a Republican, yesterday described the price of medical-malpractice insurance in Maryland as a "very serious" issue. He also said that without reform, the state could lose its "very best medical providers." However, Mr. Ehrlich and state lawmakers have been unable to strike a deal to address the cost of malpractice premiums.
Meanwhile, the Maryland State Medical Society said this week that as many as 40 percent of the state's physicians will close or relocate if premiums are not reduced. Dr. Avin said he supports the Montgomery General doctors who are asking the medical staff's executive committee if they can practice without insurance, although he was not at the meeting on Tuesday night, when they voted on the plan. Montgomery General does not give admitting privileges to physicians unless they have malpractice insurance. But doctors want the hospital to drop the requirement because, they say, high malpractice-insurance rates are driving them out of business.
Doctors complained about malpractice premiums last month after insurance regulators approved a 33 percent rate increase for Medical Mutual Liability Insurance Society of Maryland, which insures about three-fourths of the state's doctors. The increase brought the cost of premiums for some doctors to more than $150,000 a year.
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.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, October 09, 2004
BRITISH HYPOCRISY
"Tony Blair's had his minor heart operation and is apparently in fine fettle, so good luck to him. Remarkable, though, how our leading politicians seem to get treated so quickly while the rest of us NHS patients have to wait.
"Unlike Tony, I'm still waiting for treatment," says Mickey Clark, the Markets Correspondent in London's Evening Standard newspaper today. "The Prime Minister and I are both 51 and suffer from irregular heartbeats. There the similarities end."
Clark was diagnosed last year and given drugs to thin his blood and hopefully to kick-start his heart. A date was set for and operation later that spring and an appointment with the cardiologist in July. But then an ECG showed his heart seemed to be beating normally so the treatment was postponed, as was the cardiologist appointment. Indeed, the cardiologist date has since been cancelled twice, so Clark won't be seeing the specialist until next February (unless he cancels again). "Compare that with Tony Blair, who was given [the treatment] the same weekend his complaint was diagnosed."
Quite. When defenders of state medicine say "we don't want a two-tier system," they should reflect that that is exactly what we've got."
From the Adam Smith blog.
***************************
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.
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.
***************************
"Tony Blair's had his minor heart operation and is apparently in fine fettle, so good luck to him. Remarkable, though, how our leading politicians seem to get treated so quickly while the rest of us NHS patients have to wait.
"Unlike Tony, I'm still waiting for treatment," says Mickey Clark, the Markets Correspondent in London's Evening Standard newspaper today. "The Prime Minister and I are both 51 and suffer from irregular heartbeats. There the similarities end."
Clark was diagnosed last year and given drugs to thin his blood and hopefully to kick-start his heart. A date was set for and operation later that spring and an appointment with the cardiologist in July. But then an ECG showed his heart seemed to be beating normally so the treatment was postponed, as was the cardiologist appointment. Indeed, the cardiologist date has since been cancelled twice, so Clark won't be seeing the specialist until next February (unless he cancels again). "Compare that with Tony Blair, who was given [the treatment] the same weekend his complaint was diagnosed."
Quite. When defenders of state medicine say "we don't want a two-tier system," they should reflect that that is exactly what we've got."
From the Adam Smith blog.
***************************
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.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, October 08, 2004
Health Insurance Costs Rise Faster Than Wages
[There's always new rules being added by do-gooding legislators so the well-paid medical bureaucracy just keeps growing like a cancer]
"Health insurance premiums for workers are rising around three times faster than their wages, and health costs eat up a quarter of earnings for more than 14 million Americans, according to a survey on Tuesday. While benefits are being cut, health insurance premiums are rising, the report from the nonprofit Families USA found.
"Working families were squeezed by runaway health care costs over the past four years," said Families USA executive director Ron Pollack. "As a result, workers are paying much more in premiums but are receiving less health coverage, wages are being depressed; and millions of people have lost health coverage entirely."
The cost of health insurance premiums rose by nearly 36 percent on average from 2000 to 2004 in 35 states, said the group, which bills itself as a nonpartisan watchdog on health care issues. Average earnings rose just 12 percent over the same time".
More here.
[There's always new rules being added by do-gooding legislators so the well-paid medical bureaucracy just keeps growing like a cancer]
"Health insurance premiums for workers are rising around three times faster than their wages, and health costs eat up a quarter of earnings for more than 14 million Americans, according to a survey on Tuesday. While benefits are being cut, health insurance premiums are rising, the report from the nonprofit Families USA found.
"Working families were squeezed by runaway health care costs over the past four years," said Families USA executive director Ron Pollack. "As a result, workers are paying much more in premiums but are receiving less health coverage, wages are being depressed; and millions of people have lost health coverage entirely."
The cost of health insurance premiums rose by nearly 36 percent on average from 2000 to 2004 in 35 states, said the group, which bills itself as a nonpartisan watchdog on health care issues. Average earnings rose just 12 percent over the same time".
More here.
Thursday, October 07, 2004
MEDICAL MADNESS IN AUSTRALIA
Expensive surgery for the elderly is not the best use of taxpayers' money, writes Ross Gittins
Whichever side wins this election, the new government will be committed to pouring a mighty lot more money into Medicare over coming decades - far more than either side is willing to admit. But this huge injection of taxpayers' funds is likely to do more to enhance doctors' incomes than improve the quality of our health care.
The present bout of renovations to Medicare began in response to the public's concern about a sharp decline in bulk-billing by general practitioners. This decline occurred because the Howard Government had spent the past eight years sitting on the schedule fee - stopping it from rising as much as doctors' costs were rising. Watching enviously while specialists' incomes continued to grow strongly, many GPs finally broke out of the system, cutting back their bulk-billing so they could charge fees well above the schedule fee. Getting them back into the bulk-billing paddock - where the rate at which their fees rise is effectively controlled by the Government - won't be easy now they've tasted financial freedom.
Both parties give the impression they're trying to preserve bulk-billing, but only Labor is genuine. Only it is offering GPs the monetary incentives needed to possibly - possibly - lure them back into the system and get the proportion of GP consultations that are bulk-billed back up to the 80 per cent level John Howard inherited. The Liberals have limited their inducements to encourage the bulk-billing of pensioners and children. They appeared to match Labor's recent offer to pay a 100 per cent (as opposed to the present 85 per cent) rebate on the schedule fee for GP consultations, but the appearance is deceptive. Labor would pay the higher rebate only to doctors who bulk-bill, whereas the Libs would pay it also to patients who were not bulk-billed - thereby permitting GPs who so chose to increase their fees by the same amount as the increase in the rebate. So the Libs' version is designed to allow doctors to share the largesse.
Rather than seek to restore bulk-billing, the Libs' approach has been to introduce a safety net where, once a family's out-of-pocket payments (ie, doctor's fee minus Medicare rebate) exceed a threshold of $300 or $700 a year, Medicare picks up 80 per cent of all further out-of-pocket payments during the year. So the Libs are saying, we're going to let bulk-billing continue to wither for most people, but don't worry, we've got this other way of protecting you from undue expense. What's more, bulk-billing is limited mainly to GP visits, whereas our safety net comes into its own with specialists' fees, most of which are way above the schedule fee.
There's no denying the safety net is very generous (mainly because a misguided minority in the Senate forced the Government to accept much lower threshold levels than made sense). This is why the measure will cost far more than the Government originally bargained for. And indeed, the early figures for this year suggest the cost to the taxpayer will be double what was expected. Those figures showed that payments to people in Brendan Nelson's prosperous North Shore electorate exceeded those going to people in the whole of South Australia.
Actually, that isn't surprising. It's in the most prosperous suburbs that doctors don't bother bulk-billing and know they can charge way above the schedule fee, while patients can afford lots of visits to specialists even at high prices. This says the lion's share of taxpayers' money to be spent on the safety net will go to patients who don't particularly need help (including yours truly) and to those specialists in the best suburbs with the highest fees. Worse, the advent of the safety net removes the last constraint on the freedom of doctors to raise their fees: conscience. Don't worry that your patients can't afford your fee increase - as soon as they're over a quite low threshold, the taxpayer will be picking up 80 per cent of the rise. So the safety net is likely to underwrite a continuing surge in doctors' fees. Its cost will just keep exploding - but with surprisingly little of the benefit going to needy patients.
In its own way, however, Labor's rival offer, Medicare Gold, would be just as dubious and wasteful. This is the promise to end hospital waiting lists for people aged 75 and over by giving them the equivalent of free private health insurance. The proposal has two attractions from a policy perspective: it would end the duckshoving between public hospitals (state) and nursing homes (federal) over care of the frail aged, and it would make public and private hospitals part of a single, integrated system. Apart from that, Medicare Gold is bad news. Despite all Labor's fulminating over the evils of a two-tier health system, that's just what it would be: Medicare Gold for those old enough, Medicare Ordinary for the rest. This discrimination would be on the basis of age, not need. The old wouldn't face queues for elective surgery, but everyone else would. The old would get free private health insurance, everyone else would have to pay.
