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30 June, 2007

Who's Really 'Sicko'

In Canada, dogs can get a hip replacement in under a week. Humans can wait two to three years

"I haven't seen 'Sicko,' " says Avril Allen about the new Michael Moore documentary, which advocates socialized medicine for the United States. The film, which has been widely viewed on the Internet, and which will officially open in the U.S. and Canada on Friday, has been getting rave reviews. But Ms. Allen, a lawyer, has no plans to watch it. She's just too busy preparing to file suit against Ontario's provincial government about its health-care system next month.

Her client, Lindsay McCreith, would have had to wait for four months just to get an MRI, and then months more to see a neurologist for his malignant brain tumor. Instead, frustrated and ill, the retired auto-body shop owner traveled to Buffalo, N.Y., for a lifesaving surgery. Now he's suing for the right to opt out of Canada's government-run health care, which he considers dangerous. Ms. Allen figures the lawsuit has a fighting chance: In 2005, the Supreme Court of Canada ruled that "access to wait lists is not access to health care," striking down key Quebec laws that prohibited private medicine and private health insurance.

In the U.S., 83 House Democrats voted for a bill in 1993 calling for single-payer health care. That idea collapsed with HillaryCare and since then has existed on the fringes of the debate--winning praise from academics and pressure groups, but remaining largely out of the political discussion. Mr. Moore's documentary intends to change that, exposing millions to his argument that American health care is sick and socialized medicine is the cure.

It's not simply that Mr. Moore is wrong. His grand tour of public health care systems misses the big story: While he prescribes socialism, market-oriented reforms are percolating in cities from Stockholm to Saskatoon. Mr. Moore goes to London, Ontario, where he notes that not a single patient has waited in the hospital emergency room more than 45 minutes. "It's a fabulous system," a woman explains. In Britain, he tours a hospital where patients marvel at their free care. A patient's husband explains: "It's not America." Humorously, Mr. Moore finds a cashier dispensing money to patients (for transportation). In France, a doctor explains the success of the health-care system with the old Marxist axiom: "You pay according to your means, and you receive according to your needs." It's compelling material--I know because, born and raised in Canada, I used to believe in government-run health care. Then I was mugged by reality.

Consider, for instance, Mr. Moore's claim that ERs don't overcrowd in Canada. A Canadian government study recently found that only about half of patients are treated in a timely manner, as defined by local medical and hospital associations. "The research merely confirms anecdotal reports of interminable waits," reported a national newspaper. While people in rural areas seem to fare better, Toronto patients receive care in four hours on average; one in 10 patients waits more than a dozen hours.

This problem hit close to home last year: A relative, living in Winnipeg, nearly died of a strangulated bowel while lying on a stretcher for five hours, writhing in pain. To get the needed ultrasound, he was sent by ambulance to another hospital.

In Britain, the Department of Health recently acknowledged that one in eight patients wait more than a year for surgery. Around the time Mr. Moore was putting the finishing touches on his documentary, a hospital in Sutton Coldfield announced its new money-saving linen policy: Housekeeping will no longer change the bed sheets between patients, just turn them over. France's system failed so spectacularly in the summer heat of 2003 that 13,000 people died, largely of dehydration. Hospitals stopped answering the phones and ambulance attendants told people to fend for themselves.

With such problems, it's not surprising that people are looking for alternatives. Private clinics--some operating in a "gray zone" of the law--are now opening in Canada at a rate of about one per week.

Canadian doctors, once quiet on the issue of private health care, elected Brian Day as president of their national association. Dr. Day is a leading critic of Canadian medicare; he opened a private surgery hospital and then challenged the government to shut it down. "This is a country," Dr. Day said by way of explanation, "in which dogs can get a hip replacement in under a week and in which humans can wait two to three years."

Market reforms are catching on in Britain, too. For six decades, its socialist Labour Party scoffed at the very idea of private medicine, dismissing it as "Americanization." Today Labour favors privatization, promising to triple the number of private-sector surgical procedures provided within two years. The Labour government aspires to give patients a choice of four providers for surgeries, at least one of them private, and recently considered the contracting out of some primary-care services--perhaps even to American companies.

Other European countries follow this same path. In Sweden, after the latest privatizations, the government will contract out some 80% of Stockholm's primary care and 40% of total health services, including Stockholm's largest hospital. Beginning before the election of the new conservative chancellor, Germany enhanced insurance competition and turned state enterprises over to the private sector (including the majority of public hospitals). Even in Slovakia, a former Marxist country, privatizations are actively debated.

Under the weight of demographic shifts and strained by the limits of command-and-control economics, government-run health systems have turned out to be less than utopian. The stories are the same: dirty hospitals, poor standards and difficulty accessing modern drugs and tests. Admittedly, the recent market reforms are gradual and controversial. But facts are facts, the reforms are real, and they represent a major trend in health care. What does Mr. Moore's documentary say about that? Nothing.

Source




Australia: Public hospitals "too busy" -- turn away 48-year-old heart attack victim -- who dies for want of attention

As a relatively young man he might well have survived if promptly given anti-clotting agents etc.

A MAN died after besieged Gold Coast and northern NSW hospitals turned away ambulances yesterday. The man, 48, from NSW, is believed to have suffered a heart attack at Currumbin yesterday morning. Tweed Heads Hospital would not accept the man and he was taken by ambulance to Gold Coast Hospital where he died, according to a Queensland Health spokesman. "He went into cardiac arrest soon after he arrived at Gold Coast and died in the emergency department," the spokesman said.

A NSW Health spokesman confirmed the Tweed Heads Hospital was on "bypass" but said the manager was unaware of an ambulance being turned away with an emergency patient on board. A Queensland Ambulance Service spokeswoman said ambulance officers contacted the Tweed Heads hospital twice but were turned away. "We were advised that the hospital was on redirect and unable to accept the patient," she said.

Several regional hospitals were turning away ambulances yesterday, including Gold Coast, Logan, Pindara, John Flynn, Allamanda, Tweed Heads and Murwillumbah. "The (Queensland) Government has been putting its head in the sand for far too long over the bypass situation," one ambulance officer said.

