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31 July, 2006
MORE SIGNS OF NHS PRIVATIZATION
Post lifted from the Adam Smith blog
A few days ago the House of Commons Health Select Committee published its report on NHS Charges, dealing among other things with the controversial charges for when you park at a hospital to visit your seriously ill relatives. However, much more important, MPs admitted for the first time that tax financing alone will not be a sustainable future for the NHS in view of future challenges to health care.
Given the three major cost driving forces of an aging population, increasing consumer demand and rapid medical progress "the NHS may not be able to pay for every possible medical treatment.", the report states. "Some treatments or procedures may have to be charged for."
This approach would divide NHS care into a free core service and an additional choice-driven service with co-payments. Which is exactly what many health experts and doctors are expecting as the solution to the current financial difficulties of the NHS.
That is a significant shift and certainly good news, because the long-due debate on mixed funding of health care has now begun. And it also heralds a healthy paradigm shift for the NHS from a reactive to a proactive service that will favour prevention over mere cure, by increasing patients' involvement and responsibility.
That this actually works is why US "consumer-driven health care plans are placing more emphasis on preventive care as patients seek to avoid medical complications" according to a recent report. In response, more US employers are investing in wellness programmes, hoping to temper insurance cost increases by improving the health of their employees. And those who have already done so report positive results. So why not kill two birds with one stone: improve your health now and thus save money in the long term? It is a principle that certainly makes sense for the NHS too.
Killer doctor still practicing
Yet Another case of your regulators protecting you
A manslaughter charge has been recommended against a prominent Queensland surgeon who continues to operate out of a private hospital with full registration through the state's Medical Board.
Four years ago, Nardia Annette Cvitic checked into Brisbane's Mater Hospital for a hysterectomy to be performed by David Ward, who was then a respected professor of medicine at the University of Queensland. But the 31-year-old mother of two died after a drain inserted into her pelvic area during surgery reportedly punctured a major vein - an error that was allegedly compounded by Dr Ward prescribing her a bloodthinning agent.
An inquest into Cvitic's death, headed by Deputy State Coroner Christine Clements, has heard evidence that after the operation the operating theatre resembled the scene of the Granville train disaster in NSW in the 1970s. The Weekend Australian has obtained a draft submission from counsel assisting the inquest. Richard Perry informing Ms. Clements and other parties in the case: "There is sufficient admissable evidence upon which a properly instructed jury could conclude that Dr Ward is guilty of the offence of manslaughter."
He recommended that Dr Ward be committed for trial. "Further, it must be acknowledged, and done so openly and honestly, that a great tragedy occurred in this case." Mr Perry states in his draft submission. "Ms Cvitic's death is one which was, in some senses, entirely avoidable, not simply because of what may or may not have occurred during the operation ... but also because her condition, however it was caused, was one which ought not to have resulted in her death."
Dr Ward's barrister, David Tait, did not return calls yesterday and Dr Ward has previously declined to comment. Cvitic's family was unavailable. Michael Coglin, medical officer for Healthcope, which owns the Sunnybank Private Hospital in Brisbane, said yesterday Dr Ward "occasionally" operated at the hospital and there was no reason for him not to do so. "In view of some of these concerns, we've checked with the Medical Board of Queensland and we've been advised that Dr Ward is in good standing with the board, he's fully registered, and there's no reason he should not continue to practise in Queensland and our hospital," Dr Coglin said.
While the Mater had referred Dr Ward to the Medical Board, a spokeswoman has said "all appropriate action was taken" and no conditions had been attached to his registration. A District Court judge recently sanctioned an out-of-court settlement in which the Mater, the University of Queensland and the Queensland Government will put $115,000 in a trust fund for Cvitic's 10-year-old son and $60.000 in trust for her 16-year-old son.
The coroner has heard there had been complaints about Dr Ward's surgical techniques and management style before Cvitic's death, and two professors who audited some of his patient files in 2003 warned: "Something is radically wrong and it cannot continue." Russell Strong and Alex Crandon, commissioned by the Mater to conduct the audit, raised problems over Dr Ward's surgical techniques, communication skills, post-operative care and medical judgment. In only three of the 10 patient files examined did they find Dr Ward had no case to answer.
The Mater subsequently withdrew Dr Ward's surgical credentials, as did the Royal Women's Hospital, and he lost his role with the university the same year.
The above article appeared in "The Australian" newspaper on 29 July, 2006
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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30 July 2006
The terminally ill and their right to drugs
Excerpts
In the United States people who need medications to treat illness are dependent on the mercy of Food and Drug Administration (FDA). It serves as a gatekeeper to drug services, deciding which medications will and will not be available to consumers. The FDA demands that developers and manufacturers of drugs furnish data on a drug's efficacy and side effects, which it uses to make its determinations. Some organizations are demanding a change in the process to permit terminally ill people to gain speedier access to possible cures. Their demands have so far been rebuffed by regulators. Below I argue the case for liberalizing the approval process.....
Opposition to allowing terminally ill people to bypass the drug testing and approval process involves three criticisms. First, that the court decision creates a "right to experimental drugs"; that is, it creates a positive right that will impose on certain people an obligation to provide other people with experimental medications.
Second, that giving people access to experimental drugs outside of clinical trials will lessen the incentives for patients to participate in randomized, controlled trials that the FDA uses to determine whether drugs are "safe and effective," its criteria for drug approval. Thus, giving access to drugs outside the clinical trials process will undermine the FDA's ability to evaluate the risks and benefits of drugs and decide which ones deserve approval and which ones do not.
Third, that very ill patients are desperate, may not be able to rationally evaluate the choices available to them and will tend to pursue any remedy anyone claims will help them regardless of its risks or effectiveness. It follows, therefore, that such patients need to be protected from the possible adverse consequences of non-rational decisions they might make as a result.
All of these criticisms are flawed. For purposes of this argument, I will leave aside the more fundamental question of whether the FDA should even have a role in deciding which drugs are "safe and effective" and should be available to consumers. Although that is an important issue, which has been well argued by others, [9] [10] the changes sought in this court case could represent an improvement in the system we have to live under now. If ions to it can be addressed, this kind of incremental change could benefit at least some very ill patients who are now being harmed by the current system, and the change sought by the Abigail Alliance can result in a system that is both more just and more beneficial for all patients.
The "right" to experimental drugs
The first argument against access to experimental drugs for the terminally ill springs from the idea that the court victory by the Abigail Alliance creates a positive right to certain drugs. This is erroneous. The right at issue in the court case, and in this article, is a negative right: the right of a willing drug manufacturer and a willing drug consumer to engage in a voluntary transaction for a medication without interference from a third party, such as the FDA.
It has been suggested that requiring the FDA to allow consumers access to certain untested drugs may create a legal avenue to force insurers to pay for them. However, this is a defect created by government intervention in the insurance market, not a logical consequence of the right under consideration.
The drug testing process: patients in conflict?
The second major argument is that the drug testing process needs to be a balancing of opposing interests, with the interests of terminally ill patients who immediately want untested drugs balanced against those of less critically ill patients who must wait for drugs to receive FDA approval. Such approval will not be forthcoming until clinical trials have been completed and the drugs' risks and benefits are defined.
By allowing free access to drugs that have not gone through trials, the argument goes, we undercut the incentives for individuals who want the drugs to participate in trials. This ends up sacrificing the interests of those who will not get access to a drug until it has been further tested. Thus, individuals who might benefit from access to experimental drugs outside of trials benefit at the expense of other patients and society in general, and "The benefit of a few desperate patients would come at a steep cost to the rest of us." But the assumptions underlying these ions are not necessarily true, and basing the drug approval system on them is unjust.
First, it is doubtful that giving patients access to drugs outside the clinical trial system will undercut the incentives to participate in trials. People have different preferences and tolerances for risk. Based on risk preferences, patients seeking treatment for a disease can roughly be divided into two groups. One group consists of those who are willing to try untested or barely tested drugs. This may be because they have run out of meaningful therapeutic options (their disease is refractory to treatment with available therapies), or existing therapies don't do enough for their disease to give them the quality of life they desire.
They may also feel that having people who are willing to try untested drugs first is an important part of advancing the knowledge and science of disease therapy. The second group consists of patients who are more risk-averse. These patients do not want to take drugs unless they have been tested and their risks and benefits are defined to some extent (i.e., the drugs have been tested on other human beings first and the outcomes of this testing are known). Although it tends to be overlooked, there may be seriously or terminally ill patients who fall into this second group.
Some people in the first group of patients might want access to drugs that have not gone through the clinical trial system. But since they are willing to tolerate risk from drugs that have unknown effects, they also provide a pool of people who are willing to participate in clinical trials, for their own benefit and the greater benefit of others with the same illnesses, because they are willing to go first.
The only way the clinical trial system breaks down is if every single patient with a given disease wants immediate access to drugs before they have gone through any trials. Unless every patient with a given disease has the exact same level of risk tolerance, this is an unlikely scenario. Instead, the dynamics of the market can meet the needs both of patients who want immediate access to drugs and those who want better-tested drugs.
It's vital to keep in mind that manufacturers of drugs develop and market them because they see an unmet demand for the drug, and thus a possible profit opportunity. Some of that unmet demand and profit opportunity will be among patients who want drugs immediately, and are willing to take the risks involved in being the first to try them. But meeting the demand only of these patients ignores another profit opportunity: the demand created by individuals who want drugs whose risks and benefits have been defined to a greater extent by testing on other individuals. The more risk-averse second group - the individuals hesitant to try drugs that haven't been tested on others first - will still drive the demand for medications that have been rigorously tested in the clinical trial setting.
Even if drug manufacturers were permitted to sell untested medications to patients who wanted them, they would be marketing to the few people willing to take an untested or barely tested drug. It is doubtful that these people will create a market so profitable that drug companies will abandon the profit opportunities presented by drugs that have gone through the clinical trials process, and simply start selling untested drugs directly.
The larger drug market, and hence unexploited profit opportunities, will still be people who want drugs that have been through the clinical trial process. The market will adapt to meet this demand for testing and information, sustaining a system of clinical trials done to meet FDA approval standards. In this way, giving access to experimental drugs outside of trials does not actually undercut the clinical trial-based FDA approval system.....
Paternalism for the Terminally Ill
The third major argument against access to experimental drugs - that of protecting the very ill from their own choices - is a thornier problem because it rests on the same attitude of paternalism that is the entire underlying justification for the FDA. It assumes that certain individuals possess the ability to decide when other individuals are incapable of making good or rational decisions on a subject, and should be able to substitute their own judgment accordingly, forcing the original person to live with the substitute decision-maker's choice.
Note that by "ability to decide" I mean the supposed capability of one person to make a better decision for another person than that person would have made for themselves, not simply to the power Congress has conferred on some people to make other people's decisions for them. The government can give you the ability to make choices for other people. That does not mean that your choices are automatically superior; it simply imposes your own risk preferences on another person. [9] But the argument for substituting the "more rational" judgment of regulators for the "less rational" judgment of terminally ill patients is flawed.
If we are using the standard of rationality to justify paternalism, we must immediately confront the question of how we judge a patient's ability to decide rationally. Bioethicist Ezekiel Emanuel defines "the desire for unproven treatments by a few patients" as "the height of irrationality born of desperation." The first major problem with this is that individuals make real choices to try untested drugs in the context of clinical trials all the time. If they did not, these trials would not exist!.....
So is it possible to assess terminally ill patients' choices at all? Here, we can borrow the central economic insight that all value is subjective. This is usually applied in the context of individuals evaluating economic goods. But we can also apply this insight when we consider how people form valuations of the risks and benefits of disease treatment options: ".both the expected benefit of using a product and the burden of risk bearing are subjectively experienced and knowable only to the individual actor."
Thus, even the way that different people value the quality of their own lives, the value of a life with or without disability, the value of a risk to their life or health, and the value of a tradeoff between the two, is subjective. The value of those kinds of tradeoffs is not the same for every disease, or even for every individual with the same disease. ....
If the value of competing therapeutic alternatives for individual patients is subjective, then there is no ive standard an expert can use to determine how other individuals do value or should value their lives and their health. Yet we allow regulators to carry out this kind of valuation for patients all the time, without asking them if the patients themselves want it done for them.....
The value attached to different risks and benefits cannot be measured or defined in any way that would make it possible for one person to claim that they can make a more rational decision about them than another person. How, then, can we base people's access to drugs on the idea that some people can, and will, make better decisions for patients than those patients would make for themselves? We cannot, and should not, allow access to medical innovation for the sickest people to rest on such a weak and unjust foundation.
Conclusion
Although it may seem like a small victory, reforming the system for the most seriously ill is progress not only for them, but for every patient. As fundamentally flawed as the FDA drug approval system is, it is entrenched, and the majority of people are convinced that we cannot survive without it. Even so, the situation is not hopeless. We can take on the arguments justifying the FDA one at a time. We can argue convincingly that incremental reforms making drugs more widely accessible to more patients will not end in disaster, bring medical progress to a halt, or leave a trail of dead and dying people in their wake.
Allowing terminally ill people to bypass the drug testing and approval process will not create a "right to experimental drugs." It will not destroy the incentives for patients to participate in the clinical trial system. It will not make it impossible to gather scientific data on how drugs work. What it will do is allow individuals who are fully capable of rational choice to make the most important choices of all according to their own values. For the sickest people, it is not only beneficial and just, it is a matter of life itself.
More here
Your regulators will protect you (again)
Employing a loony as a psychiatrist was a good one!
Vincent Berg, the Russian immigrant exposed as an allegedly bogus psychiatrist at Queensland's "Dr Death" medical inquiry, is undergoing treatment in a psychiatric ward at the Gold Coast Hospital. Mr Berg, 54, was scheduled to face a committal hearing in Southport Magistrates Court on the Gold Coast yesterday on a charge of indecently dealing with a boy under 16. But the hearing was adjourned to January 25 next year after Mr Berg's lawyer, David Gilmore, told the court his client had voluntarily admitted himself to the psychiatric ward.
Mr Berg, who was in court for the brief hearing, is accused of sexually molesting the teenage son of one of his patients when he was employed as a psychiatrist at Townsville Hospital in 2000. The allegation was revealed during the Queensland hospitals inquiry by commissioner Tony Morris. Magistrate Ron Kilner expressed frustration that committal proceedings had still not begun, despite Mr Berg's arrest in September last year. Mr Gilmore said the defence required a psychiatric assessment of Mr Berg before he could face a committal hearing.
But prosecutor Mark Whitbread said: "He has had an opportunity to see a large number of psychiatrists, and no one has been able to give him the report he desires." Outside court yesterday, Mr Gilmore said he expected Mr Berg to apply to have his case heard before the Mental Health Tribunal. Mr Berg could face further charges resulting from his 12-month tenure as a psychiatrist at Townsville Hospital, using allegedly bogus qualifications. Geoff Davies, who took over from Mr Morris as health inquiry commissioner, recommended in his final report that police should investigate whether Mr Berg should be charged with fraud, forgery and "attempts to procure unauthorised status".
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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29 July 2006
Life Expectancy and Infant Mortality are Unreliable Measures for Comparing the U.S. Health Care System to Others
Excerpts from here. See the original for tables and references
How does the United States health care system fare when compared to the rest of the industrialized world? This is an important question. Accurately measuring our health care system relative to those of other nations can yield insight into the types of health care policies America should pursue. New York Times columnist Paul Krugman has expressed the view that the U.S. health care system is inferior:
The United States spends far more on health care than other advanced countries. Yet we don't appear to receive more medical services. And we have lower life expectancy and higher infant mortality rates than countries that spend less than half as much per person. How do we do it?
Life expectancy and infant mortality are two measures that are widely cited, yet seldom questioned. This is unfortunate, because life expectancy and infant mortality tell us little about the efficacy of a health care system. This paper examines the deficiencies of using life expectancy and infant mortality to measure a health care system. It also examines the question: How should we measure a health care system?......
Any statistic that accurately measures health-care systems across nations must satisfy three criteria. First, the statistic must assume actual interaction with the health care system. Second, it must measure a phenomenon that the health care system can actually affect. Finally, the statistic must be collected consistently across nations.
Under the first criterion, the phenomenon being measured must be one in which the individual actually has contact with the health care system. More specifically, he must have contact with a health care professional, be it a doctor, nurse, lab technician, etc. A statistic measuring the rate of cancer survival satisfies this criterion, since diagnosis and treatment of cancer requires health care professionals. By contrast, a statistic measuring the rate of car accidents would not satisfy such a criteria since health care professionals are not essential to identifying car accidents.
Some statistics may assume interaction with the health care system, but the phenomena they measure are not ones on which the health care system can have any meaningful impact. Take, for example, the rate of cancer incidence. While this statistic assumes interaction with the health care system (an incidence of cancer cannot be known without the diagnosis of a health care professional), there is little a health care system can do about the rate of cancer. Rather, cancer incidence is affected by factors such as genetics, diet, lifestyle, etc., over which the health care system has no control. Thus, to be an adequate measure of the effectiveness of a health care system, a statistic must measure a phenomenon that health care professionals can actually affect.
Finally, a statistic must be collected consistently across nations. While this seems simple in theory, in practice it is quite complicated. Nations use diverse definitions of health phenomena. This leads to some nations excluding a segment of their populations from the collection of a statistic while other nations include those segments. In such circumstances, cross-national comparisons are largely meaningless. Thus, for health care systems across countries to be meaningful, there should be little to no variation in how statistics are collected. As shown below, both life expectancy and infant mortality are poor measures of a health care system because each fails to satisfy at least one of the above criteria.
Life Expectancy
Life expectancy is a poor statistic for determining the efficacy of a health care system because it fails the first criterion of assuming interaction with the health care system. For example, open any newspaper and, chances are, there are stories about people who die "in their sleep," in a car accident or of some medical ailment before an ambulance ever arrives. If an individual dies with no interaction with the health care system, then his death tells us little about the quality of a health care system. Yet all such deaths are computed into the life expectancy statistic.
Life expectancy also largely violates the second criterion - a health care system has, at most, minimal impact on longevity. One way to see this is to reexamine the table constructed by the Center for Economic and Policy Research. The interpretation that the Center for Economic and Policy Research wants readers to derive from Table 1 is that the United States would be better off with a system of universal health care. However, a careful examination of that table yields a more accurate interpretation: There is no relationship between life expectancy and spending on health care. Greece, the country that spends the least per capita on health care, has higher life expectancy than seven other countries, including Belgium, Denmark, Finland, Germany, Netherlands, the United Kingdom and the United States. Spain, which spends the second least per capita on health care, has higher life expectancy than ten other countries that spend more.