This is a tacit admission from Labor that by itself, Medicare is not up to snuff. For decent treatment, you must have additional, private insurance. Private insurance is now an integral part of Labor's version of Medicare. Wow. By giving the elderly unfettered access to "free" hospital treatment, their doctors would gain an open go in ordering additional procedures. A $20,000 heart bypass for someone in their 80s? Not a problem. Might keep them going a few months longer.
Because specialists would be paid a higher (private) fee for operations, a lot more of them would make themselves available. Even so, the blowout in demand would lead to a constant threat of waiting lists emerging. Every time that happened, a Labor government would be under pressure to keep its promise by pouring yet more taxpayers' money into system. It would be a never-ending struggle, with a cost that was completely open-ended.
The pollies will never admit it, but waiting lists for elective surgery aren't an unfortunate accident - they're a design feature. Pollies of both colours - federal and state - use them to keep a lid on growth in the cost of public hospitals that would otherwise be uncontrollable. If Labor gave oldies an exemption from queuing, there's nothing surer than that the queues for you and me would be longer - and this despite hugely increased spending on the oldies and their doctors.
***************************
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.
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.
***************************
Expensive surgery for the elderly is not the best use of taxpayers' money, writes Ross Gittins
Whichever side wins this election, the new government will be committed to pouring a mighty lot more money into Medicare over coming decades - far more than either side is willing to admit. But this huge injection of taxpayers' funds is likely to do more to enhance doctors' incomes than improve the quality of our health care.
The present bout of renovations to Medicare began in response to the public's concern about a sharp decline in bulk-billing by general practitioners. This decline occurred because the Howard Government had spent the past eight years sitting on the schedule fee - stopping it from rising as much as doctors' costs were rising. Watching enviously while specialists' incomes continued to grow strongly, many GPs finally broke out of the system, cutting back their bulk-billing so they could charge fees well above the schedule fee. Getting them back into the bulk-billing paddock - where the rate at which their fees rise is effectively controlled by the Government - won't be easy now they've tasted financial freedom.
Both parties give the impression they're trying to preserve bulk-billing, but only Labor is genuine. Only it is offering GPs the monetary incentives needed to possibly - possibly - lure them back into the system and get the proportion of GP consultations that are bulk-billed back up to the 80 per cent level John Howard inherited. The Liberals have limited their inducements to encourage the bulk-billing of pensioners and children. They appeared to match Labor's recent offer to pay a 100 per cent (as opposed to the present 85 per cent) rebate on the schedule fee for GP consultations, but the appearance is deceptive. Labor would pay the higher rebate only to doctors who bulk-bill, whereas the Libs would pay it also to patients who were not bulk-billed - thereby permitting GPs who so chose to increase their fees by the same amount as the increase in the rebate. So the Libs' version is designed to allow doctors to share the largesse.
Rather than seek to restore bulk-billing, the Libs' approach has been to introduce a safety net where, once a family's out-of-pocket payments (ie, doctor's fee minus Medicare rebate) exceed a threshold of $300 or $700 a year, Medicare picks up 80 per cent of all further out-of-pocket payments during the year. So the Libs are saying, we're going to let bulk-billing continue to wither for most people, but don't worry, we've got this other way of protecting you from undue expense. What's more, bulk-billing is limited mainly to GP visits, whereas our safety net comes into its own with specialists' fees, most of which are way above the schedule fee.
There's no denying the safety net is very generous (mainly because a misguided minority in the Senate forced the Government to accept much lower threshold levels than made sense). This is why the measure will cost far more than the Government originally bargained for. And indeed, the early figures for this year suggest the cost to the taxpayer will be double what was expected. Those figures showed that payments to people in Brendan Nelson's prosperous North Shore electorate exceeded those going to people in the whole of South Australia.
Actually, that isn't surprising. It's in the most prosperous suburbs that doctors don't bother bulk-billing and know they can charge way above the schedule fee, while patients can afford lots of visits to specialists even at high prices. This says the lion's share of taxpayers' money to be spent on the safety net will go to patients who don't particularly need help (including yours truly) and to those specialists in the best suburbs with the highest fees. Worse, the advent of the safety net removes the last constraint on the freedom of doctors to raise their fees: conscience. Don't worry that your patients can't afford your fee increase - as soon as they're over a quite low threshold, the taxpayer will be picking up 80 per cent of the rise. So the safety net is likely to underwrite a continuing surge in doctors' fees. Its cost will just keep exploding - but with surprisingly little of the benefit going to needy patients.
In its own way, however, Labor's rival offer, Medicare Gold, would be just as dubious and wasteful. This is the promise to end hospital waiting lists for people aged 75 and over by giving them the equivalent of free private health insurance. The proposal has two attractions from a policy perspective: it would end the duckshoving between public hospitals (state) and nursing homes (federal) over care of the frail aged, and it would make public and private hospitals part of a single, integrated system. Apart from that, Medicare Gold is bad news. Despite all Labor's fulminating over the evils of a two-tier health system, that's just what it would be: Medicare Gold for those old enough, Medicare Ordinary for the rest. This discrimination would be on the basis of age, not need. The old wouldn't face queues for elective surgery, but everyone else would. The old would get free private health insurance, everyone else would have to pay.
This is a tacit admission from Labor that by itself, Medicare is not up to snuff. For decent treatment, you must have additional, private insurance. Private insurance is now an integral part of Labor's version of Medicare. Wow. By giving the elderly unfettered access to "free" hospital treatment, their doctors would gain an open go in ordering additional procedures. A $20,000 heart bypass for someone in their 80s? Not a problem. Might keep them going a few months longer.
Because specialists would be paid a higher (private) fee for operations, a lot more of them would make themselves available. Even so, the blowout in demand would lead to a constant threat of waiting lists emerging. Every time that happened, a Labor government would be under pressure to keep its promise by pouring yet more taxpayers' money into system. It would be a never-ending struggle, with a cost that was completely open-ended.
The pollies will never admit it, but waiting lists for elective surgery aren't an unfortunate accident - they're a design feature. Pollies of both colours - federal and state - use them to keep a lid on growth in the cost of public hospitals that would otherwise be uncontrollable. If Labor gave oldies an exemption from queuing, there's nothing surer than that the queues for you and me would be longer - and this despite hugely increased spending on the oldies and their doctors.
***************************
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.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, October 06, 2004
NOT ENOUGH DOCTORS FOR AUSTRALIA
And the triumph of feminism is largely to blame
"Ailing Australians may have to wait longer to see their regular general practitioner as doctors and medical students choose to work fewer hours as part of a fundamental shift in the medical profession, a new study has found. A two-year study published today in The Medical Journal of Australia found family and lifestyle will be just as important as medicine to the next generation of Australian doctors and many will opt to work part-time to accommodate their lifestyle. The move could force patients in need of immediate care to seek out other doctors. Researchers from the University of Newcastle and the Royal Australian College of General Practitioners surveyed 130 students about how they would balance their careers as doctors with their family and private lives. Although women doctors already work fewer hours than male doctors, the reality is that many find the conflict between their roles as doctors, mothers and wives a significant source of stress," said author Helen Tolhurst, a postdoctoral research fellow in the university's discipline of General Practice. With women now making up 50 per cent of medical students, this is going to have a significant impact on the delivery of medical services in the future. But Dr Tolhurst said it was "not just the women" feeling that way. "Both sexes are concerned about the impact of vocational choice on family life and lifestyle - and this is borne out by our study," she said.
Australian Medical Association state president Dr William Heddle said the change in the make-up of medical students had led to doctors working "safer hours". "But we still need to graduate enough doctors to fill the workforce," he said. "Last year, you needed 1.7 graduates for one full-time equivalent doctor with the hours the graduates were working. This used to be about 0.7 for one full-time equivalent because everyone used to work 80 hours a week." He admitted it could be difficult for female medical students to balance specialist training careers with family life.
Australian Medical Students Association president Matthew Hutchinson said changes in the demographic of medical students "put the onus on the government to really think about workforce planning. Doctors used to work 60 or 70 hours a week but these days we are not going to get that," he said. "So we need a bigger medical workforce to plug those gaps." He said 76 per cent of first-year medical students at the University of Adelaide this year were female.
More here.
THE REALITY OF "UNIVERSAL" HEALTH COVERAGE
"A woman expecting her first child was told to drive more than 135km because the hospital in her home town had no anaesthetist on call to be at the birth. Mandy Schiller, 30, had planned to have her child in her local hospital but, with husband Geoff by her side, she was forced to stay at home before being told to drive to somewhere else.