A Gold Coast Hospital spokeswoman said the hospital had been on bypass or "redirect" between 1pm and 3.30pm yesterday. She said the winter flu season was adding to pressure on hospitals.

Source




A deadbeat State health system in Tasmania

THE giant $1.3-billion Health Department has delayed paying its bills, including $69 owed to a Burnie couple struggling to survive on disability pensions. Tom Browne said he had $40 to last him the next two weeks and could not believe the department had not paid him the refund for driving his son to Hobart to see a neurosurgeon. "It just peeves me off, they don't look out for the little people anymore," he said. "To me it's a lot of money and I need the money more than they do."

Health Minister Lara Giddings revealed yesterday that her department had delayed the payment of bills because of the "tight financial problems we are in". "We do need every dollar we can get," she said. "Firm control is indeed needed to ensure that we remain within our budget. "We must all live within our budgets."

Mr Browne said he had been out of pocket for a month, having spent $80 on petrol to drive his adult son to Hobart and back. The $69 refund appeared in his bank account yesterday afternoon, hours after a question about its whereabouts from Tasmanian Greens leader Peg Putt to State Parliament. Ms Putt welcomed the payment, which she said had come after she embarrassed the Government about its "extraordinary penny-pinching".

She said three weeks after the Brownes had applied for their public transport refund, a public servant had told them about a memo circulating. She said it read: "Due to budget restraints and the end of the financial year, we are currently holding payments past the due dates."

Department deputy secretary at shared services Simon Barnsley said at June 21, Tasmania's three public hospitals owed $10.7 million to creditors. He said since then $4.7 million worth of accounts had been paid to meet all accounts outstanding more than 30 days. He said payments would continue through until June 30, in line with "standard cash management practice". "At the Royal Hobart Hospital the outstanding amount was $4.7 million -- or 1.8 per cent of budget," he said. "$3.1 million was owed at the Launceston General Hospital, or 2.2 per cent of budget -- and at the North West Regional the total outstanding was $2 million or two per cent of budget."

Ms Giddings said the department did not have a "bottomless pit" of money to tap into and there were no extra funds available. "We have to live within our budgets, and it is a problem," 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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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29 June, 2007

NHS NEGLIGENCE KILLS ANOTHER BABY

The NHS chequebook proves it

The family of a premature baby who died after emergency surgery to the wrong lung have agreed an out-of-court settlement with the hospital trust concerned. Clarke Jackson was born three months prematurely at Wythenshawe Hospital, Manchester, in April 2004, weighing 2.2lb (1kg). He died less than 11 hours later. The child’s family have pursued a legal claim against the hospital trust insisting that medical staff made a series of errors that led, at least in part, to the baby’s death.

The hospital has acknowledged that an X-ray examination revealed a problem with the baby’s left lung but that it went on to treat his right lung instead. Clarke continued to struggle for breath as his condition deteriorated.

Katrina Jackson, 34, the baby’s mother, has also claimed that staff failed to check on her during her 17-hour labour, that she was left to give birth alone and that there was nobody present to give emergency care immediately after the birth. These claims are denied by the trust, which insists that the child was so poorly he was unlikely to survive.

Mrs Jackson, of Manchester, said that the circumstances of Clarke’s death had left her wondering whether he could have lived had he been given immediate care. Mrs Jackson, who has three other children, said: “Clarke was breathing, kicking and showing all the normal signs of life when he was born. We believe he would have had a good chance with better care.

“It has left us with the question, ‘What if?’ I was in the hospital for five weeks, yet when the moment came to ensure the safest possible delivery the hospital staff just were not there doing basic things. “I had to insist on seeing Clarke’s medical records. If I hadn’t, we would have been brushed aside with the explanation that he as too poorly and wouldn’t have made it. Getting left and right mixed up has killed my son.”

The family have agreed to accept an undisclosed five-figure sum. Adam Smith, of Thompsons Solicitors, said: “This is an alarming and tragic case where hospital staff made fundamental errors.” A spokesman for the University Hospital of South Manchester NHS Foundation Trust said: “A full investigation was carried out by the trust and lessons have been learnt to minimise the risk of this tragedy occurring again. “Clarke was very poorly and was unlikely to survive but the trust has accepted that the clinical error contributed to his tragic death.

Source




Australia: Destructive neglect in a State public health system

A WOMAN may lose her hands after languishing on a rehabilitation waiting list for more than three years. The nails of Fran Murphy's crippled fingers are now growing into her palms, risking infection that could see her lose her hands. The 55-year-old has been on a rehabilitation waiting list since March 2004 for an aneurism and stroke suffered in September 2003. Her fingers are now clenched immovably into fists. The nursing home resident can't talk, but daughter Renae Caulkett said she constantly cried in distress.

"It's disgraceful. If she had therapy and physio from the beginning, her hands wouldn't be like this. "Now it is just going to be more resources to have her hands fixed and traumatic surgery and recovery for her. She is crying and in pain, and it is very distressing when you can't do anything to help."

Victoria's $5.6 million Slow to Recover scheme, providing intensive rehabilitation for those with brain injuries ineligible for treatment under the TAC or WorkCover, is the only one of its kind in Australia. Ms Murphy has routine physio and speech therapy. But occupational therapist Michelle French said she desperately needed specialist treatment, though she fears it is now too late. "Her hands are so tightly fisted you can't even open them to clean them or cut the nails. Had she managed to get services earlier -- hand therapy, stretching programs, and hand splints -- her hands would not be in the condition they are now," she said. Ms Murphy is on a public hospital waiting list to have her finger tendons cut. If this doesn't provide movement, or infection occurs, she faces the prospect of amputation.

Young People in Nursing Homes National Alliance director Dr Bronwyn Morkham said 67 people were waiting for help under the scheme. The State Budget allocated an extra $12.3 million over three years, but Dr Morkham said this would not be available until 2008 and then only to those already on the list.

Community Services Minister Gavin Jennings's spokeswoman said the scheme was at full capacity (140 patients) and the Government spent more than $1 billion a year on rehabilitation. There had been extra funding for Ms Murphy's rehabilitation while she waited to enter the program. "DHS are in regular contact with her family to ensure this support is flexible enough to help address her needs," 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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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28 June, 2007

FRED THOMPSON GETS IT:

Good to hear from the future President

We're hearing those phrases again; national health care, universal health care, socialized medicine. We're being told that government bureaucrats can take over our entire medical industry -- which by the way is the best and most complex in the world -- and make it better.

It used to be a lot easier to make the case for nationalizing health care before we actually started looking at the countries that have it. A lot of people don't seem to have noticed but, in recent years, the grand experiments in bureaucratic medicine are coming apart at the seams.

Nearest home, it was the Canadian Health Care system that lost its luster. Despite paying nearly half their incomes in taxes, and as much as 40 percent of each tax dollar on health care, many Canadian experts have recognized that their health care system’s in a state of crisis. The problem has been, simply, not enough health care facilities to serve the population -- leading to long and sometimes fatal delays while waiting for treatments. Many Canadians have started coming to the US for treatments that they just can't get at home.

Now, top officials of the British National Health Service, often held out as an example of the kind of socialized medicine America should adopt, have acknowledged that they have similar problems. One in eight National Health Service hospital patients has to wait more than a year for treatment. Thirty percent wait more than 30 weeks.

Think about it. This is what we're supposed to copy? The poorest Americans are getting far better service than that. And there's nothing about Americans that would make us any better able to run a government health care bureaucracy than the Canadians or the British. In fact, we've got less practice at that sort of thing than they do -- and we might be a lot worse at it.

Source




Filthy British government hospitals that won't come clean

Keeping a hospital clean does not require a lot of money or complicated equipment. It does require will. It requires someone to exercise authority and take responsibility

In the same week that saw the Conservative party announce its plans for the National Health Service came news that one in four NHS organisations in England is failing to comply with basic hygiene standards. Survey after survey reveals that patients are more concerned about catching an infection in hospital than any other issue.

The rise of the hospital superbug is the visible sign of a bureaucracy in crisis. Cases of MRSA in England and Wales have increased by 600% in the past decade alone, according to government figures. Britain has one of the worst records in Europe. The danger of contracting a bug here is more than 15 times higher than the next safest countries. Hospital-acquired infection (HAI) affects 300,000 people a year, claiming as many as 20,000 lives, with more than 5,000 a year dying of hospital superbugs such as MRSA.

Keeping a hospital clean does not require money or complicated equipment. It does require will. It requires someone to exercise authority and take responsibility. Florence Nightingale understood this when she cut the fatality rate of wounded soldiers from 40% to just 5% by imposing basic standards of hygiene and sanitation. She organised her nurses on almost military lines and subjected them to military discipline.

What do we have instead? One former matron, now in audit work, pointed out the difficulty of disciplining a nurse for incompetence in the NHS today. Modern management is meant to "nurture" its employees. "You can't bawl them out or they'll sue you for harassment," she explained. Instead, "in a nice, soft voice, you have to ask if that was the way she had been taught? Did she consider it appropriate?"

The hospitals I visited during a year's research appeared helpless to do anything about their wards and staff. A sister in charge of a ward has little say in how her ward is cleaned, when it is done or by whom. Certainly she has no power to discipline cleaners. All she can do is complain to the cleaning manager who deals with the outside contract cleaners.

One Filipina nurse complained: "No one tells the cleaner to change their water when it gets dirty. If you don't stipulate in the contract that the water should be changed four times when you wash a particular ward, they won't do it." She was shocked that her NHS hospital had no night cleaners as they do in the Philippines, she said.

NHS staff themselves often fail to take the risk of HAI seriously. At a hospital board meeting I attended, a consultant admitted: "I don't get stroppy with staff if they do not wash their hands." "I do," replied another doctor. "But you are a surgeon," pointed out the first, "and I am just a gentle physician." Stroppiness is not seen as a virtue in the NHS.

I was standing outside a side room, containing a patient with MRSA, talking to a matron and a nurse manager from infection control. Earlier I had been shown the apron and glove dispenser at the entrance of the room. Every nurse is supposed to put these on before touching the patient, then remove them before leaving the room. Suddenly I noticed a nurse walk in, see to the patient and then depart. She had not, despite the presence of her matron and infection control manager, touched the dispenser.

Neither woman appeared to notice. In my astonishment I interrupted them. Had I misunderstood? Was I being very stupid? It appeared not. The matron tut-tutted. "You've got to have eyes in the back of your head with these girls," she said. The infection control manager nodded sympathetically. "Doctors are far worse," she added. There was no question of a reprimand, let alone the sack.

Compare this with the enforcement of health and safety legislation elsewhere. One industrial chemist, who found himself a patient of the NHS, was horrified when he witnessed a similar scene. He would have been sacked on the spot for not wearing the protective clothing or equipment provided by his employers. NHS health and safety legislation, so powerful that it can close down a hospital, does not - as the chief executive of one hospital pointed out to me - even include infection control.

So will "autonomy and accountability", the Conservative proposals for NHS reform, do anything about our dirty buckets? The main feature of the report is how little it differs from Labour's own NHS reforms.

Patients, the Conservatives promise, can choose to be treated in the private or public sector as long as the cost is the same or below that of the NHS. If the cost is higher, patients cannot top up the NHS with their own money. This is exactly what many might wish to do when they discover how the rates of HAI in the private sector compare with the NHS. Infection rates for hysterectomies, for example, vary between 0.74% to 2.8% in private hospitals. In the NHS they are as high as 11%.

It is almost impossible for patients to make that comparison. Private hospitals include the information on their websites or are happy to give it over the phone. The matron of one told me proudly that its rate was 0% per 10,000 beds: "We often get inquiries and quite rightly so. I would want to know." In the NHS the Healthcare Commission provides information on trusts but not on individual hospitals.

Even an NHS GP found it difficult to discover such information. He explained that patients are on the "choose and book" system, but choice was restricted to locality only.

The Tories agree that standards of information in the NHS are "lamentable". They promise to provide the public with information on the "prevalence" of HAI - not only hospital by hospital, but also department by department. This information is vital. Competition and patient choice will do more than any government policy to force good practice up through the management hierarchy of the NHS.

Meanwhile, we have allowed authority to absent itself where it should be all important. Any politician contemplating healthcare reform must start with the basics. And the basics are a clean pair of hands.

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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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27 June, 2007

British mother denied cancer drug -- has to sell her house

It's very pesky trying to cash in on your health insurance when the government is the insurer. What if she did not have a house to sell? Tough luck!



A mother has been forced to sell her home to pay for private treatment with a cancer "wonder drug" after funding for it was denied. Debbie Mitchell, 39, said she was "left to sit in the corner and die" after her local primary care trust refused to pay for Sutent for her stomach cancer. The drug costs 2,500 pounds a month and to pay for it she and her partner John Forrester have now had to sell their 340,000 four-bedroom detached home in the Staffordshire village of Derrington.

"It's heartbreaking," she said. "We built the house ourselves from scratch - it's our dream home. "We love the house, we love the village, we love the people, but we've been left with no alternative. "I can't believe it's come to this. We live in such a cruel world."

Miss Mitchell was diagnosed with cancer in 1999, and had 40 per cent of her stomach removed. In May last year she received the devastating news that the disease had returned in the form of GIST (gastrointestinal stomal), a rare mutating cancer. South Staffordshire PCT paid for her to be put on the drug Glivec, even funding a double dose for her which would cost 58,000 for a year's treatment. But in February, cancer specialists treating her said her tumours were still growing and recommended Sutent, which has been shown to shrink tumours dramatically and can prolong life for two years or more.

The drug, which is widely prescribed throughout Europe and the U.S., has already been licensed for use in Britain. But it has yet to be approved by the Government's drugs watchdog, the National Institute for Health and Clinical Excellence (NICE). Until NICE guidelines are introduced, it is up to primary care trusts to decide whether to fund treatment with Sutent. It is funded in parts of Britain, but Miss Mitchell's PCT refused to pay for it on the grounds of cost and clinical effectiveness.

Its decision came even though, at 29,000 a year, it is cheaper than the double dose course of Glivec. Some experts also estimate Sutent has a 50 per cent chance of working on tumours whereas Glivec has only five per cent. "I can't take it, there's no logic there," said Miss Mitchell. "It is a postcode lottery whether you receive Sutent or not. "We all put money into the NHS pot and therefore we should all be allowed the same treatment. "My oncologists have written to the PCT, saying that I should be given the drug. Yet the PCT has not bothered to look into the circumstances of my condition, despite all the evidence. "What's the point in developing these drugs if they're not going to be used?"

She and Mr Forrester, 37, who co-own a limousine hire company, will move next month with her 18-year- old daughter Amy to a smaller 240,000 pound house they have bought in nearby Stafford. Mr Forrester's four children stay with the couple every other weekend. Miss Mitchell said: "We'll still have a mortgage because the money we've made off our house is going toward the cost of the treatment. "We've got enough money for a couple of years of the drug at the moment. After that we'll have to remortgage the new house."

In a letter sent to Miss Mitchell, the PCT defended its decision saying: "The request for treatment was turned down due to lack of evidence of clinical and cost-effectiveness."

Source




South Australian public health system in big trouble

SOUTH Australian psychiatrists have threatened to resign en masse from the state system next week, dramatically widening the public sector revolt against the Rann Government's bid to rein in costs and pay growth. Up to 50 psychiatrists are believed to be ready to quit the system on Monday if the Government does not fund 20 extra specialists to provide what their union calls a "minimum" adequate level of service and pay.

Treasurer Kevin Foley sought to rein in public sector unions last month by warning a wage breakout would tear a $190million hole in the budget if it was 1 per cent above what the Government had allowed for.

Public sector psychiatrists have now joined teachers, ambulance officers, nurses and dentists in threatening industrial action to back their demands for more financial resources than the Government is willing to commit. "This is not some idle threat, dangling out there to impress people," said Andrew Murray from the South Australian Salaried Medical Officers Association, the union representing the mental health sector. In other industrial moves:

* South Australian dentists in the public system - seeking a 35per cent pay rise over three years - took unprecedented industrial action by refusing to charge public patients gap fees.

* State schools will shut early on Thursday to allow teachers to deliver protest letters to their local MPs.

* Ambulance officers could introduce work bans today.

Mental Health Minister Gail Gago said negotiations with psychiatrists were at an "extremely sensitive stage".

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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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26 June, 2007

California hospitals going bust because of unpaid or underpaid bills

The poor MUST be treated regardless of ability to pay but government reimbursements for such care don't cover costs. Only in high income areas where most people ARE insured are hospitals doing OK. The graph below shows how insane the system is. As the population grows, hospital beds are becoming LESS available. Note the sinking red line in the top graph. The problem is nationwide



A tiny Sonoma County hospital is losing $500,000 a month. A cash-strapped Tuolumne County hospital is shutting most operations next week. But Sacramento-based Sutter Health reports a 33 percent jump in earnings. Increasingly, the financial state of California's hospitals can be summed up as a tale of the haves vs. the have-nots. As is often the case in such stories, researchers told state officials during a Capitol briefing Friday, the rich are getting richer and the poor, poorer. More than a third of the state's 355 acute-care hospitals lost money in 2005, according to the study funded by the California HealthCare Foundation, an independent think tank in Oakland. "Hospitals are critical. Failure rate is a big concern," said Scott Burns, a consultant at PriceWaterhouseCoopers and one of the authors of the report.

For consumers, fewer hospitals and beds could mean shortages in some communities and could drive up costs. In particular, the squeeze would be felt by those who depend on hospitals that receive the lion's share of their revenue from government sources, including Medi-Cal. Although the breadth of the problem is daunting, the number of money-losing hospitals is an improvement over six years ago, when roughly half of them operated in the red and industry experts predicted massive closures. Instead, between 2001 and 2005, the state lost 7.3 percent of its hospitals even as the overall occupancy rate rose by 3.2 percent, according to the report, but the authors warn California residents that key medical centers and hospitals remain vulnerable to bankruptcy and closure.

The foundation's report noted that hospitals with the worst financial performance derive 65 percent of payments from government reimbursements. In contrast, the best performers receive 63 percent of revenue from private insurance payments. Researchers say government reimbursements simply do not cover hospital expenses. "There's no question that hospitals are losing money from Medi-Cal and county indigent (reimbursements)," said Joanne Spetz, a health economist at the University of California, San Francisco. "You look at these facilities, and some are in really bad shape. They can't go on forever." The issue can't be ignored in some communities, she added: "Some ... are really safety-net hospitals. Policymakers need to address these."

Think things are bad now? In the coming years, hospital leaders will grapple with replacing buildings that do not meet more stringent seismic safety standards, a boom in the population of aged individuals, and the demand by this population for new medical technology. Hospitals also will continue to deal with ballooning payrolls fueled by shortages of nurses, pharmacists and other specialists, a growth in patient debt from those unable to pay and a burgeoning uninsured population.

As a whole, the state's hospitals are operating at razor-thin profit margins -- a median of 1.3 percent, compared with 2.9 percent nationally. Put into dollars, hospitals in 2005 spent $2,116 a day per patient while earning $2,122 in revenue -- a $6 operating profit. Still, that's double the $3 they earned in 2001.

The report highlights wide disparities across California, from profitable hospital chains in Sacramento and the Bay Area to ailing medical centers in the Los Angeles region and rural areas. In the Sacramento area, for example, the profit margin is a healthy 10 percent -- attributed largely to the dominance of Sutter Health and Catholic Healthcare West, parent of the capital's Mercy and Methodist hospitals. The report said profitable hospitals tend to be larger (150 or more beds), receive more private insurance payments than government reimbursements and exist in affluent urban communities.

"There are a number of hospitals in Los Angeles that are having to struggle. You don't have a dominant provider. You do have a lot of competition," said David O'Neill of the California HealthCare Foundation, created in 1996 with a $2.2 billion endowment from Blue Cross of California as part of concessions that allowed it to convert to for-profit status.

Anne McLeod, vice president of economic analysis for the California Hospital Association, said the toughest battles for survival are being waged in rural areas, in low-income communities or at facilities operated by counties or special districts. More than 80 facilities have sought more than $140 million in financial aid from the special state fund for financially ailing hospitals, McLeod said. The fund had about $23 million available.

On one end, there are hospital groups such as Sutter Health, which reported that its net income grew 33 percent, to $587 million, in 2006. The income will help fund an aggressive $6.6 billion Northern California expansion over the next decade. On the flip side, there are teetering facilities. In April, Palm Drive Hospital in Sebastopol filed for bankruptcy protection, buried under nearly $3 million in debt. County-run Tuolumne General Hospital in Sonora will shutter its emergency room and discontinue surgeries, intensive care and other medical services on June 30. In the Bay Area, Doctors Medical Center in San Pablo needs $25 million in capital to emerge from bankruptcy protection and ensure its long-term future.

Source




NHS shafts carers

Thousands of dementia sufferers are being denied access to crucial drugs because of "critical errors" by the Government's drug watchdog, the High Court is to be told today. The National Institute for Health and Clinical Excellence (NICE) is accused of using "flawed and out-of-date figures" to play down the impact of the drugs on the lives of carers of dementia sufferers. When it decided to restrict access to three key drugs, NICE concluded that even on the most optimistic assessment, the benefit to carers of more widespread use of medication was negligible.

Central to the case being presented by the Alzheimer's Society today is its calculation that the drugs, which slow the progress of dementia, can save carers an hour and a half each day in caring duties. The society, which represents dementia sufferers and their families, will also tell the court that NICE underestimated the cost of full-time residential care at 355 pounds a week. In fact, the weekly cost can be 1,500. The charity says that wider use of the drugs would help dementia sufferers to stay in their homes longer, saving local authorities millions of pounds.

The case, the first legal challenge to a NICE decision, has been brought by Eisai, the licensed holder of one of the three drugs in question. The pharmaceutical company Pfizer is backing Eisai's case. The Alzheimer's Society is acting as an "interested party" in the judicial review. Its evidence on how carers could benefit from wider use of the drug is new to the case. It will run until Thursday. The judge will then take several weeks to reach a decision. The court can order NICE to reconsider.

In 2005 NICE said that the three drugs, Aricept, Reminyl and Exelon, should not be available on the NHS. After a protest by those affected, NICE reconsidered and decided that the drugs could be prescribed, but only to people with middle-stage dementia. Five appeals were rejected, and a judge ruled in April that there were grounds for a judicial review. NICE has never said how much its decision to restrict access to the drugs would save the NHS, but experts put it at about 9.4 million a year.

Neil Hunt, chief executive of the Alzheimer's Society, said: "These treatments have benefited so many families. Where is the justice in NICE's decision to snatch them away? Another 100,000 people will develop dementia this year."

Andrew Dillon, chief executive of NICE, said: "Non-drug interventions have an important part to play and the evidence indicates that drugs are not effective for some patients."

Elsie Johnson is certain that her husband, Alan, 68, has benefited greatly from the Aricept he was prescribed as soon as his Alzheimer's was diagnosed in 2000. Under NICE's guidelines, he would have had to wait until his condition had deteriorated. Seven years on, the couple can still go on holiday, shop and take outings near their Gateshead home. "A month or two after he was put on Aricept, he really perked up and started to take more interest in life. We lead a pretty good life together," Mrs Johnson told The Times. "It is a terrible situation when psychiatrists are telling their patients that they know they have Alzheimer's and they know what will help, but they can't do anything until they get worse, so come back in a year." She added: I don't understand why scientists are spending time and money developing new drugs if NICE is going to stop people from getting 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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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25 June, 2007

STATINS: IS THE NHS RUN BY A MOB OF MAD MONKEYS?

One gets that impression. See the folly below. The NHS is famous for denying helpful drugs to its patients but has now decided to make one class of drugs widely available -- a class of drug that appears to do as much harm as good. See here and here. "Kill 'em or cure 'em" seems to be their thinking. Note the following crucial sentence in a big review of the evidence on the efficacy of statins: "A second review evaluated only trials in primary prevention and found similar reductions in CHD events and mortality, but a non-significant effect on all cause mortality". In other words, statins saved you from heart attacks but raised your risk of death from other causes -- the two effects cancelling one-another out. THAT is what the NHS now wants to give to millions, regardless of whether they have any current health problems or not. Isn't government wonderful? Note also the negative comments about statins in the first article I cover in today's posts on FOOD & HEALTH SKEPTIC.

MILLIONS of people are to be prescribed cholesterol-busting drugs on the NHS in Britain’s biggest mass medication programme for adults. The government’s drugs watchdog is expected this week to recommend the systematic screening of all adults at 40, 50 and 60 for heart disease. Those found to have a 20% chance of developing it over the next 10 years will be prescribed statins, the cholesterol-lowering “wonder drugs” that have had dramatic results in preventing heart disease. New research suggests that as many as 14m -- half of all adults aged 40 or over -- could be eligible for the drugs even though they have no symptoms.

Some doctors say a national screening programme could prevent up to 14,000 deaths a year. Heart disease is Britain’s biggest killer, claiming 105,000 lives a year. Other experts fear, however, that a programme of mass medication would make millions of adults dependent on drugs for the rest of their lives. Dr Peter Brindle, a researcher in cardiovascular disease at Bristol University, said: “ This is turning people into patients. They are going to be offered this preventative drug for the rest of their life with all the risks and side effects. There has to be a public debate about whether society feels this should be done.”

Statins are considered to be safe but patients can experience muscle pain or liver problems. Some doctors argue that it is not worth risking these side effects for people who are not suffering symptoms of heart disease.

At present patients who have suffered a heart attack or angina are eligible for statins on the NHS and some of those at risk, but not ill, are already being prescribed statins at their GP’s discretion. The National Institute for Health and Clinical Excellence is expected to argue that a systematic screening programme would pick up millions of other people who could benefit from the drugs. GPs would be expected to do the screening, checking patients’ cholesterol levels, blood pressure and weight and whether they smoke. Men are at higher risk than women.

If 14m people were subsequently prescribed statins, it would cost the NHS at least 560million pounds a year. But, say cardiologists, it could save billions in treatment costs. Research by Dr Ift-ikhar Haq, a consultant cardiologist in Newcastle upon Tyne, shows that if everyone aged 40 and above was screened for heart disease, 47% of those who show no symptoms would qualify for preventative treatment with statin drugs. Statins work by lowering cholesterol, which can cause fatty desposits in the arteries leading to heart disease.

Source




Australian health bosses adopting British-style dirty tricks to "fiddle" their statistics

HEALTH chiefs have been accused of using "sneaky tactics" to reduce surgery waiting times at Queensland hospitals. Thousands of patients waiting for operations are getting letters from Queensland Health asking them if they still need treatment. If they fail to reply within 30 days, they are automatically taken off the list and forced to return to their GP.

The Sunday Mail can reveal there are about 32,000 Category 2 and 3 patients who currently qualify for a letter from the department. Usually about one person in four fails to respond.

Hospital staff are outraged that as many as 8000 patients could drop off the list, perhaps without realising. They spoke out after Health Minister Stephen Robertson recently boasted how his measures to reduce surgery waits were working. One doctor, who couldn't be named because of a Queensland Health ban on staff speaking out, said it was a dirty trick to play. "It's just more sneaky tactics by the Government to make the waiting times look better", he said. "There is the risk that people could move house or be on holiday and not receive the letter. They could have their letters lost in the post, and others could just forget about replying altogether."

Ross Cartmill, Queensland president of the Australian Medical Association, said it was wrong not to publicly announce the letters were being sent. "I can understand them wanting to cleanse the waiting list by finding out who still needs treatment, but they should be using the media to tell people about it." The letters are sent out to Category 2 patients needing an operation within 90 days, and Category 3, who require surgery within a year. Managers say the letters are sent out to "ensure the highest standard of service to our patients". Patients who fail to specify they still need an operation are sent a follow-up letter. It states: "If you require further treatment for your condition, we urge you to contact your general practitioner."

There are 35,583 patients on the waiting list for operations across the state. More than 10,000 of these are waiting longer than is clinically safe with almost 200 classified as needing urgent treatment within 30 days. Health bosses refused to reveal how many people have failed to respond. Spokeswoman Carolyn Varley said: "We don't collate that." But sources told The Sunday Mail about a quarter of patients do not reply.

A second Queensland Health spokesman said the figure was not "accurate", but was unable to say what the figure was: "This process is not done to reduce waiting lists, but to ensure they are accurate and that resources can be utilised efficiently." Opposition health spokesman John-Paul Langbroek said it would be more ef- ficient and cheaper to phone patients. "This is just an underhand way to try to reduce waiting lists and it's not fair on patients," 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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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24 June, 2007

Dying for FDA reform

This year, Congress is considering a variety of legislative changes that would substantially affect the regulation of pharmaceutical drugs. There is growing momentum for congressional action to address several perceived drug safety problems, but all of the proposals under consideration would harm, not improve, patient safety by making it more difficult to get promising new drugs approved and into the hands of doctors and patients. These ill-conceived policies would also increase the already astronomical costs of bringing these medicines to market, raise prices, and reduce incentives for developers to undertake experimental projects.

Source. Full document in PDF here




No room at a major public hospital in South Australia

DOCTORS have been asked to stop sending patients to the Flinders Medical Centre emergency department. The overcrowded EU has admitted up to 74 patients a day at its emergency department during the past fortnight. That is just one below the point at which it would execute its "extreme emergency" code white plan, developed last winter after unprecedented demand for services. Documents obtained by The Advertiser show up to 180 people a day were presenting themselves at the Flinders emergency department and up to another 100 nightly. However, not all are admitted for treatment. Few are 'flu cases.

Southern Adelaide Health Service acute services executive director Michael Szwarcbord this week instructed hospital medical and nursing staff to:

DISCHARGE early as many patients as possible.

ACTIVELY "pull" patients out of emergency to other wards to free-up beds.

DEFER voluntary and planned admissions.

NOT accept any non-urgent patient transfers.

In a memo, stamped "urgent", issued to all Flinders staff on Monday, Mr Szwarcbord revealed GPs had been asked to avoid referring patients to the emergency department if there were "safe alternatives for their care".

Australian Medical Association state president Dr Peter Ford, however, said that message "placed considerable pressure on GPs" who were already heavily taxed. He claimed there was "considerable denial" in the Health Department over the pressures the system was under. As a further example, he said first-time mothers who had normal deliveries were being sent home from the Women's and Children's Hospital the same day they gave birth.

Opposition health spokeswoman Vickie Chapman yesterday claimed the documents showed Flinders was "in crisis" and the State Government's health budget was "more about saving money than lives". "The public is in pain and it is only going to get worse, not better," she said. "Those of us lucky enough to survive until 2016, when the Government's new Marjorie Jackson-Nelson Hospital opens, might have a chance but I expect the mortality rate to increase before then."

Health Minister John Hill, who is also Minister for the Southern Suburbs, admitted winter would be "a challenge for health staff". He said the Government had a strategic plan to unite hospitals, health and ambulance services, GPs and rehabilitation services in the face of a huge increase in demand. "There will also be more emphasis on keeping out of hospital patients who do not need to be there," he said. "South Australians can be assured that our health system is prepared and that our services will be providing the best possible care for our community." Mr Hill said sending patients home was "entirely a matter for the clinicians and nobody is telling them to do that". He also queried Dr Ford's suggestion officials were unaware of the pressure, saying: "We sure are, that's why we have introduced these reforms, because without them, the system will buckle."

Mr Szwarcbord's June 18 memo revealed 22 non-urgent elective surgery cases and four non-urgent elective procedures scheduled for Tuesday this week had been cancelled. "The hospital is experiencing overcrowding as a result of the high number of patients presenting to the emergency department and the number of patients requiring admission," he said. "At present, there are 61 patients in the emergency department, 35 of whom are waiting for an in-patient bed."

Memos, dated June 7, 13 and 18 obtained by The Advertiser, reveal the emergency department has been operating on code grey - 60 to 74 patients - for the past two weeks. The department has a "winter escalation plan" which works on a colour code system of green for up to 37 patients, amber for up to 54 patients, red for up to 60 patients, grey for up to 74 patients and white for 75 or more.

Mr Szwarcbord said the Flinders problem was exacerbated by the nearby Noarlunga Hospital operating at full capacity and the Repatriation General Hospital experiencing high demand. He advised staff on Monday that, while a range of measures had been implemented to "ease the situation", a "code white" would be activated if the problem escalated. Under the emergency code white, the hospital will:

INCREASE staff levels by hiring more casuals.

EXPEDITE patient discharges at all three southern region hospitals.

FACILITATE internal patient transfers, where appropriate.

LOCATE SA Ambulance staff on site to assist with transfers.

OPEN selected treatment, day patient and outpatient clinical areas for beds.

RESTRICT access to the emergency department to key staff only.

Mr Szwarcbord was unavailable for comment yesterday but Emergency Medicine director Dr Di King said in an emailed statement that high demand over the past two weeks could be the result of industrial action and reduced beds because of an upgrade of the pediatric unit. Dr King said that as part of a $153 million redevelopment at the hospital, the emergency department would be expanded to cope with a "growing volume of patients". Minor works were under way in ward 4G to provide care for 20 additional patients.

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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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23 June, 2007

I'm not going to pay a lot for this MRI

The benefits of HSAs

Nate was helping me limp off the soccer field, bearing the weight that would otherwise fall on my rapidly swelling knee. "At least we know you didn't tear your ACL," he said, referring to my anterior cruciate ligament. "How do we know that?" I asked. "Because I tore my ACL once," he said. "Believe me, if you had torn yours, you would have done a lot more screaming and crying."

The ACL runs from the shin bone to the thigh bone. It keeps your knee from dislocating when you turn or pivot — unless you turn or pivot too hard. As many aging athletes can attest, ACL damage is among the more common sports injuries. Put too much sideways pressure on your knee joint, and your ACL will tear. Which is exactly what happened to mine. So much for Nate's diagnostic skills.

There was nothing pleasant about tearing my ACL or having it surgically reconstructed. But there were a few silver linings. The first has to do with Nate, who foolishly admitted to me that when he tore his ACL, he screamed and cried more than I did. When I got the diagnosis, he was the first person I called. It's not every day you get to tell a 6' 5", 225–pound former Marine that he's a big sissy.

Another silver lining was that I finally got to use my health savings account. As a health economist, I have spent years arguing that this new type of health plan, also known as an "HSA," would make health insurance more affordable by giving patients an incentive to eliminate unnecessary medical expenditures. When Congress finally made HSAs available in 2004, I was one of the first to get one. But I've always been pretty healthy, so I never got a chance to use it. Until now.

HSAs are a far cry from HMOs. If I had an HMO, I might have gone straight from the soccer field to the emergency room, where they would have taken an X–ray and an MRI, referred me to an orthopedic surgeon, and maybe given me something for the pain. Importantly, I probably would not have asked whether the ER trip, the X–ray, or the MRI were worth the cost, because I would have been responsible for only a small portion of those costs. According to the Kaiser Family Foundation, the average HMO deductible for family coverage is about $750. (Simply setting foot in an ER can cost more than that.) Co–pays for generic drugs average $11, and most people with HMO coverage pay less than $20 for a physician visit. Oftentimes, patients face no deductibles or co–payments at all.

That kind of insensitivity to price leads patients to consume a lot more medical care — including a lot of medical care that doesn't do them any good. Thirty years ago, an enormous and well–respected study (the RAND Health Insurance Experiment) randomly assigned thousands of people with all sorts of health problems to different health plans with varying coinsurance levels. Unsurprisingly, researchers found that the less patients had to pay out–of–pocket, the more medical care they consumed. Patients who paid nothing out–of–pocket — for whom healthcare was effectively "free" — consumed 43 percent more than those with a deductible of a few thousand dollars. More surprising was that, overall, the additional care produced no better health outcomes. A lot of the added expenditures were simply wasted on low– and zero–value care.

America's dysfunctional healthcare system seems to be conducting a similar experiment over time. Back in 1965, patients paid, on average, 44 percent of their medical care out–of–pocket. Since then, that share has fallen to 14 percent. In other words, for every dollar of healthcare a patient receives, on average the patient pays only 14 cents from their own wallet. The results have been predictable. Patients demand more low–value medical care, they file more health insurance claims, and year after year, health insurance premiums rise faster than family incomes.

That's where HSAs come in. HSAs resemble the "high–deductible" insurance from the RAND experiment — where patients purchased less medical care but ended up just as healthy. High–deductible insurance has always been available, but few Americans choose it because of an odd tax quirk. Under the federal tax code, employer–provided health insurance isn't taxed — but any money you save for your out–of–pocket medical expenses is taxed. That provides a huge incentive to increase the share of medical expenses purchased through insurance, and reduce the share that patients purchase directly. That incentive is a big reason why out–of–pocket spending has fallen as a share of total private health spending.

The HSAs' big innovation was to give the money you save for your out–of–pocket expenses the same tax–free status as employer–provided insurance, thereby eliminating the bias against high–deductible insurance. Actually, it's kind of a no–brainer. No wonder it took Congress 60 years to do it.

So if you have HSA coverage, you can put money tax–free into a "health savings account" to cover your routine medical expenses. But you also have a health insurance policy with a deductible of $1,100 or more, which pays for any catastrophic medical bills. The important part is that the money in your HSA belongs to you. It remains yours even if you change jobs or change health insurance. That gives you a big incentive to spend the money wisely, because whatever you don't spend rolls over from year to year and grows, tax–free. You can spend the money on future medical expenses without ever paying taxes on it. Or you can use it for other things. The tax rules are the same as for an IRA: withdrawals are taxed as income, with an additional penalty that goes away at age 65.

Of course, HSAs are controversial. Despite the evidence from the RAND experiment, some fear that if patients are more cost–conscious, they will skimp on needed medical care. With my HSA, a $2,500 deductible, and a swollen knee, I was about to become part of this experiment. Would I make better decisions than if I were spending an HMO's money? Or would I end up hurting myself by forgoing necessary care? As my teammates kept playing, I sat on the sideline trying to figure out what to do next. Since I would be paying for my first $2,500 of medical expenses out of my HSA, I had to ask myself whether a trip to the emergency room was really necessary. I decided that the pain was bearable, so I skipped the ER and iced my knee until I was able to see my wife's orthopedist.

The orthopedist recommended both an MRI and an X–ray. Since I would be paying for these items myself, I asked him whether both were necessary. According to one estimate, as many as 30 percent of such imaging tests are either unnecessary or the wrong type of test. He agreed that the X–ray probably wasn't necessary, so I skipped it. As for the MRI, I was aware that they can be quite expensive. So I appreciated it when my orthopedist offered to intervene on my behalf if I thought his radiologist over–charged me.

Most patients don't even pay attention to the bizarre kabuki dance that goes on between the doctor's bill and the insurance company's "Explanation of Benefits." They just look for the part that says, "You owe this much." But since I knew I was paying for 100 percent of this MRI, I paid close attention to how much the radiologist charged me. And over–charge me, he did. The radiologist initially billed me $1,500, though my insurance company's "negotiated discount" brought the price down to $1,380. But even that seemed steep compared to an imaging center near my house, where, I discovered, they charge cash–paying patients just $600 per knee.

Here's a dirty little secret: the amount that healthcare providers initially charge isn't the actual price so much as the sticker price. According to a recent study, hospitals charge cash–paying patients two–and–a–half times what insurance companies ultimately pay, because insurance companies demand discounts. Savvy patients demand discounts too, and frequently get them. Unfortunately, many cash–paying patients aren't insistent, and end up getting gouged. Knowing all that, I wasn't intimidated by the radiologist's sticker price. Nor was I particularly impressed with my insurance company's negotiating skills. So I started negotiating on my own behalf. When I explained that I would be paying cash, the radiologist's billing agency lowered the price again, to about $1,000. Finally, seven months after my MRI, we settled on a price of $700. That's a 53 percent discount from the sticker price — and more than six times the discount negotiated by my insurance company.

The woman I negotiated with has handled this radiologist's billing for the last 20 years. She told me that if — God forbid — I ever need another MRI, I should just walk up to the front desk and demand a 50 percent discount. I think of it as the George Foreman approach to price negotiations: I'm not going to pay a lot for this MRI. Skipping the ER and an X–ray; haggling with the radiologist — spending my own money made me behave differently than if I were spending an HMO's money. Since ACL damage is such a common injury, it makes me wonder how many people unnecessarily use those services — or pay too much for them — each year.

That kind of cost–consciousness is one way HSAs can make health coverage more affordable. My cost–consciousness kept my expenses down, which kept me from filing claims with my insurance, which helps keep my health insurance premiums (and those of my coworkers) from rising. That may be one reason why, according to Deloitte Consulting, premiums for HSA–qualified high–deductible insurance have grown at less than half the rate of premiums for traditional insurance. The online insurance broker eHealthInsurance.com reports that in some cases, those premiums actually fall from one year to the next.

But what if my cost–consciousness led me astray? What if I had broken a bone, which only an X–ray would detect? By forgoing an X–ray, wouldn't I just be setting myself up for even greater costs down the road? As it turns out, I hadn't broken any bones. What the RAND experiment showed to be true in the aggregate was also true in my case: making me cost–conscious didn't hurt my health. People aren't perfect, but they appear to make pretty good decisions when spending their own money on healthcare.

One reason for that may be that cost–consciousness encourages patients to use information that they would otherwise ignore. When my knee dislocated, I heard a tear, not a crack — which suggested soft tissue damage, but no broken bones. The only reason I used that information to rule out an X–ray was because I had a financial incentive to avoid unnecessary spending. Without that financial incentive, I would have ignored that information, submitted to the X–ray, and pushed my insurance premiums upward — all for absolutely zero health benefit.

HSAs will not cure everything that's wrong with America's healthcare sector. But my HSA plan did get me more engaged in my healthcare decisions, in a way that benefited me directly, and that helped make health insurance a little more affordable for others. With enough savvy, cost–conscious patients behaving that way, HSAs might actually force down the prices of individual healthcare services, as well.

As if that sense of optimism wasn't silver lining enough, I did manage to find one more: all the informal healthcare I received from the other person covered under my HSA plan. It was my wife who picked me up from that soccer game, who drove me home from surgery, and who patiently endured the screaming and crying that Nate would never see. HSAs are worth a look. But a good wife is the best insurance policy.

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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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22 June, 2007

Sweden's Single-Payer Health System Provides a Warning to Other Nations

Sweden is a country of about 9.1 million people on the Scandinavian Peninsula of Northern Europe. