Health care: Three fantasies
Health care and the technologies that support it are of growing concern to most Americans. Until recently, I was something of an exception. I lead a fairly sheltered existence; I seldom think about the issues one encounters in the media. I have focused instead on my research: first in the field of computing; then, since 1990, in some of the fundamental issues of biology. During most of that time I've felt that I had nothing of special importance to say about medical issues.
Now, however, I strongly believe that the rate of progress in the field of medicine is much slower than it needs to be, and that this lag affects all of us profoundly. Many wonderful advances have been made. Yet I am disturbed by the discoveries that have not happened, or have happened but have not yet been allowed to reach the market. We must discuss the forces that constrain and retard possible breakthroughs in medical treatment, especially at this point in time, when we are on the verge of profound shifts in medicine driven by advances in technology.
One could expend a great deal of effort on detailed arguments about regulation, innovation, and desirable goals, but most of the detail would miss the essential point: we are all affected, and many of us are dying, because the system optimizes the wrong set of goals. A group of powerful people have established professional goals for medicine that seem appropriate to them and, in fact, to most Americans; yet the very selection of these aims - minimizing medical accidents, for example, or reducing the distribution of ineffective cures - has had a host of unintended, unfortunate consequences. These consequences must be discussed.
To this end, I invite you to consider three fantasies, three visions of a world in which alternative approaches to science and technology were taken. These fantasies have to do with (1) the impact of government regulation, (2) the cost of risk aversion, and (3) the choices that people make about the treatment of the terminally ill. In other words, these are fantasies about real things, and I will be making some real-world observations about them.
Fantasy 1: The Speed of Innovation
I began my career in computing in 1967. It is hard to convey how rapidly the field developed. This is how Chris Evans summarized it in 1979:
[S]uppose for a moment that the automobile industry had developed at the same rate as computers and over the same time period: how much cheaper and more efficient would the current models be? If you have not already heard the analog the answer is shattering. Today you would be able to buy a Rolls-Royce for $2.75, it would do three million miles to the gallon, and it would deliver enough power to drive the Queen Elizabeth II.
That was written just as the micro revolution was beginning. Since then, computers have affected the world in ways that were, and remain, almost unimaginable. Now, fantasize for a moment about what would have happened if the following arguments had been successfully advanced back in the 1970s and 1980s:
* Computers will inevitably perform central functions in many products, and the issue of their reliability is too critical to be left to the marketplace. Indeed, we will see computers exercising critical functions in airplanes, spacecraft, coordination of rail traffic, maintenance of nuclear reactors, and an almost unlimited number of other settings. Failures in either hardware or software can cause inconvenience, injury, or even death. Therefore, the new Federal Computer Authority (FCA) will be responsible for licensing computer products. This agency will be assigned the task of certifying the reliability of each new product.
* Because computers will play a crucial role in every consumer's life, the software used to control them must be developed by professionals who have been certified as capable of delivering state-of-the-art products. Therefore, only certified graduates of a limited number of licensed institutions will be allowed to produce software for commercial uses, and people trained in foreign institutions will be required to pass strict examinations guaranteeing their familiarity with the best current practices.
* Normal consumers are obviously not qualified to make judgments about whether or not the software they purchase will live up to expectations. The FCA must therefore have the power to determine the efficacy of programs before they are marketed. Products that are considered critical will be sold only through licensed outlets, where certified professionals can prescribe products that they consider necessary to address consumers' needs, products that have been tested and approved for these applications. For relatively noncritical applications, we will allow mass-marketing outlets to handle the appropriate products.
How would things develop from that point? At first, the FCA would probably take a pragmatic course, attempting to weed out the truly bad software and hardware while minimally constraining forward progress. The product development cycle would certainly become longer. But the really important, and unfortunate, result would be the enshrinement of the idea that the FCA was responsible for minimizing or even eliminating serious product failures.
Once the FCA acquired responsibility for preventing accidents, incentives would exist for it to make increasingly cautious judgments. As the agency became more risk-averse, the population would draw greater and greater solace from media reports of its careful regulation and quality-control. Some of the reports might be false; corruption might set in within the FCA. Because it would effectively control the release of all new technology, its approval would be something worth paying for. But if the FCA was doing its job, the product cycle would continue to lengthen, product development would become steadily more expensive, and the number of new products would be kept to a decent and approved minimum.
Now, it is precisely this fantasy situation, this kind of regulatory environment, that currently exists in the health care industry. As a result, health care technology is progressing at only a fraction of the pace that might be achievable.
In the case of computing we see what can be accomplished with minimal regulation. In the case of health care we observe the outcome of a highly regulated process. Most cost-benefit analyses of regulatory protocols consider the trade-off between prevention of accidents and delay of the products that reach the market. But if you reflect on the computing industry, you will realize that the effect of regulation is the simple nonexistence of many products that could have reached the market, but did not. In such cases, you cannot quantify the effect of regulation, because the advances just cease to occur; the innovations just cease to happen. The delay of events that do eventually occur is certainly important, but the dramatic reduction in innovation is far more so.
Right now, reduction of innovation is an issue of grave importance. We have reached the stage in our understanding of the human genome where a dramatic acceleration of medical technology is possible. Let me explain.
Within the cells of every person's body is a collection of DNA that determines many of the details that support life. This collection of DNA, called a genome, acts as blueprint for processes that allow a living cell to begin, grow, and divide. We can now gain access to the information stored in a genome through a process called sequencing. The cost of sequencing a person's genome is dropping rapidly, and it is the information learned in this process that will drive much of modern medicine. The basic vision goes like this:
* Many, if not most, drugs have a favorable effect on a small percentage of the population but a neutral or unfavorable effect on other people. If we can, through the sequencing of genomes, predict which individuals will react favorably to a specific drug, the usefulness of drugs will be dramatically increased.
* We will be sequencing a large number of diverse human genomes. We will then look at them and see how they differ. We have tabulated specific spots that reflect differences, even though we cannot now identify the effect of each difference. Let us call such a difference an SNP (this happens to stand for "single-nucleotide polymorphism," a fact that you need not remember). We will determine a set of, say, a million SNPs; then we will check them against specific human beings, creating an SNP profile for each person.
* When we have accumulated thousands, eventually millions, of SNP profiles, we will correlate them with the ways in which people react to specific drugs. In this way, we will be able to predict, with gradually improving accuracy, which people can benefit from those drugs. The generation and use of these SNP profiles has the potential for revolutionizing modern medicine. It may result in the saving of millions of lives.
This is only one of many technologies that will grow out of our ability to sequence large numbers of genomes at rapidly decreasing costs. Such innovations are likely to occur, however, only in the regulation-free environment that has characterized computer technology.
Fantasy 2: The Price of Risk Aversion
This second fantasy involves anticancer drugs. Suppose that two such drugs are available. Further suppose that each of them has the following properties:
* The drug is a total cure for exactly 50% of the population.
* The drug is lethal for the other 50% of the population.
And let us suppose that the two drugs are complementary - together they could cure all members of the population, assuming that a sick person could know which of the two drugs to take - and that the use of SNP profiles will eventually allow prediction of benefits with 100% accuracy. In other words, suppose we can foresee a time when we will be able to make an entirely accurate prediction of the efficacy of these drugs, though right now our ability to predict is pretty poor.
This is clearly a contrived fantasy, but I believe it captures the essence of the current situation. We do have many drugs that offer dramatic therapeutic benefits to one or another subpopulation, but potentially lethal damage to other subpopulations. We do have an emerging technology (SNPs) that will increase the predictability of benefits. How might this field of investigation progress, in the absence of regulation? Here is how I fantasize the course of events involving the two complementary drugs:
* At first the manufacturers of each drug would offer it to individuals who willingly risk a 50% chance of death in order to gain a real chance of being cured, given that, absent the use of either drug, they would almost certainly die soon. These potential consumers would be informed of the risks; some would accept them; and 50% would be cured - while 50% would die.
* Because the value of the drugs would be directly related to the chance of curing the patients, strong incentives would exist to improve the odds of success. This would encourage efforts to characterize SNPs for all the patients who took the drugs. Long before the cause of success or failure could be accurately determined, it would be possible to identify subpopulations that exhibited much higher and much lower success rates for each drug.
* The odds of predicting which of the two drugs would work for any specific patient would begin to improve. This would lead to more patients taking the risk of ingesting one or the other of the drugs, which would lead in turn to a rapidly growing body of statistics that could support more accurate analysis of correlations between SNPs and therapeutic outcomes. A positive feedback loop would be established, quickly leading to vastly improved outcomes.
Now the question I wish to pose is this: is there any way this can happen, given existing principles of regulation? Under current law, a drug may not be brought to market unless it is judged both safe and effective. Consider what would happen if a drug showed up in a lab, it looked promising, and a doctor gave it (probably illegally) to two friends who were dying from cancer, one of whom died, while the other was totally cured. If the story became known, I suspect the doctor would face prosecution, even if both his friends had been fully informed of all the data he possessed, and both had elected to take the risk. In my view, a well-informed adult should have the right to take potentially fatal risks. But that is yet another fantasy, because this right is wholly unrecognized in the present medical environment.
To summarize: the normal progression of events in an unregulated, risk-friendly environment would have every possibility of producing a 100% cure rate, while the existing, regulated, risk-averse environment would bar any progress toward using the full therapeutic properties of either of the two drugs in question. This alone constitutes grounds for rethinking the priorities of the existing system.
Fantasy 3: The Purpose of Saving Lives
In my last fantasy, I want you to think of yourself as a person who runs a government agency with a substantial budget, an agency that is responsible for saving the lives of as many people as possible who have been diagnosed with cancer and have a probable life expectancy of less than a year. The lives of thousands of these people depend on your judgment. (Remember, every day 1,500 people die from cancer in America.) Your job is to make decisions that can save their lives. The U.S. government alone spends about $5 billion a year just on cancer research. Let us suppose that you have a serious portion of that budget to spend. What will you do?
Take some time and think about it. I don't believe that the answer is completely obvious, but I would guess that if people think seriously about this fantasy, they will identify a number of ideas that clearly should be tried. I believe that if hundreds of highly qualified scientists, doctors, and entrepreneurs were asked to describe how they would proceed, many useful options and insights would emerge. I have performed this exercise a number of times myself. No matter how often I reconsider the issue, I just do not see people arriving at something like this:
I have it; I see the key principle. What we need to do first is to make it impossible for anyone to take a drug that might kill him. That is where we should start. Then we need to construct a list of cures that have been proposed but probably won't work. We will make sure to prevent such scams.
The idea that sensible people might come to such conclusions strikes me as completely preposterous. Yet as you know, these are the policies that are now in place, supported and mandated by government and the health care establishment. The result is predictable: our ability to provide medical technology to patients in need is dramatically constrained, and the cost-benefit analyses that underlie all business decisions, and should underlie all practical decisions about health care, are heavily skewed to reflect the costs of conforming to regulatory requirements.
It is clear that most Americans sincerely believe there is nothing but goodwill behind this system. I have no doubt, however, that your own fantasy of what you might do to help the terminally ill will stand in judgment of things as they are.
* * *
I have used three fantasies to argue that the current health care industry in the United States is crippled by regulation and risk aversion. The effect has been to constrain product development and innovation.
What is truly upsetting about this situation is that we are commonly confronted with arguments in which the U.S. health care system is designated as "private" and contrasted with the "public" systems of other countries. This distinction focuses on the delivery of the existing technology of health care. Instead, the focus should be on the set of industries that advance the technology of medicine and medical procedures. In that context the critical issue is the degree of regulation, which in turn affects the rate of innovation.
Medicine, like computing, is entering a period in which extremely rapid innovation is possible, most notably advances relating to the availability of genomic data. I believe the advances that will inevitably occur will be so stunning that we will lose sight of how paltry they are - compared with what might have been, if innovation had been unconstrained.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, October 13, 2006
Thursday, October 12, 2006
HOPELESS NHS HOSPITALS
A hardcore group of debt-ridden hospitals are offering poor-quality patient care, Patricia Hewitt, the Health Secretary, will admit today. The chief health watchdog in England is expected to expose these hospitals, declaring them “weak”. The Healthcare Commission’s annual assessment of the NHS, to be released tomorrow, comes as many hospitals and health trusts, struggling to curb spending, are cutting frontline services. A group of 63 trusts are responsible for 70 per cent of the NHS’s deficit.
Ms Hewitt told The Times that trusts that were running up debts were also likely to be mismanaging parients and have worse waiting times, cleanliness and MRSA infections. “I’m afraid that a lot of the trusts with the worst financial records are also weak on quality of care,” she said. “You can see why when you visit hospitals like that. “They are not making the best use of their resources, not working through the processes of making sure everybody is paying attention to hygiene and cleanliness, and if they’re not doing that, they’re probably not going through the processes of making sure everything else is being done properly.”
Nearly a third of hospitals and a quarter of all 570 NHS organisations failed to balance their books in 2005-06, leaving the NHS with a net deficit of 547 million pounds, the Health Department announced this week.
Ms Hewitt will ask failing trusts to propose and implement an action or improvement plan within a month, if measures are not in place. “We are going to be asking all of those trusts to sit down with their strategic health authority and set out very clearly what they can do and what more they intend to do,” she said.
However, the commission will paint a varied picture. “The report will show considerable variation in performance across the country,” she said. “Clearly, we will have some trusts that are excellent on quality, but also excellent on financial management, but we will also have trusts that fail on both.”
Five years ago the Government introduced hotel-style star ratings for hospitals to encourage them to improve quality of care. However, a new system uses a wider range of measures, including clinical and financial performance, to rate trusts as excellent, good, fair or weak. The inclusion of financial management will damage the ratings of many hospitals. The NHS deficit has more than doubled in the past 12 months, with the biggest problems concentrated in the South East and eastern England. In recent months, thousands of job cuts have been announced in order to make savings.
Ms Hewitt said that the previous system of assessment had not helped to tackle the problem. “Star ratings muddled up the quality of care with the use of resources and financial management,” she said. “One of the problems we identified last year when the deficit came out was that the star ratings system was ignoring small deficits and not sending out the right message to trusts who overspent. When you’ve got a trust that is quite weak in its financial management, they are generally weak at other things as well.” The latest figures show that 120 of 548 NHS organisations are now predicting deficits for the current financial year, with 90 per cent of the estimated gross deficit originating from 71 of the trusts.
The commission’s report will be published along with a website that will provide information about the performance of all NHS trusts in England, and offer comparisons. The commission is likely to support strongly early action on those trusts judged to be weak. It has promised the assessment will be tougher than star ratings, with fewer trusts falling in to the top category. The score for the quality-of-services rating will be based on how well trusts meet the commission’s 24 core standards in areas such as safety and clinical effectiveness. “In general I would expect that trusts that were doing well under the old system will do well under the new system,” Ms Hewitt said. “But this is a tougher assessment and it’s designed to be because what the NHS can do for patients is much greater that it used to be, and patient expectation is rising every year, so it’s right that the commission should be setting the bar higher.”