More robust statistical analysis confirms that health care spending is not related to life expectancy. Studies of multiple countries using regression analysis found no significant relationship between life expectancy and the number of physicians and hospital beds per 100,000 population or health care expenditures as a percentage of GDP. Rather, life expectancy was associated with factors such as sanitation, clean water, income, and literacy rate. A recent study examined cross-national data from 1980 to 1998. Although the regression model used initially found an association between health care expenditure and life expectancy, that association was no longer significant when gross domestic product (GDP) per capita was added to the model. Indeed, GDP per capita is one of the more consistent predictors of life expectancy.
Yet the United States has the highest GDP per capita in the world, so why does it have a life expectancy lower than most of the industrialized world? The primary reason is that the U.S. is ethnically a far more diverse nation than most other industrialized nations. Factors associated with different ethnic backgrounds - culture, diet, etc. - can have a substantial impact on life expectancy. Comparisons of distinct ethnic populations in the U.S. with their country of origin find similar rates of life expectancy. For example, Japanese-Americans have an average life expectancy similar to that of Japanese.
A good deal of the lower life expectancy rate in the U.S. is accounted for by the difference in life expectancy of African-Americans versus other populations in the United States. Life expectancy for African-Americans is about 72.3 years, while for whites it is about 77.7 years. What accounts for the difference? Numerous scholars have investigated this question. The most prevalent explanations are differences in income and personal risk factors. One study found that about one-third of the difference between white and African-American life expectancies in the United States was accounted for by income; another third was accounted for by personal risk factors such as obesity, blood pressure, alcohol intake, diabetes, cholesterol concentration, and smoking and the final third was due to unexplained factors. Another study found that much of the disparity was due to higher rates of HIV, diabetes and hypertension among African Americans. Even studies that suggest the health care system may have some effect on the disparity still emphasize the importance of factors such as income, education, and social environment.
A plethora of factors influence life expectancy, including genetics, lifestyle, diet, income and educational levels. A health care system has, at best, minimal impact. Thus, life expectancy is not a statistic that should be used to inform the public policy debate on health care.
Infant Mortality
At first glance, infant mortality appears to be a good measure of a health care system. First, it assumes interaction with a health care system since most babies born in the industrialized world are born in a hospital or other health care facility. It also satisfies the second criterion of assuming that health care professionals can affect the outcome, since doctors and nurses have a direct impact on the survival chances of a newborn. If infant mortality were accepted as an adequate measure based on those two criteria alone, then the U.S. health care system is one of the least effective in the industrialized world. This can be seen by constructing a table using the data on infant mortality utilized in the report from the Physicians for a National Health Program. Table 2 shows that on infant mortality, the U.S. ranks below all nations save New Zealand.
But infant mortality tells us a lot less about a health care system than one might think. The main problem is inconsistent measurement across nations. The United Nations Statistics Division, which collects data on infant mortality, stipulates that an infant, once it is removed from its mother and then "breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles... is considered live-born regardless of gestational age." While the U.S. follows that definition, many other nations do not. Demographer Nicholas Eberstadt notes that in Switzerland "an infant must be at least 30 centimeters long at birth to be counted as living." This excludes many of the most vulnerable infants from Switzerland's infant mortality measure.
Switzerland is far from the only nation to have peculiarities in its measure. Italy has at least three different definitions for infant deaths in different regions of the nation. The United Nations Statistics Division notes many other differences. Japan counts only births to Japanese nationals living in Japan, not abroad. Finland, France and Norway, by contrast, do count births to nationals living outside of the country. Belgium includes births to its armed forces living outside Belgium but not births to foreign armed forces living in Belgium. Finally, Canada counts births to Canadians living in the U.S., but not Americans living in Canada. In short, many nations count births that are in no way an indication of the efficacy of their own health care systems. The United Nations Statistics Division explains another factor hampering consistent measurement across nations:
...some infant deaths are tabulated by date of registration and not by date of occurrence... Whenever the lag between the date of occurrence and date of registration is prolonged and therefore, a large proportion of the infant-death registrations are delayed, infant-death statistics for any given year may be seriously affected.
The nations of Australia, Ireland and New Zealand fall into this category. Registration problems hamper accurate collection of data on infant mortality in another way. Looking at data from 1984-1985, Eberstadt argued that, "Underregistration of infant deaths may also be indicated by the proportion of infant deaths reported for the first twenty-four hours after birth." Eberstadt found that in the U.S. and Canada more than a third of all infant death occurred during the first day, but in Sweden and France they accounted for less than one-fifth. Table 3 shows that the pattern still holds today.
Inconsistent measurement explains only part of the difference between the U.S. and the rest of the world. Were measurements to be standardized, according to Eberstadt, "America might move from the bottom third toward the middle, but it would be unlikely to advance into the top half." Another factor affecting infant mortality Eberstadt identifies is parental behavior. Pregnant women in other countries are more likely to either be married or living with a partner. Pregnant women in such households are more likely to receive prenatal care than pregnant women living on their own. In the U.S., pregnant women are far more likely to be living alone. Although the nature of the relationship is still unclear (it is possible that mothers living on their own are less likely to want to be pregnant), it likely leads to a higher rate of infant mortality in the U.S. In summary, infant mortality is measured far too inconsistently to make cross-national comparisons useful. Thus, just like life expectancy, infant mortality is not a reliable measure of the relative merits of health care systems.
Conclusion
Life expectancy and infant mortality are wholly inadequate comparative measures for health care systems. Life expectancy is influenced by a host of factors other than a health care system, while infant mortality is measured inconsistently across nations. Neither of these measures provides the United States with conclusive guidance on health care policy, let alone serve as reliable evidence that a system of universal health care "should be implemented in the United States."
Do measures that would permit accurate cross-national comparisons of health care systems exist? The most exhaustive source of cross-national data is the Organization for Economic Co-operation and Development (OECD). Yet the OECD notes that in most cases its data is not "internationally comparable" because "there is a lack of international agreement on the most promising indicators and many definitions of each indicator that could be adopted."
To rectify this problem, the OECD and the Commonwealth Fund have embarked on a collaborative effort to develop comparable measures across nations. Called the "OECD Health Care Quality Indicators Project," it is taking the "first steps towards a comprehensive reporting system for quality of care in OECD member countries." A recent report updating the progress of this project looks promising. For example, one standard that an indicator must meet is its "susceptibility to being influenced by the health care system." The researchers pose important questions on this regard, including, "Can the health care system meaningfully address this aspect or problem?" and "Does the health care system impact on the indicator independent of confounders like patient risk?" In other words, these statistics will assume interaction with a health care system and measure phenomena that a health care system actually affects. Furthermore, the aim of this project is to assure that data is collected consistently across nations, so that national policymakers have "the opportunity to compare the performance of their health care delivery systems against a peer group"
While the project researchers have chosen many indicators that measure phenomena that are actually affected by a health care system, comparability issues across nations remain. For example, one indicator measures the fatality rate within 30 days of those diagnosed with acute myocardial infarction (heart attack). However, the report notes that some "countries are able to track patients after hospital discharge, [while] some are not."
Hopefully such difficulties can be resolved as the project progresses. In the meantime, policymakers, pundits and reporters should stop referring to life expectancy and infant mortality as meaningful comparative measures of health care systems.
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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28 July 2006
SOME NHS PRIVATIZATION
A giant American firm is poised to take over the responsibility for spending more than 4 billion pounds a year of NHS money in the biggest privatisation yet seen in the health service, The Times has learnt. Novation, the Texas-based group, is in the final stages of negotiating a far-reaching contract that will make it and its German partner, DHL, responsible for buying everything from bandages to hip implants for the health service. The move will mark a massive step towards opening up the NHS to outside companies and is certain to inflame simmering tensions within the Labour Party over what is perceived as creeping privatisation.
Unison, the largest public sector union, announced plans yesterday to ballot members on strike action over the move, and accused Tony Blair of accelerating his market-driven NHS reforms. Such action could coincide with the party conferences and put the battle for the soul of the Labour Party centre stage as Mr Blair comes under pressure to set a timetable for his departure. Many in the party want to draw a line on private sector involvement in the NHS but Mr Blair says that the test of keeping the health service public is whether services are free to the user.
Karen Jennings, head of health at Unison, said: "The Government's decision to privatise is driven by pure dogma and an obsession with market-testing."
The Times has learnt that DHL/Novation is expected to take over from the NHS Logistics Authority and much of the NHS Purchasing and Supply Agency, which are responsible for 4.2 billion pounds a year of purchasing and distribution, or about 5p out of every NHS pound. The disclosure comes less than a month after The Times revealed that the world's largest private health companies were being asked to submit tenders for control of primary care trusts, which spend 80 per cent of the NHS's budget. The advertisement was withdrawn soon afterwards for "redrafting".
Novation has promised big savings by making tougher, more efficient buying arrangements, alarming unions and the medical devices industry. John Wilkinson, director-general of the Association of British Healthcare Industries, has written to Andy Burnham, the Health Minister, to raise a concerns including fears over "the concentration of such buying power in a single entity". DHL/Novation would make savings by concentrating on a few large suppliers, squeezing out smaller ones that could not compete on price, he said. That, he added, would have a profound impact on whether patients received new and innovative treatments - which often come from smaller companies - and would undermine the strategy of the Treasury and the Department for Trade and Industry to encourage such companies. "We support the need for better procurement in the NHS, but nobody in their right mind would hand over this much power to one organisation when savings, not quality, is the target.
"These small, innovative companies are forging the latest medical breakthroughs for patients, yet the Government's NHS policy is going to send many of them into bankruptcy. Thousands of jobs are at stake and patients will miss out on the latest care. "We would welcome a system of several purchasing organisations to provide contestability, not this proposed monopoly."
DHL/Novation will be paid on the basis of the money it saves the NHS, with no similar incentive for quality. The contract is expected to cover a huge range of equipment, from bandages and syringes to pacemakers and hip prostheses. The Department of Health has refused requests to disclose the full list, on the ground that it is a confidential part of the negotiations. It was no secret that NHS Logistics, responsible for distributing products to hospitals, was due to be privatised, and that DHL/Novation was the preferred bidder. But it appears that the privatisation will go much wider than thought, to include much of the NHS Purchasing and Supply Agency as well. NHS Logistics employs 1,400 staff in five distribution centres, making an average of 1,200 deliveries a day to 10,000 destinations. Unison represents about 1,000 of its staff.
Source
Californian health care "Summit"
Schwarzenegger listens to proposals
Gov. Arnold Schwarzenegger hasn't come up with a concrete plan to help Californians contend with spiraling health care costs. He says he'll unveil one next year if he's re-elected. To date, his position on health care largely has been defined by his opposition to ideas that impose new costs on businesses and government. But to demonstrate that the issue is important to him, Schwarzenegger on Monday sat for four hours in a room with about 200 experts on health care and health costs, including union heads, CEOs of big businesses, directors of health-insurance companies and consumer advocates.
The event -- pointedly called a summit on health care affordability, rather than coverage -- underscored the largest division between two sides in the debate: those who believe the solution is to expand the number of people, especially the working poor, who have health insurance and those who believe the answer is to cut costs by making health care more efficient and requiring consumers to pay more up front to discourage them from using health services if they don't really need them.
Though he hasn't explicitly outlined his position, the Republican governor suggested Monday that he falls more into the second category. At the end of the four-hour session, he said he was particularly struck by the market-based solutions, such as technological innovation and "patient responsibility" that some of the speakers advocated. "We all have the same goal, which is to make health care affordable, accessible and make it more efficient," he said.
Schwarzenegger has also made it clear that he opposes a Democratic measure in the Legislature, Senate Bill 840, that would insure all Californians through a "single-payer" system operated by the state, calling it a "tax increase."
The governor said he called Monday's meeting as a first step toward formulating a plan for solving the health care crisis in a state where insurance premiums are up 55 percent in the past five years and 20 percent of residents -- nearly 7 million people -- are uninsured.
His political opponents called it an election-year ploy. Schwarzenegger's Democratic challenger in the general election, state Treasurer Phil Angelides, followed the governor to UCLA to hold a health care summit of his own. And about two dozen members of the California Nurses Association picketed Schwarzenegger's event, saying his policies were unfriendly to consumers. "What he's talking about when he talks about universal health care is all the health care an individual can afford," said CNA President Rose Ann DeMoro, whose organization has not yet endorsed a candidate in the gubernatorial race. "There's no drug company or insurer that this governor doesn't love."
To date, the governor has blocked health care solutions that would require both private industry and government to pick up the costs. He vetoed a Democratic bill that would have expanded public health insurance programs so all children in the state would be insured. He supported the repeal of Senate Bill 2, a state law requiring all large businesses to provide coverage to their workers.
Until last week, when he changed his stance, he opposed using the state's purchasing power to financially punish drug companies that did not discount their products for the uninsured. Acting on a request from hospitals concerned about the financial impact, the governor tried to overturn a requirement that hospitals have one nurse on duty for every five patients. The nurses stymied that effort in court.
Schwarzenegger's event included participants from all ends of the political spectrum, including Safeway CEO Steve Burd and Andy Stern, national president of the Service Employees International Union. But Democratic Mayors Gavin Newsom of San Francisco and Antonio Villaraigosa of Los Angeles, who were invited, did not attend. Nonetheless, the governor said the solution must be bipartisan.
One of the featured speakers was Timothy Murphy, the head of the Office of Health and Human Services in Massachusetts, where Democrats and Republicans just enacted a universal health insurance program for all residents that expands government coverage for the poor, requires citizens to pay for coverage if they can afford it and works to bring down the price of health insurance for individual buyers who can't get it through their jobs. The key to getting it done was blending many approaches, Murphy said. "You need to be able to compromise and trade," he said.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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27 July 2006
COME TO THE NHS FOR SUPERBUGS, NOT SUPERDRUGS
More than 50,000 patients contracted one of the most serious hospital superbugs last year, a rise of more than 17 per cent on 2004, latest health figures reveal. Experts from the Health Protection Agency, the public health watchdog, gave warning yesterday of increasing numbers of Clostridium difficile cases, including rarer infections in patients under the age of 65. The HPA statistics, which showed annual totals of 51,690 cases for C. difficile and 7,087 for MRSA, followed the release of a damning report into superbug outbreaks at one hospital where 65 patients died. The Healthcare Commission, the Government's health inspectorate, said that a culture of poor hygiene and serious inaction by senior managers at Stoke Mandeville Hospital in Buckinghamshire was to blame for many of the deaths.
The commission revealed that a total of 33 people died as a result of two separate outbreaks of C. difficile at the hospital in the past three years. The deaths of a further eight people could also be traced to C. difficile, while complications linked to the bug claimed a further 24 lives. The report detailed a catalogue of serious hygiene offences, including faeces on bed rails, patients' clothes kept on the floor, soiled commodes and a shortage of nurses. The HPA's statistics offered further evidence of the failure of hospitals to address the problem of superbugs, most of which affect the elderly.
Peter Borriello, director of the HPA's centre for infections, said that the 17.2 per cent rise in C. difficile cases could be attributed both to an increased number of cases and improved reporting. He added that more instances could well occur if stronger action was not taken. In the past year 60 per cent of all trusts reported an increase in C. difficile cases. The data revealed a more positive picture for methicillin-resistant Staphylococcus aureus (MRSA), with the number of cases down slightly from 7,233 in 2004-05. However, it fell far short of government targets for a 50 per cent cut by 2008.
Significant decreases were seen in London, previously the worst-affected region, and Yorkshire and Humberside, but there was a slight increase in the North West. The figures also showed that 25 per cent of patients with MRSA had the disease on admission to hospital, 8 per cent of cases were in renal patients and 15 per cent were diagnosed while in intensive or high-dependency care. While older people are particularly at risk from C. difficile, the figures showed a rise among younger age groups. A quarter of all cases occurred in those aged under 65.
Almost 30 per cent of the samples in 2005 were caused by a particularly virulent strain of the bug, known as type 027, which has been associated with several serious outbreaks, including those at Stoke Mandeville Hospital. In 2004 there were 2,247 deaths in which C. difficile was the underlying cause mentioned on death certificates in England and Wales and a further 1,168 deaths in which MRSA was mentioned, according to the Office for National Statistics. Andy Burnham, the Health Minister, said that new powers meant that "improvement notices" could now be served on trusts that still failed to follow government guidelines on hospital infections.
Source
Australia: A view from close-up of a dysfunctional government health system
For many years I have been working as an emergency nurse at a busy Brisbane hospital. My first few years in emergency nursing were so rewarding. Every day I felt like the team I worked with was not only saving lives but also changing lives for the better. But soon the excitement wore off and the reality hit me of what was happening to the Queensland Health system. For years I have watched staff struggle to even keep their practice safe due to the conditions that we are enduring day in and day out. I have seen first-hand what it's like in the public health system. Let me tell you it's not pretty.
It is a harsh truth that there is a growing demand on the system and the money injected into it is not sufficient. Those who pay the price are not the politicians who decide how much money to allocate to health, but rather the likes of your loved ones and friends. There is increasing pressure on emergency departments due to many reasons:
* People are presenting with ailments that GPs could fix, but there are not enough bulk-billing services or after-hours clinics.
* Increasing lack of skilled staff in areas such as emergency due to high numbers of trained staff who are leaving the field.
* An increasing population, therefore an increasing number of people presenting to emergency departments, which means an increase in the patient-to-staff ratio.
* Not enough operational hospital beds. Hospitals throughout Brisbane have wards that are fully stocked but are empty of patients because there is no funding for staff.
Patients are waiting in emergency departments for up to 24 hours to get a hospital bed. Do you understand the implications of this? I am often forced to choose which patient should come off a trolley so that a more critically ill patient can have a bed. Sometimes I cannot take anyone off a trolley. Sick patients are put in chairs because there are simply not enough resources. I have watched patients have cardiac arrests on ambulance trolleys in the corridor while waiting for a bed in the emergency department. Ambulance officers can wait more than two hours to offload a patient at times.
I have seen nurses conduct cardiac tests on patients lying on the floor because there was absolutely no place to put this patient having a heart attack. Every day, patients wait far beyond their allocated triage time to receive medical treatment. As a triage nurse, it is terrifying to see someone with a potentially life-threatening condition wait up to three hours when they should be seen within 30 minutes.
The patients and their families become really angry about this and I don't blame them. Daily now I am verbally abused and so are my colleagues. It has become a frequent occurrence for an angry patient to threaten my life. I have seen the stress of working in this environment take its toll on many doctors and nurses, including me. Lots of excellent staff have left or are in the process of leaving because it seems the situation is only going to get worse.
Once we just had to deal and cope with the reality of what our jobs involved. Now we are not only trying to save lives, but also trying to do this within a system that is potentially killing our patients. I suggest to the state and federal governments that they send a representative to work a full 10 days straight with an emergency nurse - not just walk through an emergency department when you are campaigning. What true reality will that give you? It is obvious that you are not aware of the extremely dangerous conditions patients are being put in or I simply would not be writing this.
To the public I say, next time you feel like threatening a health professional, maybe instead you should consider voicing your anger in a letter to The Sunday Mail. It is time for you to speak up for your rights before someone you love is hurt by the public health system this State Government has created. I write this anonymously because I am bound to a contract with Queensland Health. A condition of my employment is that I don't disclose any information to the media or public regarding what happens within the hospital I work. So the sad truth is the public really have no idea what is happening behind closed doors - until it's happening to them.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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26 July 2006
BRITISH GOVERNMENT HOSPITAL DELIBERATELY STARVES AN AWARE ELDERLY PATIENT TO DEATH
They wouldn't even sit her up to give her a cup of tea. She died of thirst -- in a supposedly modern hospital, of all places!
A family who claimed their elderly mother endured a terrifying death after being deliberately starved by a hospital doctor put their case before a coroner yesterday. Norfolk and Norwich University Hospital allegedly decided that Olive Knockels, a former school matron who had suffered a stroke, would have no quality of life if she recovered. The case, in 2003, prompted renewed debate about guidelines giving doctors the power to let elderly patients starve. An inquest was told that Mrs Knockels, 91, died despite a court injunction forcing doctors to reinstate nutrition and hydration as well as antibiotics. They were also told to stop prescribing the powerful painkiller diamorphine without the written consent of the patient's daughter, Ivy West.
The order was made by Mr Justice Forbes in the High Court on October 6, 2003, after an application by Mrs Knockels' grandson, Christopher West. Four days earlier all food and fluid had been withdrawn. The next day, however, the order was varied by the judge when David Maisey, a consultant, telephoned him. In the amended order, of October 7, nutrition and hydration were to be reinstated only "so far as is medically possible". On October 8, Mrs Knockels, from Holt, Norfolk, died.
In a statement to William Armstrong, the coroner, Mrs West said her mother had begged her for something to eat and drink, or a cup of tea, but the request was refused by a nurse, on the doctor's orders. Her last days were spent with her false teeth and hearing aid removed from her bedside, in a cold hospital room. She was admitted on September 14, 2003, after a suspected stroke.After two weeks Dr Maisey allegedly told Mrs West that he was surprised her mother was still alive and said that if the family intervened, he would have them arrested. Mrs West said that on another visit her mother had looked terrified and had tried, unsuccessfully, to tell her something. Three days later she pleaded with her daughter: "Help. Help me please."
The family contacted SOS-NHS Patients in Danger, which has criticised deliberate dehydration and starvation and the inappropriate use of sedatives and diamorphine. Julia Quenzler, the founder of the organisation, advised the family of their legal rights and the High Court injunction followed. In a statement, Christopher West said: "I told Dr Maisey: `I wouldn't treat my dog like that', and he said it was easier for vets because they . . . can put animals to sleep."
When Mrs Knockels was admitted, she was given intravenous fluids but, ten days later, nurses found they could not gain access to a vein so it was decided fluids would be given by subcutaneous infusion. But, the inquest was told, on October 2, medical staff found fluid leaking and the removal of the equipment was ordered. Two attempts were said to have been made to insert a naso-gastric tube, but without success.
Dr Maisey told the coroner: "The prognosis was very poor. Mrs Knockels was almost certain to die . . . within the next few weeks. She was lying flat. To have put any food or liquid in her mouth would have led possibly to asphyxiation." The cause of death had been recorded as cerebral infarction, but Michael Jarmulowicz, a consultant histopathologist, told the coroner that death was due to a lack of food and fluid and that the cerebral infarction was the secondary cause of death.
Source
Politicians forced to over-rule irresponsible medical regulators
Doctors love their own. This is an update of a report posted previously on July 7, 2006
Premier Peter Beattie will consider changing the law to stop some convicted criminals from practising medicine in Queensland after the Medical Board this week re-registered a convicted rapist and known drug addict. Despite pleading guilty in 2002 to rape, attempted rape, deprivation of liberty and assault, James Samuel Manwaring is considered fit to practise medicine in Queensland. Manwaring is now listed as a registered doctor on the Medical Board's public access website.
He had a history of drug addiction while practising in Australia, the US and UK. After pleading guilty in 2002 to a vicious attack against his then wife, he was told by District Court judge Brian Hoath that nothing could 'excuse your involvement in these offences'. However, the Health Practitioner's Tribunal last July allowed him to immediately apply for re-registration after he had met a stipulation to submit hair for drug testing. The tribunal further imposed 24 conditions on his registration which would be strictly monitored. The conditions are listed on the board's public access inter-net register.
The Premier called for a report into the board's decision after revelations earlier this month that Manwaring was eligible for re-registration. He demanded that the board explain its position saying he was 'buggered if he knew' how Manwaring could qualify to practise again. Mr Beattie last night said he had received advice that legislation could be passed to 'prevent candidates from being registered or re-registered if they have been in-volved in specific criminal or other activities which affect their fitness to practice'. "I will now seek advice from the Health Practitioners Registration Board on the possible effects of such legislation," he said.
Manwaring's registration was listed on the board's website at the weekend, to the horror of his victim, Pat Gillespie. Ms Gillespie, a former journalist and public servant, has voluntarily identified herself as his victim. She said she was stunned to hear of the board's decision to re-gister Manwaring, given his his-tory of drug abuse and violent criminal convictions. She called on Mr Beattie to ensure Manwaring would never practise in Queensland again. "Someone has to warn the public what Manwaring is like," she said. "The medical board will not tell the public that he is a convicted drug addict, rapist and wife-basher."
The Medical Board yesterday defended Dr Manwaring's registration, saying it was forced to implement the tribunal's decision if he met eligibility criteria. [A lie. They have a power of discretion]
The above article appeared in the Queensland "Gold Coast Bulletin" (p. 9) on 19 July, 2006
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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25 July 2006
ABUSIVE NHS HOSPITAL
A hospital for people with learning disabilities, at the centre of an investigation into patient abuse, will close. The Cornwall Partnership NHS Trust, which runs Budock Hospital, near Falmouth, was criticised in a report for widespread institutional abuse of patients. The report, part of an inquiry by the Healthcare Commission and the Commission for Social Care Inspection (CSCI), was published this month, describing years of abusive practices, underlying problems that have never been addressed and the failure of senior trust executives to face up to concerns. It is understood that 14 people with learning disabilities at Budock Hospital will be relocated by December. The Cornwall Partnership Trust will also be handing over the care of nearly 170 people in 46 community homes. A spokesman for the trust confirmed that the hospital would close.
Several treatment centres and units for people with learning disabilities were investigated throughout 2005 after allegations of abuse first surfaced in October 2004. Government inspectors found evidence of 64 incidents of abuse over the five years to last October, including staff hitting, pushing and dragging people in their care. There were also reports of staff withholding food, forcing patients to take cold showers and relying too much on medication to control behaviour. Staff also restrained people illegally. The investigation team found that one person spent 16 hours a day tied to their bed or wheelchair, with staff wrongly believing it was for the patients own protection. The report also revealed that one person suffered multiple injuries over time, including a fractured skull.
During the investigation 40 people with learning disabilities were referred by a CSCI and the Healthcare Commission to Cornwall County Council under the procedure for the protection of vulnerable adults. A few weeks after the East Cornwall branch of the charity Mencap first raised concerns, seven staff were suspended by the trust, five of whom have since been dismissed. Patricia Hewitt, the Health Secretary, has announced an audit of all services in England for people with learning disabilities who are in NHS or private-sector care.
Source
Another killer doctor in a Queensland public hospital
Officials at one of Queensland's top hospitals approached the family of a dead patient to offer an out-of-court settlement after discovering that her surgeon -- a respected professor of medicine -- had a questionable safety record. Nardia Annette Cvitic, a 31-year-old mother of two, died from massive blood loss and organ failure after a hysterectomy performed by Bruce Ward at the Mater Hospital in 2002. A coronial inquest has heard that the operating theatre after Cvitic's operation resembled the scene of the Granville train disaster in NSW in the 1970s. A drain inserted into her pelvic area apparently punctured a major vein, a mistake compounded by Dr Ward wrongly prescribing a blood-thinning agent.
Documents obtained by The Australian show that guardians for Cvitic's two sons were approached by Mater officials in early 2003 and encouraged to make a medical negligence claim for "loss of dependency". The Mater had earlier commissioned a surgical audit from two professors who examined Dr Ward's treatment of 10 patients, including Cvitic, and warned "something is radically wrong and it cannot continue". Russell Strong and Alex Crandon identified problems with Dr Ward's surgical techniques, communication skills, post-operative care and judgment.
After being urged to pursue a claim, lawyers for Cvitic's family entered negotiations with Dr Ward's three employers -- the Mater, the Queensland Government and the University of Queensland -- and sought medical and psychiatric opinions on the impact Cvitic's death had on her two young sons. But it was not until Deputy State Coroner Christine Clements began public hearings in March this year that the claim was accelerated, with a mediation hearing in April setting out the proposed settlement amounts.
District Court judge Helen O'Sullivan approved the settlement last week, a legal requirement given the age of the beneficiaries. Cvitic's youngest son, a 10-year-old diagnosed after his mother's death with Asperger's syndrome, will have $115,000 held in trust, while her eldest son, 16, will have $60,000 held in trust. Dr Ward's employers will pay legal and administration costs, but the figures represent only what Cvitic would have provided for her children had she not died, and do not cover damages or compensation, even though dependency claims are usually an acknowledgement of negligence.
Ms Clements -- who will decide whether Dr Ward should face manslaughter or criminal negligence charges over Cvitic's death -- has yet to set a date for the resumption of public hearings in the inquest. Dr Ward's lawyers could not be contacted last night, nor could members of Cvitic's family. Dr Ward was a professor at the University of Queensland for 10 years but left in 2003. While the Medical Board of Queensland has maintained his registration, he has lost the right to operate at the Mater and other public hospitals, but is understood to still work at Brisbane's Sunnybank Private Hospital.
Australian Lawyers Alliance state president-elect Ian Brown said dependency claims were capped by the state Government. "Dependency claims, just like all others, are governed by the unfair restrictions of the liability reforms," Mr Brown said.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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24 July 2006
COME TO THE NHS FOR NEEDLESS SURGERY
Hard to get needed surgery but easy to get unnecessary surgery -- Just another government bureaucracy doing the sort of thing that government bureaucracies do
Patients with ailments that could be cured by drugs are instead undergoing unnecessary and painful surgery simply because of where they live, according to Englands Chief Medical Officer. Professor Sir Liam Donaldson said that by scrapping operations such as hysterectomies and tonsil removal the NHS could save billions of pounds a year. His annual report, which was released yesterday, calls for urgent action to reduce the wide variations in care experienced across the country and urged the National Institute for Health and Clinical Excellence to issue guidelines on which treatments doctors should stop prescribing.
Sir Liam said that tonsillectomies and hysterectomies were still regularly performed despite guidelines recommending treatment through drugs. He said that children from low-income areas were more likely to have their tonsils removed, but if the tonsillectomy rate in low-income areas matched that of higher-income ones, about 8,000 operations could be avoided every year, saving about 6 million pounds.
Doctors performed about 38,000 hysterectomies in 2004-05. However, there were fewer operations in north central London than in Northumberland and Tyne and Wear. In my view, this level of variation in clinical practice is not acceptable, Sir Liam said. If the average rate of hysterectomy in England could be reduced to that achieved in the 20 per cent of the country with the lowest current rates, then 5,900 operations, costing 15 million pounds, could be avoided per annum.
Sir Liams report also highlighted the wide variations in the treatment of coronary heart disease. In some parts of the country, heart attack patients who needed revascuralisation a procedure that improves blood flow to the heart were twice as likely to be offered less intrusive but just as effective operations as those in other areas. Another example of waste was the 574 different hip joints the NHS used. He said that these could be reduced significantly.
Sir Liam proposed a system of incentives and penalties to encourage doctors to prescribe appropriate treatments. He said that computers in hospitals and GP surgeries could be programmed to block a doctor from prescribing a treatment that had little or no evidence of its worth. The NHS could also learn a great deal from the aviation industry and adopt standard operating procedures. This would not only encourage equitable care but also help to ensure better patient safety, Sir Liam said. Inappropriate variation may be a function of poor knowledge, the flawed application of the correct knowledge, a lack of resources or the inappropriate al of extant resources, he said.
More here
'Third World' health care in Queensland government hospitals
The report below gives you an idea of why nearly half of all Australians go to Australia's superb private hospitals instead
Hospital patients are waiting on trolleys, in chairs and even on the floor for up to 24 hours before a bed is available at a Brisbane emergency department. Staff at the Royal Brisbane and Women's Hospital are struggling with 30 per cent more patients to treat than they have beds for. They have told the Australian Medical Association that all 950 beds are full and capacity is overflowing. AMA president Dr Zelle Hodge said hospitals needed to operate at no more than 85 per cent capacity in order to be safe and to cope. "By operating at 130 per cent capacity, the Royal Brisbane Hospital is making conditions unsafe for patients and pushing staff beyond their limits," she said. "This is distressing for patients and their families, and is not the treatment they should be subjected to. "There are a lot of better ways the Government could spend taxpayers' money rather than advertising."
A nurse at one Brisbane hospital, who did not want to be named for fear of losing her job, said emergency patients were being put in extreme danger. "I have watched patients have cardiac arrests on ambulance trolleys in the corridor while waiting for a bed in the emergency department," she said. "Everyday patients wait far beyond their allocated time to receive treatment."
Government targets say treatment should be given within 30 minutes but a Federal Government annual report published this month shows that in 2004-05, Queensland emergency departments treated just 58 per cent of emergency patients within the recommended time. This month the Beattie Government boasted of more hospital beds and shorter waiting times in a glossy brochure "Keeping Our Promise" mailed at a cost of more than $300,000. Between December 2005 and May this year, the Government spent almost $2 million of taxpayers' money to reassure people about the health system is meeting their needs.
In contrast, Queensland Health reports released in April show patients are also waiting longer than the clinically desirable time for scheduled operations. Many who require urgent surgery are waiting up to a year, despite guidelines saying the operation should be carried out in 30 days.
Opposition health spokesman Dr Bruce Flegg said the Government must stop wasting money on publicity. "Clearly the situation with emergency departments has not improved, and no amount of spin and glossy brochures is going to make any difference," he said. Health Minister Stephen Robertson denied the occupancy rate at the Royal Brisbane had ever reached 130 per cent. He said the Government was investing $280.3 million into emergency departments over five years, and would increase the number of beds across the state by 860 over three years.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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23 July 2006
YOUR REGULATORS WILL PROTECT YOU
At least 1.5 million Americans are sickened, injured or killed each year by errors in prescribing, dispensing and taking medications, the influential Institute of Medicine concluded in a major report released yesterday. Mistakes in giving drugs are so prevalent in hospitals that, on average, a patient will be subjected to a medication error each day he or she occupies a hospital bed, the report by a panel of experts said.
Following up on its influential 2000 report on medical errors of all kinds, the institute, a branch of the National Academies, undertook the most extensive study ever of medication errors in response to a request made by Congress in 2003 when it passed the Medicare Modernization Act. The report found errors to be not only harmful and widespread, but very costly as well. The extra expense of treating drug-related injuries occurring in hospitals alone was estimated conservatively to be $3.5 billion a year. "Even I was surprised and shocked by how common and serious a problem this is," said panel member Albert Wu, a drug safety specialist at Johns Hopkins University. "Everyone in the health-care system has to wake up and take this more seriously."
Many of these medication errors could be avoided if doctors adopted electronic prescribing, if hospitals had a standardized bar-code system for checking and dispensing drugs, and if patients made more of an effort to know about the risks of the drugs they take, the report said.
The panel members said the problem requires immediate action and that many key players in health care have been slow to take the steps -- and invest the money -- needed to significantly reduce medication errors. At least a quarter of the injuries caused by drug errors are clearly preventable, the report said. "Everyone in the health-care system knows this is a major problem, but there's been very little action, and it's generally remained on the back burner," panel member Charles B. Inlander said in an interview. "With this report, we hope to give everyone involved good, hard information on how they can prevent medication errors, and then create some pressure to have them implement it."
Common errors include doctors writing pre ions that could interact dangerously with other drugs a patient is taking, nurses putting the wrong medication -- or the wrong dose -- in an intravenous drip and pharmacists dispensing 100-milligram pills rather than the prescribed 50-milligram dose. The report spotlighted the case of Betsy Lehman, a 39-year-old health reporter for the Boston Globe who died in 1994 after being given an erroneously high dosage of an experimental chemotherapy agent.
The study, funded by the Centers for Medicare and Medicaid Services, was assembled by 17 experts in related fields who analyzed research in the field, as well as government reports and data. They also held public forums to hear from representatives from the health-care system. Panel co-chair J. Lyle Bootman, of the College of Pharmacy of the University of Arizona in Tucson, said there is enough research and data on medication errors to conclude that there is a major problem, but not enough to fully understand and address the issue. He said the nation should spend $100 million a year to research drug errors, especially among pediatric and psychiatric patients and in long-term care facilities, where medications are heavily used.
The report looks to new technologies in addition to electronic prescribing to dramatically reduce the number of medication errors. Hospitals, for instance, could greatly benefit by having a standardized bar-code system to ensure that a patient gets the correct medicine, it says. But drug companies and vendors have created six distinct systems requiring different bar-code readers, the report said, making them a far less useful safety tool for hospitals.
The report did not address whether some drugs should be pulled from the market because of their intrinsic risks or whether the Food and Drug Administration does an adequate job of ensuring that approved drugs are safe for general use. That is the subject of another institute study expected to be released soon. But the panel members made clear that they believe the pharmaceutical industry and the FDA have not done enough to make drug information accessible to consumers and to make drug packaging as error-proof as it could be. The report said, for instance, that many medications would be better dispensed in blister packs that make it easier to identify them and for consumers to remember whether they have taken that day's dosage. It also said too many drugs have similar names that are easy to confuse.
In a statement, the FDA embraced the report and said it "provides a much needed perspective on the frequency, severity and preventable nature of medication errors." It said the recommendations "are supported by efforts already underway at FDA in the areas of medication error prevention, patient education and label comprehension."
The report endorsed much wider use of electronic prescribing. Inlander, president of the People's Medical Society, a Pennsylvania consumer health advocacy group, said chain pharmacies have been "ahead of the pack" in adopting such prescribing. The report said that all health-care providers should have plans in place by 2008 to move to electronic prescribing and dispensing, and that doctors should give up their traditional pre ion pads by 2010.