Their experience is typical of the stress and trauma faced by country mothers. A survey released yesterday shows 45 per cent of women in rural NSW cannot give birth in their local areas because of a lack of specialist health services and staff. The survey released by the Gender, Women and Social Policy research group at Charles Sturt University, Wagga Wagga, found country women had trouble accessing GPs and health specialists, and were far behind their city cousins when it came to education, childcare, transport and mental health services.....
The couple eventually arrived at Wagga Base Hospital, with Mrs Schiller giving birth to son Nicholas, her first child, at 5.35am. She checked out at lunchtime that day to head back to Young. "I wanted to go home and check into Young Hospital so I could be near family and friends," Mrs Schiller said. "We've got a brand new hospital here and it seems totally stupid that I couldn't use it to have my baby. "The whole experience adds to the stress of giving birth for the first time, I know in my pre-natal classes the other mothers were very worried about it. Sometimes the anaesthetist is gone for a week at a time and if you're due that week what do you do?"
The couple's trauma is repeated on a daily basis across NSW, said Danette Watson from Maternity Coalition. "Perfectly healthy women are being forced to go out of town to give birth simply because of the shortage of full-time anaesthetists," she said. Southern Area Health Southern Slopes division general manager Margaret Gerkens said Young's single anaesthetist was not on duty that day and no locums were available."
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.
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.
***************************
And the triumph of feminism is largely to blame
"Ailing Australians may have to wait longer to see their regular general practitioner as doctors and medical students choose to work fewer hours as part of a fundamental shift in the medical profession, a new study has found. A two-year study published today in The Medical Journal of Australia found family and lifestyle will be just as important as medicine to the next generation of Australian doctors and many will opt to work part-time to accommodate their lifestyle. The move could force patients in need of immediate care to seek out other doctors. Researchers from the University of Newcastle and the Royal Australian College of General Practitioners surveyed 130 students about how they would balance their careers as doctors with their family and private lives. Although women doctors already work fewer hours than male doctors, the reality is that many find the conflict between their roles as doctors, mothers and wives a significant source of stress," said author Helen Tolhurst, a postdoctoral research fellow in the university's discipline of General Practice. With women now making up 50 per cent of medical students, this is going to have a significant impact on the delivery of medical services in the future. But Dr Tolhurst said it was "not just the women" feeling that way. "Both sexes are concerned about the impact of vocational choice on family life and lifestyle - and this is borne out by our study," she said.
Australian Medical Association state president Dr William Heddle said the change in the make-up of medical students had led to doctors working "safer hours". "But we still need to graduate enough doctors to fill the workforce," he said. "Last year, you needed 1.7 graduates for one full-time equivalent doctor with the hours the graduates were working. This used to be about 0.7 for one full-time equivalent because everyone used to work 80 hours a week." He admitted it could be difficult for female medical students to balance specialist training careers with family life.
Australian Medical Students Association president Matthew Hutchinson said changes in the demographic of medical students "put the onus on the government to really think about workforce planning. Doctors used to work 60 or 70 hours a week but these days we are not going to get that," he said. "So we need a bigger medical workforce to plug those gaps." He said 76 per cent of first-year medical students at the University of Adelaide this year were female.
More here.
THE REALITY OF "UNIVERSAL" HEALTH COVERAGE
"A woman expecting her first child was told to drive more than 135km because the hospital in her home town had no anaesthetist on call to be at the birth. Mandy Schiller, 30, had planned to have her child in her local hospital but, with husband Geoff by her side, she was forced to stay at home before being told to drive to somewhere else.
Their experience is typical of the stress and trauma faced by country mothers. A survey released yesterday shows 45 per cent of women in rural NSW cannot give birth in their local areas because of a lack of specialist health services and staff. The survey released by the Gender, Women and Social Policy research group at Charles Sturt University, Wagga Wagga, found country women had trouble accessing GPs and health specialists, and were far behind their city cousins when it came to education, childcare, transport and mental health services.....
The couple eventually arrived at Wagga Base Hospital, with Mrs Schiller giving birth to son Nicholas, her first child, at 5.35am. She checked out at lunchtime that day to head back to Young. "I wanted to go home and check into Young Hospital so I could be near family and friends," Mrs Schiller said. "We've got a brand new hospital here and it seems totally stupid that I couldn't use it to have my baby. "The whole experience adds to the stress of giving birth for the first time, I know in my pre-natal classes the other mothers were very worried about it. Sometimes the anaesthetist is gone for a week at a time and if you're due that week what do you do?"
The couple's trauma is repeated on a daily basis across NSW, said Danette Watson from Maternity Coalition. "Perfectly healthy women are being forced to go out of town to give birth simply because of the shortage of full-time anaesthetists," she said. Southern Area Health Southern Slopes division general manager Margaret Gerkens said Young's single anaesthetist was not on duty that day and no locums were available."
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.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, October 05, 2004
BIG PROBLEMS AND TRIVIAL RESPONSES
Another email from a U.S. doctor:
"I am a physician in the U.S., and I love your socialized medicine pearls, the latest of which -- by another medical practitioner -- I want to comment on. I just wanted to tell you, we have JCAHO coming to our hospital this month. It is causing all the panic you note. What a dog and pony show! We'll do all this total b.s., and it's all about the show...nothing to do with really taking care of patients. It's all about jobs for doctors and other adminstrators who can't make it in the "real world", or so I am convinced.
Recently, there was a campaign that we all not use certain abbreviations, thought to lead to horrible mistakes in the ER; for instance, we have to write ml instead of cc for our IV infusion rates. Or write out morphine sulfate instead of MS. (Both of these we have done since day 1 that I have been in practice, which is since 1979, and I recall neither leading to a single accident. Oh well.). JCAHO, on their website, recommended an entire scheme to get us to use the good and not bad abbrevations, including making up songs and posters and well....here's a partial list pasted from their website:
It gets much, much worse. I looked at the latest "FAQS" for the Patient safety guidelines, revision 8/30/04. It took me several minutes just to scroll, with just cursory reading, through the entire list. I opened the "printer friendly" PDF version...it's 24 pages LONG. This is obscene. These folks, I can tell you, have smoked too many "joints" and thus the name.
And yes, I came up with the even more juvenile "Operation, in response to Operation BANEM above: Forgive Us Clearly Klutzy Emergency Medicos, (You can figure out the acronym!) since we do such an obviously horrible job, killing hundreds of thousands via time-tested abbreviations.
Of course, none of the problems could be from overcrowding, over-utliization, overbearing bureaucracy, overabundant lawsuits and fear of same or other REAL reasons medicine is so messed up!
Your previous correspondent did leave out other factors: Insurance. Medical insurance, both private and govt. is horribly construed here. It is dissimilar to any other insurance, and because of the low pay copays of employer-offered care, or no-pays of govt. programs such as Medicaid, care is overutilized. People run in to the ER I work in with paper cuts and knee scrapes. Heaven forfend they would put a bandage themselves or an antiseptic at home. I am not exaggerating.
No one cares or worries about the true cost of care. So the "free lunch" theory is in place, as everyone assumes the "system" can pay for everything. And they have to pay less than the price of a baseball game ticket. A family of four have to pay out something like $200 US to go to a ballgame here, on average. No big deal, but to shell out that for an ER visit...oh my, we are gouging them!
Also, I can't forget that doctors' organizations are guilty also... licensing laws have kept down the supply of doctors, and there are other mechanisms that physician groups have tried over the years to restrict the supply of "providers" to keep up licenses. I know that is heresy to my own group, but it's true.
My contention is that all groups are guilty....govt., insurers, pharmacy companies, patients, employers, physicians, lawyers and patients and their families. There is not a single group NOT guilty in the medical care "crisis". Which is why we'll end up with socialized medicine, because it is such a muddle and so many groups are involved in the muck-up, that the political will will be to turn to the govt. to fix the crisis, though they are the MOST guilty of all!
***************************
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.
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.
***************************
Another email from a U.S. doctor:
"I am a physician in the U.S., and I love your socialized medicine pearls, the latest of which -- by another medical practitioner -- I want to comment on. I just wanted to tell you, we have JCAHO coming to our hospital this month. It is causing all the panic you note. What a dog and pony show! We'll do all this total b.s., and it's all about the show...nothing to do with really taking care of patients. It's all about jobs for doctors and other adminstrators who can't make it in the "real world", or so I am convinced.
Recently, there was a campaign that we all not use certain abbreviations, thought to lead to horrible mistakes in the ER; for instance, we have to write ml instead of cc for our IV infusion rates. Or write out morphine sulfate instead of MS. (Both of these we have done since day 1 that I have been in practice, which is since 1979, and I recall neither leading to a single accident. Oh well.). JCAHO, on their website, recommended an entire scheme to get us to use the good and not bad abbrevations, including making up songs and posters and well....here's a partial list pasted from their website:
Have the list printed on pens.
Send monthly reminders of the list to staff via computer.
Educate and monitor staff who document in the medical record.
Create an educational display for use during Patient Safety Awareness Week.
Educate affiliated health care professional education programs about the list.
Place articles in employee and physician newsletters.
Provide mouse pads with the list.
Convene regional/community meeting to develop consistent list for physicians who maintain privileges at two or more facilities.
Direct pharmacy not to accept any of the prohibited abbreviations.
Orders with dangerous abbreviations or illegible handwriting must be corrected before being dispensed.
Conduct a mock survey and question staff to test their knowledge.
Work with software vendor to ensure changes are made to be consistent with the list.
At every medical staff meeting, give patient safety updates, including information about the prohibited abbreviations.
Identify and promote "Physician Champions" who support accreditation-related activities and advocate for full compliance with the NPSGs.
Ask every staff person to sign a statement that he/she has received the list and agrees not to use the abbreviations.
Create a catchy name or theme: Do the "Write" Thing; "Dirty Dozen"; "Outlaw Abbreviations"; "Join the Patient Safety Posse"; "Operation BANEM" (Banned Items); Uncle Sam-style poster saying "You can prevent a fatal error;"
Promote a "Do not use abbreviation of the month" campaign.
Create a song incorporating the "do not use" list.
Create a slide show/presentation illustrating poor handwriting and dangerous abbreviations. Include actual examples from your organization.
Please feel free to use any of these practices that you feel may be helpful for your staff.
It gets much, much worse. I looked at the latest "FAQS" for the Patient safety guidelines, revision 8/30/04. It took me several minutes just to scroll, with just cursory reading, through the entire list. I opened the "printer friendly" PDF version...it's 24 pages LONG. This is obscene. These folks, I can tell you, have smoked too many "joints" and thus the name.
And yes, I came up with the even more juvenile "Operation, in response to Operation BANEM above: Forgive Us Clearly Klutzy Emergency Medicos, (You can figure out the acronym!) since we do such an obviously horrible job, killing hundreds of thousands via time-tested abbreviations.
Of course, none of the problems could be from overcrowding, over-utliization, overbearing bureaucracy, overabundant lawsuits and fear of same or other REAL reasons medicine is so messed up!
Your previous correspondent did leave out other factors: Insurance. Medical insurance, both private and govt. is horribly construed here. It is dissimilar to any other insurance, and because of the low pay copays of employer-offered care, or no-pays of govt. programs such as Medicaid, care is overutilized. People run in to the ER I work in with paper cuts and knee scrapes. Heaven forfend they would put a bandage themselves or an antiseptic at home. I am not exaggerating.
No one cares or worries about the true cost of care. So the "free lunch" theory is in place, as everyone assumes the "system" can pay for everything. And they have to pay less than the price of a baseball game ticket. A family of four have to pay out something like $200 US to go to a ballgame here, on average. No big deal, but to shell out that for an ER visit...oh my, we are gouging them!
Also, I can't forget that doctors' organizations are guilty also... licensing laws have kept down the supply of doctors, and there are other mechanisms that physician groups have tried over the years to restrict the supply of "providers" to keep up licenses. I know that is heresy to my own group, but it's true.
My contention is that all groups are guilty....govt., insurers, pharmacy companies, patients, employers, physicians, lawyers and patients and their families. There is not a single group NOT guilty in the medical care "crisis". Which is why we'll end up with socialized medicine, because it is such a muddle and so many groups are involved in the muck-up, that the political will will be to turn to the govt. to fix the crisis, though they are the MOST guilty of all!
***************************
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.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, October 04, 2004
HOSPITAL VOUCHERS?
It's the Left that is proposing something of that sort in Australia
"Private health-care providers will be big winners if Labor wins office this week... Labor's $2.9 billion Medicare Gold proposal, providing free health care for everyone over 75, would provide a massive windfall to private hospitals and the companies that operate them.
Health care analyst Marcus Wilson of Macquarie Equities said the resulting increase in admissions would reduce spare capacity in the private sector. "It's going to be a boom for them," he said. "If it was to go through in the way it's proposed, any additional use of existing beds is going to be significant for private hospitals."
Companies that operate facilities with high vacancy rates stand to benefit most. One of the biggest, Healthscope, operates hospitals on average only 68 per cent full. If Medicare Gold can push that towards maximum capacity around 90 per cent, the company would reap a huge benefit..... "
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.
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's the Left that is proposing something of that sort in Australia
"Private health-care providers will be big winners if Labor wins office this week... Labor's $2.9 billion Medicare Gold proposal, providing free health care for everyone over 75, would provide a massive windfall to private hospitals and the companies that operate them.
Health care analyst Marcus Wilson of Macquarie Equities said the resulting increase in admissions would reduce spare capacity in the private sector. "It's going to be a boom for them," he said. "If it was to go through in the way it's proposed, any additional use of existing beds is going to be significant for private hospitals."
Companies that operate facilities with high vacancy rates stand to benefit most. One of the biggest, Healthscope, operates hospitals on average only 68 per cent full. If Medicare Gold can push that towards maximum capacity around 90 per cent, the company would reap a huge benefit..... "
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.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, October 03, 2004
THE GUILTY ARE WELL PROTECTED IN N. IRELAND
"The system for investigating deaths in Northern Ireland's hospitals has failures, according to a report by the province's Human Rights Commission. The report, written by Tony McGleenan, professor of law at the University of Ulster and a practising barrister, criticises the absence of an automatic requirement for an investigation into a death in hospital. "The system of death certification can conceal the presence of individual or systemic errors which have contributed to the death," the report says.
A total of 14 462 people died in Northern Ireland in 2003, of whom 7464 died in hospitals, 3042 in nursing homes, and 58 in psychiatric hospitals.
The Human Rights Commission, which is charged with ensuring that human rights are fully protected in law, asked Professor McGleenan to examine hospital deaths in the context of Article 2 of the European Convention on Human Rights. The chief commissioner, Professor Brice Dickson, said the commission has received a number of complaints from people concerning alleged medical negligence in hospitals in Northern Ireland and that the report was one method by which the commission was trying to address people's concerns.
According to Professor McGleenan the key question he set out to answer was "whether there is currently in place an effective system of ensuring that life is protected in hospital systems." In concluding that there is not he criticises the practice whereby a coroner retains wide discretion as to whether a postmortem examination should be carried out when a hospital death is reported to him. He is also critical of coroners combining investigative and judicial roles when holding an inquest".
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.
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 system for investigating deaths in Northern Ireland's hospitals has failures, according to a report by the province's Human Rights Commission. The report, written by Tony McGleenan, professor of law at the University of Ulster and a practising barrister, criticises the absence of an automatic requirement for an investigation into a death in hospital. "The system of death certification can conceal the presence of individual or systemic errors which have contributed to the death," the report says.
A total of 14 462 people died in Northern Ireland in 2003, of whom 7464 died in hospitals, 3042 in nursing homes, and 58 in psychiatric hospitals.
The Human Rights Commission, which is charged with ensuring that human rights are fully protected in law, asked Professor McGleenan to examine hospital deaths in the context of Article 2 of the European Convention on Human Rights. The chief commissioner, Professor Brice Dickson, said the commission has received a number of complaints from people concerning alleged medical negligence in hospitals in Northern Ireland and that the report was one method by which the commission was trying to address people's concerns.
According to Professor McGleenan the key question he set out to answer was "whether there is currently in place an effective system of ensuring that life is protected in hospital systems." In concluding that there is not he criticises the practice whereby a coroner retains wide discretion as to whether a postmortem examination should be carried out when a hospital death is reported to him. He is also critical of coroners combining investigative and judicial roles when holding an inquest".
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.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, October 02, 2004
SOME REASONS WHY AMERICAN MEDICINE IS SO EXPENSIVE
Below is an article written by a U.S. medical specialist who wishes to remain anonymous
JCAHO (Joint Commission on Accredition of Healthcare Organizations) is a quasi private organization that is approved by Medicare for accrediting hospitals - to assure quality care. Like most bureaucracies, JCAHO has mushroomed to become an end in itself - the "quality assurance" process has become more important than the quality itself. JCAHO produces guidelines that have become almost the law itself - violations can lead to loss of Medicare funding, and malpractice settlements.
There is great controversy over whether JCAHO does, in fact, improve the quality of care. Citations for incomplete or absent dictations for surgical procedures, when the emergency room is overwhelmed with patients, hardly improves anything; often, the doctors and everyone else may be operating on accident victims all night long and may simply forget to sign the records or do the dictation. Likewise, citations for lack of proper physician signatures, how often the ivs are changed, whether the nurse knew the fire safety rules, whether they have proper IV badges, hardly determines quality.