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
A hardcore group of debt-ridden hospitals are offering poor-quality patient care, Patricia Hewitt, the Health Secretary, will admit today. The chief health watchdog in England is expected to expose these hospitals, declaring them “weak”. The Healthcare Commission’s annual assessment of the NHS, to be released tomorrow, comes as many hospitals and health trusts, struggling to curb spending, are cutting frontline services. A group of 63 trusts are responsible for 70 per cent of the NHS’s deficit.
Ms Hewitt told The Times that trusts that were running up debts were also likely to be mismanaging parients and have worse waiting times, cleanliness and MRSA infections. “I’m afraid that a lot of the trusts with the worst financial records are also weak on quality of care,” she said. “You can see why when you visit hospitals like that. “They are not making the best use of their resources, not working through the processes of making sure everybody is paying attention to hygiene and cleanliness, and if they’re not doing that, they’re probably not going through the processes of making sure everything else is being done properly.”
Nearly a third of hospitals and a quarter of all 570 NHS organisations failed to balance their books in 2005-06, leaving the NHS with a net deficit of 547 million pounds, the Health Department announced this week.
Ms Hewitt will ask failing trusts to propose and implement an action or improvement plan within a month, if measures are not in place. “We are going to be asking all of those trusts to sit down with their strategic health authority and set out very clearly what they can do and what more they intend to do,” she said.
However, the commission will paint a varied picture. “The report will show considerable variation in performance across the country,” she said. “Clearly, we will have some trusts that are excellent on quality, but also excellent on financial management, but we will also have trusts that fail on both.”
Five years ago the Government introduced hotel-style star ratings for hospitals to encourage them to improve quality of care. However, a new system uses a wider range of measures, including clinical and financial performance, to rate trusts as excellent, good, fair or weak. The inclusion of financial management will damage the ratings of many hospitals. The NHS deficit has more than doubled in the past 12 months, with the biggest problems concentrated in the South East and eastern England. In recent months, thousands of job cuts have been announced in order to make savings.
Ms Hewitt said that the previous system of assessment had not helped to tackle the problem. “Star ratings muddled up the quality of care with the use of resources and financial management,” she said. “One of the problems we identified last year when the deficit came out was that the star ratings system was ignoring small deficits and not sending out the right message to trusts who overspent. When you’ve got a trust that is quite weak in its financial management, they are generally weak at other things as well.” The latest figures show that 120 of 548 NHS organisations are now predicting deficits for the current financial year, with 90 per cent of the estimated gross deficit originating from 71 of the trusts.
The commission’s report will be published along with a website that will provide information about the performance of all NHS trusts in England, and offer comparisons. The commission is likely to support strongly early action on those trusts judged to be weak. It has promised the assessment will be tougher than star ratings, with fewer trusts falling in to the top category. The score for the quality-of-services rating will be based on how well trusts meet the commission’s 24 core standards in areas such as safety and clinical effectiveness. “In general I would expect that trusts that were doing well under the old system will do well under the new system,” Ms Hewitt said. “But this is a tougher assessment and it’s designed to be because what the NHS can do for patients is much greater that it used to be, and patient expectation is rising every year, so it’s right that the commission should be setting the bar higher.”
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, October 11, 2006
Australia: Public hospital cancer scanners unused
Thousands of patients are being forced to wait for potentially life-saving scans while the equipment to diagnose them sits idle in Queensland public hospitals. More than $6 million worth of state-of-the-art cancer-detecting equipment at the Princess Alexandra Hospital has not been used since being installed almost five months ago. Queensland Health's failure to attract and maintain radiography staff is being blamed for the equipment at the PA and other hospitals being under-utilised. Meanwhile, thousands of potential cancer patients and stroke victims await access to CT scanners, MRI machines and angiographic suites to detect internal bleeding, clotting and other traumas.
A Medical Radiation Professionals Group spokesman yesterday said radiographers were warning of the looming crisis because poor working conditions meant the problems were worsening. "The Health Minister has done absolutely nothing but repeatedly trotted out the industrial relations process," he said. "Tell that to patients in pain, patients suffering cancer and patients who need help today and cannot wait until tomorrow." According to the MRPG, more than 1000 patients were waiting for up to two months for diagnostic scans at the PA while the equipment goes unused.
The Royal Brisbane Hospital is suffering similar problems with the angiographic suite and gastro-internal treatment facilities on reduced working hours because of the shortage of radiographers. About 800 patients of the Gold Coast Hospital are expected to wait 10 weeks for diagnostics scans, double the wait time of 12 months ago.
The MRPG spokesman said the Gold Coast Hospital's much-touted cardiac catheter lab may have to end its 24-hour service but Health Minister Stephen Robertson flatly rejected that. "The 24-hour service is not being reduced, nor is there any planned reduction or shortage of radiographers on the Coast," he said. Mr Robertson said the number of radiographers working for Queensland Health had increased by 70 in the 12 months to June. However, he conceded there were problems with staff numbers at the PA and Royal Brisbane and Women's Hospital. "Over the last four months the PA has seen an unprecedented expansion of new technology capability and they have struggled to recruit at the same rate," he said. "The RBWH is actively trying to recruit new radiographers. In the meantime, RBWH will continue to provide all urgent and emergency services."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thousands of patients are being forced to wait for potentially life-saving scans while the equipment to diagnose them sits idle in Queensland public hospitals. More than $6 million worth of state-of-the-art cancer-detecting equipment at the Princess Alexandra Hospital has not been used since being installed almost five months ago. Queensland Health's failure to attract and maintain radiography staff is being blamed for the equipment at the PA and other hospitals being under-utilised. Meanwhile, thousands of potential cancer patients and stroke victims await access to CT scanners, MRI machines and angiographic suites to detect internal bleeding, clotting and other traumas.
A Medical Radiation Professionals Group spokesman yesterday said radiographers were warning of the looming crisis because poor working conditions meant the problems were worsening. "The Health Minister has done absolutely nothing but repeatedly trotted out the industrial relations process," he said. "Tell that to patients in pain, patients suffering cancer and patients who need help today and cannot wait until tomorrow." According to the MRPG, more than 1000 patients were waiting for up to two months for diagnostic scans at the PA while the equipment goes unused.
The Royal Brisbane Hospital is suffering similar problems with the angiographic suite and gastro-internal treatment facilities on reduced working hours because of the shortage of radiographers. About 800 patients of the Gold Coast Hospital are expected to wait 10 weeks for diagnostics scans, double the wait time of 12 months ago.
The MRPG spokesman said the Gold Coast Hospital's much-touted cardiac catheter lab may have to end its 24-hour service but Health Minister Stephen Robertson flatly rejected that. "The 24-hour service is not being reduced, nor is there any planned reduction or shortage of radiographers on the Coast," he said. Mr Robertson said the number of radiographers working for Queensland Health had increased by 70 in the 12 months to June. However, he conceded there were problems with staff numbers at the PA and Royal Brisbane and Women's Hospital. "Over the last four months the PA has seen an unprecedented expansion of new technology capability and they have struggled to recruit at the same rate," he said. "The RBWH is actively trying to recruit new radiographers. In the meantime, RBWH will continue to provide all urgent and emergency services."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, October 10, 2006
Free-market medicine
The health-care system in the United States is beset by problems. After years of feeling shortchanged by managed care, doctors and hospitals are demanding and getting greater compensation; the elderly (under Medicare) have no prescription coverage; and many people find health insurance of any kind unaffordable. Managed care, which was hailed as the answer to spiraling costs, is under legislative and legal assault, while health-care costs are rising at double-digit rates. Proposed solutions range from a Canadian-style single-payer system to medical savings accounts to staying the course with managed care. First, before discussing these issues, some characteristics of the health-care system that get little attention:
Inefficiency. In 1999, health-care costs in the United States totaled about $1.2 trillion (13 percent of GDP). One measure of the medical industry's inefficiency can be gleaned from examining the experience of a 2,000-patient clinic in Renton, Washington. Using a concept known as SimpleCare, the clinic has been able to reduce the price of outpatient care by requiring patients to pay in full at the time they are seen. The clinic charges 30-50 percent less than what a regular clinic would charge for such things as office visits and X-rays. The savings come from bypassing the bureaucracy: No staff are needed to get managed-care approval, file endless claims, or coax payment from insurance companies. (Patients are encouraged to get low-cost insurance to cover catastrophic illness.)1
Preventable Disease. Tobacco use, diet, obesity, and lack of exercise can be linked to nearly two-thirds of cancer deaths in the United States.2 A proper diet can substantially lower high blood pressure.3 Sedentary habits account for a substantial portion of deaths due to coronary artery disease, type 2 diabetes, as well as loss of functional ability in older adults.4 Osteoporosis can be prevented by not smoking, consuming calcium and vitamin D, engaging in weight-bearing exercise, limiting alcohol and caffeine consumption, and (for some women) taking supplemental estrogen.5 According to Dr. Christopher Fanta, head of the asthma treatment program at Brigham and Women's Hospital, "Asthma is considered the most common preventable cause of hospitalization."6 Fewer than a third of women of childbearing age take the vitamin folic acid, which has been shown to prevent disabling birth defects.7
Although making lifestyle changes that prevent disease is not easy, the fact remains that consumers have neither the financial motivation nor the access to information that would allow them to select doctors who have a proven track record in educating and motivating their patients.
Unnecessary Treatment. Studies have shown that various medical procedures and regimens are overused. Examples include treatment for Lyme disease,8 back surgery,9 myringotomies (insertion of tiny tubes to prevent ear infection),10 hysterectomies,11 and laparoscopic gallbladder and anti-reflux surgery.12 A common assumption is that treatment is driven by medical necessity. However, in a series of studies, Dr. John E. Wennberg found that the amount of health care consumed by individuals is highly dependent on where they live, on the capacity of the local health-care system, and on the practice styles of local physicians.13
Poor Performance. A substantial number of physicians are falling short in the practice of medicine. Examples include poor control of hypertension,14 potential errors made by sleep-deprived interns,15 lack of cardiac stethoscope proficiency,16 under-use of beta blockers for preventing subsequent heart attacks,17 inadequate control of cholesterol,18 under-use of blood-clot dissolving therapy,19 inadequate pain management in cancer patients,20 and poor communication with patients.21
Imperfect Knowledge
Medical Uncertainty. Standardized algorithms and guidelines based on scientific evidence have shown themselves to be successful in treating disease and saving lives. However, in a 1997 article Dr. David Mirvis made these points: Uncertainty remains a fact of life in medical practice. Physicians don't know the full extent of a patient's disease or the best single approach to diagnosis and treatment. Biological variability is a major challenge. The same condition may result in different outcomes in different patients due to genetic predispositions, co-morbidity, or other factors. Knowledge of the characteristics of disease and the effects of therapies is far from complete. Diagnostic tests are imperfect and many treatments are based not on scientific principles but on learned practices, assumptions, and other nonscientific formulations. Much uncertainty results from lack of knowledge of the outcomes of what physicians do. A consequence of the high level of medical uncertainty is the existence of a range, rather than a single point, of acceptable practice. This range is broad enough to allow substantial variations in practice patterns.22
State Mandates. A 1989 study found that states have passed more than 700 statutes requiring health insurers to cover specific providers, diseases, or high-risk individuals. Mandated benefits run the gamut from hair-transplant and acupuncture coverage to mental health and maternity coverage.23 A follow-up study, published in 1999, found that 20 to 25 percent of uninsured Americans lack coverage because of benefit mandates. The proliferation of mandated benefits has increased the cost of health insurance, disproportionately hurting employees who work for small businesses, which can't afford to self-insure and thereby avoid the mandates.24
Bone marrow transplantation, for example, is a complex, expensive ($60,000), and painful experimental treatment for late-stage breast cancer, which places the patient at high risk for infection. Beginning in the early 1990s, after preliminary indications of promising results, lawsuits and political pressure led to legislation in ten states, forcing insurers to cover the procedure. Such laws made it difficult to recruit women into clinical trials because women did not want to take the chance of being "randomized" into a control group. By 1999, 5,000 women a year were undergoing transplants nationwide. By the spring of 2000 it became clear that such transplants were no more effective than chemotherapy alone at standard doses.25
Income Tax Distortion. Many writers have pointed out that for the 90 percent of people who obtain their health insurance through their employers, the tax-exempt status of employer-provided health insurance encourages a huge overconsumption of health insurance and hence overconsumption of health-care services, compared to how people would spend their money in the absence of tax exemption.26 For someone in a 33 percent tax bracket, for example, $2 of taxable income turns into $3 of tax-free income, which can be spent on health insurance without any change in disposable income.
Stiffing the Piper. Health-care costs have risen dramatically in the last few decades, while patients' out-of-pocket share of those expenses has declined: In 1960 patients paid, on average, 20.8 percent of hospital costs and 61.6 percent of physician costs. By 1999 those figures had dropped to 3.2 percent and 11.4 percent, respectively.27
Failed Prescriptions
Managed care, which came into prominence in the 1990s, was initially successful at holding down health-care costs. However, doctors, hospitals, and patients were soon fighting back, and the inherent weaknesses of third-party control were revealed: By requiring patients to pay no more than a token copayment, managed care removes the incentive to economize and undermines patient control of health-care encounters. The central tenet of managed care is that consumers are ill-equipped to deal directly with health-care providers; managed-care organizations must act as intermediaries, handling the complexities of medical payment and quality assessment, leaving consumers to make their wishes known by choosing from a list of rival health plans provided by their employers. This is an anemic form of competition, which is as effective in securing cost-effective health care as a passenger would be in arriving at his destination by telling a blindfolded driver when to step on the accelerator, hit the brake, or turn the steering wheel. To achieve the goal of cost-effective care, consumers need to choose at the level of the individual provider and medical procedure, and face both the costs and benefits of their choices.
A more fundamental problem with managed care is that many medical decisions fall into a gray area where definitive scientific judgment cannot be rendered for individual cases. This gray area is the subject of a tug of war between patients and managed-care administrators. Patients, many of whom are being treated for diseases partly of their own making, want no expense to be spared in their treatment, since someone else is footing the bill. Managed-care organizations, on the other hand, make money (or stay solvent) by limiting the amount of care rendered to subscribers. This gray area is large enough to make the difference between financial success and failure for the organizations and large enough to give patients who are denied care plenty of ammunition when seeking legislative and legal action against those organizations.
A Canadian-style single-payer health care system is nothing more than a massive managed-care arrangement with government bureaucrats in control and without a meaningful appeals process for care denied or delayed. The same problems inherent in private managed care arise in a government-run system. Moreover, as a rule, government programs cannot satisfy consumer demand. Since all goods and services are finite and require human effort to produce, rationing is unavoidable. Only the method of rationing is subject to choice. The free market rations on the basis of income; the method of rationing is the familiar pricing system. When this system is circumvented by the government to provide a "free" good or service, all constraints on demand are removed, making inevitable the explicit rationing of supply by some government authority or the disappearance of the good or service altogether. Regarding universal access to health care, it should be noted that before government intervention in the health-care system, a variety of private organizations provided free medical care to the poor.28
Medical Savings Accounts
Medical savings account (MSA) health plans were introduced at the federal level as a demonstration project in 1996. The central feature of these employer-provided plans is a savings account controlled by the insured individual and used to pay for routine health care. An accompanying low-cost catastrophic insurance policy covers health- care expenses that exceed the high yearly deductible. MSA plans enjoy the same tax advantage as other employer-provided health insurance. Although unspent MSA funds roll over from year to year, they can only be spent on health care.29
The high deductible associated with MSA health plans leads to substantial savings in administrative costs because many low-dollar claims for routine medical care are never filed. In addition, having patients spending their own money on health care makes them more prudent consumers, which means less spending on unnecessary health care services.
However, MSA health plans have drawbacks. They perpetuate the income tax distortion of health-care spending (discussed above) and are subject to legislative manipulation: Under current law, MSA plans are hamstrung by limited availability and growth, unnecessary complexity, and design features that put them at a disadvantage in the marketplace.30 Finally, MSA critics argue that the very idea of government direction or control of consumer spending is inimical to a free market.
The Solution
The solution to the problems discussed above is to treat health care more like other products and services. This means repealing all tax exemptions for health insurance and health-care spending, enacting a compensating tax cut unrelated to individual health-care consumption, eliminating all health-insurance mandates and other regulation, and letting the market sort things out.
The market would probably respond to such deregulation the same way it did before government intervened in health care: As early as the 1940s commercial insurers included deductibles and copayments in their sickness insurance offerings and excluded many elective treatments from coverage, all in an effort to restrain demand for unnecessary and costly medical services. Commercial insurers also used actuarial risks to calculate premium payments and paid individual subscribers, instead of hospitals.31 Giving patients a substantial financial stake in the cost of their care will make them interested in the cost-effectiveness of that care.
A second part of a market-driven solution would likely be giving patients access to information comparing the performance of competing physicians, just as consumer magazines provide information on competing products. To do this, independent organizations might determine what physicians accomplish in a clinical setting by measuring the health status of patients before and after treatment. To be cost-effective, such measurement would probably make use of electronic medical records.
Employees on expense accounts spend much more freely than when making purchases with their own hard-earned money. Similarly, patients consume medical services with little regard for cost when someone else is paying for them. In a climate of unnecessary medical care, preventable disease, and medical uncertainty, insulating consumers from the cost of choices they or their doctors make guarantees inefficiency and runaway costs.
Cost-sharing refers to the requirement that patients bear a significant share of the cost of all medical care rendered in their behalf. It does not refer to paying insurance premiums (which do nothing to constrain health-care consumption). The RAND health-insurance experiment showed that patients who have to pay for part of their care cut back substantially on the use of medical services.32 While the market will figure out the right mix of deductibles and copayments, it seems likely that as an individual's yearly health-care expenses rise, his out-of-pocket share of new health-care expenditures will decline. However, from an economic point of view, it would be optimal if no one's out-of-pocket share of medical expenses ever dropped to zero, giving every consumer a stake in the cost of every medical visit, test, procedure, hospitalization, or prescription drug he consumes. An immediate effect of such cost-sharing would be to give physicians a newly found interest in cost control for the benefit of their patients and as a means to attract business.
Measuring Physician Performance
In many cases, poor physician performance (discussed above) is due to lack of feedback; in the absence of evidence to the contrary, it is natural to assume that one's performance is adequate or even superior to that of one's peers.
In an attempt to control costs, managed-care organizations have been measuring the process of health-care delivery, rather than identifying physicians who keep their patients healthy. In a newly deregulated market, one can imagine managed-care organizations dropping their review and oversight functions in favor of collecting and disseminating (for a fee) information on the performance of physicians (and eventually hospitals). If such a service were to periodically measure a patient's health status during the course of treatment, the change in these measurements, collected for a sufficient number of patients (and adjusted for severity of illness, co-morbidity, and patient demographics), could be used to measure doctors based on the results they achieve in their patients.
Assessing outcomes is appealing because of its narrow focus: As long as a patient's health status can be objectively measured, none of the intervening steps that are part of medical treatment need be evaluated. Concern about the number and type of tests performed, improper use of high-tech equipment, medications prescribed, or the appropriateness of the treatment chosen would be superfluous. Poor choices by a physician in such matters would either be reflected in higher costs or worse outcomes than those of other physicians.
For preventive medicine and most chronic diseases the performance of physicians is inextricably linked to patient compliance and cooperation. As a result, the performance of physician and patient would probably have to be measured jointly. Nonetheless, in the context of a system controlled by any third party, measuring a physician based on the behavior of his patients would likely be unacceptable to the marketplace.
However, in a health-care system that includes patient cost-sharing, measuring the performance of physician and patient jointly makes sense. No third-party coercion would be needed; a patient's financial stake in the cost of care would serve as a necessary and sufficient constraint on his behavior.
Doctors with performance scores showing a low-key approach to smoking cessation, for example, would attract patients with no intention of quitting. Such doctors would suffer no financial penalty other than that brought on by the indifference of smokers looking for a more aggressive approach to their problem. Moreover, doctors with low cessation scores who have high scores in other areas would attract nonsmokers who have no reason to care about quitting.
Meanwhile, patients with a desire to quit smoking, lose weight, improve their diet, or begin an exercise program could choose physicians with performance scores showing a successful track record in preventive medicine. And doctors who felt certain patients weren't living up to their end of the bargain (regarding compliance with treatment plans) would be free to refer them elsewhere. Thus the goals of physician and patient would be in alignment.
Indicators to be measured would probably be those known to be closely related to good health and closely related in time to physician intervention. Examples of possible indicators are cholesterol levels, blood pressure, blood-glucose levels, and patient satisfaction.
The government would play an important role in establishing and enforcing a patient's right to control his medical information. Beyond that, patient privacy would be protected because the measurement system would not need identifying information.
The health-care market has failed to produce high-quality, low-cost medicine for two reasons: Consumers are insulated from the cost of medical care by third-party payers, and information on the performance of competing physicians is not available. Fixing the incentives and providing consumers with physician performance data will cause unnecessary surgery to decline, physician performance to improve, disease prevention to increase, and health-care efficiency to rise.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The health-care system in the United States is beset by problems. After years of feeling shortchanged by managed care, doctors and hospitals are demanding and getting greater compensation; the elderly (under Medicare) have no prescription coverage; and many people find health insurance of any kind unaffordable. Managed care, which was hailed as the answer to spiraling costs, is under legislative and legal assault, while health-care costs are rising at double-digit rates. Proposed solutions range from a Canadian-style single-payer system to medical savings accounts to staying the course with managed care. First, before discussing these issues, some characteristics of the health-care system that get little attention:
Inefficiency. In 1999, health-care costs in the United States totaled about $1.2 trillion (13 percent of GDP). One measure of the medical industry's inefficiency can be gleaned from examining the experience of a 2,000-patient clinic in Renton, Washington. Using a concept known as SimpleCare, the clinic has been able to reduce the price of outpatient care by requiring patients to pay in full at the time they are seen. The clinic charges 30-50 percent less than what a regular clinic would charge for such things as office visits and X-rays. The savings come from bypassing the bureaucracy: No staff are needed to get managed-care approval, file endless claims, or coax payment from insurance companies. (Patients are encouraged to get low-cost insurance to cover catastrophic illness.)1
Preventable Disease. Tobacco use, diet, obesity, and lack of exercise can be linked to nearly two-thirds of cancer deaths in the United States.2 A proper diet can substantially lower high blood pressure.3 Sedentary habits account for a substantial portion of deaths due to coronary artery disease, type 2 diabetes, as well as loss of functional ability in older adults.4 Osteoporosis can be prevented by not smoking, consuming calcium and vitamin D, engaging in weight-bearing exercise, limiting alcohol and caffeine consumption, and (for some women) taking supplemental estrogen.5 According to Dr. Christopher Fanta, head of the asthma treatment program at Brigham and Women's Hospital, "Asthma is considered the most common preventable cause of hospitalization."6 Fewer than a third of women of childbearing age take the vitamin folic acid, which has been shown to prevent disabling birth defects.7
Although making lifestyle changes that prevent disease is not easy, the fact remains that consumers have neither the financial motivation nor the access to information that would allow them to select doctors who have a proven track record in educating and motivating their patients.
Unnecessary Treatment. Studies have shown that various medical procedures and regimens are overused. Examples include treatment for Lyme disease,8 back surgery,9 myringotomies (insertion of tiny tubes to prevent ear infection),10 hysterectomies,11 and laparoscopic gallbladder and anti-reflux surgery.12 A common assumption is that treatment is driven by medical necessity. However, in a series of studies, Dr. John E. Wennberg found that the amount of health care consumed by individuals is highly dependent on where they live, on the capacity of the local health-care system, and on the practice styles of local physicians.13
Poor Performance. A substantial number of physicians are falling short in the practice of medicine. Examples include poor control of hypertension,14 potential errors made by sleep-deprived interns,15 lack of cardiac stethoscope proficiency,16 under-use of beta blockers for preventing subsequent heart attacks,17 inadequate control of cholesterol,18 under-use of blood-clot dissolving therapy,19 inadequate pain management in cancer patients,20 and poor communication with patients.21
Imperfect Knowledge
Medical Uncertainty. Standardized algorithms and guidelines based on scientific evidence have shown themselves to be successful in treating disease and saving lives. However, in a 1997 article Dr. David Mirvis made these points: Uncertainty remains a fact of life in medical practice. Physicians don't know the full extent of a patient's disease or the best single approach to diagnosis and treatment. Biological variability is a major challenge. The same condition may result in different outcomes in different patients due to genetic predispositions, co-morbidity, or other factors. Knowledge of the characteristics of disease and the effects of therapies is far from complete. Diagnostic tests are imperfect and many treatments are based not on scientific principles but on learned practices, assumptions, and other nonscientific formulations. Much uncertainty results from lack of knowledge of the outcomes of what physicians do. A consequence of the high level of medical uncertainty is the existence of a range, rather than a single point, of acceptable practice. This range is broad enough to allow substantial variations in practice patterns.22
State Mandates. A 1989 study found that states have passed more than 700 statutes requiring health insurers to cover specific providers, diseases, or high-risk individuals. Mandated benefits run the gamut from hair-transplant and acupuncture coverage to mental health and maternity coverage.23 A follow-up study, published in 1999, found that 20 to 25 percent of uninsured Americans lack coverage because of benefit mandates. The proliferation of mandated benefits has increased the cost of health insurance, disproportionately hurting employees who work for small businesses, which can't afford to self-insure and thereby avoid the mandates.24
Bone marrow transplantation, for example, is a complex, expensive ($60,000), and painful experimental treatment for late-stage breast cancer, which places the patient at high risk for infection. Beginning in the early 1990s, after preliminary indications of promising results, lawsuits and political pressure led to legislation in ten states, forcing insurers to cover the procedure. Such laws made it difficult to recruit women into clinical trials because women did not want to take the chance of being "randomized" into a control group. By 1999, 5,000 women a year were undergoing transplants nationwide. By the spring of 2000 it became clear that such transplants were no more effective than chemotherapy alone at standard doses.25
Income Tax Distortion. Many writers have pointed out that for the 90 percent of people who obtain their health insurance through their employers, the tax-exempt status of employer-provided health insurance encourages a huge overconsumption of health insurance and hence overconsumption of health-care services, compared to how people would spend their money in the absence of tax exemption.26 For someone in a 33 percent tax bracket, for example, $2 of taxable income turns into $3 of tax-free income, which can be spent on health insurance without any change in disposable income.
Stiffing the Piper. Health-care costs have risen dramatically in the last few decades, while patients' out-of-pocket share of those expenses has declined: In 1960 patients paid, on average, 20.8 percent of hospital costs and 61.6 percent of physician costs. By 1999 those figures had dropped to 3.2 percent and 11.4 percent, respectively.27
Failed Prescriptions
Managed care, which came into prominence in the 1990s, was initially successful at holding down health-care costs. However, doctors, hospitals, and patients were soon fighting back, and the inherent weaknesses of third-party control were revealed: By requiring patients to pay no more than a token copayment, managed care removes the incentive to economize and undermines patient control of health-care encounters. The central tenet of managed care is that consumers are ill-equipped to deal directly with health-care providers; managed-care organizations must act as intermediaries, handling the complexities of medical payment and quality assessment, leaving consumers to make their wishes known by choosing from a list of rival health plans provided by their employers. This is an anemic form of competition, which is as effective in securing cost-effective health care as a passenger would be in arriving at his destination by telling a blindfolded driver when to step on the accelerator, hit the brake, or turn the steering wheel. To achieve the goal of cost-effective care, consumers need to choose at the level of the individual provider and medical procedure, and face both the costs and benefits of their choices.
A more fundamental problem with managed care is that many medical decisions fall into a gray area where definitive scientific judgment cannot be rendered for individual cases. This gray area is the subject of a tug of war between patients and managed-care administrators. Patients, many of whom are being treated for diseases partly of their own making, want no expense to be spared in their treatment, since someone else is footing the bill. Managed-care organizations, on the other hand, make money (or stay solvent) by limiting the amount of care rendered to subscribers. This gray area is large enough to make the difference between financial success and failure for the organizations and large enough to give patients who are denied care plenty of ammunition when seeking legislative and legal action against those organizations.
A Canadian-style single-payer health care system is nothing more than a massive managed-care arrangement with government bureaucrats in control and without a meaningful appeals process for care denied or delayed. The same problems inherent in private managed care arise in a government-run system. Moreover, as a rule, government programs cannot satisfy consumer demand. Since all goods and services are finite and require human effort to produce, rationing is unavoidable. Only the method of rationing is subject to choice. The free market rations on the basis of income; the method of rationing is the familiar pricing system. When this system is circumvented by the government to provide a "free" good or service, all constraints on demand are removed, making inevitable the explicit rationing of supply by some government authority or the disappearance of the good or service altogether. Regarding universal access to health care, it should be noted that before government intervention in the health-care system, a variety of private organizations provided free medical care to the poor.28
Medical Savings Accounts
Medical savings account (MSA) health plans were introduced at the federal level as a demonstration project in 1996. The central feature of these employer-provided plans is a savings account controlled by the insured individual and used to pay for routine health care. An accompanying low-cost catastrophic insurance policy covers health- care expenses that exceed the high yearly deductible. MSA plans enjoy the same tax advantage as other employer-provided health insurance. Although unspent MSA funds roll over from year to year, they can only be spent on health care.29
The high deductible associated with MSA health plans leads to substantial savings in administrative costs because many low-dollar claims for routine medical care are never filed. In addition, having patients spending their own money on health care makes them more prudent consumers, which means less spending on unnecessary health care services.
However, MSA health plans have drawbacks. They perpetuate the income tax distortion of health-care spending (discussed above) and are subject to legislative manipulation: Under current law, MSA plans are hamstrung by limited availability and growth, unnecessary complexity, and design features that put them at a disadvantage in the marketplace.30 Finally, MSA critics argue that the very idea of government direction or control of consumer spending is inimical to a free market.
The Solution
The solution to the problems discussed above is to treat health care more like other products and services. This means repealing all tax exemptions for health insurance and health-care spending, enacting a compensating tax cut unrelated to individual health-care consumption, eliminating all health-insurance mandates and other regulation, and letting the market sort things out.
The market would probably respond to such deregulation the same way it did before government intervened in health care: As early as the 1940s commercial insurers included deductibles and copayments in their sickness insurance offerings and excluded many elective treatments from coverage, all in an effort to restrain demand for unnecessary and costly medical services. Commercial insurers also used actuarial risks to calculate premium payments and paid individual subscribers, instead of hospitals.31 Giving patients a substantial financial stake in the cost of their care will make them interested in the cost-effectiveness of that care.
A second part of a market-driven solution would likely be giving patients access to information comparing the performance of competing physicians, just as consumer magazines provide information on competing products. To do this, independent organizations might determine what physicians accomplish in a clinical setting by measuring the health status of patients before and after treatment. To be cost-effective, such measurement would probably make use of electronic medical records.
Employees on expense accounts spend much more freely than when making purchases with their own hard-earned money. Similarly, patients consume medical services with little regard for cost when someone else is paying for them. In a climate of unnecessary medical care, preventable disease, and medical uncertainty, insulating consumers from the cost of choices they or their doctors make guarantees inefficiency and runaway costs.
Cost-sharing refers to the requirement that patients bear a significant share of the cost of all medical care rendered in their behalf. It does not refer to paying insurance premiums (which do nothing to constrain health-care consumption). The RAND health-insurance experiment showed that patients who have to pay for part of their care cut back substantially on the use of medical services.32 While the market will figure out the right mix of deductibles and copayments, it seems likely that as an individual's yearly health-care expenses rise, his out-of-pocket share of new health-care expenditures will decline. However, from an economic point of view, it would be optimal if no one's out-of-pocket share of medical expenses ever dropped to zero, giving every consumer a stake in the cost of every medical visit, test, procedure, hospitalization, or prescription drug he consumes. An immediate effect of such cost-sharing would be to give physicians a newly found interest in cost control for the benefit of their patients and as a means to attract business.
Measuring Physician Performance
In many cases, poor physician performance (discussed above) is due to lack of feedback; in the absence of evidence to the contrary, it is natural to assume that one's performance is adequate or even superior to that of one's peers.
In an attempt to control costs, managed-care organizations have been measuring the process of health-care delivery, rather than identifying physicians who keep their patients healthy. In a newly deregulated market, one can imagine managed-care organizations dropping their review and oversight functions in favor of collecting and disseminating (for a fee) information on the performance of physicians (and eventually hospitals). If such a service were to periodically measure a patient's health status during the course of treatment, the change in these measurements, collected for a sufficient number of patients (and adjusted for severity of illness, co-morbidity, and patient demographics), could be used to measure doctors based on the results they achieve in their patients.
Assessing outcomes is appealing because of its narrow focus: As long as a patient's health status can be objectively measured, none of the intervening steps that are part of medical treatment need be evaluated. Concern about the number and type of tests performed, improper use of high-tech equipment, medications prescribed, or the appropriateness of the treatment chosen would be superfluous. Poor choices by a physician in such matters would either be reflected in higher costs or worse outcomes than those of other physicians.
For preventive medicine and most chronic diseases the performance of physicians is inextricably linked to patient compliance and cooperation. As a result, the performance of physician and patient would probably have to be measured jointly. Nonetheless, in the context of a system controlled by any third party, measuring a physician based on the behavior of his patients would likely be unacceptable to the marketplace.
However, in a health-care system that includes patient cost-sharing, measuring the performance of physician and patient jointly makes sense. No third-party coercion would be needed; a patient's financial stake in the cost of care would serve as a necessary and sufficient constraint on his behavior.
Doctors with performance scores showing a low-key approach to smoking cessation, for example, would attract patients with no intention of quitting. Such doctors would suffer no financial penalty other than that brought on by the indifference of smokers looking for a more aggressive approach to their problem. Moreover, doctors with low cessation scores who have high scores in other areas would attract nonsmokers who have no reason to care about quitting.
Meanwhile, patients with a desire to quit smoking, lose weight, improve their diet, or begin an exercise program could choose physicians with performance scores showing a successful track record in preventive medicine. And doctors who felt certain patients weren't living up to their end of the bargain (regarding compliance with treatment plans) would be free to refer them elsewhere. Thus the goals of physician and patient would be in alignment.
Indicators to be measured would probably be those known to be closely related to good health and closely related in time to physician intervention. Examples of possible indicators are cholesterol levels, blood pressure, blood-glucose levels, and patient satisfaction.
The government would play an important role in establishing and enforcing a patient's right to control his medical information. Beyond that, patient privacy would be protected because the measurement system would not need identifying information.
The health-care market has failed to produce high-quality, low-cost medicine for two reasons: Consumers are insulated from the cost of medical care by third-party payers, and information on the performance of competing physicians is not available. Fixing the incentives and providing consumers with physician performance data will cause unnecessary surgery to decline, physician performance to improve, disease prevention to increase, and health-care efficiency to rise.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, October 09, 2006
NEW SUPERBUG IN NHS
Because of negligent failure to isolate at-risk patients and an amazing failure at asepsis
Wounded troops returning from Iraq have been linked by government scientists to outbreaks of a deadly superbug in National Health Service hospitals. Injured soldiers flown back to be treated on the NHS have been infected with a rare strain of Acinetobacter baumannii, a superbug resistant to antibiotics. At one hospital in Birmingham in 2003 the bacteria went on to infect 93 people, 91 of whom were civilians. Thirty-five died, although the hospital has not been able to establish whether the superbug was a contributory factor.
The revelation comes amid growing concerns about the treatment of wounded troops on NHS wards alongside civilian patients. It follows reports that a paratrooper, wounded in Afghanistan and treated at the hospital — Selly Oak in Birmingham — was allegedly threatened by a Muslim visitor.
Acinetobacter baumannii commonly inhabits soil and water and is associated with warmer climates such as the Middle East. It is resistant to most common antibiotics and, if left untreated, can lead to pneumonia, fever and septicemia. The bacterium has become a concern in the US army, where it has been identified in more than 240 military personnel since 2003, killing five.
The first case in a British soldier returning from Iraq has been disclosed by scientists from the government’s Health Protection Agency. In a survey of 30 NHS trusts that had received troops, they discovered a soldier at Selly Oak, which houses the Royal Centre for Defence Medicine, had been infected with a strain of the bacterium known as “T”. Another British soldier infected with the superbug was admitted to the hospital in November 2004.
Dr Mark Enright, a reader in epidemiology at London’s Imperial College, said the superbug can spread rapidly in intensive care wards. It can also survive on dry surfaces for up to 20 days. “The problem is that acinetobacter can spread like wildfire between patients. If you’ve got someone who has been evacuated from Iraq with multiple burns and acinetobacter, it would spread to patients in the same unit from the hands of nursing staff and doctors.” [No aseptic procedures?? What an appalling admission!]
The Ministry of Defence said it was negotiating with Selly Oak to create a military-only ward, and added that it had introduced “stringent isolation and infection control measures” that had helped limit infections among military personnel to two soldiers, both of whom survived.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Because of negligent failure to isolate at-risk patients and an amazing failure at asepsis
Wounded troops returning from Iraq have been linked by government scientists to outbreaks of a deadly superbug in National Health Service hospitals. Injured soldiers flown back to be treated on the NHS have been infected with a rare strain of Acinetobacter baumannii, a superbug resistant to antibiotics. At one hospital in Birmingham in 2003 the bacteria went on to infect 93 people, 91 of whom were civilians. Thirty-five died, although the hospital has not been able to establish whether the superbug was a contributory factor.
The revelation comes amid growing concerns about the treatment of wounded troops on NHS wards alongside civilian patients. It follows reports that a paratrooper, wounded in Afghanistan and treated at the hospital — Selly Oak in Birmingham — was allegedly threatened by a Muslim visitor.
Acinetobacter baumannii commonly inhabits soil and water and is associated with warmer climates such as the Middle East. It is resistant to most common antibiotics and, if left untreated, can lead to pneumonia, fever and septicemia. The bacterium has become a concern in the US army, where it has been identified in more than 240 military personnel since 2003, killing five.
The first case in a British soldier returning from Iraq has been disclosed by scientists from the government’s Health Protection Agency. In a survey of 30 NHS trusts that had received troops, they discovered a soldier at Selly Oak, which houses the Royal Centre for Defence Medicine, had been infected with a strain of the bacterium known as “T”. Another British soldier infected with the superbug was admitted to the hospital in November 2004.
Dr Mark Enright, a reader in epidemiology at London’s Imperial College, said the superbug can spread rapidly in intensive care wards. It can also survive on dry surfaces for up to 20 days. “The problem is that acinetobacter can spread like wildfire between patients. If you’ve got someone who has been evacuated from Iraq with multiple burns and acinetobacter, it would spread to patients in the same unit from the hands of nursing staff and doctors.” [No aseptic procedures?? What an appalling admission!]
The Ministry of Defence said it was negotiating with Selly Oak to create a military-only ward, and added that it had introduced “stringent isolation and infection control measures” that had helped limit infections among military personnel to two soldiers, both of whom survived.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, October 08, 2006
Aetna Releases Broadest Study To Date Of Consumer-Directed Plans
Aetna announced today the results of the broadest study to date of consumer-directed plans -- a review of four years of data to determine the impact of consumer-directed health plans on 1.6 million Aetna members. This includes members in an Aetna HealthFund consumer-directed plan, as well as employees within the same employer groups who have chosen other benefits options. The study finds that, five years after the launch of Aetna HealthFund, consumer-directed plans consistently result in lower medical costs, maintained or improved levels of chronic and preventive care, and increased usage of generic medications and consumer tools and information.
"We're very pleased to see many positive developments among employer groups who offer an Aetna HealthFund product. Most notably, we find lower medical costs and maintained or improved chronic and preventive care," said Aetna Chairman, CEO and President Ronald A. Williams. "The financial results achieved by full replacement plans are particularly significant - equating to a savings of $1 million per 1,000 members over a three-year period while still maintaining quality care." Among the key study findings:
Full replacement plans see the most significant savings from Aetna HealthFund. Health Reimbursement Arrangement (HRA) plans effective in January of 2003 experienced an average medical cost trend of 1 percent over three years, meaning that medical costs for these plans increased only 3 percent between 2002 and 2005.
Employers who offered Aetna HealthFund as an option are seeing savings across all products offered. Those who offered an HRA option plan effective in January of 2003 experienced an average medical cost trend of 6.7 percent over a three-year period.
Both Aetna HealthFund HRA and Health Savings Account (HSA) members with chronic conditions maintained or improved the level of care they received prior to joining the plan, including a 6 percent higher usage of inhaled steroids among asthmatics when compared to a similar population.
Preventive care was also maintained or improved. For example, first-year HSA members received cervical cancer screenings at a 13.8 percent higher rate than PPO members.
Generic drug utilization for HRA members was 4.5 percent higher than PPO members.
The study is a unique snapshot of how offering a consumer-directed plan as an option impacts all employees in a group, regardless of which plan they choose. The 1.6 million members studied include 134,000 HRA members from 99 employers, 18,000 HSA members from 27 employers, and 1.45 million Aetna members from those same employer groups who have chosen other benefits offerings. These members were compared to a population of 1.4 million Aetna PPO members comprised of all large employer groups. Four years of data was studied for HRA members, two years of data was studied for HSA members, and three years of data was studied for the comparison population.
"Aetna is committed to studying the impact of our consumer-directed plans. We want to gauge the performance of the plans we offer to our customers so that we can consistently enhance and improve our offerings. In addition, we are working to expand the body of knowledge around these relatively new products to increase understanding and adoption of consumer-directed plans," said Williams.
This is Aetna's third annual study of its HRA members and its first review of HSA members. It focused on answering several key questions - including who is choosing the plan, and the impact of the plan on cost of care and consumer behavior. Other notable findings included:
HSA members are saving money in their fund, with more than half (52 percent) rolling over their entire fund in 2005; approximately half (49 percent) of HRA members rolled over some or all of their fund in 2005.
Aetna HealthFund members accessed online tools more than twice as often as members of other plans, based on the experiences of five large employer groups.
The average age and family size of Aetna HealthFund members (31.6 average age, 2.2 average family size) is very similar to other employees included in the study (33.4 average age, 2.3 average family size).
Aetna launched its first-generation Aetna HealthFund HRA product in September 2001 and its Aetna HealthFund HSA product in December of 2003. Since its inception, the Aetna HealthFund family of products has expanded to include a wide variety of fund and account options meeting the unique needs of employers of all sizes and individuals. Aetna HealthFund leverages Aetna's unique resources, including one of the largest networks of physicians, dentists, hospitals, pharmacies and health professionals; its extensive experience in claims payment and administration of innovative health benefits; and the company's powerful online resources and self-service tools.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Aetna announced today the results of the broadest study to date of consumer-directed plans -- a review of four years of data to determine the impact of consumer-directed health plans on 1.6 million Aetna members. This includes members in an Aetna HealthFund consumer-directed plan, as well as employees within the same employer groups who have chosen other benefits options. The study finds that, five years after the launch of Aetna HealthFund, consumer-directed plans consistently result in lower medical costs, maintained or improved levels of chronic and preventive care, and increased usage of generic medications and consumer tools and information.
"We're very pleased to see many positive developments among employer groups who offer an Aetna HealthFund product. Most notably, we find lower medical costs and maintained or improved chronic and preventive care," said Aetna Chairman, CEO and President Ronald A. Williams. "The financial results achieved by full replacement plans are particularly significant - equating to a savings of $1 million per 1,000 members over a three-year period while still maintaining quality care." Among the key study findings:
Full replacement plans see the most significant savings from Aetna HealthFund. Health Reimbursement Arrangement (HRA) plans effective in January of 2003 experienced an average medical cost trend of 1 percent over three years, meaning that medical costs for these plans increased only 3 percent between 2002 and 2005.
Employers who offered Aetna HealthFund as an option are seeing savings across all products offered. Those who offered an HRA option plan effective in January of 2003 experienced an average medical cost trend of 6.7 percent over a three-year period.
Both Aetna HealthFund HRA and Health Savings Account (HSA) members with chronic conditions maintained or improved the level of care they received prior to joining the plan, including a 6 percent higher usage of inhaled steroids among asthmatics when compared to a similar population.
Preventive care was also maintained or improved. For example, first-year HSA members received cervical cancer screenings at a 13.8 percent higher rate than PPO members.
Generic drug utilization for HRA members was 4.5 percent higher than PPO members.
The study is a unique snapshot of how offering a consumer-directed plan as an option impacts all employees in a group, regardless of which plan they choose. The 1.6 million members studied include 134,000 HRA members from 99 employers, 18,000 HSA members from 27 employers, and 1.45 million Aetna members from those same employer groups who have chosen other benefits offerings. These members were compared to a population of 1.4 million Aetna PPO members comprised of all large employer groups. Four years of data was studied for HRA members, two years of data was studied for HSA members, and three years of data was studied for the comparison population.