Cecil B. Wilson, board chairman of the American Medical Association, also voiced support for "e-prescribing" and other information technology, but he said that "physicians face a dizzying array of choices when trying to purchase [the technology], while struggling with high costs, interoperability and ease of use." Michael C. Tooke, chief medical officer of the Delmarva Foundation, which works on health-care quality in more than 30 states, said e-prescribing will bring a needed end to deciphering physicians' illegible handwriting but cannot guarantee that a drug order is typed correctly. "E-prescribing is just going to allow us to make different errors and faster," he said. "It never just boils down to one thing."
The report's most striking findings concerned hospitals and long-term care facilities, which it said generally do not report errors to patients or family members unless they result in injury or death. The panel said all health-care organizations should report medication errors to patients, whether or not they cause harm. Based on past studies, the panel estimated that drug errors cause at least 400,000 preventable injuries and deaths in hospitals each year, more than 800,000 in nursing homes and facilities for the elderly, and 530,000 among Medicare recipients treated in outpatient clinics. The report said the actual numbers are probably much higher.
Locally, more than four dozen Maryland hospitals take part in comprehensive annual surveys of their safety measures, including procedures for averting medication mistakes. Frederick Memorial Hospital has a particularly active medication safety program, which includes a computerized system to "reconcile" medications at numerous steps in a patient's stay. The system has helped to quickly catch problems, including the omission of needed drugs, which clinical nurse specialist Susan Archer said "can make all the difference."
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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22 July 2006
S.F. OKs Universal Health Plan
San Francisco moved closer Tuesday to becoming the nation's first city to provide health care coverage for all its residents. The city's Board of Supervisors unanimously approved a plan that would give adults access to medical services regardless of immigration or employment status. The plan's estimated cost is $200 million a year.
Financed by local government, mandatory contributions from employers and income-adjusted premiums, the universal care plan would cover the cost of everything from checkups, pre ion drugs and X-rays to ambulance rides, blood tests and operations. Unlike health insurance, it would not pay for services obtained outside San Francisco. Participants would have to receive care at existing clinics and public hospitals and from doctors who already participate in an HMO for low- and middle-income clients.
The Board of Supervisors must vote on the plan, which has been strongly opposed by the business community, once more for it to become final. Businesses with more than 50 employees would have to start participating next July, while smaller enterprises would begin in April 2008.
Source
U.K.: FOOLISH MEDICALIZATION OF FOOLISH BEHAVIOUR
By Theodore Dalrymple
There are many heroin addicts in prison. Most of them, for obvious reasons, say something like: I would give up the heroin, if only I got the help. This implies, of course, that there exists a technical means by which the behaviour of addicts can be changed, so that no further effort at abstinence will be necessary on their part. The addict sees himself as a person who is ill, like someone with pneumonia, whom it is the duty of the system the paraphernalia of doctors, nurses, social workers, drug counsellors and so forth to cure. Until such time as the system fulfils its duty, the addict can continue in his habit, secure in the knowledge that he is not to blame, but the system that has failed to cure him.
This is a point of view that the Government has accepted in its entirety, indeed welcomed with a song in its heart; for does it not represent a job creation opportunity? The Government believes, or affects to believe, that the connection between crime and heroin addiction is a simple one: namely, that addicts rob, steal and burgle in order to pay for the heroin without which they will suffer the most terrible withdrawal symptoms. This is nonsense.
Actually, addiction to opiates is not incompatible with work. The great anti-slavery campaigner William Wilberforce took a tincture of opium every day of his very productive life. In the United States in the 1930s, it was found that the majority of injecting morphine addicts still worked, despite their problems with supply.
The criminal records of most addicts who end up in prison are extensive before they ever took up heroin indeed, a few of them claim to have first taken heroin in prison. In the 1950s, it was found that at least three quarters of the still very small number of heroin addicts in Britain (the numbers of such addicts having increased by between 2,500 and 6,000 times since then to between 150,000 and 300,000) had criminal records before they ever took heroin. In other words, in so far as there is a causative connection between addiction and criminality, it is that criminality or whatever predisposes people to it causes addiction and not addiction that causes criminality.
This is borne out not only by the statistics, but by the biography of one of the most famous addicts of recent times, William Burroughs. Burroughs was born into a well-to-do family in St Louis, and from an early age found criminality alluring, at the age of 12 being much influenced by reading the memoirs of a violent criminal called Jack Black. After Harvard, but before he addicted himself to heroin, Burroughs spent some time robbing down-and-out drunks on the New York subway, which is not a sign of a refined moral sensibility, to say the least. (He later disembarrassed himself of his wife by shooting her dead while they were in Mexico, and though he generally disdained his own bourgeois background, he had no hesitation in using family money to bribe himself free.)
It is true that addicts who are prescribed methadone as replacement for their heroin commit fewer burglaries and other crimes than they did before they were prescribed it, I suspect largely because methadone is more consistently sedating than heroin. But it is not true that they become law-abiding citizens after taking methadone: in one series, addicts given methadone committed (on self-report) three acquisitive crimes a month, not exactly a sign of irreproachable uprightness.
Nor is it true that addicts can give up if, but only if, they receive the help they claim they want. Huge numbers of American servicemen addicted themselves to heroin during the Vietnam war. Almost all of them gave up spontaneously soon after their return to the US, and two years later their rate of addiction was no higher than that among drafted con s who never made it to Vietnam because the war ended.
Moreover, Mao Zedong managed to cure 20 million opium addicts by his usual rather uncompromising methods. It wouldnt have made sense for Mao to have threatened retribution for people who contracted, say, appendicitis or cancer of the bowel, in the hope of reducing the incidence of those conditions: this suggests that addiction to opiates is a pretend illness and treatment is pretend treatment.
It is not true that heroin addicts take a couple of doses and then find themselves enslaved. On the contrary, addicts usually spend a year or so taking heroin intermittently before they decide to take it regularly. It would be truer to say that they hook heroin, than that (as they usually put it, in order to deny their own responsibility) they are hooked by heroin. It is simply implausible to suggest that addicts become addicted by inadvertence or ignorance: the vast majority of the addicted come from backgrounds in which ignorance of history and arithmetic is perfectly possible, but not ignorance of the heroin way of life.
Is any great harm done by pretending that opiate addiction is a disease like any other? After all, a portion of mankind will always resort to mind- altering drugs to obscure the existential problems that confront us all. Certainly methadone when prescribed carelessly as it is in Britain is a dangerous drug, and can cause nearly as many deaths as heroin itself.
There is a more intangible harm, however, to the pretence: the existence of drug clinics sends a message to addicts that they are ill and in need of treatment rather than they have chosen a disastrous path in life. It conceals from people their responsibility for their own lives, a responsibility we all find irksome at times, but acceptance of which is the only basis of a meaningful life.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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21 July 2006
Deadly government medicine in the Australian State of Victoria
Here is a frightening statistic that should focus the mind. On some estimates, 3500 people have died unnecessarily in Victoria since the Bracks Government was elected. Think that through. What if the road toll had suddenly surged by so many? There would be public fury. What if the murder rate had leapt by 500 a year or terrorists were picking off Victorians at about ten a week? What if poor regulation of hygiene in the food industry was killing two people each working day? The pressure to fix it would be massive. If any other collection of problems was allowing so many people to die unnecessarily there would be public outrage and the full community focus would be on analyzing and solving the problem. So why are these lives different?
They are all people with families, and they are all equally dead. Why accept this? These people haven't died behind the wheel or at the wrong end of a gun, the accusation is that they have died because Victoria's health system is not working well enough. That much now seems beyond dispute, although the awful statistics have been sharpened by a passionate doctor who represents medical staff in public hospitals. Dr. Peter Lazzari is chair of the chairs of medical staff in the hospitals and himself a senior physician. His concern has provoked a flair for dramatic language that has been overly harsh but aimed to seize attention and did.
He has accused Steve Bracks of behaving like an undertaker and claimed the Australian Medical Association has abandoned patients: ``I officially declare a state of war, ``he said. ``The beds are bursting and the Government is architect of genocide against innocent Victorians.'' That is the ridiculous language of intense frustration. But the government has not directly disputed his figures, and admits much needs to be done. The argument now is about how to do it, and that is why Dr. Lazzari is right to try to shock the public out of its apathy and acceptance.
He says there are 500 deaths each year on waiting lists, 250 of which are avoidable. The government's own figures, revealed under Freedom of Information laws, show this could be a realistic assessment. He further claims that overcrowded hospitals cause another 250 unnecessary deaths each year. Again, government figures show hospitals are short 550 beds, and although Dr. Lazzari cannot prove overcrowding kills 250, it is reasonable to assume that as a representative of doctors in the system he has a fair idea what is going on.
Of course the government does not want such death. It has worked hard to improve the system, but now in the face of such an appalling statistic it is defensive and secretive because it knows health is a dangerous political issue. Much of what official information is available has been dragged out through FOI laws. Now, rather than encouraging an all-in debate that might throw up ideas and save lives the government prefers chanting politically targeted statistics designed to confuse.
The acting Health Minister Gavin Jennings finally recognized reality, admitting that the government had to take responsibility for the 500 deaths and for ``continued suffering'' on waiting lists. But the minister's spokesman offered this: ``The Government is proud of its record in health. This year Victorian hospitals will treat around 300,000 more people than they did when the government was elected. We have employed 6035 extra nurses and 1365 extra doctors.'' Perhaps that is true, but it is little consolation to the families of the 500 dead who need not be dead. Quoting staff numbers and dollars spent only proves the depth of the problem, because it is still not fixed. What is urgently needed in this are facts, ideas, and less political spin.
The Government needs to put aside political sensitivity and the State Opposition needs to allow them the breathing space to do it. Accurate and detailed figures on waiting lists and bed shortages need to be released, not dragged out through FOI. For example, we need to know how many patients on the lists are being reclassified as their health worsens. We need to know whether official waiting lists include those waiting to see a specialist and if not how many are waiting. We need to know how many patients wait so long they are deemed unfit for surgery by the time their case is at the front of the queue. And we need to know whether Dr. Lazzari is right and how many died because they waited too long. Doctors, God bless them, would throw endless billions of dollars at the system because all they want to do is help people.
The country does not have endless billions of dollars to spend so instead we need co-operation, consultation, openness and ideas. Perhaps hospitals can work smarter, not leaner. Perhaps medical staff can be freed from bureaucratic duties so they can concentrate on medicine ahead of bean-counting.
Perhaps waiting lists can be better managed. Perhaps there are ideas that would allow specialists to see more patients. Perhaps we should ask why this country tolerates the expensive and ridiculous duplication of the system through state and federal bureaucracies that sit around getting fatter while frail people can't get a bed. It is unlikely there is a person working inside the health system without a view on how to make it better. Victoria must end the defensiveness and listen. The politicians must put aside point scoring and construct a bi-partisan think tank to chase solutions.
There will never be a zero avoidable death rate, just as the roads will always kill some people. But if the united community focus that has built around the road toll can be applied to hospitals, lives will be saved. Once, 1034 deaths on the roads were considered inevitable. Now that is unthinkable. Five hundred unnecessary deaths in the hospital system must today be considered equally atrocious.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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20 July 2006
NHS HOSPITALS DISCOVER PATIENT SAFETY
Every mental health trust in the country is to be instructed to review its approach to patients safety after the publication of a report describing alleged rapes, sexual assaults and sexual harassment. Officials have been aware of the report for more than eight months, but published it only yesterday a week after The Times revealed its contents. They said that a separate inquiry had been started into the most serious alleged incidents, which include 11 reports of rapes by NHS staff. Ministers have faced a barrage of criticism this week for failing to act on the information: no safety alert or progress report was issued, which health campaigners and politicians describe as gross neglect.
The report, With Safety in Mind: Mental Health Services and Patient Safety, describes 122 serious incidents within two years. As well as the 19 rape cases revealed by The Times, there were 20 reported incidents of consensual sex, 13 of exposure, 18 of sexual advance and 26 of touching. Of the nineteen reported rapes, eight were allegedly carried out by a fellow patient and eleven by a member of staff. The report, compiled by the National Patient Safety Agency, acknowledges the likelihood of underreporting of incidents. It also calls for a new definition of harm in incident reports to include psychological trauma.
Responding to the publication yesterday, Louis Appleby, the National Director for Mental Health, said that he had started an inquiry into the most serious allegations and that every mental health trust would be asked to review procedures to protect patients. Although the vast majority of NHS patients receive safe and effective care, any incident where the safety of a patient is compromised is one incident too many, Professor Appleby said. We must investigate and learn from all these incidents.
The report brings into question the Governments claim to have set up single-sex wards that are safe and ensure personal dignity across the health service. The pledge, made by Tony Blair when in Opposition in 1996, has been fulfilled in 99 per cent of mental health settings, the Government says.
The patient safety agency analysis covers almost 45,000 incidents reported by staff between November 2003 and September 2005. Most of the incidents relating to the 84 mental health trusts took place in the 12 months to last October.
Paul Farmer, chief executive of Mind, the mental health charity, described the report as shocking and called for an urgent audit of single-sex wards. People who are extremely vulnerable should be treated with the best care and attention, not subjected to abuse, he said. Andrew McCulloch, chief executive of the Mental Health Foundation, suspected that the levels of violence and abuse described in the report were the tip of the iceberg. It is scandalous that such abuse is allowed to take place. If a woman went into hospital for a heart operation and was raped during her stay, it would be a national scandal. But women who are raped while in mental health services are simply not believed.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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19 July 2006
INAPPROPRIATE NHS HOSPITALS
Billions of pounds are being spent on hospitals for the NHS that will not be suitable for the planned new patterns of care. A new report claims that the NHS could be left with white elephants huge hospitals that will take 30 years to pay off, when the future of healthcare lies with smaller, more flexible units closer to where people live. The report says that awareness of this in the Department of Health has brought capital investment of all kinds to a shuddering halt just as new policies are changing the ways in which care will be delivered. Opportunities for investing in appropriate new buildings are likely to be missed as the system lurches into the stop part of a stop-go cycle.
The report, whose lead author is Professor Nick Bosanquet, of Imperial College, is published by Reform, the market-oriented think-tank that was the first to predict the NHS funding crisis and the need to cut jobs. Reform backs the Governments health initiatives, such as payment by results, patient choice and the White Paper Our Health, Our Care, Our Say, which seeks to move more care away from hospitals and into primary care, but its report, Investment in the NHS, gives warning that the NHS has spent the past decade building over-large and expensive units and now faces a freeze on the kind of investment that can lead to service improvement.
The evidence that investment has stopped comes from the NHS accounts, which show that there was an underspend of 1.2 billion last year on the capital account, double the level of 2004-05. The report predicts that the current financial year will also show a large underspend. The first large NHS acute hospital to have a self-contained single room for every patient is being planned, with managers predicting a reduced incidence of MRSA, speedier recoveries and cost savings. Pembury Hospital, in Kent, will be demolished and rebuilt for 330 million pounds.
Source
INDIAN UPDATE
I mentioned a month ago that Blue Ridge were considering this. It seems they have now gone ahead. Sad when health costs could send a business broke
Don't look now, but that operation you've been putting off may be outsourced - to India. American companies are encouraging workers to travel to India and other countries for costly medical procedures, Business Insurance magazine reports. "It saves you literally tens of thousands of dollars," said Bonnie Blackley, benefits director at Canton, N.C.-based Blue Ridge Paper Products. A heart valve replacement, for example, that runs between $68,000 and $198,000 in the United States costs only $18,000 in India.
Blackley said that although her company's survival depended on keeping medical costs in check, local health care providers "offered no extra discount or anything." So she contracted with IndUShealth, a "medical tourism" company that specializes in arranging employee travel to accredited hospitals and board-certified physicians in India.
Because of lower labor costs, India, Thailand, Singapore, Mexico and Costa Rica could pose some stiff competition for U.S. medical providers. "We've globalized every other industry. Why not health care?" said Ted Nussbaum, director of North American health care consulting at Watson Wyatt Worldwide in Stamford, Conn.
But Chuck Kelley, medical director at Outrigger Enterprises Inc. in Honolulu, told the magazine it will be hard to persuade employees to travel abroad for medical care. "Health care treatment is a very personal issue for Americans, and when they are sick, they want to be close to their family and in the care of providers they know and trust - even if they are not the best," Kelley said. "They will settle for inferior and more expensive treatment to be home."
Companies like Blue Ridge plan to give their employees a financial incentive to go abroad by offering to cover them and their dependents for any out-of-pocket costs.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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18 July 2006
Australian prisoners lap up $70 million worth of medical perks
And that's just in the State of New South Wales
Inmates are undergoing plastic surgery, hormone therapy and erection dysfunction procedures as taxpayers fund an expanding prison health system costing nearly $70 million-a-year. An investigation by The Daily Telegraph has revealed inmates are getting premium medical care that has featured 256 elective surgery operations over the past two years, including a series of bizarre optional procedures. The erectile dysfunction surgery was required to stop a young inmate feeling pain during erections - despite sex being officially banned inside New South Wales prisons.
Other procedures since 2004 revealed in official Justice Health documents include five cases of plastic surgery, a male circumcision, a tubal ligation, a tonsillectomy, a facial lesion removal and two hip replacements. Seven procedures involved removal of ingrown toenails with one on March 14 this year including "trimming of other toenails". The inventory of elective surgery procedures, obtained under Freedom of Information, even included a caesarian birth five days before Christmas last year. Six natural births also took place and six inmates are receiving hormone therapy. About 1120 are receiving methadone.
Taxpayers spent $69.15 million last year funding Justice Health, an 80 per cent increase on the $38.26 million in 2001. The bill does not cover the costs of surgery and clinical procedures in public hospitals. These are picked up by NSW Health and not covered by Medicare.
The runaway prison medical bill will add to concerns the Iemma Government has gone soft in its management of the state's jails. Last week The Daily Telegraph reported the Government had returned a television set and sandwich maker to serial killer Ivan Milat, despite an outcry from victims' families. The Government was also embarrassed last month by revelations that a gang rapist with cancer had his sperm frozen before undergoing chemotherapy so he could have children on his release.
A spokesman for the the prison officers division of the Public Service Association said he believed inmates got better health care than the rest of the community. "These guys in jail see the nurse for anything and if they need to see a specialist they are referred straight away. Somebody else organises it all for them. They don't have to do a thing," the spokesman said. "Even if they get a pimple on their backside they get themselves down to hospital to get it lanced."
Nurse numbers alone have surged over the past five years, from 142 to 506, equal to one nurse for every 20 prisoners. Martha Jabour, of the Homicide Victims Support Group, said it was disturbing prisoners were getting access to elective surgery for procedures such as erection dysfunction.