Prior to the JCAHO visit (every 3 years) there is great hysteria among QM (quality management) nurses and other highly-paid "consultants" to make sure the hospital is spic and span - walls are painted, floors are polished, and many drills are held to make sure everything is perfect. Much time and effort (and eventually money) is spent on this essentially circular motion. An adversary relation develops among these QM people and the entire hospital staff - they demand "quality" while the budget is cut.
The bottom line with JCAHO is that much money is spent on questionable procedures "because Medicare requires it".
--------------
The HIPAA (Health-Insurance Portability and Accountability Act) was allegedly introduced to "protect patient privacy". Not so. Much effort and many compliance seminars by highly-paid consultants, and massive expansion of the IT staff (for "compliance" with encryption technology, etc..) has created an adversary relationship between staff and hospital. Sneaking into your mother's medical records could get you fined or fired or put in jail.
While limiting public access to "sensitive medical data", Government has even more access. In truth, the only real harm could come from insurance companies denying you coverage because you have "high risk" conditions; but they have this data anyway.
Perhaps someone who has comitted sex crimes may not want their medical data public, but police records usually have this information and it is often a public record. So a massive expensive process has been introduced to solve a non-problem.
---------------------
MALPRACTICE: This is a problem that some say adds 10-20% to the cost of medical care. The problem is massive. Not only are predatory trial lawyers legally protected (mostly by Democrats) because of their massive political contributions, but many patients feel that "they owe me" if something bad happens. We call this the "lottery mentality" - many people truly believe they will retire with a medical malpractice settlement. Of course, dishonest judges make the problem worse. Aside from the money extracted from doctors and hospitals, there are additional expenses that result from the threat of malpractice, and prevention of lawsuits.
One example was the mother who brought her son to the ER (emergency room) with a bump on his head. The ER doctor ordered a neurological consult, CT scan, MRI (x-ray tests costing thousands of dollars - total visit about $3000) - reason? The ER doctor probably has marching orders (called "policy" ) to "cover all angles" -- "just in case the patient has a brain injury". This is purely medicolegal - it the child has not lost consciousness and has no "localizing signs" (like weakness of a hand or leg, dizziness, etcc. ) there is simply no reason for all these tests - simply observing the patient and a little ice to the head and a mother's hug is all that is needed. Wisely, this woman signed out "AMA" (against medical advice) - still probably got charged over $100 just for showing up).
As an Obstetrical Anesthesiologist, I face "unnecessary cesarean sections" daily. Of course, "necessary" is defined by litigation potential, not medical judgement. Several examples illustrate this problem:
1. A lady with premature twins (24 weeks) was in labor. Some would do an immediate C-section to protect the fragile premature baby - some believe that a normal delivery would be hard on the delicate premature baby's head; others disagree on this. But the only "no risk" way to do this is a C-section, so no one can sue a doctor for not doing it. My colleague did not do a C-section because the results on such a premature fetus are dismal - survival is low, and damage to survivors is common; he simply let nature take its course and the patient delivered. He took a chance on being sued, but practiced better medicine.
2. Another lady with a 25 week fetus was immediately taken to the operating room and a C-section was done. This was another doctor who just didn't want to deal with the medicolegal issues; unfortunately, the majority of doctors do this - who can blame them?
3. Another younger doctor did a C-section on a lady that was showing a "trend" on the fetal monitoring strip. There was no "danger signal" of "iminent damage", but there was a definite abnormality. The baby came out screaming. Of course, the C-section was done to avoid any criticism that one wasn't done if something did go wrong. Doing a C-section because "something might go wrong" is like ensuring that a fly is dead by killing it with a sledgehammer.
------------------------
MEDICAL WASTE: On my way in to work, I pass by this "Medical Waste" trailer. This trailer is hauled off periodically, and another is placed.
The hospital is full of these boxes with different color coded liners for needles, liquid waste (which is solidified by powder; I am not sure if simply pouring this stuff down the drain would be safer than mixing the powder with the liquid - either way, some exposure id possible), surgical drapes, etc..
There is nothing in the hospital that could be any more infectious or dangerous than what's going down the sewers already, so all the hysteria about "liquid waste" and special containers for it etc.. Is nothing but additional baggage created by regulators.
Likewise for paper drapes and the paper and plastic used to package surgical supplies - much of this stuff could be safely burned on-site (as used to be done) - all germs would be killedI am sure that California greens long ago stopped this practice for "clean air".
------------------------
HOUSKEEPING: The people from "environmental services" often wear paper shoe covers and plastic gloves and surgical masks at times when they are dusting. I am unsure whether this is because of some hysteria about germs, regulations, or because the management simply doesn't want to be bothered with lawsuits from unhappy employees who say they had an "unsafe workplace").
------------------------
NUCLEAR MEDICINE: Low level radioactive isotopes are used in many tests, and higher level isotopes for therapy for cancer.
Regulations for disposal of this mostly harmless material are just unvelievable - and the low level stuff is subject to almost the same regulations for disposal of atomic bombs.
This regulation has been so expensive to maintain that only a few companies remain to dispose of these isotopes - last count down to 2 or 3 - which has had the predictable effect - disposal costs have increased tenfold.
-------------------------
MEDICAL RECORDS: It's just difficult for people outside medicine to imagine how hysterical the medical records business has become.
Some records are simply lost - pages fall out of the binder and people forget about putting them back.
Then some clerk spends hours on a single record - going through it to find missing signatures; for a complex patient, there may be literally dozens of signatures missing (people get busy and they simply forget to sign - but to the Feds, this can be viewed as fraud - but that's another problem).
Then, each missing signature is flagged with a color coded tag, and then the fun begins - each doctor with a missing signature receives a nasty letter telling them that their privileges will be pulled it they don't sign the records. For me, I receive the letter, give it to my secertary who then sends a student worker to medical records to get the record, I sign it, and send it back; for each transaction, there is time and money that produces nothing. Then the record is recycled to the other doctors. Just insane, expensive, and contributes nothing to the care of patients.
---------------------------
COMPLIANCE: Prosecuting doctors and medical centers for "Medicare Fraud" has become big business following laws passed by the Clinton administration.
In the past, many attending doctors signed for residents when the attendings weren't present - everyone did this in a charity institution where much of the care was unfunded. Of course, the Feds see it differently - some of Medicare Part B (hospital funding) is designated for "training doctors" (residents) so the Feds didn't like the idea of an absent attending sending a separate bill. {As usual, the goals of the Feds are out of tune with reality - they want "equal care" for"the poor" but are not willing to fund it equally}.
Our institution was hit with a large fine for "Medicare Fraud" - mostly focused on one doctor. Part of the "Corporate Integrity Agreement" was "compliance training". This was the most bloated waste of time of all - MANDATORY for every worker in the entire institution - requiring a day off of work - even for part time employees {I calculated at least a cost of several million dollars just for lost time; that didn't count the full time "consultants" and "compliance attorneys" and an entire new staff or "experts".
------------------------
CONCLUSION: All these expenses add up to make American medical care the most expensive in the world. And Government cannot fix it - they are the cause. HIPAAS and JCAHO have been created by government, and malpractice has escalated because of legal protection of trial lawyers by Government. Solution? Less Government.
***************************
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.
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.
***************************
Below is an article written by a U.S. medical specialist who wishes to remain anonymous
JCAHO (Joint Commission on Accredition of Healthcare Organizations) is a quasi private organization that is approved by Medicare for accrediting hospitals - to assure quality care. Like most bureaucracies, JCAHO has mushroomed to become an end in itself - the "quality assurance" process has become more important than the quality itself. JCAHO produces guidelines that have become almost the law itself - violations can lead to loss of Medicare funding, and malpractice settlements.
There is great controversy over whether JCAHO does, in fact, improve the quality of care. Citations for incomplete or absent dictations for surgical procedures, when the emergency room is overwhelmed with patients, hardly improves anything; often, the doctors and everyone else may be operating on accident victims all night long and may simply forget to sign the records or do the dictation. Likewise, citations for lack of proper physician signatures, how often the ivs are changed, whether the nurse knew the fire safety rules, whether they have proper IV badges, hardly determines quality.
Prior to the JCAHO visit (every 3 years) there is great hysteria among QM (quality management) nurses and other highly-paid "consultants" to make sure the hospital is spic and span - walls are painted, floors are polished, and many drills are held to make sure everything is perfect. Much time and effort (and eventually money) is spent on this essentially circular motion. An adversary relation develops among these QM people and the entire hospital staff - they demand "quality" while the budget is cut.
The bottom line with JCAHO is that much money is spent on questionable procedures "because Medicare requires it".
--------------
The HIPAA (Health-Insurance Portability and Accountability Act) was allegedly introduced to "protect patient privacy". Not so. Much effort and many compliance seminars by highly-paid consultants, and massive expansion of the IT staff (for "compliance" with encryption technology, etc..) has created an adversary relationship between staff and hospital. Sneaking into your mother's medical records could get you fined or fired or put in jail.
While limiting public access to "sensitive medical data", Government has even more access. In truth, the only real harm could come from insurance companies denying you coverage because you have "high risk" conditions; but they have this data anyway.
Perhaps someone who has comitted sex crimes may not want their medical data public, but police records usually have this information and it is often a public record. So a massive expensive process has been introduced to solve a non-problem.
---------------------
MALPRACTICE: This is a problem that some say adds 10-20% to the cost of medical care. The problem is massive. Not only are predatory trial lawyers legally protected (mostly by Democrats) because of their massive political contributions, but many patients feel that "they owe me" if something bad happens. We call this the "lottery mentality" - many people truly believe they will retire with a medical malpractice settlement. Of course, dishonest judges make the problem worse. Aside from the money extracted from doctors and hospitals, there are additional expenses that result from the threat of malpractice, and prevention of lawsuits.
One example was the mother who brought her son to the ER (emergency room) with a bump on his head. The ER doctor ordered a neurological consult, CT scan, MRI (x-ray tests costing thousands of dollars - total visit about $3000) - reason? The ER doctor probably has marching orders (called "policy" ) to "cover all angles" -- "just in case the patient has a brain injury". This is purely medicolegal - it the child has not lost consciousness and has no "localizing signs" (like weakness of a hand or leg, dizziness, etcc. ) there is simply no reason for all these tests - simply observing the patient and a little ice to the head and a mother's hug is all that is needed. Wisely, this woman signed out "AMA" (against medical advice) - still probably got charged over $100 just for showing up).
As an Obstetrical Anesthesiologist, I face "unnecessary cesarean sections" daily. Of course, "necessary" is defined by litigation potential, not medical judgement. Several examples illustrate this problem:
1. A lady with premature twins (24 weeks) was in labor. Some would do an immediate C-section to protect the fragile premature baby - some believe that a normal delivery would be hard on the delicate premature baby's head; others disagree on this. But the only "no risk" way to do this is a C-section, so no one can sue a doctor for not doing it. My colleague did not do a C-section because the results on such a premature fetus are dismal - survival is low, and damage to survivors is common; he simply let nature take its course and the patient delivered. He took a chance on being sued, but practiced better medicine.
2. Another lady with a 25 week fetus was immediately taken to the operating room and a C-section was done. This was another doctor who just didn't want to deal with the medicolegal issues; unfortunately, the majority of doctors do this - who can blame them?
3. Another younger doctor did a C-section on a lady that was showing a "trend" on the fetal monitoring strip. There was no "danger signal" of "iminent damage", but there was a definite abnormality. The baby came out screaming. Of course, the C-section was done to avoid any criticism that one wasn't done if something did go wrong. Doing a C-section because "something might go wrong" is like ensuring that a fly is dead by killing it with a sledgehammer.
------------------------
MEDICAL WASTE: On my way in to work, I pass by this "Medical Waste" trailer. This trailer is hauled off periodically, and another is placed.
The hospital is full of these boxes with different color coded liners for needles, liquid waste (which is solidified by powder; I am not sure if simply pouring this stuff down the drain would be safer than mixing the powder with the liquid - either way, some exposure id possible), surgical drapes, etc..
There is nothing in the hospital that could be any more infectious or dangerous than what's going down the sewers already, so all the hysteria about "liquid waste" and special containers for it etc.. Is nothing but additional baggage created by regulators.
Likewise for paper drapes and the paper and plastic used to package surgical supplies - much of this stuff could be safely burned on-site (as used to be done) - all germs would be killedI am sure that California greens long ago stopped this practice for "clean air".
------------------------
HOUSKEEPING: The people from "environmental services" often wear paper shoe covers and plastic gloves and surgical masks at times when they are dusting. I am unsure whether this is because of some hysteria about germs, regulations, or because the management simply doesn't want to be bothered with lawsuits from unhappy employees who say they had an "unsafe workplace").
------------------------
NUCLEAR MEDICINE: Low level radioactive isotopes are used in many tests, and higher level isotopes for therapy for cancer.
Regulations for disposal of this mostly harmless material are just unvelievable - and the low level stuff is subject to almost the same regulations for disposal of atomic bombs.
This regulation has been so expensive to maintain that only a few companies remain to dispose of these isotopes - last count down to 2 or 3 - which has had the predictable effect - disposal costs have increased tenfold.
-------------------------
MEDICAL RECORDS: It's just difficult for people outside medicine to imagine how hysterical the medical records business has become.
Some records are simply lost - pages fall out of the binder and people forget about putting them back.
Then some clerk spends hours on a single record - going through it to find missing signatures; for a complex patient, there may be literally dozens of signatures missing (people get busy and they simply forget to sign - but to the Feds, this can be viewed as fraud - but that's another problem).
Then, each missing signature is flagged with a color coded tag, and then the fun begins - each doctor with a missing signature receives a nasty letter telling them that their privileges will be pulled it they don't sign the records. For me, I receive the letter, give it to my secertary who then sends a student worker to medical records to get the record, I sign it, and send it back; for each transaction, there is time and money that produces nothing. Then the record is recycled to the other doctors. Just insane, expensive, and contributes nothing to the care of patients.
---------------------------
COMPLIANCE: Prosecuting doctors and medical centers for "Medicare Fraud" has become big business following laws passed by the Clinton administration.
In the past, many attending doctors signed for residents when the attendings weren't present - everyone did this in a charity institution where much of the care was unfunded. Of course, the Feds see it differently - some of Medicare Part B (hospital funding) is designated for "training doctors" (residents) so the Feds didn't like the idea of an absent attending sending a separate bill. {As usual, the goals of the Feds are out of tune with reality - they want "equal care" for"the poor" but are not willing to fund it equally}.
Our institution was hit with a large fine for "Medicare Fraud" - mostly focused on one doctor. Part of the "Corporate Integrity Agreement" was "compliance training". This was the most bloated waste of time of all - MANDATORY for every worker in the entire institution - requiring a day off of work - even for part time employees {I calculated at least a cost of several million dollars just for lost time; that didn't count the full time "consultants" and "compliance attorneys" and an entire new staff or "experts".
------------------------
CONCLUSION: All these expenses add up to make American medical care the most expensive in the world. And Government cannot fix it - they are the cause. HIPAAS and JCAHO have been created by government, and malpractice has escalated because of legal protection of trial lawyers by Government. Solution? Less Government.
***************************
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.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, October 01, 2004
A HOSPITAL SO BAD IT IS NEARLY DEAD
"The Los Angeles County Board of Supervisors on Monday unexpectedly moved to shut down the trauma unit at Martin Luther King Jr./Drew Medical Center, immediately drawing the ire of physicians, politicians and community activists. The only public hospital serving a large swath of South Los Angeles, King/Drew treats more trauma patients than any other hospital in the region except County-USC Medical Center.
The proposed trauma closure, expected to take effect in about 90 days, amounts to a last-ditch scramble to save a foundering hospital that repeatedly has been cited by regulators for harming patients and in some cases contributing to their deaths. Under pressure from federal health officials, the supervisors also agreed to hire outside managers to run the hospital — replacing the team of county health leaders who have run it for nearly a year.
The reaction from community leaders was swift and mostly negative. Assemblyman Mervyn Dymally (D-Compton), who has led legislative hearings on the future of King/Drew, was outraged. "I could see if they were going to close some other department, but not the trauma center. My God, this is a crisis," he said. But Assemblyman Mark Ridley-Thomas (D-Los Angeles), applauded the board's latest actions, saying they were long overdue. "It's about time that the Board of Supervisors faced up to their responsibility, and has chosen to take appropriate action, albeit unpopular," he said. "There's no expert in the area of public healthcare worth his or her salt who would deny that Martin Luther King hospital was in need of radical intervention."
The trauma unit, dedicated to treating life-threatening injuries from such incidents as shootings and car accidents, served 2,150 patients last year... Supervisor Michael Antonovich deemed the county's efforts to fix King/Drew over the last eight months "pathetic." ... "It took so many losses of life and inferior medical treatments to bring us to the stage where we are today," he said at the supervisors' news conference....
Over the last nine months, his agency removed the hospital's administrator and medical director, hired a nursing turn-around firm, installed an internal team of crisis managers and responded to demands from a host of accrediting groups and regulatory agencies. "We didn't know how much we were going to find and how hard the process would be," Garthwaite said. But many politicians said the county supervisors' actions would inevitably lead to the closure of the entire hospital."
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.
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 Los Angeles County Board of Supervisors on Monday unexpectedly moved to shut down the trauma unit at Martin Luther King Jr./Drew Medical Center, immediately drawing the ire of physicians, politicians and community activists. The only public hospital serving a large swath of South Los Angeles, King/Drew treats more trauma patients than any other hospital in the region except County-USC Medical Center.
The proposed trauma closure, expected to take effect in about 90 days, amounts to a last-ditch scramble to save a foundering hospital that repeatedly has been cited by regulators for harming patients and in some cases contributing to their deaths. Under pressure from federal health officials, the supervisors also agreed to hire outside managers to run the hospital — replacing the team of county health leaders who have run it for nearly a year.
The reaction from community leaders was swift and mostly negative. Assemblyman Mervyn Dymally (D-Compton), who has led legislative hearings on the future of King/Drew, was outraged. "I could see if they were going to close some other department, but not the trauma center. My God, this is a crisis," he said. But Assemblyman Mark Ridley-Thomas (D-Los Angeles), applauded the board's latest actions, saying they were long overdue. "It's about time that the Board of Supervisors faced up to their responsibility, and has chosen to take appropriate action, albeit unpopular," he said. "There's no expert in the area of public healthcare worth his or her salt who would deny that Martin Luther King hospital was in need of radical intervention."
The trauma unit, dedicated to treating life-threatening injuries from such incidents as shootings and car accidents, served 2,150 patients last year... Supervisor Michael Antonovich deemed the county's efforts to fix King/Drew over the last eight months "pathetic." ... "It took so many losses of life and inferior medical treatments to bring us to the stage where we are today," he said at the supervisors' news conference....
Over the last nine months, his agency removed the hospital's administrator and medical director, hired a nursing turn-around firm, installed an internal team of crisis managers and responded to demands from a host of accrediting groups and regulatory agencies. "We didn't know how much we were going to find and how hard the process would be," Garthwaite said. But many politicians said the county supervisors' actions would inevitably lead to the closure of the entire hospital."
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.
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, September 30, 2004
NEGLIGENT DOCTOR BANNED IN CANADA BUT STILL OK FOR BRITAIN'S NHS
"The official inquiry into incompetent gynaecologist Richard Neale has called for reform of the way doctors are recruited and employed by the NHS. Neale was struck off in 2000 after being found guilty of serious professional misconduct. A General Medical Council hearing concluded he botched operations on 12 women. In total more than 250 women said they had been damaged by Neale. The inquiry calls for a new body to oversee the employment of doctors
It also says that checks should be made on all doctors appointed from overseas as standard. The report also says the complaints procedure at Friarage Hospital was poor. Patients were not actively encouraged to follow up their initial complaints, and were given little or no help with how to navigate the system. "Generally speaking we have found that the climate in which Richard Neale operated did not lend itself to full and objective examination of what was going wrong with the doctor-patient relationship. His attitude to some patients and some colleagues was arrogant, dismissive and overbearing; it stifled complaints by patients and criticisms by colleagues alike."
Neale was over-confident, and over-reached himself in performing certain clinical practices, the report finds. He also deliberately allowed his employers to be misled on a number of occasions, including failing to disclose the fact that he had been struck off in Canada. However, the report says that adequate checks on his clinical ability were not carried out. "Vulnerable patients, such as many of those treated by Richard Neale, deserve better," the report says....
The official inquiry, ordered by the government, was boycotted by many of his alleged victims because it was not held in public.....
In a statement, the GMC apologised for the way it had handled the Neale case in the 1980s. "We cannot defend the GMC procedures that 15 years ago failed by allowing him to practise in this country despite his record in Canada".
More here.
"The official inquiry into incompetent gynaecologist Richard Neale has called for reform of the way doctors are recruited and employed by the NHS. Neale was struck off in 2000 after being found guilty of serious professional misconduct. A General Medical Council hearing concluded he botched operations on 12 women. In total more than 250 women said they had been damaged by Neale. The inquiry calls for a new body to oversee the employment of doctors
It also says that checks should be made on all doctors appointed from overseas as standard. The report also says the complaints procedure at Friarage Hospital was poor. Patients were not actively encouraged to follow up their initial complaints, and were given little or no help with how to navigate the system. "Generally speaking we have found that the climate in which Richard Neale operated did not lend itself to full and objective examination of what was going wrong with the doctor-patient relationship. His attitude to some patients and some colleagues was arrogant, dismissive and overbearing; it stifled complaints by patients and criticisms by colleagues alike."
Neale was over-confident, and over-reached himself in performing certain clinical practices, the report finds. He also deliberately allowed his employers to be misled on a number of occasions, including failing to disclose the fact that he had been struck off in Canada. However, the report says that adequate checks on his clinical ability were not carried out. "Vulnerable patients, such as many of those treated by Richard Neale, deserve better," the report says....
The official inquiry, ordered by the government, was boycotted by many of his alleged victims because it was not held in public.....
In a statement, the GMC apologised for the way it had handled the Neale case in the 1980s. "We cannot defend the GMC procedures that 15 years ago failed by allowing him to practise in this country despite his record in Canada".
More here.
Wednesday, September 29, 2004
A DOCTOR WHO CAN'T READ A LABEL KILLS
And a culture of carelessness kills
"A critic of declining standards in the National Health Service died after being given a large overdose of iron by a hospital doctor who did not read the instructions on the drug's label properly. Carys Pugh, 63, a former president of a patients' association in Wales, was taken to casualty at the Royal Glamorgan Hospital after the blunder turned her skin brown and "saturated" her liver with iron.
While she fought for survival in hospital for seven weeks, Mrs Pugh suffered a heart attack and contracted deep vein thrombosis in both legs, a chest infection and then E.coli. Finally, she suffered a second heart attack that killed her.
When her daughter, Hawys Pugh, complained to the hospital authorities about what had gone wrong she was told that the doctor who had carried out the routine infusion for suspected anaemia had found the instructions difficult to decipher and that he had only read half of them. "They told me that because the text was in two columns instead of one, the doctor just read the section on how much to give, but didn't bother reading the rest which said over what duration it should be given," Miss Pugh said. "Instead, he just put the entire dose into her system in one go. They suggested it was the manufacturer's fault and said they would be contacting them."
The officials dismissed Miss Pugh's concerns that the overdose had caused her mother's initial heart attack and refused to name the doctor concerned, insisting that the trust had a "no blame" culture.
Miss Pugh said last week: "Basically, they admitted that it had been a mistake and an accident due to a failure to read the instructions, but denied it was negligence, which I find ridiculous." Miss Pugh said that the way that her mother, who was the head of the Mid Glamorgan Valley's patients' association in the 1990s and a staunch critic of the NHS's failures, had been treated was "a disgrace".
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.
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.
***************************
And a culture of carelessness kills
"A critic of declining standards in the National Health Service died after being given a large overdose of iron by a hospital doctor who did not read the instructions on the drug's label properly. Carys Pugh, 63, a former president of a patients' association in Wales, was taken to casualty at the Royal Glamorgan Hospital after the blunder turned her skin brown and "saturated" her liver with iron.
While she fought for survival in hospital for seven weeks, Mrs Pugh suffered a heart attack and contracted deep vein thrombosis in both legs, a chest infection and then E.coli. Finally, she suffered a second heart attack that killed her.
When her daughter, Hawys Pugh, complained to the hospital authorities about what had gone wrong she was told that the doctor who had carried out the routine infusion for suspected anaemia had found the instructions difficult to decipher and that he had only read half of them. "They told me that because the text was in two columns instead of one, the doctor just read the section on how much to give, but didn't bother reading the rest which said over what duration it should be given," Miss Pugh said. "Instead, he just put the entire dose into her system in one go. They suggested it was the manufacturer's fault and said they would be contacting them."
The officials dismissed Miss Pugh's concerns that the overdose had caused her mother's initial heart attack and refused to name the doctor concerned, insisting that the trust had a "no blame" culture.
Miss Pugh said last week: "Basically, they admitted that it had been a mistake and an accident due to a failure to read the instructions, but denied it was negligence, which I find ridiculous." Miss Pugh said that the way that her mother, who was the head of the Mid Glamorgan Valley's patients' association in the 1990s and a staunch critic of the NHS's failures, had been treated was "a disgrace".
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.
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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Tuesday, September 28, 2004
How eight states destroyed their individual insurance markets: "Since February of this year, "Health Care News" has featured a series of monthly case studies documenting how community rating and guaranteed issue mandates have destroyed the individual health insurance markets in eight states. These mandates are not merely poorly crafted laws: They represent fundamentally bankrupt ideas in what should be a voluntary, consumer-driven insurance marketplace."
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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.
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.
***************************
***************************
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.
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, September 27, 2004
Bureaucratizing private medicine: "In the late 1970s, the Supreme Court decided the antitrust laws should apply to 'professionals' such as lawyers and physicians. In 1993, lawyers at the FTC and the DOJ's Antitrust Division made up a set of rules governing how physicians and other health care providers should run their businesses. To avoid antitrust charges, independent physicians had to organize their practices according to a government-approved economic model. Experimentation or deviation from this model would subject doctors to criminal price-fixing charges on top of potential treble-damage civil lawsuits."
OVERALL STATISTICS MISLEADING
"The United States spends more on health care than any country on earth -- nearly 15 percent of its overall economy. That's nearly a half again as much as other countries and on a per capita basis, no one else is even close. Yet if one looks at the performance of our health care system, we're clearly not getting what we pay for. "USA Today" last week published a list of the top 50 countries in terms of life expectancy. The United States ranked third from the bottom. That's right. We're number 48. This year, Americans can expect an average life span of 77.4 years, nearly four years behind the Japanese... "
A quick look at the Centers for Disease Control website at health disparities in the United States gives a few clues about why our health care system performs so poorly despite outlandish costs. While the overall U.S. life expectancy rate is 77 years, the rate for blacks is about 72 years with black males at a Third World-level of 68 years...... It's not middle-class moms in suburban hospitals losing babies. It's poor mothers without prenatal care. It's teenagers who hide their pregnancies, deliver low birth weight babies and have few support systems to help them care for their newborns.....
In this election season, by all means let's have a debate about how to provide health insurance to the 43 million Americans without it. But let's also talk about who in this society suffers from ill health, why they suffer and what can be done about the social and economic disparities that lead to ill health. It will take more than universal insurance coverage to tackle those issues.
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.
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.
***************************
OVERALL STATISTICS MISLEADING
"The United States spends more on health care than any country on earth -- nearly 15 percent of its overall economy. That's nearly a half again as much as other countries and on a per capita basis, no one else is even close. Yet if one looks at the performance of our health care system, we're clearly not getting what we pay for. "USA Today" last week published a list of the top 50 countries in terms of life expectancy. The United States ranked third from the bottom. That's right. We're number 48. This year, Americans can expect an average life span of 77.4 years, nearly four years behind the Japanese... "
A quick look at the Centers for Disease Control website at health disparities in the United States gives a few clues about why our health care system performs so poorly despite outlandish costs. While the overall U.S. life expectancy rate is 77 years, the rate for blacks is about 72 years with black males at a Third World-level of 68 years...... It's not middle-class moms in suburban hospitals losing babies. It's poor mothers without prenatal care. It's teenagers who hide their pregnancies, deliver low birth weight babies and have few support systems to help them care for their newborns.....
In this election season, by all means let's have a debate about how to provide health insurance to the 43 million Americans without it. But let's also talk about who in this society suffers from ill health, why they suffer and what can be done about the social and economic disparities that lead to ill health. It will take more than universal insurance coverage to tackle those issues.
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.
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, September 26, 2004
BOTCHED DIAGNOSTIC TEST LEADS TO LEG AMPUTATION
"The blue-grey colour on Lynette Jeffrey's foot grew "like a wave on the beach", intermittently receding, only to creep higher up her ankle each time. The 50-year-old sat up in a Liverpool Hospital bed and watched in horror as gangrene enveloped her left leg. A doctor told her that she would die within 24 hours if it was not amputated.
Mrs Jeffrey is suing the South West Sydney Area Health Service, and three doctors, for more than $750,000 in the NSW Supreme Court, claiming they failed to warn her of risks from an angiogram she had in August 1997.
"They pushed me up from the bed and my foot was blue, bluey grey ... and then it was a lighter grey," Mrs Jeffrey told the court yesterday. The tragic irony was that Mrs Jeffrey, a diabetic, woke up hours later without her left leg in the same amputee ward where only three months earlier she was told that she would lose her right leg because of circulatory problems and the presence of gangrene on her right foot.
Mrs Jeffrey, who has since moved from Bossley Park in Sydney to her hometown of Ulverstone in northern Tasmania, refused the amputation, and still has her right leg. "I told him [the doctor] straight away that that was not going to happen to me," she said.
However, the diagnostic test she underwent then - an angiogram - had resulted in severe blood clotting in her left leg, after an artery wall in her groin was ruptured with a catheter. The hospital did not deny this happened, but claimed it warned Mrs Jeffrey it was a common complication, the court heard".
["a common complication" !!!!!]
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.
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 blue-grey colour on Lynette Jeffrey's foot grew "like a wave on the beach", intermittently receding, only to creep higher up her ankle each time. The 50-year-old sat up in a Liverpool Hospital bed and watched in horror as gangrene enveloped her left leg. A doctor told her that she would die within 24 hours if it was not amputated.
Mrs Jeffrey is suing the South West Sydney Area Health Service, and three doctors, for more than $750,000 in the NSW Supreme Court, claiming they failed to warn her of risks from an angiogram she had in August 1997.
"They pushed me up from the bed and my foot was blue, bluey grey ... and then it was a lighter grey," Mrs Jeffrey told the court yesterday. The tragic irony was that Mrs Jeffrey, a diabetic, woke up hours later without her left leg in the same amputee ward where only three months earlier she was told that she would lose her right leg because of circulatory problems and the presence of gangrene on her right foot.
Mrs Jeffrey, who has since moved from Bossley Park in Sydney to her hometown of Ulverstone in northern Tasmania, refused the amputation, and still has her right leg. "I told him [the doctor] straight away that that was not going to happen to me," she said.
However, the diagnostic test she underwent then - an angiogram - had resulted in severe blood clotting in her left leg, after an artery wall in her groin was ruptured with a catheter. The hospital did not deny this happened, but claimed it warned Mrs Jeffrey it was a common complication, the court heard".
["a common complication" !!!!!]
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.
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, September 25, 2004
Good doctors destroyed by power-mad bureaucrats: "It's uncomfortable to hear Dr. Frank Fisher speak. His eyes are usually glassed over, seemingly on the verge of tears. ... As he talks, you get the impression that he's just a small dose of bad news away from shattering into a thousand pieces. And with good reason. Fisher, a Harvard-trained physician, once specialized in the treatment of chronic pain. He served a predominantly rural and poor population in California. About 5-10 percent of his 3,000 clients were pain patients, victims of illnesses like cancer, steep falls or car accidents. A little more than five years ago, California Attorney General Bill Lockyer initiated a high-profile campaign against pain doctors who prescribe high doses of opioids -- drugs such as Oxycontin, Vicodin and codeine. Lockyer made Frank Fisher his example."
NO FIX FOR AUSTRALIA'S PUBLIC HOSPITALS
Leftist promises won't help
"Labor's promise to inject $1 billion into public hospitals has drawn a mixed response from public hospital groups and the nation's most influential doctors' organisation. While public hospitals welcomed the plan as a necessary boost to a system under strain, the Australian Medical Association said the policy was based on "wrong assumptions about relieving the pressure on hospital emergency departments".....
The AMA - which earlier yesterday expressed "outrage" at "the gross misrepresentation" of doctors in Labor's television advertisements depicting an auction for a doctor's consultation - said it was not the co-ordinated policy that was needed. It was a shortage of hospital beds, not a shortage of general practitioner services, that was causing queues at public hospitals, the AMA vice president, Mukesh Haikerwal, said.....
The Australian Healthcare Association, representing about 500 public hospitals, said the Labor plan was "a great start" but it was disappointed it did not specifically tackle the need for more public hospital beds. "The declining bed numbers is the major reason for 'bed block' in hospital emergency departments, resulting in patients spending too long on trolleys waiting for admission," the association's executive director, Prue Power, said....
But the Australian Private Hospitals Association said the Labor focus was "too narrow" and ignored the private hospitals where most surgery was performed".
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.
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.
***************************
NO FIX FOR AUSTRALIA'S PUBLIC HOSPITALS
Leftist promises won't help
"Labor's promise to inject $1 billion into public hospitals has drawn a mixed response from public hospital groups and the nation's most influential doctors' organisation. While public hospitals welcomed the plan as a necessary boost to a system under strain, the Australian Medical Association said the policy was based on "wrong assumptions about relieving the pressure on hospital emergency departments".....
The AMA - which earlier yesterday expressed "outrage" at "the gross misrepresentation" of doctors in Labor's television advertisements depicting an auction for a doctor's consultation - said it was not the co-ordinated policy that was needed. It was a shortage of hospital beds, not a shortage of general practitioner services, that was causing queues at public hospitals, the AMA vice president, Mukesh Haikerwal, said.....
The Australian Healthcare Association, representing about 500 public hospitals, said the Labor plan was "a great start" but it was disappointed it did not specifically tackle the need for more public hospital beds. "The declining bed numbers is the major reason for 'bed block' in hospital emergency departments, resulting in patients spending too long on trolleys waiting for admission," the association's executive director, Prue Power, said....
But the Australian Private Hospitals Association said the Labor focus was "too narrow" and ignored the private hospitals where most surgery was performed".
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.
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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