"Aetna is committed to studying the impact of our consumer-directed plans. We want to gauge the performance of the plans we offer to our customers so that we can consistently enhance and improve our offerings. In addition, we are working to expand the body of knowledge around these relatively new products to increase understanding and adoption of consumer-directed plans," said Williams.
This is Aetna's third annual study of its HRA members and its first review of HSA members. It focused on answering several key questions - including who is choosing the plan, and the impact of the plan on cost of care and consumer behavior. Other notable findings included:
HSA members are saving money in their fund, with more than half (52 percent) rolling over their entire fund in 2005; approximately half (49 percent) of HRA members rolled over some or all of their fund in 2005.
Aetna HealthFund members accessed online tools more than twice as often as members of other plans, based on the experiences of five large employer groups.
The average age and family size of Aetna HealthFund members (31.6 average age, 2.2 average family size) is very similar to other employees included in the study (33.4 average age, 2.3 average family size).
Aetna launched its first-generation Aetna HealthFund HRA product in September 2001 and its Aetna HealthFund HSA product in December of 2003. Since its inception, the Aetna HealthFund family of products has expanded to include a wide variety of fund and account options meeting the unique needs of employers of all sizes and individuals. Aetna HealthFund leverages Aetna's unique resources, including one of the largest networks of physicians, dentists, hospitals, pharmacies and health professionals; its extensive experience in claims payment and administration of innovative health benefits; and the company's powerful online resources and self-service tools.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, October 07, 2006
Injured British soldiers 'on NHS waiting lists'
They can't even care for the troops -- or don't they want to? People who are willing to put their lives at risk on the command of their government surely deserve better
The treatment of soldiers wounded in Iraq and Afghanistan was described as appalling by the man who commanded the British army during the Falklands war. Field Marshal Lord Bramall said once injured soldiers were brought back to the UK they were left to languish on NHS waiting lists. "This is where I think they're not being treated properly," he said.
But the MoD's director of health care denied soldiers were being abandoned in the NHS and said after-care was good. Air Commodore Paul Evans said most of their recovery took place in military rehabilitation centres. He was responding to Lord Bramall, who was particularly critical of the treatment of soldiers when they initially left hospital.
"They then have to go onto after care and then they get lost in the NHS, they have to join waiting lists and so on. "This is where I think they're not being treated properly and this goes for the TA [National Guard] as well."
Meanwhile, the Daily Telegraph reported that 5,000 soldiers are waiting for treatment on the NHS, while a military hospital, the Royal Hospital Haslar, in Hampshire, is vastly underused. The MoD prefers the Royal Centre for Defence Medicine at Selly Oak Hospital in Birmingham to the Haslar hospital. Injured troops are sent there initially before being referred to their local NHS hospitals and GPs.
But Lord Bramall said not enough resources were being provided for Selly Oak. "It was going to be the centre of excellence, but of course not enough money has been put into it, there's no proper accommodation, there's no nurses' accommodation. "They've only got one and half wards in the hospital, a surgical ward and half a trauma ward."
The MoD said that Selly Oak's "excellent health care" and training opportunities could not be met at Haslar hospital but a spokeswoman said she could not confirm the 5,000 figure. She said the "vast majority" of troops would not have been injured during combat but may have been in a car accident. Air Commodore Evans said the majority of recovery time for soldiers was within a military environment, after NHS care had seen them through the "acute phase".
Rehabilitation takes place either at 13 regional centres around the country or at the main centre at Hedley Court in south London, which specialises in intensive physiotherapy, he said. "There they can spend many months to bring them back up to a maximum functional outcome in a military environment," he said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
They can't even care for the troops -- or don't they want to? People who are willing to put their lives at risk on the command of their government surely deserve better
The treatment of soldiers wounded in Iraq and Afghanistan was described as appalling by the man who commanded the British army during the Falklands war. Field Marshal Lord Bramall said once injured soldiers were brought back to the UK they were left to languish on NHS waiting lists. "This is where I think they're not being treated properly," he said.
But the MoD's director of health care denied soldiers were being abandoned in the NHS and said after-care was good. Air Commodore Paul Evans said most of their recovery took place in military rehabilitation centres. He was responding to Lord Bramall, who was particularly critical of the treatment of soldiers when they initially left hospital.
"They then have to go onto after care and then they get lost in the NHS, they have to join waiting lists and so on. "This is where I think they're not being treated properly and this goes for the TA [National Guard] as well."
Meanwhile, the Daily Telegraph reported that 5,000 soldiers are waiting for treatment on the NHS, while a military hospital, the Royal Hospital Haslar, in Hampshire, is vastly underused. The MoD prefers the Royal Centre for Defence Medicine at Selly Oak Hospital in Birmingham to the Haslar hospital. Injured troops are sent there initially before being referred to their local NHS hospitals and GPs.
But Lord Bramall said not enough resources were being provided for Selly Oak. "It was going to be the centre of excellence, but of course not enough money has been put into it, there's no proper accommodation, there's no nurses' accommodation. "They've only got one and half wards in the hospital, a surgical ward and half a trauma ward."
The MoD said that Selly Oak's "excellent health care" and training opportunities could not be met at Haslar hospital but a spokeswoman said she could not confirm the 5,000 figure. She said the "vast majority" of troops would not have been injured during combat but may have been in a car accident. Air Commodore Evans said the majority of recovery time for soldiers was within a military environment, after NHS care had seen them through the "acute phase".
Rehabilitation takes place either at 13 regional centres around the country or at the main centre at Hedley Court in south London, which specialises in intensive physiotherapy, he said. "There they can spend many months to bring them back up to a maximum functional outcome in a military environment," he said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, October 06, 2006
A CURE FOR SOME BLINDNESS
But will the NHS be able to afford it? Note a previous story here
A condition that causes thousands of Britons to go blind every year can be halted and even reversed with a monthly injection. Trials into a treatment for age-related macular degeneration (AMD), which is diagnosed in more than 20,000 elderly people a year and is the commonest cause of blindness, have shown dramatic results for almost all who use it. Patients given Lucentis did not only have the gradual deterioration of their sight halted, but even regained vision lost to the disease. For decades, patients with the condition, which leaves 10 per cent of sufferers blind, have been told there is little or nothing that can be done to slow the disease, let alone reverse it. But in a new trial Lucentis reversed sight damage in more than a third of participants with "wet" AMD, the most damaging form of the disease. It also prevented further loss of vision in almost all who were treated with it.
About 24,000 patients a year have wet AMD diagnosed. It is responsible for 90 per cent of cases where people lose their sight entirely: loss of vision is caused by the growth of new blood vessels behind the retina, which cause bleeding and scarring.
Lucentis, developed by the Californian company Genentech, does not yet have a British licence. At 1,000 pounds a treatment, it will raise serious funding questions for the NHS if recommended for use by the National Institute for Health and Clinical Excellence (NICE), which is conducting an appraisal. Costs for treating all newly diagnosed cases to a course of monthly injections - the regime used in the trial - are put at 400 million pounds.
Steve Winyard, head of campaigns at the Royal National Institute of the Blind, said that the results were very exciting. "These results show that the drug is just as good as we thought it was going to be. About 30 per cent of these patients got a significant gain in sight, which shows that the drug also offers improvements as well as preventing sight loss." John Blake, 75, one of the few patients in Britain to have been treated with Lucentis, said that the drug had improved his sight sufficiently for him to be able to take up golf again. "Everything had gone, 80 per cent of my life had gone", he said. "I couldn't drive or watch TV," he said. "Within three days my sight had improved. It cost me nearly 5,000 pounds, but I'm very pleased."
The two trials published today in The New England Journal of Medicine compared Lucentis with a placebo and Visudyne, the only treatment hitherto available on the NHS. In the placebo-controlled trial, 716 US patients were randomly given Lucentis at two dose levels, or a placebo. Over two years, a third of patients given the higher dose of Lucentis gained in visual acuity, compared with only 4 per cent given the placebo. On average, Lucentis patients were able to read about six more letters on the optician's chart after two years of treatment than at the start, while those given a placebo could read fifteen fewer letters.
In the second trial, Lucentis was compared with Visudyne. Over two years, between 35 and 40 per cent of those given Lucentis improved by an average of 15 letters, while fewer than 6 per cent of the Visudyne group did this well. Yit Yang, a consultant ophthalmologist from Wolverhampton, described the results as very striking. "These results mean that potentially people with wet AMD can become independent again and return to activities such as reading, shopping and hobbies."
Source
NHS-speak 'demeaning to patients'
Terms such as "frequent flyers" and "bed-blockers", used by ministers and NHS staff to describe patients, are demeaning, the patients' tsar says. Harry Cayton said such negative words shifted blame to patients and should be avoided, the Royal Society of Medicine journal said. Frequent flyers - patients who are in and out of hospital - and bed-blockers are common phrases in the NHS. The Department of Health said it would take the comments on board.
Mr Cayton, the national director for patients and the public, said of the term frequent flyers: "It implies that somehow these people want regular trips to hospital, that they are collecting points, that they enjoy the health and life-threatening roundabout of continual admission, treatment and discharge." Other phrases, such as bed-blockers, shifted the blame from the NHS to the patient, and further examples of labels included referring to those who do not turn up for appointments as "DNAs".
He also attacked the use of words like "dement" to describe somebody with Alzheimer's disease. He added: "Labelling people in this way is the most common way in which the NHS dehumanises those it is supposed to care for." He said most of the language was used to describe elderly people, possibly reflecting an ageist culture. "Older people generally use the health service most often but they are also sometimes the least able to speak up for themselves, the most vulnerable."
Mr Cayton said he understood that health workers needed to create distance due to the stresses of the job, but added they should find other ways of achieving that distance. A Department of Health spokesman said: "It is important that we are sensitive to the terms patients do not find acceptable. "Harry Cayton is one of our very valued National Directors and an incredibly experienced champion for patients' rights. "We welcome his views and will take this feedback on board."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
But will the NHS be able to afford it? Note a previous story here
A condition that causes thousands of Britons to go blind every year can be halted and even reversed with a monthly injection. Trials into a treatment for age-related macular degeneration (AMD), which is diagnosed in more than 20,000 elderly people a year and is the commonest cause of blindness, have shown dramatic results for almost all who use it. Patients given Lucentis did not only have the gradual deterioration of their sight halted, but even regained vision lost to the disease. For decades, patients with the condition, which leaves 10 per cent of sufferers blind, have been told there is little or nothing that can be done to slow the disease, let alone reverse it. But in a new trial Lucentis reversed sight damage in more than a third of participants with "wet" AMD, the most damaging form of the disease. It also prevented further loss of vision in almost all who were treated with it.
About 24,000 patients a year have wet AMD diagnosed. It is responsible for 90 per cent of cases where people lose their sight entirely: loss of vision is caused by the growth of new blood vessels behind the retina, which cause bleeding and scarring.
Lucentis, developed by the Californian company Genentech, does not yet have a British licence. At 1,000 pounds a treatment, it will raise serious funding questions for the NHS if recommended for use by the National Institute for Health and Clinical Excellence (NICE), which is conducting an appraisal. Costs for treating all newly diagnosed cases to a course of monthly injections - the regime used in the trial - are put at 400 million pounds.
Steve Winyard, head of campaigns at the Royal National Institute of the Blind, said that the results were very exciting. "These results show that the drug is just as good as we thought it was going to be. About 30 per cent of these patients got a significant gain in sight, which shows that the drug also offers improvements as well as preventing sight loss." John Blake, 75, one of the few patients in Britain to have been treated with Lucentis, said that the drug had improved his sight sufficiently for him to be able to take up golf again. "Everything had gone, 80 per cent of my life had gone", he said. "I couldn't drive or watch TV," he said. "Within three days my sight had improved. It cost me nearly 5,000 pounds, but I'm very pleased."
The two trials published today in The New England Journal of Medicine compared Lucentis with a placebo and Visudyne, the only treatment hitherto available on the NHS. In the placebo-controlled trial, 716 US patients were randomly given Lucentis at two dose levels, or a placebo. Over two years, a third of patients given the higher dose of Lucentis gained in visual acuity, compared with only 4 per cent given the placebo. On average, Lucentis patients were able to read about six more letters on the optician's chart after two years of treatment than at the start, while those given a placebo could read fifteen fewer letters.
In the second trial, Lucentis was compared with Visudyne. Over two years, between 35 and 40 per cent of those given Lucentis improved by an average of 15 letters, while fewer than 6 per cent of the Visudyne group did this well. Yit Yang, a consultant ophthalmologist from Wolverhampton, described the results as very striking. "These results mean that potentially people with wet AMD can become independent again and return to activities such as reading, shopping and hobbies."
Source
NHS-speak 'demeaning to patients'
Terms such as "frequent flyers" and "bed-blockers", used by ministers and NHS staff to describe patients, are demeaning, the patients' tsar says. Harry Cayton said such negative words shifted blame to patients and should be avoided, the Royal Society of Medicine journal said. Frequent flyers - patients who are in and out of hospital - and bed-blockers are common phrases in the NHS. The Department of Health said it would take the comments on board.
Mr Cayton, the national director for patients and the public, said of the term frequent flyers: "It implies that somehow these people want regular trips to hospital, that they are collecting points, that they enjoy the health and life-threatening roundabout of continual admission, treatment and discharge." Other phrases, such as bed-blockers, shifted the blame from the NHS to the patient, and further examples of labels included referring to those who do not turn up for appointments as "DNAs".
He also attacked the use of words like "dement" to describe somebody with Alzheimer's disease. He added: "Labelling people in this way is the most common way in which the NHS dehumanises those it is supposed to care for." He said most of the language was used to describe elderly people, possibly reflecting an ageist culture. "Older people generally use the health service most often but they are also sometimes the least able to speak up for themselves, the most vulnerable."
Mr Cayton said he understood that health workers needed to create distance due to the stresses of the job, but added they should find other ways of achieving that distance. A Department of Health spokesman said: "It is important that we are sensitive to the terms patients do not find acceptable. "Harry Cayton is one of our very valued National Directors and an incredibly experienced champion for patients' rights. "We welcome his views and will take this feedback on board."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, October 05, 2006
HEALTH INSURANCE MORE EXPENSIVE? PERHAPS THAT'S BY DESIGN!
Comment from Neal Boortz
We have reports that health insurance costs are on the rise ... again. Since 2000 health insurance rates for families have gone up by over 60%. Now .. here's what you don't hear in the news. Just why is health insurance getting so expensive? There are a few good reasons:
First .. mandates. Year after year state governments across the nation add mandates to health insurance coverage. This means that the health insurance companies are mandated to provide certain coverage to the insured, no matter what the consumer wants.
A prime example here would be maternity benefits. Have you ever tried to buy a health insurance policy that doesn't include maternity benefits? In many states you can't do it. State law forbids it.
These aren't health insurance policies. They're medical payment plans. The purpose of insurance is to cover you for an unexpected expense. Unexpected. For those of you who went to government schools, that means an expense that you didn't plan on and didn't know was coming.
When you make the decision to have a baby you know that decision carries certain financial consequences. You know that you're going to have to pay for pre-natal care plus the cost of delivering the baby. Now its been quite some time since I've been involved in all this ... but let's say that the initial medical costs are about $10,000. Why, pray tell, should this be paid by insurance? Now sure, if you go to the hospital to deliver a baby, and something goes wrong, there may be some additional and unexpected expenses. Did you hear that word? Unexpected! Well there's a valid reason for a payment from your health insurance company!
Why the mandate for maternity coverage? One word. Politics. Politicians earn points with voters by giving them what is essentially a free pass on having a baby. Remember me? I'm the one who forced your health insurance company to pay for your last baby! Aren't you glad you didn't have to pay for that out of your own pocket! You sure had a lot of things to spend that money on other than paying the full costs of childbirth, didn't you! Now you be sure to remember me at the polls on election day, you hear?
Then we have this argument. If you can't afford the costs of childbirth, than you damned sure can't afford to raise a child. There are various estimates out there for the cost of raising a child to the age of 18, but I don't remember seeing a figure less than about $200,000. If you can' cough up 5% of that figure to have the child, what real chance do you have of covering the rest?
Are the other mandates? You bet! How about a mandate for drug and alcohol rehab. Many states have enacted just such a mandate. Do you use drugs? Are you a drunk? No? Then what do you need with this coverage? Answer: You don't need this coverage. Tough. You're getting it anyway, and you're going to have to pay for it, courtesy of your friendly local politician. Ditto for other mandates such as psychological treatment and counseling.
As long as we treat what we call health insurance as a medical payment plan, it is going to continue to get more and more expensive. Start treating it like insurance again .. something to cover unexpected medical costs ... and watch the prices start to come down.
Now let's talk about extraordinary medical advances. Medical science can do some rather spectacular things, These spectacular medical procedures are spectacularly expensive. Just how far are we going to go in making sure that every American is somehow entitled to every single wonder drug and procedure that comes down the pike? If someone comes up with a new surgical device that can treat ulcers, but only at an extraordinarily expensive cost ... say $75,000 for each treatment ... does this mean that every single insured person in this country is entitled to the $75,000 ulcer treatment rather than less expensive conventional treatments? Many would argue that that the insured is entitled to the whole ball of wax ... every single advancement available to them. Well, if that's the way we want it, we're going to soon find that health insurance is the single most expensive thing that Americans will ever have to buy.
One more thing. Let's not forget the corrosive aspects of power here. Politicians thrive on power. It seems that every day of their lives is a constant quest to acquire more and more power. One of the quickest and surest ways to acquire power is to work to absolve ordinary citizens of responsibility over various aspects of their lives. Let's face it, there is little fun in spending the time and money necessary to develop and maintain a comprehensive plan for your own health care and the health care of your family. When a politicians comes along and offers to take this burdensome task off your shoulders, few people would say "no thank you."
For those who do actually want to accept this responsibility for themselves, politicians will try to make it all but impossible. Tax breaks are available for businesses who provide health insurance for their employees. Many of those same tax breaks are not available for the individual who tries to acquire that coverage for himself. Now why would that be? Could it possibly be that the political class wants to discourage individuals from accepting responsibility for their own lives? Could it be that politicians want us to all operate under the assumption that our health care is always someone else's responsibility, but never ours? People who abandon responsibility for the important aspects of their own lives must pass that responsibility on to someone or something else. What better way to condition people to be government dependent.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Comment from Neal Boortz
We have reports that health insurance costs are on the rise ... again. Since 2000 health insurance rates for families have gone up by over 60%. Now .. here's what you don't hear in the news. Just why is health insurance getting so expensive? There are a few good reasons:
First .. mandates. Year after year state governments across the nation add mandates to health insurance coverage. This means that the health insurance companies are mandated to provide certain coverage to the insured, no matter what the consumer wants.
A prime example here would be maternity benefits. Have you ever tried to buy a health insurance policy that doesn't include maternity benefits? In many states you can't do it. State law forbids it.
These aren't health insurance policies. They're medical payment plans. The purpose of insurance is to cover you for an unexpected expense. Unexpected. For those of you who went to government schools, that means an expense that you didn't plan on and didn't know was coming.
When you make the decision to have a baby you know that decision carries certain financial consequences. You know that you're going to have to pay for pre-natal care plus the cost of delivering the baby. Now its been quite some time since I've been involved in all this ... but let's say that the initial medical costs are about $10,000. Why, pray tell, should this be paid by insurance? Now sure, if you go to the hospital to deliver a baby, and something goes wrong, there may be some additional and unexpected expenses. Did you hear that word? Unexpected! Well there's a valid reason for a payment from your health insurance company!
Why the mandate for maternity coverage? One word. Politics. Politicians earn points with voters by giving them what is essentially a free pass on having a baby. Remember me? I'm the one who forced your health insurance company to pay for your last baby! Aren't you glad you didn't have to pay for that out of your own pocket! You sure had a lot of things to spend that money on other than paying the full costs of childbirth, didn't you! Now you be sure to remember me at the polls on election day, you hear?
Then we have this argument. If you can't afford the costs of childbirth, than you damned sure can't afford to raise a child. There are various estimates out there for the cost of raising a child to the age of 18, but I don't remember seeing a figure less than about $200,000. If you can' cough up 5% of that figure to have the child, what real chance do you have of covering the rest?
Are the other mandates? You bet! How about a mandate for drug and alcohol rehab. Many states have enacted just such a mandate. Do you use drugs? Are you a drunk? No? Then what do you need with this coverage? Answer: You don't need this coverage. Tough. You're getting it anyway, and you're going to have to pay for it, courtesy of your friendly local politician. Ditto for other mandates such as psychological treatment and counseling.
As long as we treat what we call health insurance as a medical payment plan, it is going to continue to get more and more expensive. Start treating it like insurance again .. something to cover unexpected medical costs ... and watch the prices start to come down.
Now let's talk about extraordinary medical advances. Medical science can do some rather spectacular things, These spectacular medical procedures are spectacularly expensive. Just how far are we going to go in making sure that every American is somehow entitled to every single wonder drug and procedure that comes down the pike? If someone comes up with a new surgical device that can treat ulcers, but only at an extraordinarily expensive cost ... say $75,000 for each treatment ... does this mean that every single insured person in this country is entitled to the $75,000 ulcer treatment rather than less expensive conventional treatments? Many would argue that that the insured is entitled to the whole ball of wax ... every single advancement available to them. Well, if that's the way we want it, we're going to soon find that health insurance is the single most expensive thing that Americans will ever have to buy.
One more thing. Let's not forget the corrosive aspects of power here. Politicians thrive on power. It seems that every day of their lives is a constant quest to acquire more and more power. One of the quickest and surest ways to acquire power is to work to absolve ordinary citizens of responsibility over various aspects of their lives. Let's face it, there is little fun in spending the time and money necessary to develop and maintain a comprehensive plan for your own health care and the health care of your family. When a politicians comes along and offers to take this burdensome task off your shoulders, few people would say "no thank you."
For those who do actually want to accept this responsibility for themselves, politicians will try to make it all but impossible. Tax breaks are available for businesses who provide health insurance for their employees. Many of those same tax breaks are not available for the individual who tries to acquire that coverage for himself. Now why would that be? Could it possibly be that the political class wants to discourage individuals from accepting responsibility for their own lives? Could it be that politicians want us to all operate under the assumption that our health care is always someone else's responsibility, but never ours? People who abandon responsibility for the important aspects of their own lives must pass that responsibility on to someone or something else. What better way to condition people to be government dependent.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, October 04, 2006
FEAR OF RACISM ACCUSATIONS KEEPS HOPELESS LOS ANGELES BLACK HOSPITAL GOING
Even after years of trying to fix it have failed. It's blacks who suffer, of course
A majority of the County Board of Supervisors has said it supports handing over management of the embattled Martin Luther King Jr./Drew Medical Center to a nearby public facility with a better track record. Meanwhile, Gov. Arnold Schwarzenegger on Thursday pledged to do what he could to keep King/Drew running.
The hospital's fate was put in peril last week when federal regulators announced they would yank critical funding at the end of the year because of repeated lapses in patient care. Having Harbor-UCLA Medical Center, about 10 miles from King/Drew, manage the troubled hospital is one of several options the supervisors are mulling.
Harbor, a larger public hospital in Torrance, has avoided many of the problems that have plagued King/Drew - a hospital built after the 1965 Watts riots to provide care for largely poor and minority South Los Angeles communities. "I think that Harbor would be what I would support," said Supervisor Yvonne Brathwaite Burke, whose district includes King/Drew. "Obviously, Harbor is a hospital in my district that I believe has a very high quality."
Since January 2004, the U.S. Centers for Medicare and Medicaid Services has cited King/Drew for numerous lapses in care that have injured or killed patients. The county Department of Health Services is set to release its recommendations Tuesday.
Officials have indicated that the two main options are handing King/Drew's operations to another county facility or finding a private operator. Negotiations with a private company could be impractical, however, given the tight time frame, county officials have said. Federal regulators, who have said King/Drew must make major changes before receiving U.S. funding again, have not commented on the Harbor plan. King/Drew collects about $200 million annually - about half its budget - for treating Medicare and Medi-Cal patients.
Harbor-UCLA officials, who must follow the direction of the Board of Supervisors, declined to comment Thursday. Sandra Shewry, director of the California Department of Health Services, said the state would assist the county once it chooses a plan to save King/Drew. At a bill signing in Pasadena, Schwarzenegger said it was important to keep the hospital open. "They have great challenges, but we are going to do everything we can to provide help and assistance," he said.
Source
MORE SEMI-PRIVATIZATION OF THE NHS
It's their only remaining option
A struggling NHS hospital is on the verge of being taken over by a foundation trust. Heart of England, a much-vaunted foundation trust in Birmingham, is poised to acquire the nearby Good Hope Hospital, which has been in dire financial straits. Good Hope would be formally dissolved and its assets, liabilities and staff taken over. Foundation trusts, unlike ordinary ones, are able to borrow, make surpluses and invest while also being at risk of going bust. In its first year of operation Good Hope made a 5 million pound surplus on a 280 million turnover.
According to the Financial Times, Heart of England will be guaranteed some business from the strategic health authority. The deal will not be finalised until it has been agreed how much of Good Hope's historic debt of 27 million can be written off or absorbed by the strategic health authority. Monitor, the foundation trust regulator, said: "This approach will not be suitable for every NHS hospital that gets into financial difficulties, because Good Hope can be made viable. But we expect there will be similar transactions, in perhaps double digits."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Even after years of trying to fix it have failed. It's blacks who suffer, of course
A majority of the County Board of Supervisors has said it supports handing over management of the embattled Martin Luther King Jr./Drew Medical Center to a nearby public facility with a better track record. Meanwhile, Gov. Arnold Schwarzenegger on Thursday pledged to do what he could to keep King/Drew running.
The hospital's fate was put in peril last week when federal regulators announced they would yank critical funding at the end of the year because of repeated lapses in patient care. Having Harbor-UCLA Medical Center, about 10 miles from King/Drew, manage the troubled hospital is one of several options the supervisors are mulling.
Harbor, a larger public hospital in Torrance, has avoided many of the problems that have plagued King/Drew - a hospital built after the 1965 Watts riots to provide care for largely poor and minority South Los Angeles communities. "I think that Harbor would be what I would support," said Supervisor Yvonne Brathwaite Burke, whose district includes King/Drew. "Obviously, Harbor is a hospital in my district that I believe has a very high quality."
Since January 2004, the U.S. Centers for Medicare and Medicaid Services has cited King/Drew for numerous lapses in care that have injured or killed patients. The county Department of Health Services is set to release its recommendations Tuesday.
Officials have indicated that the two main options are handing King/Drew's operations to another county facility or finding a private operator. Negotiations with a private company could be impractical, however, given the tight time frame, county officials have said. Federal regulators, who have said King/Drew must make major changes before receiving U.S. funding again, have not commented on the Harbor plan. King/Drew collects about $200 million annually - about half its budget - for treating Medicare and Medi-Cal patients.
Harbor-UCLA officials, who must follow the direction of the Board of Supervisors, declined to comment Thursday. Sandra Shewry, director of the California Department of Health Services, said the state would assist the county once it chooses a plan to save King/Drew. At a bill signing in Pasadena, Schwarzenegger said it was important to keep the hospital open. "They have great challenges, but we are going to do everything we can to provide help and assistance," he said.
Source
MORE SEMI-PRIVATIZATION OF THE NHS
It's their only remaining option
A struggling NHS hospital is on the verge of being taken over by a foundation trust. Heart of England, a much-vaunted foundation trust in Birmingham, is poised to acquire the nearby Good Hope Hospital, which has been in dire financial straits. Good Hope would be formally dissolved and its assets, liabilities and staff taken over. Foundation trusts, unlike ordinary ones, are able to borrow, make surpluses and invest while also being at risk of going bust. In its first year of operation Good Hope made a 5 million pound surplus on a 280 million turnover.
According to the Financial Times, Heart of England will be guaranteed some business from the strategic health authority. The deal will not be finalised until it has been agreed how much of Good Hope's historic debt of 27 million can be written off or absorbed by the strategic health authority. Monitor, the foundation trust regulator, said: "This approach will not be suitable for every NHS hospital that gets into financial difficulties, because Good Hope can be made viable. But we expect there will be similar transactions, in perhaps double digits."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, October 03, 2006
BRITISH CONSERVATIVES HAVE THE RIGHT IDEA
(When they're not scared of their own shadows)
David Cameron's policy chief has declared there will be "no limit" to privatisation of the National Health Service under a Conservative government. In comments that threaten to damage the Tories' carefully crafted new image on the eve of their conference in Bournemouth, Oliver Letwin has outlined plans for a huge increase in the use of private companies in healthcare provision. His vision would reduce the NHS to a commissioning body, with many patient services provided by a range of businesses.
Letwin, chairman of the Tories' policy review, said that contracting out healthcare was in the best interests of patients and any reputable organisation should be allowed to compete for the work. Andrew Lansley, shadow health secretary, has given only vague indications of the party's plans for the health service, focusing instead on the need to free it from red tape and Whitehall targets.
Letwin said the Tories would have "no hang-ups" about use of the private sector in healthcare, although the NHS would remain free of charge. Asked if there would be any limits, he said: "No limits, no. Let the commissioning bodies decide where patients can best be cured. If people can provide services under the NHS which are good services - social enterprises, private bodies or NHS foundations - if they can satisfy the commissioners within the NHS that the best way is through them, then they should be part of the show."
Conservative Central Office immediately tried to play down the remarks, insisting there was no plan to break up the NHS. Letwin's remarks threaten to undo months of work by Cameron and his team to convince voters of the party's commitment to public services. Labour strategists greeted his intervention with glee, saying it exposed the Tories' real intention to dismantle the NHS. "This plays perfectly into our hands," said one. "We'll say Cameron's touchy-feely image is all window dressing but underneath they are the same old Tories who believe `private sector good, public sector bad'. " Labour, which has extended the private sector's role in the NHS, has said that it expects independent operators to have no more than 10% of the business during its current term of office. Ed Balls, the Treasury minister and a close ally of Gordon Brown, said: "David Cameron's plan for the privatisation of the NHS means the end of free healthcare as we know it."
Letwin outlined his vision for the NHS as Cameron faces his first conference as leader. He is under pressure for his refusal to detail his policies since taking over from Michael Howard last year. In his opening speech today he is expected to say it would be "superficial" and "insubstantial" to "make up policies to meet the pressures of the moment". He will tell delegates that policies rushed out without careful consideration will not stand the test of time. "Policy without principle is like a house without foundations. We must think for the long term," he is expected to say.
Cameron will set out his big idea as "social responsibility" - that businesses, doctors, teachers and parents should be trusted to resolve their own problems rather than have solutions dictated to them by government: "When we see challenges to overcome, we do not just ask what government can do. We ask what people can do, what society can do." Cameron's advisers believe that although Labour's intentions have been good, it has tried to solve problems by imposing too many regulations, such as making it mandatory for parents to fit child booster seats in their cars or imposing targets on NHS trusts. "We are more in favour of supernannies than the nanny state," he will say. One example which Cameron may cite in his speech is allowing parents to use childcare tax credits to pay neighbours, friends or grandparents for looking after children - rather than, like Labour, restricting the state benefit to established local government schemes.
Source
Queensland ambulance service still endangering patients
Despite greatly increased funding
A woman with a brain aneurism had to wait more than an hour for an ambulance after her plea for help was recorded as a headache complaint. The woman was working out at a suburban gym when she collapsed in agonising pain, holding her head and screaming "I'm going to die". Gym staff immediately dialled triple-0, but it was 80 minutes - with the woman lapsing in and out of consciousness - before paramedics arrived.
An ambulance spokeswoman last night confirmed the incident occurred last Thursday morning at the EnergyXpress gym in the Brisbane suburb of Bellbowrie. The spokeswoman said that, as the call had been recorded as being for a "50-year-old woman with a headache", it was treated as a low priority. "One hour later we got another call to say the lady was experiencing altered consciousness, so an ambulance was dispatched immediately," the spokeswoman said, adding that crews were attending other high-priority cases in the area at the time.
The woman underwent surgery in a Brisbane hospital on Friday night and was last night released from intensive care. But the woman's sister, who asked that family members not be identified, said her sister faced a long road to recovery. "I'm very upset that it happened and that she was waiting such a long time," she said. "It's still very raw for us and very upsetting."
Jessica Williams said she was working out with her mother when she heard a terrible scream. "At first we thought it was a personal trainer pushing someone a bit too hard, then we realised it was a lot worse than that," she said. "She was holding her head and she was screaming: 'My head's going to explode. I'm going to die. There's something wrong'."
Queensland Liberal leader Bruce Flegg, whose electorate takes in Bellbowrie, called for the service to release the full transcript of the initial call. "Clearly it is unacceptable to wait an hour and a half for an ambulance," Dr Flegg said. "Staff are under severe stress (but) there should be adequate resources because of the ambulance levy, but it is not flowing into improved services."
A spokesman for Ambulance Employees Queensland said communications officers were being forced to work up to eight 10-hour shifts in a row causing stress and fatigue that could lead to mistakes.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
(When they're not scared of their own shadows)
David Cameron's policy chief has declared there will be "no limit" to privatisation of the National Health Service under a Conservative government. In comments that threaten to damage the Tories' carefully crafted new image on the eve of their conference in Bournemouth, Oliver Letwin has outlined plans for a huge increase in the use of private companies in healthcare provision. His vision would reduce the NHS to a commissioning body, with many patient services provided by a range of businesses.
Letwin, chairman of the Tories' policy review, said that contracting out healthcare was in the best interests of patients and any reputable organisation should be allowed to compete for the work. Andrew Lansley, shadow health secretary, has given only vague indications of the party's plans for the health service, focusing instead on the need to free it from red tape and Whitehall targets.
Letwin said the Tories would have "no hang-ups" about use of the private sector in healthcare, although the NHS would remain free of charge. Asked if there would be any limits, he said: "No limits, no. Let the commissioning bodies decide where patients can best be cured. If people can provide services under the NHS which are good services - social enterprises, private bodies or NHS foundations - if they can satisfy the commissioners within the NHS that the best way is through them, then they should be part of the show."
Conservative Central Office immediately tried to play down the remarks, insisting there was no plan to break up the NHS. Letwin's remarks threaten to undo months of work by Cameron and his team to convince voters of the party's commitment to public services. Labour strategists greeted his intervention with glee, saying it exposed the Tories' real intention to dismantle the NHS. "This plays perfectly into our hands," said one. "We'll say Cameron's touchy-feely image is all window dressing but underneath they are the same old Tories who believe `private sector good, public sector bad'. " Labour, which has extended the private sector's role in the NHS, has said that it expects independent operators to have no more than 10% of the business during its current term of office. Ed Balls, the Treasury minister and a close ally of Gordon Brown, said: "David Cameron's plan for the privatisation of the NHS means the end of free healthcare as we know it."
Letwin outlined his vision for the NHS as Cameron faces his first conference as leader. He is under pressure for his refusal to detail his policies since taking over from Michael Howard last year. In his opening speech today he is expected to say it would be "superficial" and "insubstantial" to "make up policies to meet the pressures of the moment". He will tell delegates that policies rushed out without careful consideration will not stand the test of time. "Policy without principle is like a house without foundations. We must think for the long term," he is expected to say.
Cameron will set out his big idea as "social responsibility" - that businesses, doctors, teachers and parents should be trusted to resolve their own problems rather than have solutions dictated to them by government: "When we see challenges to overcome, we do not just ask what government can do. We ask what people can do, what society can do." Cameron's advisers believe that although Labour's intentions have been good, it has tried to solve problems by imposing too many regulations, such as making it mandatory for parents to fit child booster seats in their cars or imposing targets on NHS trusts. "We are more in favour of supernannies than the nanny state," he will say. One example which Cameron may cite in his speech is allowing parents to use childcare tax credits to pay neighbours, friends or grandparents for looking after children - rather than, like Labour, restricting the state benefit to established local government schemes.
Source
Queensland ambulance service still endangering patients
Despite greatly increased funding
A woman with a brain aneurism had to wait more than an hour for an ambulance after her plea for help was recorded as a headache complaint. The woman was working out at a suburban gym when she collapsed in agonising pain, holding her head and screaming "I'm going to die". Gym staff immediately dialled triple-0, but it was 80 minutes - with the woman lapsing in and out of consciousness - before paramedics arrived.
An ambulance spokeswoman last night confirmed the incident occurred last Thursday morning at the EnergyXpress gym in the Brisbane suburb of Bellbowrie. The spokeswoman said that, as the call had been recorded as being for a "50-year-old woman with a headache", it was treated as a low priority. "One hour later we got another call to say the lady was experiencing altered consciousness, so an ambulance was dispatched immediately," the spokeswoman said, adding that crews were attending other high-priority cases in the area at the time.
The woman underwent surgery in a Brisbane hospital on Friday night and was last night released from intensive care. But the woman's sister, who asked that family members not be identified, said her sister faced a long road to recovery. "I'm very upset that it happened and that she was waiting such a long time," she said. "It's still very raw for us and very upsetting."
Jessica Williams said she was working out with her mother when she heard a terrible scream. "At first we thought it was a personal trainer pushing someone a bit too hard, then we realised it was a lot worse than that," she said. "She was holding her head and she was screaming: 'My head's going to explode. I'm going to die. There's something wrong'."
Queensland Liberal leader Bruce Flegg, whose electorate takes in Bellbowrie, called for the service to release the full transcript of the initial call. "Clearly it is unacceptable to wait an hour and a half for an ambulance," Dr Flegg said. "Staff are under severe stress (but) there should be adequate resources because of the ambulance levy, but it is not flowing into improved services."
A spokesman for Ambulance Employees Queensland said communications officers were being forced to work up to eight 10-hour shifts in a row causing stress and fatigue that could lead to mistakes.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, October 02, 2006
RATS DESERTING THE SINKING NHS IT PROJECT
Computer Sciences Corporation (CSC), the US software group, was left to pick up the pieces yesterday after Accenture walked away from the NHS's troubled 12.4 billion pound IT modernisation project. In the most serious blow yet for the controversial project, which has been beset with delays and glitches, Accenture said that it would bow out, leaving only three key suppliers - BT, Fujitsu and CSC. The move comes months after the American consulting group booked a $450 million provision for expected losses from the work, blaming the late delivery of key software designed by iSoft.
Although Accenture's work, worth about 1.97 billion pounds, will be picked up by CSC, its move to extricate itself from the programme at such an advanced stage raised questions about the feasibility of the procurement terms and the ability of the Government to hit the planned budget and 2010 deadline. Under the terms of the project the risks associated with it, such as extra costs and delays, lie firmly with the companies involved instead of with NHS Connecting for Health.
The switch is the fourth such upset - BT and Fujitsu have both been forced to switch software sub-contractors and CSC has ditched ComMedica in favour of GE healthcare. The problems recently led BT to install a new chief executive for its London work. However fears that iSoft, the troubled healthcare group, would be dealt another blow receded yesterday when it emerged that its work with Accenture on the project would be transferred to CSC by January.
Richard Bacon, Tory MP and a member of the Public Accounts Committee, said: "The decision by a firm as big as Accenture, and for whom the Government is such a big customer, to quit is an eloquent testament to how difficult it is to do the project the way the Government is trying to do it."
However, Connecting for Health, the agency that runs the programme, insisted that the removal of Accenture would not increase the bill for the project or threaten its deadline. It is delayed by two years already but CfH insists it will make up this lost time. Under its settlement Accenture will keep 110 million of the 173 million pounds it has been paid by the NHS and pay back the balance. It said it would not be liable for any further penalties and any potential legal action has been abandoned
Source
VICTORIA (AUSTRALIA) GETS IT WRONG
Two current reports below
Health critic faces sack
A public hospital doctor who defied a Bracks Government gag on hospital staff to become one of its most outspoken critics faces the sack. Dr Peter Lazzari claims he is being silenced, with the state election less than two months away. But the Eastern Health network said an investigation into allegations of breaches of protocols made against Dr Lazzari had nothing to do with his activism. The doctor has vowed to fight the allegations and has been "unequivocally" backed by hospital colleagues.
Dr Lazzari, a senior specialist physician at Angliss Hospital in Melbourne's outer east, has spoken out on several issues since defying a gag in 2003. In July, he called Premier Steve Bracks a "funeral director", blaming health system shortcomings for 500 patient deaths a year.
This week, Angliss bosses asked Dr Lazzari to respond to the alleged protocol breaches and warned he could be sacked. Dr Lazzari said he could not comment on the allegations, but said they were ludicrous. "This is a deliberate beat-up to try to stop me from speaking out on issues which are critical to life and death," he said.
Eastern Health spokeswoman Beth Excell said: "There have been a number of allegations made against Dr Lazzari and the hospital has a responsibility to investigate. "We are working through these with Dr Lazzari, but none relate to his choice to speak publicly about health issues." Opposition health spokeswoman Helen Shardey said: "This is an outrageous persecution of a genuine, passionate and brave surgeon who is prepared to speak out on important health issues."
Source
Patient had to bring her own mattress
A terminally-ill woman with spine cancer had to buy a new mattress because her hospital bed sagged. Nurses encouraged the new mattress to be brought into Frankston Hospital, she said. Joy Murray, who has breast cancer that has spread to her spine, entered hospital on September 11 because of agonising back pain. But the 64-year-old says the mattress she was placed on had a 15cm dip and it put her in worse pain. Mrs Murray said nurses offered extra morphine and told her there were no spare mattresses.
When she suggested her husband, David, buy a new one, she said they encouraged her. Mr Murray went to Frankston's Clark Rubber the next day and bought a $139 mattress, while staff dumped the discarded one.
Mrs Murray, back at home yesterday, said she had never experienced anything like it during 18 years of hospital stays. Peninsula Health medical services director Dr Peter Bradford said Mrs Murray was offered four other mattresses. Opposition Health spokeswoman Helen Shardey said Mrs Murray "has endured a great deal and it's a very sad state of affairs when hospital patients are forced to buy their own mattresses".
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Computer Sciences Corporation (CSC), the US software group, was left to pick up the pieces yesterday after Accenture walked away from the NHS's troubled 12.4 billion pound IT modernisation project. In the most serious blow yet for the controversial project, which has been beset with delays and glitches, Accenture said that it would bow out, leaving only three key suppliers - BT, Fujitsu and CSC. The move comes months after the American consulting group booked a $450 million provision for expected losses from the work, blaming the late delivery of key software designed by iSoft.
Although Accenture's work, worth about 1.97 billion pounds, will be picked up by CSC, its move to extricate itself from the programme at such an advanced stage raised questions about the feasibility of the procurement terms and the ability of the Government to hit the planned budget and 2010 deadline. Under the terms of the project the risks associated with it, such as extra costs and delays, lie firmly with the companies involved instead of with NHS Connecting for Health.
The switch is the fourth such upset - BT and Fujitsu have both been forced to switch software sub-contractors and CSC has ditched ComMedica in favour of GE healthcare. The problems recently led BT to install a new chief executive for its London work. However fears that iSoft, the troubled healthcare group, would be dealt another blow receded yesterday when it emerged that its work with Accenture on the project would be transferred to CSC by January.
Richard Bacon, Tory MP and a member of the Public Accounts Committee, said: "The decision by a firm as big as Accenture, and for whom the Government is such a big customer, to quit is an eloquent testament to how difficult it is to do the project the way the Government is trying to do it."
However, Connecting for Health, the agency that runs the programme, insisted that the removal of Accenture would not increase the bill for the project or threaten its deadline. It is delayed by two years already but CfH insists it will make up this lost time. Under its settlement Accenture will keep 110 million of the 173 million pounds it has been paid by the NHS and pay back the balance. It said it would not be liable for any further penalties and any potential legal action has been abandoned
Source
VICTORIA (AUSTRALIA) GETS IT WRONG
Two current reports below
Health critic faces sack
A public hospital doctor who defied a Bracks Government gag on hospital staff to become one of its most outspoken critics faces the sack. Dr Peter Lazzari claims he is being silenced, with the state election less than two months away. But the Eastern Health network said an investigation into allegations of breaches of protocols made against Dr Lazzari had nothing to do with his activism. The doctor has vowed to fight the allegations and has been "unequivocally" backed by hospital colleagues.
Dr Lazzari, a senior specialist physician at Angliss Hospital in Melbourne's outer east, has spoken out on several issues since defying a gag in 2003. In July, he called Premier Steve Bracks a "funeral director", blaming health system shortcomings for 500 patient deaths a year.
This week, Angliss bosses asked Dr Lazzari to respond to the alleged protocol breaches and warned he could be sacked. Dr Lazzari said he could not comment on the allegations, but said they were ludicrous. "This is a deliberate beat-up to try to stop me from speaking out on issues which are critical to life and death," he said.
Eastern Health spokeswoman Beth Excell said: "There have been a number of allegations made against Dr Lazzari and the hospital has a responsibility to investigate. "We are working through these with Dr Lazzari, but none relate to his choice to speak publicly about health issues." Opposition health spokeswoman Helen Shardey said: "This is an outrageous persecution of a genuine, passionate and brave surgeon who is prepared to speak out on important health issues."
Source
Patient had to bring her own mattress
A terminally-ill woman with spine cancer had to buy a new mattress because her hospital bed sagged. Nurses encouraged the new mattress to be brought into Frankston Hospital, she said. Joy Murray, who has breast cancer that has spread to her spine, entered hospital on September 11 because of agonising back pain. But the 64-year-old says the mattress she was placed on had a 15cm dip and it put her in worse pain. Mrs Murray said nurses offered extra morphine and told her there were no spare mattresses.
When she suggested her husband, David, buy a new one, she said they encouraged her. Mr Murray went to Frankston's Clark Rubber the next day and bought a $139 mattress, while staff dumped the discarded one.
Mrs Murray, back at home yesterday, said she had never experienced anything like it during 18 years of hospital stays. Peninsula Health medical services director Dr Peter Bradford said Mrs Murray was offered four other mattresses. Opposition Health spokeswoman Helen Shardey said Mrs Murray "has endured a great deal and it's a very sad state of affairs when hospital patients are forced to buy their own mattresses".
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, October 01, 2006
A rare open admission of public hospital failure in Costa Rica
The news site quoted below usually touts the great work done by the Cuban medical system and is very supportive of Castro, Hugo Chazez in Venezuela and Evo Moralis in Bolivia. There has been no reference, however, to the recent outbreak of dengue in epidemic proportions in Cuba nor to the inability of the medical system there to control it. If you aren't familiar with this problem (you won't read about it in the MSM) Cuba Net has a good report here
The emergency room at the San Juan de Dios hospital had to be closed for some eight hours yesterday as hospital staff and doctors could not cope with the quantity of patients requiring medical attention. The announcement was made shortly after 12 noon, asking people not to go the downtown hospital emergency room as they would accept patients until 8:00pm. Hospital officials and officials of the Caja Costarricense de Seguro Social (CCSS) made the decision to close off the emergency facility to allow medical staff to catch up on existing cases. Hospital officials said that they had some 50 patients in the emergency ward when only 18 beds were available.
Those requiring attention were being asked to visit other facilities like the Calderon Guardia Hospital and Hospital Mexico. Patients being transferred by ambulance were being sent to San Rafael de Alajuela and Vicente de Paul, Heredia facilities.
Rosa Climent, medical chief for the CCSS, said that yesterday's crisis is just one chapter more at the San Juan de Dios. Just a little over a month, medical authorities complained of the shortage of 16 anesthesiologists which has resulted in the waiting list for surgeries to grow to more than 8,000. In addition, unofficial reports have been floating that the hospital is lacking some 400 beds, equipment that does not work, flooded floors, cracked walls and four areas closed off due to collapses in the construction.
Climent said that the CCSS is working on a "Master Plan" to address all the problems at the hospital, in the hopes of bettering conditions, both for the medical staff and patients. To achieve their end, Climent said that hey will seek the support of the Organizacion Panamericana de la Salud (Panamerican health organization).
The San Juan de Dios hospital is one of the most important medical facilities located in the middle of downtown San Jose
Source
Dodgy doctors working in Australia but governments don't care
Comment below by John P Collins, dean of education at the Royal Australasian College of Surgeons
During the recent inquiry on skills recognition by the federal parliament, evidence was presented to the Migration Committee reflecting concerns about the lack of proper assessment of overseas-trained doctors, and of surgeons in particular. The question that immediately arises is whether the Australian public should be concerned about standards of surgical care provided by surgeons trained overseas? And, what processes, in any, are in place to ensure all surgeons working in Australian hospitals are properly assessed and up to requirements? The first answer is - not usually, and rarely when the existing systems of assessment in place for this purpose in Australia are applied.
The Royal Australasian College of Surgeons is responsible for the training of all surgeons who train in Australia and New Zealand. Those in its programs must undertake comprehensive education and training, gain wide surgical experience and undergo repeated assessments to ensure they have reached the uniform standard required to practise surgery without supervision.
No one would disagree that there must be in place an equally robust process which assesses the competence of overseas-trained surgeons who wish to work in Australia and New Zealand. These surgeons vary enormously in their level of training and experience and include those who are outstanding and occasionally leaders in their field, as well as those who may have had minimal, or indeed no, formal training. There is an established national assessment process available in Australia which is endorsed by the Australian Medical Council, the different medical colleges and the state registration boards. The colleges have worked on streamlining their processes and now have agreed timelines within which they must complete the process.
For surgeons, the process is initiated when an individual first applies to the Australian Medical Council, which ensures the submitted documentation is in order and verifies whether the applicant has bona fide qualifications. Already this year this rigorous process has screened out two applicants whose documentation did not stack up and who never got to practise in Australia. The application is then forwarded to the College of Surgeons, where assessment includes checking for level of training, experience and assessment, recency of practice and documented evidence of "good standing" from the formal registration authorities in the country of their origin. This is followed by a structured interview. A decision is made as to whether an applicant is either "substantially comparable", "partially comparable" or "not comparable" to an Australian-trained surgeon.
Those who are substantially comparable are required to undertake a period of supervision in their new post, usually over one year, and those considered partially comparable must undertake a period of upskilling and complete the college's exit examination. Those who are not comparable must sit the Australian Medical Council registration examination if they wish to remain in Australia, following which they can apply for surgical training in the same manner as all Australian-trained medical graduates. For those who wish to work in positions designated as "area of need", a decision is made as to whether the applicant has the competencies required to undertake the specific post for which they have applied.
The real worry lies in the number of doctors appointed into surgical positions without any such assessment taking place, because state and territory registration boards are using their discretionary power to grant registration - often due to pressure to fill a longstanding vacant hospital post. Of equal concern is that many of these doctors have no proper supervision in their local workplace. No one is certain how many such appointments have or are being made, but this college regularly receives applications from people who have been in posts for some considerable time. Furthermore there seems to be no local pressure on these surgeons from either their employers or registration boards to apply for formal assessment.
There is often an ongoing tension between the need for safety and standards and the supply of surgical care. However, the recent experience in Queensland clearly demonstrates the danger of bypassing the established assessment processes. A somewhat controversial issue surrounds the requirement for all appointed overseas-trained surgeons to work under supervision for a defined period, usually not less than one year. The federal inquiry was told this is an imposition, as many have already worked as specialists elsewhere and the requirement may impact on specialist recruitment. This rhetoric needs to be balanced by the reality that not all doctors who appear competent on paper and at interview are actually competent once they are in the local workplace.
Overseas-trained surgeons hail from many different countries, with widely divergent cultures and health systems. Once appointed in Australia they require a period to learn local hospital systems, establish support networks and confirm both to themselves, their colleagues and their employers that they can work in what is often a very different environment to the one which they have previously worked in.
There are many anecdotes of overseas-trained surgeons who have benefited greatly by a period of supervision and upskilling, some of whom have been enabled through this process to realise their career aspirations and provide a lasting contribution to the Australian community. Inevitably there also are some practitioners who have been found wanting in different ways. It is vital that these people are quickly identified and a process put in place to ensure patient care is not compromised.
The availability of appropriate local supervisors is also a real issue, particularly in rural or remote areas. The college would prefer overseas surgeons appointed into such positions to first work for a short period in a major hospital where they can be properly supervised, learn how the healthcare system works and establish their networks. The federal government does provide some financial assistance for such a program, but it is rather limited and does not meet the identified needs.
The Productivity Commission has recommended the introduction of a national accreditation board for the assessment of overseas-trained doctors, but it remains unclear what this new bureaucracy will entail. It is to be hoped that the experience and credibility gained by the Australian Medical Council will not simply be dismantled. We are not struggling with the absence of a robust, agreed assessment system - but with the fact it is not always applied. Surely this must be made mandatory.
The Royal Australasian College of Surgeons is very supportive of overseas-trained surgeons. We recognise their importance as part of the surgical workforce and the substantial contribution they make to the healthcare of Australians. At the same time one of the most fundamental roles of the college since its inception 80 years ago has been to ensure that safety and standards of surgical care are foremost at all times. The college will continue to advocate for these issues, not only from its own trainees but for all who practise surgery in both Australia and New Zealand.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The news site quoted below usually touts the great work done by the Cuban medical system and is very supportive of Castro, Hugo Chazez in Venezuela and Evo Moralis in Bolivia. There has been no reference, however, to the recent outbreak of dengue in epidemic proportions in Cuba nor to the inability of the medical system there to control it. If you aren't familiar with this problem (you won't read about it in the MSM) Cuba Net has a good report here
The emergency room at the San Juan de Dios hospital had to be closed for some eight hours yesterday as hospital staff and doctors could not cope with the quantity of patients requiring medical attention. The announcement was made shortly after 12 noon, asking people not to go the downtown hospital emergency room as they would accept patients until 8:00pm. Hospital officials and officials of the Caja Costarricense de Seguro Social (CCSS) made the decision to close off the emergency facility to allow medical staff to catch up on existing cases. Hospital officials said that they had some 50 patients in the emergency ward when only 18 beds were available.
Those requiring attention were being asked to visit other facilities like the Calderon Guardia Hospital and Hospital Mexico. Patients being transferred by ambulance were being sent to San Rafael de Alajuela and Vicente de Paul, Heredia facilities.
Rosa Climent, medical chief for the CCSS, said that yesterday's crisis is just one chapter more at the San Juan de Dios. Just a little over a month, medical authorities complained of the shortage of 16 anesthesiologists which has resulted in the waiting list for surgeries to grow to more than 8,000. In addition, unofficial reports have been floating that the hospital is lacking some 400 beds, equipment that does not work, flooded floors, cracked walls and four areas closed off due to collapses in the construction.
Climent said that the CCSS is working on a "Master Plan" to address all the problems at the hospital, in the hopes of bettering conditions, both for the medical staff and patients. To achieve their end, Climent said that hey will seek the support of the Organizacion Panamericana de la Salud (Panamerican health organization).
The San Juan de Dios hospital is one of the most important medical facilities located in the middle of downtown San Jose
Source
Dodgy doctors working in Australia but governments don't care
Comment below by John P Collins, dean of education at the Royal Australasian College of Surgeons
During the recent inquiry on skills recognition by the federal parliament, evidence was presented to the Migration Committee reflecting concerns about the lack of proper assessment of overseas-trained doctors, and of surgeons in particular. The question that immediately arises is whether the Australian public should be concerned about standards of surgical care provided by surgeons trained overseas? And, what processes, in any, are in place to ensure all surgeons working in Australian hospitals are properly assessed and up to requirements? The first answer is - not usually, and rarely when the existing systems of assessment in place for this purpose in Australia are applied.
The Royal Australasian College of Surgeons is responsible for the training of all surgeons who train in Australia and New Zealand. Those in its programs must undertake comprehensive education and training, gain wide surgical experience and undergo repeated assessments to ensure they have reached the uniform standard required to practise surgery without supervision.
No one would disagree that there must be in place an equally robust process which assesses the competence of overseas-trained surgeons who wish to work in Australia and New Zealand. These surgeons vary enormously in their level of training and experience and include those who are outstanding and occasionally leaders in their field, as well as those who may have had minimal, or indeed no, formal training. There is an established national assessment process available in Australia which is endorsed by the Australian Medical Council, the different medical colleges and the state registration boards. The colleges have worked on streamlining their processes and now have agreed timelines within which they must complete the process.
For surgeons, the process is initiated when an individual first applies to the Australian Medical Council, which ensures the submitted documentation is in order and verifies whether the applicant has bona fide qualifications. Already this year this rigorous process has screened out two applicants whose documentation did not stack up and who never got to practise in Australia. The application is then forwarded to the College of Surgeons, where assessment includes checking for level of training, experience and assessment, recency of practice and documented evidence of "good standing" from the formal registration authorities in the country of their origin. This is followed by a structured interview. A decision is made as to whether an applicant is either "substantially comparable", "partially comparable" or "not comparable" to an Australian-trained surgeon.
Those who are substantially comparable are required to undertake a period of supervision in their new post, usually over one year, and those considered partially comparable must undertake a period of upskilling and complete the college's exit examination. Those who are not comparable must sit the Australian Medical Council registration examination if they wish to remain in Australia, following which they can apply for surgical training in the same manner as all Australian-trained medical graduates. For those who wish to work in positions designated as "area of need", a decision is made as to whether the applicant has the competencies required to undertake the specific post for which they have applied.
The real worry lies in the number of doctors appointed into surgical positions without any such assessment taking place, because state and territory registration boards are using their discretionary power to grant registration - often due to pressure to fill a longstanding vacant hospital post. Of equal concern is that many of these doctors have no proper supervision in their local workplace. No one is certain how many such appointments have or are being made, but this college regularly receives applications from people who have been in posts for some considerable time. Furthermore there seems to be no local pressure on these surgeons from either their employers or registration boards to apply for formal assessment.
There is often an ongoing tension between the need for safety and standards and the supply of surgical care. However, the recent experience in Queensland clearly demonstrates the danger of bypassing the established assessment processes. A somewhat controversial issue surrounds the requirement for all appointed overseas-trained surgeons to work under supervision for a defined period, usually not less than one year. The federal inquiry was told this is an imposition, as many have already worked as specialists elsewhere and the requirement may impact on specialist recruitment. This rhetoric needs to be balanced by the reality that not all doctors who appear competent on paper and at interview are actually competent once they are in the local workplace.
Overseas-trained surgeons hail from many different countries, with widely divergent cultures and health systems. Once appointed in Australia they require a period to learn local hospital systems, establish support networks and confirm both to themselves, their colleagues and their employers that they can work in what is often a very different environment to the one which they have previously worked in.
There are many anecdotes of overseas-trained surgeons who have benefited greatly by a period of supervision and upskilling, some of whom have been enabled through this process to realise their career aspirations and provide a lasting contribution to the Australian community. Inevitably there also are some practitioners who have been found wanting in different ways. It is vital that these people are quickly identified and a process put in place to ensure patient care is not compromised.
The availability of appropriate local supervisors is also a real issue, particularly in rural or remote areas. The college would prefer overseas surgeons appointed into such positions to first work for a short period in a major hospital where they can be properly supervised, learn how the healthcare system works and establish their networks. The federal government does provide some financial assistance for such a program, but it is rather limited and does not meet the identified needs.
The Productivity Commission has recommended the introduction of a national accreditation board for the assessment of overseas-trained doctors, but it remains unclear what this new bureaucracy will entail. It is to be hoped that the experience and credibility gained by the Australian Medical Council will not simply be dismantled. We are not struggling with the absence of a robust, agreed assessment system - but with the fact it is not always applied. Surely this must be made mandatory.
The Royal Australasian College of Surgeons is very supportive of overseas-trained surgeons. We recognise their importance as part of the surgical workforce and the substantial contribution they make to the healthcare of Australians. At the same time one of the most fundamental roles of the college since its inception 80 years ago has been to ensure that safety and standards of surgical care are foremost at all times. The college will continue to advocate for these issues, not only from its own trainees but for all who practise surgery in both Australia and New Zealand.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
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