Justice Health chief Dr Richard Matthews vigorously defended the care offered to inmates. He denied they jumped waiting list queues that all other patients faced. Dr Matthews said the Justice Health's budget had increased in line with the prison population. But he said inmates should not get inferior care as "punishment". "Our view is that these folks are our patients. We have no interest in their offences, in fact we prefer not to know," said Dr Matthews.
Source
Australia: More of the usual high standards in a government hospital
An expectant mother was forced to wait more than half an hour in the delivery room of Caboolture Hospital while medical staff searched for a clean set of forceps. Now the woman must be tested for hepatitis C because the forceps, when they were found, were not properly sterilised. A Queensland Health spokesman said the hospital had only four sets of forceps, now increased to five. The forceps were not sterilised because there was not time, and excessive demand on the day had used up all the sets. In the end the forceps had only been sterilised chemically, the spokesman said.
Dr Michael Whitby, an expert in infectious diseases, said it was not ideal practice for the hospital to have reused the birthing instruments, but the risk was very low of the mother contracting a disease as long as they were chemically sterilised. Testing the woman was a prudent action, he said. AMA president Dr Zelle Hodge said some visiting doctors take their own surgical instruments to hospitals because the state's equipment was not always good enough. The state Budget did not contain enough funding for basic infrastructure and service delivery costs, Dr Hodge said.
Susan Wheatley's husband, Noel, was in the delivery room as the doctor waited more than 30 minutes for a midwife to find forceps to deliver his child. The doctor had used suction on the baby's head, but the procedure failed. "It just seemed very disorganised to me," he said. "Emergency equipment should be kept in a emergency cupboard, not have people searching for it - I was livid. "I don't know what a set of forceps cost, but probably less than a lunchtime engagement in Parliament."
Opposition health spokesman Bruce Flegg said there should be an immediate inquiry. "You don't use unsterilised instruments - you just don't do it," Dr Flegg said. "The reason you need a sterilisation unit is you don't always know what instruments you need when you do a procedure. "Chemical sterilisation doesn't meet accreditation standards for a hospital. Even in a general practice, it wouldn't pass." Mr Wheatley said he did not plan to sue Queensland Health unless his wife contracted hepatitis. However, he said he wanted to let other women know what his wife endured.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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17 July 2006
SAN FRANCISCO SOCIALIZED MEDICINE SCHEME
Residents... are driving San Francisco officials to enact a unique but controversial program to offer inexpensive health care to residents who have none. Though the proposal resulted from months of negotiations among a myriad of interests, many in the city's business community oppose the legislation. They cite its requirement that employers set aside a minimum amount per worker to finance either private health insurance or access to the city's new program.
Nonetheless, the proposal is likely to win overwhelming board approval on Tuesday. Even Mayor Gavin Newsom, who describes himself as an ally of business, enthusiastically endorses the proposal and its financing component. "There is a fundamental here," he said during a press conference last week. "That is, an obligation to provide a strategy to create health care for 82,000 people where everybody participates (in its financing) -- employee, employer and government."
Advocates are near giddy about the program, calling it bold, innovative and a model for other local governments and the state. The San Francisco program "does create this sense of, if you can do something like this here, all but for leadership, good process, good deliberations, there is no reason we can't do this in California," said Dr. Sandra Hernandez, who co-chaired a mayoral panel that devised portions of the program. Those are "big ifs," she added.
For one, California voters in 2004 narrowly repealed a law requiring many businesses to pay for most of their workers' health coverage -- a concept that the San Francisco proposal borrows. And other local jurisdictions with a less robust medical infrastructure than San Francisco's may find such a program more difficult to implement. Under the Health Access Program, all San Francisco residents who are not already covered by insurance could enroll and select a primary care doctor. Participants would go to public and private clinics and hospitals for care, and be charged a co-payment based on their income. However, that care will not be "portable"; it could not be obtained outside San Francisco and would not be available to people living outside the city. Hence, the program cannot be called insurance.
Proponents who have long fought for large-scale government-mandated health insurance programs are untroubled by the distinction, given the financial and legal barriers the city faced in crafting the program. They note that people with health insurance frequently get care within their immediate community. The program, to be phased in starting next July, will cost an estimated $200 million annually. Half of that would by financed from funds the city already spends on indigent care. Co-payments would bring in about $56 million. State and federal funds would contribute as much as $20 million. The remainder will come from businesses, with 20 or more workers, which will contribute up to $1.60 per hour for each employee.
Companies can continue to offer coverage as long as it meets the minimum cost requirement set by the legislation. That would discourage employers from "dumping" their workers into the city program, supporters explain. Firms with fewer than 20 workers are exempt, as are nonprofits with fewer than 50 employees. Over time the program should reduce expenditures at costly emergency rooms, where many of the uninsured now go for care, supporters contend. It also should make for better workers who feel more secure about medical care, they add.
Supporters know they face hurdles drafting and implementing the details, and informing potential participants of the program. "The real challenge is going to be . getting the thing up and running," said Supervisor Tom Ammiano, the legislation's chief sponsor.
Business owners applaud the program's intent but blanch at the extra costs. "We want legislation that will work as opposed to legislation that will cripple small and medium businesses," Lara Truppelli, owner of two eateries, told supervisors at a meeting last week. "Your hands are in my checking account," said Susan Lieber, owner of a firm that provides workers for food events. "Don't make this a city of nothing more than chains because nobody (else) can afford to do business here."
Labor unions pushed for the proposal partly because employers are increasingly reducing medical coverage, said Paul Kumar of the Service Employees International Union's San Francisco local. By setting a minimum amount of coverage that companies must meet, the program would stop that erosion, he said.
Jim Lazarus of the San Francisco Chamber of Commerce said unions want to extend the concept of forcing employers to pay for health care into other counties and states. He said he expects someone to file a lawsuit to halt the city's new coverage, though the chamber has made no decision about that step. But political leaders are pushing forward nonetheless. Supervisor Bevan Dufty recounted how a waitress at a favorite restaurant who had no health insurance had to spend $10,000 to diagnose what turned out to be a benign lump in one breast. "There are going to be changes . in the economy of San Francisco" because of the program, Dufty said. "Maybe meals will become more expensive. . But (the city) is going to move forward just a little bit. And we're going to say that we care about people." [With other people's money!]
Source
U.K.: Row over private healthcare role
Public sector union Unison claims the government intends to go ahead with the privatisation of primary care services. In June the Department of Health pulled an advertisement asking private firms to tender for key roles in health care management across Primary Care Trusts. A new ad has now been published in the Official Journal of the European Union, and Unison says it could lead to firms taking over "a huge range of services".
Health Minister Andy Burnham said it was about securing "quality support". Local health managers at primary care trusts (PCTs) currently buy in services, although in some areas it has been devolved to GPs. The government says it is only looking for firms to provide expert advice to PCTs and it would be up to local officials to decide if they wanted to use that private expertise. "If they're able to use the best possible advice and support available from around the world to do that job, then certainly as a health minister, I want them to have access to that high quality support," Mr Burnham told the BBC Radio 4 Today programme.
Last month, Health Minister Lord Warner withdrew an earlier form of the notice from an EU journal when it provoked uproar from unions. He said that a drafting error had been responsible for the mistaken impression that clinical services were up for tender. But according to Unison the new advertisement shows "very, very little difference" with the last one. "It's very clear that this new advert is inviting organisations to provide a huge range of management, health and support services across PCTs," Unison's head of health, Karen Jennings, told the Today programme.
She said other unions and professional organisations shared Unison's concern. "This advert not only enables PCTs to continue to outsource commissioning responsibility, but it's also so unspecified and open-ended in its nature, it is effectively allowing outsourcing to take place on the widest possible scale," she said. "So, for example, a private firm could come in and start to commission for other services for the NHS."
But Mr Burnham denied that the private firms were being brought in to decide what services were offered on the NHS. "They (PCTs) are publicly accountable for the services they commission on behalf of their local population - and that will not change."
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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16 July 2006
Unsafe working hours for Australian doctors still ongoing
Doctors in Queensland will continue to work unsafe hours - with some GPs on call for 24 hours a day - until shortages in the health system can be dealt with. As the Beattie Government said it had exceeded recruitment targets by hiring 1200 health staff since the Dr Death scandal, the Queensland Medical Board was preparing a safe working hours inquiry that could exacerbate the state's doctor shortage.
Medical board executive officer Jim O'Dempsey said a discussion paper would be released within a month to guide development of working hours standards. "The Medical Board ... is developing standards of healthy work practices with the medical profession to help doctors realise that taking care of their own health is an important part of taking care of their patients," he said. A draft of the discussion paper, obtained by The Australian, shows the average number of working hours for doctors has already dropped from 46.7 hours a week to 44.4 hours in five years. However, the paper warns that if every doctor in Australia worked three fewer hours a week, Queensland would need an extra 1000 doctors to manage the same amount of work.
Queensland Public Sector Union general secretary Alex Scott said he supported a move to ensure doctors worked safe hours, but not unless there were more doctors to fill the gaps. "The fact is, doctors are not going to walk off the job. They are committed ... and if they are needed they are not going to walk away," he said. "We think a cap (on working hours) is a good idea, but it has to be resourced properly."
Health Minister Stephen Robertson said he believed any move to limit doctors' hours would not exacerbate existing workforce shortages but could help retain staff in the long term. "The responsibility (of safe hours) should be shared," he said. "There's an element of personal responsibility, but the system has to support doctors and nurses who need to manage fatigue ... In the long term, you have to be able to retain your workforce, so they don't leave you because of exhaustion."
Australian Medical Association state president Zelle Hodge noted the case of a Sunshine Coast doctor whose fatigue after working 20 hours straight was found to have contributed to the death of a young girl he had inadequately treated. "The young doctor there was asked to work long hours and when difficulties occurred, Queensland Health did not help," she said.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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15 July 2006
Why Socialized Medicine Leads to the Prohibition of Private Medicine
A post lifted from George Reisman
An article in todays (Feb. 20, 2006) New York Times makes clear that Canadas much ballyhooed system of socialized medicine, in addition to being plagued by interminable waits for treatment, has prohibited competition from private medicine. But now, as the result of a ruling last June by Canadas Supreme Court, limited forms of private medical care are apparently in process of being allowed to appear, at least in some provinces. In The Times articles words: The cracks are still small in Canada's vaunted public health insurance system, but several of its largest provinces are beginning to open the way for private health care eventually to take root around the country. [See full Times article.]
The Canadian Supreme Courts decision was the outcome of a lonely and courageous struggle conducted at great personal cost in time and money by a Canadian physician, Dr. Jacques Chaoulli. Dr. Chaoulli went to court with the case of a chemical salesman who had been forced to wait a year for a hip replacement and who at the same time was prohibited from paying for private surgery. As described in an earlier Times article, Dr. Chaoulli arguedthat regulations that create long waiting times for surgery contradict the constitutional guarantees for individuals of life, liberty and the security of the person,' and that the prohibition against private medical insurance and care is for sick patients an infringement of the protection against cruel and unusual treatment.''
To most Americans it may come as something of a shock simply to learn that all is not well with health care in Canada. Thats because Canadas system has continuously been held up as the model for the United States to follow. Sometimes it seems that every ignoramus with a graduate-school diploma is ready to pontificate on how wonderful medical care is north of the border and that to solve our problems with medical care, all we need do is adopt that wonderful, single-payer Canadian system.
I could stop here, with the satisfaction of conveying knowledge that the system of socialized medical care in Canada is in fact so unwell that the door to its replacement with private medical care has been opened. But there is a deeper point I want to make, which will help to establish why socialized medicine is a profoundly evil and immoral system, that should never be implemented anywhere.
And this is the fact that the prohibition of private medical care that has existed in Canada is not some inexplicable accident but, on the contrary, follows logically from the very nature of socialized medicine. The connection is this:
Socialized medicine is advocated as the means of making medical care free or almost free, thereby enabling even the very poorest people to afford all of it that they need. Unfortunately, when medical care is made free, the quantity of it that people attempt to consume becomes virtually limitless. Office visits, diagnostic tests, procedures, hospitalizations, and surgeries all balloon. If nothing further were done, the cost would destroy the governments budget. Something further is done, and that is that cost controls are imposed. The government simply draws the line on how much it is willing to spend. But so long as nothing limits the office visits, requests for diagnostic tests, etc., etc., waiting lines and waiting lists grow longer and longer.
Then the government seeks to limit the number of office visits, tests, procedures, etc., etc., by more narrowly limiting the circumstances in which they can occur. For example, a given diagnostic test may be allowed only when a precise set of symptoms is present and not otherwise. A hospitalization or surgery may be denied if the patient is over a certain age.
As part of the process of cost control, the government controls and sometimes reduces the compensation it allows to physicians and surgeons. For example, in the present fiscal year, in the United States, the fees paid to physicians by Medicare are scheduled to fall by four percent. (The New York Times, Feb. 4, 2006.)
Now all one need do to understand why socialized medicine leads to the prohibition of private medicine is simply to hold in mind the combination of deteriorating medical treatment and controlled physician incomes under socialized medicine and ask what would happen if an escape from this nightmare exists in the form of private medicine. Obviously, physicians who want to earn a higher income and to have the freedom to treat their patients in accordance with their own medical judgment will flee the socialized system for the private system and leave basically only the dregs of medicine for what will remain of the socialized system. That is what the governments prohibition of private medical care is designed to prevent. This was confirmed in arguments before the Canadian Supreme Court. The Times article on the subject reported thatVarious medical experts, government representatives and union leaders argued in court that privatization of insurance and services would bring an exodus of medical talent from public to private practices, and make waiting times even longer.
And there you have it. Socialized medicine destroys the quality of medical care and dare not allow the competition of private medical care. To prevent that competition, it must prohibit private medical care and establish a legal monopoly on medical care.
Another Queensland Health bungle plays itself out
They sure know how to hire good staff. At least this guy did not kill anyone so I guess that is progress
An overseas health bureaucrat has had his contract terminated by the State Government in a deal that is likely to cost taxpayers in excess of $100,000 for only five weeks' work. Royal Brisbane and Women's Hospital clinical CEO Dr Thomas Ward left the job yesterday following an incident when he tried to sack the hospital's executive director of nursing services, Lesley Fleming. The Canadian medical bureaucrat was forced into an embarrassing backdown during which he was forced to reinstate Ms Fleming and issue a humiliating apology after action by senior nurses and their union.
Premier Peter Beattie announced Dr Ward's departure yesterday, but would not be drawn on the specifics. "I think it is fair to say we've obviously had negotiations with the doctor concerned and we're keen for everybody to move on," Mr Beattie said. "He has decided to return to Canada and we support that decision. I think he would have been relieved and we support his relief." Mr Beattie said he had approved a termination payment to Dr Ward of three months' pay, an amount which he said was "fairly normal in the circumstances".
Opposition health spokesman Bruce Flegg said senior medical staff had confirmed to him that Dr Ward had been pushed rather than resigned. "When he came back from a meeting on Wednesday morning someone asked him what was wrong and he only said 'I am devastated'," Dr Flegg said. "He was shoved on a flight at 9.30am this morning (Thursday) as part of settlement to get him out of the country so he couldn't be interviewed."
Queensland Nurses Union state secretary Gay Hawksworth said nurses from the Royal Brisbane Hospital attending the QNU conference yesterday greeted the news of Dr Ward's demise "with applause". "I went to a meeting last week and he admitted he had made a huge error - that he had got bad advice and that he knew he was now two years behind where he would want to be because he knew he had lost the confidence of nurses, and that made his position untenable," Ms Hawksworth said.
A media release issued by Mr Beattie and Health Minister Stephen Robertson when Dr Ward was employed in Queensland had described him as "an internationally respected health care systems manager, strategist and planner".
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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14 July 2006
The NHS long wait
Hidden waiting lists for NHS treatment, revealed for the first time, indicate that patients wait an average of seven weeks for diagnostic tests. Until now the Government has measured only how long patients wait for their first consultant appointment and then for treatment. Waits for vital diagnostic tests have been ignored.
The promise that all patients will be treated within 18 weeks of referral by a family doctor has obliged the Department of Health to start measuring these diagnostic waits. The results indicated large variations by area and by test - but also that the ambitious 18-week target was achievable, Andy Burnham, a Health minister, said yesterday.
About half of patients were being seen within the target time, officials said, but less than 1 per cent were waiting more than two years. Three quarters of tests are carried out within 13 weeks, the interim target the NHS is aiming for across the service by April 2007.
By April 2008 the target will be six weeks and by the end of that year the entire "patient journey" should be no more than 18 weeks. A small minority is expected to experience longer waits, either for clinical reasons or out of choice. But the department has yet to decide how much "wriggle room" to allow for these patients.
Every month the NHS does 50 million tests. Of the 15 key tests for which waits were measured, slightly more than 200,000 were taking more than 13 weeks to complete. A census of trusts that looked at 500 less common tests found roughly another 250,000 of these were taking more than 13 weeks. That means that, at present, 450,000 tests are taking longer than the target set for next April. This is not a large proportion of the total number of tests done, making next April's target look achievable.
The department's calculations of average waits indicate that the longest are for hearing tests, with colonoscopy taking almost as long. But the department also published data suggesting that waits for MRI and CT scans had fallen sharply since October 2005, when choice was introduced for patients who did not have a scan scheduled within the next 20 weeks.
The data indicate that allowing patients to choose where to go for their scans has cut the number waiting longer than 26 weeks from almost 16 per cent to less than 1 per cent. Andrew Lansley, the Shadow Health Secretary, said that the figures did not give the whole story.
"We know that some patients are forced to wait longer than 26 weeks, but we do not know the maximum wait," he said. "Some patients are waiting longer than two years for crucial diagnostic tests. Any significant wait for diagnosis is unacceptable. It would be an entirely alien concept to a patient in France, Germany, the United States and many other countries that they should have to wait for any diagnostic tests. It should be the same here."
Source
Australia: Mammogram incompetence in Queensland's socialized medicine system
There are increasing concerns about Queensland Health's breast cancer screening service after it emerged yesterday that 9300 women's mammograms had to be reviewed last year. The review was ordered after three of the five radiologists contracted to BreastScreen in Cairns failed to detect the expected number of small cancers in the 2004-2005 financial year. All films taken during that year were checked in the review, which took the service's most experienced radiologist almost five months to complete.
From the checks, 83 women were recalled to repeat their tests and two were found to have ductual carcinoma in situ, a non-invasive form of breast cancer. Two Gold Coast women this week launched legal action against Queensland Health alleging negligence after their aggressive cancers were not detected from their mammograms.
Opposition health spokesman Bruce Flegg accused the Government of a cover-up for not publicly announcing the review, but the Government asserted the review showed quality assurance processes were working. Queensland Health senior director of cancer screening services Jennifer Muller said the review was part of the normal quality control processes. "It's not an unusual event that we would want to do a review because we're committed to providing a high quality service," Ms Muller said.
Health Minister Stephen Robertson said BreastScreen was continually undertaking quality control measures, which led to the "exhaustive review" of the Cairns service. "No service is perfect but when you consider the number of women now using the service throughout Australia we will provide a world-class service," he said. "What we've seen over the last couple of days is experts from that service coming out and saying that we provide a service that identifies nine out of 10 cancers - it's not perfect. "The important thing is when we find problems or the service hasn't met appropriate standards . . . we fix it, and that's what we've done in the Cairns case."
But Dr Flegg accused the Minister of a cavalier approach to public health. "I think it raises some pretty serious issues when they knew there was a quality problem with readings in Cairns," he said.. "I think it does cast a doubt in the minds of patients as to how reliable the reading at BreastScreen Queensland is."
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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13 July 2006
NHS CAN'T HANDLE PREMMIES
Premature babies are being sent hundreds of miles to be placed in intensive-care units, an audit has indicated. The UK has the highest rate of premature births in Western Europe, and one of the poorer records in treating premature babies, Bliss, the charity which commissioned the audit, said.
An average of three babies a day have to be transferred. Many are moved more than 100 miles, and the longest recorded journey was 286 miles, Rob Williams, the charitys chief executive, said. Since the first audit of services last year, things had worsened, he added. Despite a government commitment in 2003 of 70 million pounds to improve care, it still fell short of an acceptable standard. The money was welcome but nothing like enough to achieve what is needed. The service is overstretched, under- resourced and slow to respond to promising initiatives. Ninety-five per cent of units are working at overcapacity, and 78 per cent of intensive and special-care units had to close their doors to new admissions, up from 72 per cent in 2004.
Most importantly, he said, hospitals failed to apply to babies the same nursing care that would be provided to adults. In adult intensive-care units, there was, on average, one nurse for every patient but only 3 per cent of baby intensive-care units achieved the same standard. Neonatal care for babies is provided by 22 networks of hospitals. But the survey found that transfers outside networks were common. Parents were often poorly informed and not told that their babies might need special care.
Sarah Skates, from Crayford in Kent, gave birth to twins after 26 weeks of pregnancy. One child was transferred to a hospital in Norwich, and the other to a hospital in Surrey, a two-hour journey in the opposite direction. The twins father went to stay in Norwich while their mother stayed at home to look after her older child. It was, she said, the hardest time of my life.
The research was carried out for Bliss by the National Perinatal Epidemiology Unit at Oxford. The report says that the Department of Health should require intensive-care units to have a nurse for every baby. A spokeswoman for the Department of Health said: On average, a quarter of neonatal intensive-care cots are empty at any given time, so the creation of local neonatal networks has helped local areas assist each other when demand is greatest. These provide as much of this care locally as is possible, but there will always be occasions when transfer to a more specialist unit outside the network may offer better outcomes.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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12 July 2006
THE GOOD OLD GENEROUS AMERICAN TAXPAYER
The recent state budget debate over whether California should provide health insurance for children who are undocumented immigrants largely overlooked one key fact: The government already spends almost $1 billion a year for some health care services for the undocumented through Medi-Cal.
Amid a renewed national focus on illegal immigration, health services for undocumented immigrants in California returned as a political flash point this year for the first time since debate over Proposition 187 roiled the state in the 1990s. Republican lawmakers persuaded Democrats and GOP Gov. Arnold Schwarzenegger to drop $23 million for new insurance coverage for undocumented children. But almost no one was talking about the programs that Proposition 187 was intended to cut before it was blocked in court in the late 1990s: prenatal care, nursing home care and other services funded by Medi-Cal for undocumented immigrants.
Over the past decade, those services have grown by 50 percent into a $1 billion annual program serving hundreds of thousands of people each year. Spending growth has been slower than in the Medi-Cal program overall, which went up more than 100 percent in the past decade, to about $35 billion annually. Both the number of people receiving services and the cost of those services have risen: The number of undocumented women giving birth covered by Medi-Cal rose almost 25 percent from 85,000 in 1995 to 105,000 in 2004. Meanwhile, the overall costs of those births rose by about 135 percent during that time.
State officials say the increases are largely due to inflation in health care costs and to a change in the rules allowing more people to qualify for Medi-Cal. Republican lawmakers say the fight over Proposition 187 has limited their ability to try to cut existing programs. So they're focusing on trying to stop any efforts to expand services to the undocumented. "We've realized our hands are pretty much tied by the fact that the Proposition 187 appeal was dropped in court," said Sen. Dennis Hollingsworth, R-Murietta, one of the lawmakers leading this year's budget fight.
More here
U.K.: NHS FAILURES GO RIGHT TO THE TOP
Poor leadership, bad management and inadequate board members are the main reasons for hospitals and primary care trusts running up deficits, the Audit Commission has found. While managements tend to blame the system, the fault lies not in their stars but in themselves, the commission says. In 2005-06, the commission published 25 public interest reports, in which local auditors were sufficiently alarmed about the financial state of NHS bodies to make their concerns public.
Now the lessons of these reports have been gathered in a single document, Learning the Lessons from Financial Failure in the NHS. Last year the NHS ran up a large deficit, even though it is mandated to balance its books. Although the majority of NHS organisations did so, a minority failed, some by huge margins.
Steve Bundred, the chief executive of the commission, denied that parts of the NHS were underfunded. He said that organisations that ran into difficulties had been warned but had failed to make changes. Of 25 trusts examined the total deficit in 2005-06 was 173.6 million pounds, in spite of financial support from other parts of the NHS worth 86 million pounds.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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11 July 2006
RAPE IN BRITISH "NATIONAL HEALTH" HOSPITALS
Can you imagine the litigation if these were private hospitals? Handwringing is all you get from government hospitals
Women were the victims of more than 100 incidents of rape, sexual assault and sexual harassment in NHS mental health units over two years, according to a confidential report being held by the Government. The Times has learnt that the report, which gives details of more than ten rapes and, in a single year, three unwanted pregnancies, has yet to be published eight months after it was received by the Department of Health. The findings bring into question the Governments claim to have set up single-sex wards that are safe and ensure personal dignity across the health service. The pledge, made by Tony Blair in 1996, was supposed to have been met by the end of 2002.
Mental health campaigners said the report confirmed growing fears that the Government was compromising patient safety in some of the countrys mental health trusts and psychiatric wards in district general hospitals. Ministers are accused of not tackling the problem as a matter of urgency despite having the information to alert them. Incidents in mental health settings appeared to be a far lesser concern than those in other hospital environments such as cancer wards, campaigners said, even though psychiatric patients were likely to be the worst affected by such experiences.
Details of the report, leaked to The Times by Whitehall sources, come from data collected by the National Learning and Reporting System, a monitoring programme set up in November 2003 by the National Patient Safety Agency (NPSA). All healthcare organisations were linked to the system by the end of 2004, including the countrys 84 mental health trusts, and the first national report was published in July last year. However, such was the concern over sexual assault in mental health settings that a separate study the Mental Health Observatory Report was commissioned. Most of the recorded incidents took place in the 12 months to October 2005 as most mental health trusts were among the last organisations to join the reporting programme. It is understood to include both patient-on-patient and staff-on-patient incidents and ranges from men exposing themselves to women, physically assaulting them and committing rape.
The reports findings reached the Department of Health last November. It is understood that the hold-up has occurred at the NHS gateway, a system set up to disseminate inspection information efficiently [!!!!] throughout the service.
Paul Farmer, chief executive of Mind, the leading mental health charity, described the data as extremely concerning. With an estimated 22 per cent of safety incidents in the NHS going unreported, the full picture could be even worse, he said. We are talking about the care of some of the most vulnerable patients. I think people will rightly be appalled by these findings.
Spending on mental health has increased by 600 million pounds since 2000, with funding for extra nurses, teams in the community and high-security units. But concerns remain that inpatient services which care for a range of conditions, from severe depression to self-harm and suicidal tendencies have been overlooked and are likely to suffer further. Health leaders say that the recent deficits are having a severe effect on mental healthcare, with cuts in staff and bed numbers adding to the problems of providing single-sex wards. Estimates from the Conservatives suggest that more than half of NHS trusts have been forced to close wards. The Government says that only 11 trusts have been affected.
Asked about the Mental Health Observatory Report in the House of Lords last month, Lord Warner, the Health Minister, said in a written answer that it would be released later this year. A Freedom of Information request, submitted by Mind in April, was rejected by the NPSA on the grounds that the material was in the process of being published. The agency accepted that it had had the information since the previous November and said it had the definite intention to publish in the near future. The Department of Health said yesterday that it did not comment on leaked documents. A spokesperson said that some data needed further analysis before the report could be published
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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10 July 2006
NHS KNOW-NOTHINGS
Thousands of lives are being put at risk every year in the NHS because of the Government's failure to set up an effective system to monitor patient safety and prevent mistakes recurring, an influential cross-party committee said yesterday. A report by the Committee of Public Accounts, the parliamentary spending watchdog, describes the performance of the National Patient Safety Agency, which was set up to improve safety in health settings, as "extremely weak" and "dysfunctional".
In 2004-05 there were more than 1.2 million safety incidents and near-misses, half of which could have been avoided if health trusts had learnt from past mistakes. The report, which is based on work by the National Audit Office and evidence from the Department of Health, the safety agency and the Chief Medical Officer, concludes that a culture of secrecy and inadequate safety regulation is preventing error reduction in the NHS.
A total of 974,000 incidents were reported to the agency in 2004-05, but these represented only about three-quarters of the actual total, the committee found. It said that an average of 22 per cent of incidents go unreported, most of which were medication errors and incidents leading to serious harm.
Edward Leigh, chairman of the committee, said that arguably the most worrying finding was the apparent inability of the health service to reduce avoidable and recurring mistakes. "These statistics would be terrifying enough without our learning that there is undoubtedly substantial under- reporting of serious incidents and deaths . . . The NHS simply has no idea how many people die each year from patient safety incidents," Mr Leigh said. "What this points to are two related and deep-seated failures. One is the failure of the NHS to secure accurate information on serious incidents and deaths. The other is the failure on a staggering scale to learn from previous experience."
The report, A Safer Place for Patients: Learning to Improve Patient Safety, said estimates that one in ten patients admitted to hospitals in developed countries is unintentionally harmed showed the urgent need for an effective system. The errors are costing the health service about o2 billion a year in extra bed days and o400 million in settled clinical negligence claims. The report said that the safety agency had "provided only limited feedback to NHS trusts on solutions to reduce serious incidents". Underreporting by staff, particularly doctors, also remained a problem.
It added that "few trusts have formally evaluated their safety culture" and "insufficient progress" had been made on achieving targets set out by the Department of Health. The report also refers to data showing that less than a quarter of trusts routinely inform patients involved in a reported incident and 6 per cent do not involve patients at all. It noted that the size and complexity of the NHS workload, which treats a million people every 36 hours, meant that errors were inevitable. Peter Walsh, of the patient safety charity Action against Medical Accidents, called for urgent action as a result of the report.
Susan Williams, joint chief executive of the safety agency, said that progress had been made, but more was needed to ensure "even safer healthcare".
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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9 July 2006
A WONDERFUL STORY BUT NO CREDIT TO THE NHS
Will he ever be told that government doctors intended to kill him?
When doctors turned off James Smarts life-support machine after he had spent ten days in a coma, his mother believed that her two-year-old son could not survive. But, against all odds, James started to breathe on his own and is on his way to a full recovery. Yesterday he played at home in Wakefield, West Yorkshire, as his mother, Ellie Craven, 21, told how he came back from the brink of death.
James had shown no sign of life after contracting pneumococcal meningitis. Doctors feared that if he survived he would be in a vegetative state for the rest of his life. But, two months after being released from hospital, he continues to amaze medical staff.
James began to feel unwell in February and his mother took him to the doctor. Despite having a high temperature, freezing hands and a sore throat, all that was suspected was a throat infection. Less than 24 hours later meningitis was diagnosed and the boy went into a coma. Ms Craven was in labour with her second child when James was rushed to hospital. He was placed on a life-support machine as medical staff drained fluid from his brain. After ten days, with no sign of progress, he was taken off it. Nobody could believe it when he started breathing, Ms Craven said. James suffered a small amount of brain damage, but after nine weeks in hospital, where he underwent intensive physiotherapy and speech therapy, he returned home.
Source
In the USA, coma patients are often kept alive for years. In Britain's "caring" socialized medicine system, this little boy was allowed only 10 days. Personal note: This story moved me to tears
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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8 July 2006
Demeaning the dead -- the NHS continues its downhill slide
By Melanie Phillips
People say that you can measure how civilised a country is by the way it treats its dead. Judging by that yardstick, it would seem that parts of Britain are not very civilised at all. At Queen's Park hospital in Blackburn, the bodies of patients who have died have been left on hospital wards overnight, apparently because a funding crisis has resulted in a shortage of night porters who are needed to move them to the mortuary.
The East Lancashire Trust in charge of the hospital - which subscribes to an NHS scheme entitled `pursuing perfection' -says that because it is under pressure to save 11.6 million pounds by next April, it can't afford to replace four night porters who are off sick or who have resigned. Since it takes two porters to move and lift a body, when staff are left alone overnight it is therefore impossible for them to move from the wards patients who have died. One porter at the hospital has claimed that last week, three bodies were left on the wards for more than eight hours.
This is sickening and revolting. Leaving the bodies of patients in their beds like this is utterly unacceptable. It shows a total lack of respect for the dead, and the likely distress caused to other patients needs no imagination. The NHS budget now runs to a massive annual total of more than 80 billion. Yet the service cannot even afford to treat a dead body with elementary respect. Yes, we all know that despite the astronomical sums being poured into the NHS it has nevertheless managed to get itself into a 500 million deficit and is in a permanent state of crisis as a result.
Yet there is still money to pay the salaries of the serried ranks of bureaucrats, who have helped reduce the NHS to its current parlous state of mismanagement. The East Lancashire Trust itself is currently advertising on its website for a Director of Strategy and Implementation at an annual salary of 95-100,000 pounds. This exalted figure will get the `chance to transform services and improve the patient experience.' It is also advertising for something called a Supply Chain Director, at a salary of 75,000 pounds, a post which is apparently essential to ensure `we obtain maximum value from our 500 milion-plus annual spend within Cumbria and Lancashire.' Is it really `improving the patient experience' or `obtaining maximum value' for patients to find they are sharing their ward with a corpse that has been left in the next bed for hours on end? Isn't there something dramatically wrong with the Trust's priorities here?
Our health service is spending ever increasing sums on cutting-edge medical technology. As a country we are moving into the brave new world of designer babies, face transplants and cloning. These advances are held to be evidence of the superiority and prowess of our civilisation. Yet we seem to be no longer capable of observing even the basic decencies of a civilised society. The way we treat the dead is of the greatest possible significance not just to the health service but to society at large. For if we do not show respect to the dead, we will not show it to the living.
The rituals around our treatment of dead people signify the respect we have for human life itself. That's why the desecration of graves or cemeteries is so shocking. That's why we close the eyes of the deceased, or cover their faces with a sheet; it's why we prepare them decently before we bury them. We treat a dead body with this kind of reverence because to do otherwise would be to show that we have no intrinsic respect for our common humanity and for what it actually means to be a human being. We reaffirm this common bond even towards the physical remains of a life that has departed, precisely to signal that to be human is to be more than a mere assembly of working parts and that we are not just a lump of flesh. If we don't do this, if we treat a dead body as if it were no more than an inanimate thing, we dehumanise not just the person who has died but ourselves and our fellow human beings too.
Yet that is just what was done at the Queen's Park hospital, where dead people were treated with no more thought than bags of refuse waiting to be collected. It is simply no excuse to say there wasn't enough money. It suggests rather a breakdown in some pretty basic codes of decency. It appears that this scandal only came to light when a porter who was unable to move a body from a ward because he was alone wrote an incident report to the management. But what about the other hospital staff who must have noticed that a dead patient had been left for hours on a ward? What about the nurses who were seeing to other patients on these wards? Why didn't they immediately do something about it? Didn't they care? Did they even notice?
Unfortunately, the financial black hole is by no means the worst thing that has happened to our health service. Far more serious and disturbing is the loss of something much more fundamental than money, even though it is more intangible. What has disappeared in distressingly large measure is the ethic of care, at the heart of which is recognition of the dignity of every human being and the intrinsic respect to which that gives rise.
Of course, there are many nurses, doctors and other NHS staff who provide magnificent and sensitive care, particularly where sick children, patients in intensive care or relatively young people suffering life-threatening diseases are concerned. But in too many areas, respect for human dignity has been cast aside. Take mixed-sex wards, for example, which, despite many government promises to phase them out, still exist. These wards cause untold distress to many patients, particularly to elderly people. And it is the elderly who have suffered most of all from this erosion of respect within our health service. In too many of our hospitals, the treatment of elderly patients is simply inhumane. They are neglected so that some who are too frail to feed themselves are left without food. Others have their lives ended altogether by the withdrawal of food and hydration on the grounds that their lives are no longer worth living.
A recent survey found that up to 5,000 frail and elderly patients die each year because they are not put in intensive care beds for monitoring after their operations, having been written off because they are old. Such contempt for old people surely has its roots in the widespread erosion of religious belief, which has resulted in a loss of respect for the innate value of human life. Instead, respect is now afforded in proportion to the presumed usefulness of that life. Dead people, of course, are no longer useful at all - so much so that in some quarters they are not even being regarded as people but as useless s. The shocking revelations from Blackburn suggest that the NHS is suffering not merely from a financial crisis but a moral one, too - and one that reflects upon all of us.
Source
One of my readers who is a public-hospital medical specialist in the USA wrote to Melanie regarding the above article as follows:
"I was touched like never before by your column on Demeaning the Dead. It was like being at the dentist when he is drilling and he hits a nerve. In a small space, you put into words what is wrong with society. A while ago, some woman was rescuing dogs disposed of in a city dump in South Africa. They were left to die. At first I thought this was extreme on her part. But then my wife said something wise - she said that, in a society that treats animals this way, how do you think they treat people? Likewise, how they treat the dead DOES reflect on how they treat the living.
The motive here is NOT economic. Someone can ALWAYS be recruited in a hospital - supervising nurses, who would have to be coerced to get their hands dirty hauling a body to the morgue. Security personnel, phone operators, cafeteria workers, even doctors. There is ALWAYS SOMEBODY. Leaving a body in a room with a living patient is just a passive aggressive stab at "the system".
And it's not good economics to leave a dead person in a hospital bed. As busy as hospitals are, economic efficiency would be greater with live patients rather than dead patients occupying beds".
The downward spiral continues in Queensland public hospitals
A shortage of nursing staff has forced Queensland's largest public hospital to cut back elective surgery for the next three months. More cuts are likely to limit operations to fewer than 1800. A leaked memo from the hospital revealed that since March "there have been ongoing elective operating sessions cancelled due to insufficient nursing and anaesthetic technical staff to provide safe patient care". "In addition, demand for emergency surgery is exceeding the current emergency OR (operating room) capacity," the memo says.
In the past year, the staffing shortages and additional demand for emergency operations have meant patients have faced last-minute cancellation of elective surgery. Several people who contacted The Courier-Mail said they had operations cancelled after they had been prepared and wheeled into the operating theatre.
Queensland Health Central Area Health Service acting general manager Terry Mehan said planned cuts in elective surgery were more appropriate than making last-minute cancellations to elective surgery lists. Mr Mehan said the hospital usually conducted 30 to 32 elective surgery sessions each day and the new roster would reduce that to 24 or 26 sessions each day. "Emergency surgery is exactly that. It is surgery that cannot wait. And this new roster system developed by the clinicians at the coalface aims to ensure emergency cases will not have to wait," he said. "We believe this will be a great improvement on ad hoc last-minute elective surgery cancellations. Last-minute cancellations result in stress and inconvenience for patients." Mr Mehan said demand for elective and emergency surgery was increasing throughout the state. "And there is a shortage of nursing staff, particularly of nurses with operating theatre skills," he said.
Australian Medical Association Queensland president Zelle Hodge said last-minute cancellations of elective operations had been "going on for some time" at RBWH. Dr Hodge said the shortage of beds meant Queensland's public hospitals were operating at full capacity and had no room to move should there be a disaster or seasonal fluctuations. "Ideally hospitals should plan to run at 85 per cent capacity to deal with these fluctuations," Dr Hodge said. "But we know the RBWH is constantly running at about 130 per cent capacity. This means patients with serious cancers have to wait. They are being significantly disadvantaged in our public hospital system."
Opposition health spokesman Bruce Flegg said that previously a lack of doctors had been blamed for cancellations. "Now it is a lack of technical staff and nurses to open operating theatre," he said. "This is the same government which has recently spent millions of taxpayers' money on promoting how things have changed inside our public hospitals because of its successful recruitment programs for doctors and nurses."
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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7 July 2006
YOUR REGULATORS WILL PROTECT YOU (1)
20% of U.S. Transplant Centers Are Found to Be Substandard
About a fifth of federally funded transplant programs fail to meet the government's minimum standards for patient survival or perform too few operations to ensure competency, a Los Angeles Times investigation has found. The U.S. Centers for Medicare and Medicaid Services has allowed 48 heart, liver and lung transplant centers to continue operating despite sometimes glaring and repeated lapses, the newspaper's review found. There are 236 approved centers nationwide.
Although many of the substandard programs treat small numbers of patients, their collective failings carry a significant toll. Consider the latest available statistics, for transplants performed between 2002 and 2004. Nine lung programs failed to meet the minimum Medicare standards for survival, number of surgeries or both. These hospitals accounted for 21 more deaths than would be expected, based on a government-funded analysis of how all patients fare nationwide within a year of surgery. It is adjusted for the condition of the patients and the organs. Three dozen heart transplant programs didn't meet federal standards for survival or volume. They accounted for 43 more deaths than expected. Altogether, the programs examined by The Times had 71 more patients die than expected within a year of transplant.
"The bottom line message is that there are too many programs in the United States that need to be shut down," said Dr. Mark L. Barr, a cardiothoracic transplant surgeon at USC and president of the International Society for Heart and Lung Transplantation.
The disclosure of Medicare's failings follows a series of reports in The Times detailing dangerous lapses in oversight of the national transplant system. Three transplant centers in California have closed since September after their problems came to light. Medicare, which funds most of the nation's transplant centers, requires programs to perform a minimum number of transplants and to achieve a specific survival rate to be certified for funding. The benchmarks vary by organ, and there are none for kidney transplants. Should the programs later fall short, Medicare rules mandate no sanction, only that the programs turn themselves in.
The agency has the authority to pull certification - and therefore funding - from any center that does not meet its standards. But it rarely does. It has cut off funding to 11 centers since 2000. In nearly all of those cases, it moved only after the programs had voluntarily ceased operations, according to federal documents reviewed by The Times. In one case, its decertification came eight months after the program shut down.
Only recently, after The Times began asking detailed questions, did the agency step up its scrutiny. In March, it sent letters to all its approved programs, asking for information about their staffing and performance. It already has found about 25 programs that are "seriously out of compliance" with Medicare standards, said one agency official who spoke on condition of anonymity because the findings are preliminary. Some programs have problems so severe that the agency is considering immediate decertification, the official said. That could force closure.
Some transplant surgeons say Medicare has been too permissive, continuing to support poor-performing programs abandoned by private insurers. "This is a continued artificial bolstering of the programs that shouldn't exist," Barr said. To decertify such programs, he said, "would have been the natural Darwinian process to occur. The weakest in the herd get weeded out." The records of these centers are no secret. The Times identified the 48 programs by examining the total number of transplants performed in 2005 by each Medicare-approved center, as well as the latest survival statistics made public in January by government-funded transplant researchers. All of the information is available on the websites of the United Network for Organ Sharing and the Scientific Registry of Transplant Recipients.
More here
YOUR REGULATORS WILL PROTECT YOU (2)
Rapist doctor back to work in Australia
The Medical Board of Queensland is set to renew the practising rights of a doctor convicted and jailed four years ago for violent criminal offences, including rape. James Samuel Manwaring's probable reprieve under strict conditions imposed by the registration body has appalled his former employer, original complainant Dr Bruce Flegg, and stunned his victim.
Dr Manwaring, who graduated as a medical student from the University of Queensland in 1985, had a history of drug addiction which compromised the care he provided in jobs in Australia, the US and the United Kingdom. He committed his most serious offences in 2000 against a woman, who suffered serious physical injuries and mental trauma. After pleading guilty in late 2002 to rape, attempted rape, deprivation of liberty and assault, Dr Manwaring was told by District Court Judge Brian Hoath that nothing could "excuse your involvement in these offences". "During the course of your sexual assault on the complainant, she suffered multiple bruises and the aggravation of pre-existing degenerative changes in her jaw," Judge Hoath said.
Medical board head Jim O'Dempsey declined to be interviewed late yesterday, but confirmed in a written statement that Dr Manwaring "has met the stipulation of the Health Practitioners Tribunal to be eligible to apply for re-registration". Dr Manwaring could not be contacted late yesterday. The board's statement said that 24 conditions, including the testing of his hair for traces of drugs, would be closely monitored. "It should be noted Dr Manwaring cannot start practice as there are a number of the conditions imposed by the tribunal where he requires board approval prior to commencement of practice," the statement said.
Sources close to the medical board said it had not used its power and discretion to reject Dr Manwaring "despite the inescapable grounds that the man is a convicted and violent criminal with a shocking history as a practitioner".
Dr Flegg, who owned a medical practice before becoming a Liberal Party state MP, yesterday slammed the board's decision as reckless and irresponsible. "Serious violent criminal offences are not compatible with professional standards. I believe the board has been weak and feeble in not wanting to be legally challenged," Dr Flegg said yesterday. "Manwaring is a violent convicted criminal and a serious professional offender. "The board is supposed to be the guardian of standards and public confidence."
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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6 July 2006
CALIFORNIA PANDERS TO THE MERCURY FREAKS
Probably wise if it lifts vaccination rates
Vaccines containing a mercury-based preservative are now largely off-limits to children under 3 and pregnant women in California. The only exception to the new state law, which took effect on Saturday, is the vaccine against Japanese encephalitis virus, a deadly mosquito-borne illness endemic to certain parts of Asia. The new law, by Fran Pavley, D-Agoura Hills, was aimed at reducing the risk of neurodevelopmental problems such as autism, which many parents believe can be traced to exposure to thimerosal, long used as a preservative in many vaccines.
Several large federal studies have shown no link between childhood vaccines and autism, but additional research is continuing. The U.S. Public Health Service and the American Academy of Pediatrics in 1999 began to advocate the elimination of thimerosal from vaccines because some infants who received them were exposed to mercury at levels that exceeded Environmental Protection Agency guidelines. Except for trace amounts, which are allowable under the new law, thimerosal has been removed from childhood vaccines.
The flu vaccine had been an exception. But concerns about its safety re-emerged in 2004, after the federal government recommended that babies between 6 months and 2 years be added to the list of those who should get annual flu shots. Aventis Pasteur, the company that manufactures the lion's share of flu vaccine, has increased the supplies of its thimerosal-free version in response to demand. "Based on what we know, we anticipate there will be an adequate supply of thimerosal-free flu vaccine for pregnant women and children under 3," said Department of Health Services spokesman Ken August.
The state has ordered 684,480 doses of flu vaccine to be distributed to counties for the upcoming season. The total includes 50,000 doses of thimerosal-free vaccine for children ages 1-3 and 15,000 doses for pregnant women. In addition, the state ordered 10,000 doses of FluMist, also thimerosal-free, for use in healthy people ages 5-49.
Aventis had opposed the Pavley bill, citing in a statement concerns that the ban could "undermine public confidence in immunization and ultimately deprive children of access to needed influenza vaccine." In response to industry worries and related concerns cited by the American Academy of Pediatrics, the legislation ultimately was amended to give the industry more time to stock up on thimerosal-free flu vaccine. The new law also allows for exceptions when no other alternatives are available or during public health emergencies.
August said Kim Belshe, health and human services secretary, issued an exception for the Japanese encephalitis virus vaccine: "Given the absence of a mercury-free vaccine against Japanese encephalitis virus and because the risks of fatal disease or brain injury far exceed any risk of mercury in the vaccine, the secretary is exercising her authority and temporarily exempting the vaccine from the provision of the law for a 12-month period." About 50,000 cases of the disease are reported annually in Asia. There is no cure, and up to 25 percent of those infected die from the disease.
August said that California distributes about 32,000 doses of the three-dose vaccine annually. Last year, 19,000 went to the military and the rest to people traveling to certain parts of Asia. It is unknown how many of those doses went to very young children or pregnant women.
Source
Bad bill of health for Queensland
Services provided by Queensland public hospitals have deteriorated during the tenure of the Beattie Government, and new national data rates the performance of the state's hospitals as among the worst in Australia. Released yesterday, the State of Our Public Hospitals June 2006 Report measures each state against its performance in 1998-99 and 2004-05.
Premier Peter Beattie said yesterday that he had not seen the report, but dismissed the findings, saying they were based on old figures. Mr Beattie said his Government had increased funding in October's mini-Budget and again in this year's Budget. "We've dramatically increased funding . . . $9 billion extra over the next five years," he said.
However, the report does provide a report card on the first seven years of his Government, according to the state Opposition and the Australian Medical Association. When Mr Beattie was elected in 1998, the number of people being admitted to public hospitals was above the national average. In 2004-05, the number admitted was 9 per cent lower than the national average. Public hospital beds reflect a similar trend. In 1998-99, Queensland had more hospital beds than the national average. But by 2004-05, it was below the national average. In terms of funding, in 1998-99, public patients in Queensland received only 81 per cent of the national average. This had declined to 79.8 per cent by 2004-05. Even the area of elective surgery, in which Queensland was rated the best in the country, has recorded a similar fall -- from 16 per cent above the national average in 1998-99 to just above the national average in 2004-05.
Federal Health Minister Tony Abbott was critical of the information provided by Queensland on elective surgery. "The report is only as good as the quality of the information provided by the states. If the states give us dodgy information then we will get a dodgy result," Mr Abbott said.
AMA Queensland president Zelle Hodge acknowledged that the report had come out before the recent mini-Budget which increased public hospital funding. In spite of this, she said the report showed Queensland still had "a very, very, very long way to go". Dr Hodge said most of the recent health funding increases had gone in salaries and did not address the critical shortage of beds which was now affecting the provision of services in public hospitals.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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5 July 2006
BRITAIN NOW HAS A "SURPLUS" OF NURSES (AS WELL AS DOCTORS)
Because the overspent NHS has now sacked so many of them and cannot afford to hire as many as are needed
Nurses from outside the EU will require work permits to take up jobs in the NHS, in a move designed to give homegrown nursing graduates a better chance of getting a job. Nearly 11,500 foreign nurses came to Britain from outside the EU in 2004-05, the last year for which complete records are available. India supplied the most, followed by the Philippines and Australia. Now it will be difficult for others to come, because a work permit will be granted only if a job cannot be filled by British or EU applicants. The rule removes nurses from the Home Office shortage occupation list and applies to nurses in bands 5 and 6 those who have between a few months and 18 months experience.
The move is a reaction to a growing surplus of nurses, which has made it harder for many British graduates to find a job; but the Royal College of Nursing (RCN) was critical. Dr Beverly Malone, general secretary of the RCN, said: International nurses have always been there for the UK in times of need and it beggars belief that they are now being made scapegoats for the current deficits crisis. Removing nursing from the list of recognised shortage professions is short-termism in the worst possible sense. We know that the vast majority of international nurses are employed in bands 5 and 6, the very bands which are going to be affected. If this goes ahead, I guarantee that the effects will be far-reaching and immediate. Over 150,000 nurses are due to retire in the next five to ten years and we will not replace them with homegrown nurses alone.
Lord Warner, the Health Minister, said that large-scale recruitment of international nurses was only ever intended to be a short-term measure. Extra investment in training meant that there was no longer a need to hire junior nurses from abroad, he said. The change does not affect nurses already working in Britain and there would still be specialist nursing vacancies.
Last week a survey of 20 universities by the Council of Deans showed that more than 80 per cent of nurses qualifying this summer have yet to find a job, compared with 30 per cent at this time last year. The council, which represents the universities who train nurses, said that the situation was very serious. It showed, for example, that only a quarter of students who have already graduated from one London university have found work, while just 5 per cent from a midwifery faculty in the North East have secured a post. Andrew Murrison, the Shadow Health Minister, said: This move is presumably designed to save the Governments blushes as hospitals cut jobs and freeze nursing posts in a desperate attempt to resolve deficits.
Source
PAIN IN GERMANY
With the country distracted by the prospect of tomorrow's World Cup semi-final against Italy, Angela Merkel's Government quietly announced the most painful reform yet of the national health system. The overhaul - immediately denounced as suspect, inadequate and antisocial by the opposition - came after all-night negotiations between the Christian Democrats and the Social Democrats, the two governing parties.
The health reforms provide for compulsory health insurance for all children - at an extra cost next year of 1.5 billion Euros - which has been a long-standing aim of the Social Democrats. However, Frau Merkel, the Chancellor, insisted that this could not be financed through yet another tax increase. So health insurance contributions for the whole nation will go up by 0.5 per cent from next year.
The reforms were vehemently criticised by the state insurers, patients' associations and by employers. Big business argues that it will become even more expensive to hire new employees.
The fundamental aim of the change is to give more choice to patients and to meet the huge costs of prescribed medicines.
Economists predict that from January next year domestic demand in Germany is likely to dribble away as consumers are squeezed by higher taxes. Political analysts predict that the Government will run into trouble in the second half of the year. "I don't see how this current line-up can hope to last the course," Herr Westerwelle said.
More here
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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4 July 2006
British medical bungling good for Australia
Recruiters plan to target an oversupply of more than 11,000 British doctors to fix Australia's chronic doctor shortage. Health officials and representatives from the national GP training scheme will travel to Britain this year to woo doctors who fear they will be left in dead-end jobs after planned changes by the Blair Government. Recruiters hope the availability of a well-trained pool of doctors may also reduce the chance of a safety scandal akin to events at Bundaberg Base Hospital in Queensland, where surgeon Jayant Patel was accused of harming patients.
The British Medical Association is up in arms over Mr Blair's changes. It claims 21,000 qualified doctors would compete for fewer than 10,000 training posts that lead to medical consultant roles - the top tier of specialists. Those who miss out on one of the 10,000 training posts may end up in hospital roles that offer negligible opportunities for better pay or career advancement, or even out of work.
Some doctors, such as Stephen Byrne, 27, are emigrating. After two weeks as a neurosurgery registrar at Flinders Medical Centre in Adelaide, he said his work here was more interesting than in Britain, he received better training and he was not worried his career would be stifled. "I made the decision (to apply for work in Australia) at the end of February. I was looking to go into a career in neurosurgery but I didn't see much point in hanging around the UK trying to chase one of a dwindling number of jobs," he said.
No official estimate of Australia's doctor shortage exists, but a federal Government study on general practice last year found a nationwide shortage of between 800 and 1300 GPs. Senior health bureaucrats in NSW, Queensland, South Australia and Western Australia agreed that the British oversupply offered a significant opportunity to cut doctor shortages. Queensland Premier Peter Beattie went to London last year to recruit 1200 health staff, including 300 doctors and 500 nurses. Since then, 849 doctors had expressed interest, and 10 had started work, with another 15 appointed.
Source
Billions of extra government spending on health buys you this:
Queensland eye patients in limbo after closure
The temporary closure of the Queensland Eye Bank means patients with failing eyesight face an indefinite wait for their vision to be restored, Opposition health spokesman Bruce Flegg said today. Dr Flegg said the Eye Bank, at Princess Alexandra Hospital in Brisbane, could no longer supply eye tissue to surgeons who operate on around 500 Queenslanders a year. He said staff resignations meant the Queensland Health facility had been closed for six weeks and there was "no light at the end of the tunnel". "Queensland currently is the only state in Australia not offering a cornea transplant service," Dr Flegg said. He said the situation shows the "falsity" of Premier Peter Beattie's claim of Queensland Health having hundreds of extra clinical staff. Dr Flegg said it would take only weeks to train nursing staff to harvest the cornea donations and keep them in a suitable condition at the Eye Bank for surgeons to use.
A Queensland Health spokeswoman said it was hoped the Eye Bank would reopen by the end of July. Some corneas have been imported from interstate for emergencies.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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3 July 2006
Hilarious: Trying to use bureaucracy instead of incentives as a "hurry up"
You don't see many government employees hurrying!
Surgeons who dawdle over operations are to be identified in an official ranking system intended to monitor the performance of every consultant. Charts to be issued this week will assess surgeons working in the 10 most common specialisms, including general surgery, paediatric medicine, geriatric medicine and cardiology. The system of "performance indicators" will be announced this week by ministers, seeking to boost NHS productivity. A recent report from the King's Fund, an independent advisory body, said patients had not benefited from a 340 milion pound salary increase for consultants.
NHS trust managers will be able to use the data - which will not be made public - to tell slow surgeons to copy the methods of faster colleagues. Ministers point to the example of a specialist who more than doubled his output at a Norfolk hospital by using "production line" techniques learnt in France, which ensure he is never kept waiting for his next patient. John Petri, an orthopaedic specialist, radically increased the number of patients treated using a technique he calls "dual surgery". While he is operating on one patient, anaesthetists prepare the next, ensuring no time is wasted before the patient arrives in theatre. His technique cleared his waiting list at the James Paget trust in Great Yarmouth.
However, the plan has dismayed consultants, who warn that such pressure could foster "conveyor-belt" surgery. Similar rankings will be introduced this autumn to monitor spending on agency nurses, unnecessary emergency admissions and whether patients are being kept on wards unnecessarily. Andrew Burnham, a health minister, said: "This is not a big stick with which to beat consultants. It's a positive tool to help them make the best use of their time. If they do, then consultants, patients and taxpayers benefit." Burnham said consultants had "quite rightly" seen significant pay increases but must now demonstrate that the public was "getting value for that money".
The Department of Health says consultants are now paid 68% more in cash terms than they were in 1997, with those on the minimum salary scale earning an annual 70,823 from November 2006. A few of the most successful earn up to 165,000 in the NHS and many supplement their salaries with private work.
Ministers accept that most surgeons are "multi-taskers" who also care for inpatients, teach juniors and carry out research, making it difficult to judge their performance. Dr Jonathan Fielden, the deputy chairman of the British Medical Association's consultants' committee, said: "We don't see patients as cans of beans on a production line. If people are pressing us to push patients through in a factory-style manner, that would be opposed." He said most consultants wanted to improve their output and would work with managers if the data were used positively. "Unfortunately, with the financial pressures in the NHS, there has been a deterioration in relationships in some trusts." An analysis of surgeons' time sheets by the University of Birmingham, has revealed that some consultants were performing nearly six times as many operations as others.
Source
Queensland health sure know how to hire the good guys
Nobody seems to be steering the ship and they lurch from one crisis to another
The new head of Queensland's biggest hospital has lost the support of nursing staff after the bungled sacking of a senior nurse. Queensland Health director-general Uschi Schreiber met the Royal Brisbane and Women's Hospital's new clinical chief executive officer Thomas Ward and director of nursing Lesley Fleming yesterday.
The meeting was called after Dr Ward sacked Ms Fleming on Thursday and gave her five minutes to clear out her desk. She was reinstated several hours later and Dr Ward was forced to apologise and admit he did not have "a clear grasp of the industrial relations processes within Queensland Health". Dr Ward only started the job three weeks ago. After the meeting, Queensland Health said Dr Ward and Ms Fleming had "committed themselves to working together in a collaborative manner".
Queensland Nurses' Union state secretary Gay Hawksworth said RBWH nursing staff was still "very unhappy" with Dr Ward's actions. "Whilst they appreciate that the director of nursing is now back in the job, Dr Ward has shown his management style and they will be watching everything he does in the future," she said. Ms Hawksworth said Ms Fleming was not given a reason for her dismissal. "She had about a 30-second meeting with him and he handed her a letter and said 'your contract has been terminated, leave now'."
Shadow minister for health Bruce Flegg said Dr Ward's position was untenable. "Clearly, once you have this sort of tension operating at the most senior level, you have a dysfunctional situation," Dr Flegg said. He cast doubt on Dr Ward's credentials, saying he had not practised medicine for years and had not worked in Australia.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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2 July 2006
GIVING HEALTHCARE REAL COMPETITION
Anathema to the simplicity-dreamers of the Left
The Harvard Business School professor, often described as America's foremost business strategist, has never shied away from tackling intractable problems. Over the past two decades, for example, he has devoted considerable energy toward fostering economic development in American inner cities. But his latest challenge is one that has stumped the best and brightest business theorists, politicians, and policy makers: America's dysfunctional healthcare system. And Porter is staking his reputation on a pre ion that calls for a healthy dose of competition.
In a long essay in the June edition of Harvard Business Review, the 57-year-old Porter argues for redefining healthcare competition on the level of specific diseases and treatments, rather than on the level of health plans, networks, or hospital groups. ''The wrong kinds of competition have made a mess of the American healthcare system," contend Porter and his coauthor, Elizabeth Olmsted Teisberg of the University of Virginia. ''The right kind of competition can straighten it out."
The article is significant not only for its critique, but also because it bears the Michael Porter stamp. One of only 15 ''university professors" (the highest designation for faculty members) at Harvard University, his 16 books on strategy, competitive advantage, and business clusters have made him among the most sought-after business thinkers in the world. Porter consults for corporations, regions, and even nations. He is an adviser to Governor Mitt Romney and a former instructor of President Bush. He runs his Institute for Strategy and Competitiveness from Ludcke House, his stucco neo-Georgian headquarters on Harvard Business School's campus. And his views can influence conventional wisdom in the corporate world and even in the public policy arena.
But healthcare may prove to be a tough sell, even for Porter. ''It may take a decade," said Dr. Toby Cosgrove, leader of the Cleveland Clinic Foundation, who applauds Porter's effort. ''How fast do you think anybody can move a fifth of the US economy?" Still, it is clear that when Michael Porter talks, people listen. ''Sometimes you need a fresh look at things," said Mary R. Grealy, president of the Healthcare Leadership Council, a health policy advocacy group in Washington representing a coalition of health plans, physicians groups, hospitals, health clinics, and pharmaceutical and medical device companies. ''What's different about professor Porter is that he understands other industries, and he's trying to translate some of their experiences into healthcare. He's not mired in the system."
What attracted Porter to the healthcare sector, in fact, was its standing as a competitive industry that seemed to defy the laws of competition. In properly functioning businesses, from personal computers to mobile phones, product and process improvements drive down prices and costs, quality rises, markets expand, and uncompetitive players go out of business. In healthcare, costs are forever climbing, services are restricted or rationed, many patients receive poor care, preventable medical errors persist, and there are wide discrepancies in costs and quality among providers and across geographic areas.
Porter and Teisberg have a deceptively simple diagnosis: Healthcare competition today works on the wrong level. The players -- health plans, payers, providers, and doctors -- engage in what the authors call ''zero-sum competition," dividing value rather than creating it. They seek to transfer costs onto one another, limit access to care, hoard information, and stifle innovation, all to the detriment of patients.
The right kind of competition should occur at the level of preventing, identifying, and treating patients' conditions and diseases, Porter and Teisberg assert. They call for collecting and disseminating information about the outcome of medical procedures, so patients can make intelligent choices about physicians and hospitals. They also recommend transparency in billing and pricing to reduce cost shifting, discrimination, and other inefficiencies. And they propose increased specialization by healthcare providers, resulting in more centers of excellence in conditions and treatments that compete for patients. ''There's only one kind of competition that's directly connected to healthcare value," Porter maintained in an interview. ''And that's the competition about who can do the best job of your prostate surgery, with the least complications and the best recovery records. That's where the competition needs to be. Yet that kind of competition has been all but eliminated in the system, in a misguided effort to save costs."
Most of the tried-and-failed healthcare reform efforts of the past decade have emphasized government playing a larger role, as it does in Canada, the United Kingdom, and other countries. By contrast, the Porter-Teisberg approach would be a largely private sector solution, with employers helping to instigate change by negotiating with health insurers and providers for quality, choice, and transparency.
Government would have a role, not as a ''single payer" or an insurer of last resort, but by blocking network restrictions, hospital consolidation, and multiple hospitalization bills, and helping to set a framework for reform through its Medicare program. The role of health plans, meanwhile, would be more akin to that of coaches and advisers, helping their members navigate the system and find the best care.
Even before this month's publication of their article, which they plan to expand into a book over the next six months, Porter and Teisberg shared their two years of research and analysis with groups of healthcare industry leaders. And a few already have begun to reexamine their role as employers. Merck & Co., the pharmaceutical giant based in Whitehouse Station, N.J., has formed a senior level management committee -- headed by Raymond V. Gilmartin, the Merck chief executive -- that is working with its human resources staff to change the company's approach to purchasing healthcare for employees. ''Senior management has not really engaged the issue of healthcare as an operational issue," Gilmartin said. ''They have looked at it as just a benefit, and often at how to reduce the cost of that benefit . . . It's been quite a while since we've had new thinking in the healthcare area."
Teisberg, an economist who began collaborating with Porter when she was at Harvard in the early 1990s, moved to the University of Virginia in 1996 to teach at its Darden Graduate School of Business Administration. She got interested in healthcare years ago when a family health issue gave her insight into both the good and bad aspects of the US healthcare system. Speaking of herself and Porter, she said, ''Neither one of us has come at this as a healthcare expert. We're out there talking to people because we care about this. It matters."
Porter and Teisberg both anticipate pushback from the parties invested in the current system. Employers and insurers may continue to focus on cost-cutting as a top priority. Doctors, health plans, and hospitals may resist publishing data on outcomes, arguing that such information could be misleading without the proper context because physicians and clinics with the best reputations tend to take on the toughest cases and therefore may have higher failure rates.
As for the health plans, Porter said flatly, ''I suspect they will have a bit of indigestion over this . . . They are used to saying, 'OK, I have this power and I can bargain down rates with certain providers.' We advocate that there shouldn't be price discrimination. That is, somebody shouldn't pay more just because they're insured by one health plan versus another. It doesn't make any economic sense."
Still, there is a broad consensus that the healthcare industry is overdue for reform. Grealy and Gilmartin said elements of what Porter and Teisberg are proposing already are being introduced or tested in pilot projects around the country. Health insurers in Massachusetts, for example, are moving toward enabling members to search the Web for the best-rated hospitals for specific surgeries or illnesses. And, the M.D. Anderson Cancer Center and Texas Heart Institute, both in Houston, are among a growing number of institutions developing their specialties rather than trying to be all things to all people; such sites increasingly are referring patients with related conditions to other specialty centers.
Such efforts still aren't widespread, but Porter is hoping his proposals can be a spur to new thinking, especially among physicians. ''What more thrilling thing to do as a doctor than to try to be the best?" the professor asked rhetorically. ''Isn't that why you went into medical school? . . . Well, how are you going to know if you're not competing with anybody, if there's no information, if there's no data collected?"
Porter's style, refined in countless lectures at Harvard Business School, is to overwhelm listeners with his energy and the sheer logic of his ideas. He is both intellectual and animated. On a recent visit to WBUR's radio studio, where he discussed his healthcare proposal with ''On Point" host Tom Ashbrook, Porter rocked from side to side in his swivel chair, traced arcs through the air with his hands, and seemed to be only warming up to his subject when the 50-minute taping drew to a close.
One question with which Porter is wrestling is how to get from the current dysfunctional state of healthcare to the model that he and Teisberg have layed out. Porter said he is committed to meeting with industry executives, and state and federal regulators, to lend his support to initiatives and reform efforts that move in the right direction. Porter also has his eyes on the presidential campaign where, he believes, ''the debate now is totally about cost shifting and not value creation" in healthcare. Could his proposal influence that debate? ''I hope so," Porter said. ''I would love to challenge both candidates to see what they're going to do to engage these issues."
Source
Billions fail to help health
In Queensland as in the U.K.
A leaked memo written by Queensland Health's chief has revealed the Beattie Government has failed to substantially reduce surgical waiting lists despite an unprecedented funding boost and the Premier's claims to have turned the corner on health. The memo, by Director-General Uschi Schreiber, also warns that the integrity of Queensland Health's budget is at risk because little attention is being paid to how the billions of dollars the Government has promised to fix the sector's problems is spent. The two-page document's message is in stark contrast to the glossy brochure on health - titled "Keeping our promise" - mailed out to every Queensland household at a cost of more than $300,000.
A letter from Peter Beattie accompanying the brochure promised the funding would lead to "more hospital beds, shorter waiting times and better health care". But on surgery waiting lists, Ms Schreiber's memo states: "Despite the additional funds in 2005-06, to date, the available data indicates no substantial improvement. This is disappointing. "The effective management of elective surgery is crucial because the public health system's performance is constantly being assessed by the community by reference to this area of service delivery."
Ms Schreiber has summoned top bureaucrats to a strategy forum next week, asking them to justify their existing programs and rein in spending as "there is no further additional funding available" for the 2006-07 financial year. In the June 9 memo, leaked to The Courier-Mail yesterday, Ms Schreiber expresses frustration that a core function of Queensland Health, elective surgery, is still lagging. "It has become apparent that the recent substantial increases in funding to the Queensland public health system has led to a lack of attention to maintaining budget integrity, to the detriment of current and future service sustainability. I am also concerned that the large increases in funding have not been translated into improvements in performance, particularly in relation to elective surgery."
In a further leaked memo dated June 28, Ms Schreiber warns that the growth in employment [As in Britain, the money has gone on bureaucrats] in Queensland Health had increased "beyond the targeted levels". "Our current projections indicate this level of increase in staff may not be sustainable within our current budget al ," wrote Ms Schreiber, who was appointed to the top job a year ago after the sacking of Dr Steve Buckland.
Ms Schreiber said yesterday she had a mandate to look after health as well as taxpayers' funds and to remind doctors, nurses and administrators that there was not a bottomless well of money. "This is about ensuring that we don't go over budget," she said. "If I'm not careful in managing the place, it will flip the other way where people think there is no reason to keep looking at budget integrity. "We are doing more surgery than the Queensland Health system has ever done in its history. It indicates ever-increasing demand. We have to find a whole lot of new reforms for elective surgery."
The Schreiber warnings come as Mr Beattie reassures Queenslanders in an expensive advertising campaign that the biggest ever reforms to the health system are paying off. An extra $9.7 billion over five years has been pledged by Mr Beattie for "more doctors, nurses and allied health professionals, more hospital beds, shorter waiting times and better health care".
Health Minister Stephen Robertson and Mr Beattie yesterday defended the cost to taxpayers of the advertising blitz. "It's really important that we produce a report card which highlights exactly where the reforms are being done. Queenslanders are entitled to know how the system is improving," Mr Beattie said. But Opposition Leader Lawrence Springborg accused Mr Beattie of "spending $8 million on propaganda trying to convince Queenslanders they have turned the corner". "Despite all the glossy taxpayer-funded advertising and the self-congratulatory claims that they have turned the corner on health, the reality is that under Labor the waiting lists have grown by a further 13 per cent under the Beattie Labor Government," Mr Springborg said. "This is devastating news for those people forced to wait to get the health care they need."
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. ***************************
1 July 2006
NHS BEING PRIVATIZED?
The worlds biggest private health companies are being invited to bid for the chance to spend substantial chunks of the 80 billion pound NHS budget. A six-page contract notice placed by the Department of Health in the supplement to the Official Journal of European Union, and seen by The Times, encourages the private sector to apply for a wide range of roles in the control and running of primary care trusts (PCTs). The trusts are responsible for about 80 per cent of the annual 80 billion NHS budget. They not only fund GP surgeries but also commission hospital operations and have a large say over which drugs patients in their area can receive. Critics said that the move was like putting the NHS up for sale, while some also said it signalled the end of PCTs role as providers of clinical services.
Last night, after being contacted by The Times, the department suddenly withdrew the advertisement. It said that drafting errors in the document had given the false impression that clinical services provided by PCTs would be phased out in favour of the private sector. However, it insisted that plans to broaden use of expert help from the private sector for ailing PCTs remained accurate.
Health economists said that while the Government had tentatively suggested expanding the use of private firms as purchasers of care for NHS patients one of the key roles of a primary care trust the document went much farther. It invited tenders for a multitude of services, including general management, financial management, healthcare administration and human resources. Additional information, provided on request to potential applicants, revealed that candidates should have experience of managing 300 million-plus health budgets. The stipulation meant that only the largest insurers and providers, such as the American firms United Healthcare and Kaiser Permanente, were likely to be suit- able. The advertisement asked for tenders, or requests to participate, by July 17, with selected candidates due to have been notified by the beginning of August.
Policy experts and health campaigners questioned last night how an initiative with such major repercussions for the future of British healthcare could be introduced without public debate. Mark Hellowell, research Fellow at the Centre for International Public Health Policy, said that the document implied that the Government felt a lot of services run by PCTs were inadequate and would be more efficiently provided by the private sector. He added that it was not possible to know exactly what the Governments intentions were, because there had been no public announcement or debate and the initiative did not appear in any manifesto. The scope appears to go beyond commissioning care. It is the full gamut of PCT activities, he said. When a government comes out with a policy, it normally wants to shout about it. But it seems with this that they want to do it on the quiet.
Private providers already supply a small but growing proportion of NHS operations, diagnostics and mental health facilities. The Department of Health is understood to be particularly keen to get independent firms involved in the purchasing of care, which would reassure commercial health providers that they will not fall victim to any NHS bias. Alex Nunns, spokesman of the campaign group Keep Our NHS Public, said that the move flew in the face of government insistence that it was not privatising the NHS by stealth.
Source
Firemen sent to medical emergency
This is the ambulance system that has supposedly been "fixed" by the Queensland government. A defibrillator might have saved the woman
A woman died from a heart attack after volunteer firefighters were sent to her home because no paramedic was available. Christine Matthews, 55, of Mungallala, near Mitchell, suffered cardiac arrest early on Friday. A Triple-0 call to the QAS from a family member had to be redirected to the Fire and Rescue Service.
Sources said the ambulance officer was on leave at the time and there was no replacement on duty. The call was put through to the volunteer firemen at Mungallala, about 600km west of Brisbane, who responded to the emergency, arriving at the woman's home at Tyrconnel Street at 5.14am.
The firemen, who only had the standard 20 minutes' supply of oxygen on their truck, arrived to find Ms Matthews had no pulse and they carried out resuscitation for 30 minutes. A Queensland Fire and Rescue Service spokesman said the part-time firemen did "a damn good job" trying to revive Ms Matthews.
A senior volunteer fireman at Mitchell commandeered the unused ambulance and picked up a doctor and director of nursing from Mitchell Hospital, driving them the 44km to Mungallala. They arrived at 5.41am and Ms Matthews was treated by the doctor and nurse with a defibrillator, but was pronounced dead.
A QAS spokesman said the firemen were the "closest available emergency unit". "In rural and remote areas, all emergency response agencies and staff co-operate at critical times to provide the best possible service to their local community," he said.
Opposition Leader Lawrence Springborg said it was another example of Queenslanders suffering, despite paying ambulance taxes. "This tragic case highlights just how the Labor Government has abandoned regional and rural Queenslanders," he said. Mungallala has also been without a policeman for some time after the previous officer transferred and no replacement was sent.
The article above appeared in the Brisbane "Sunday Mail" on June 25, 2006
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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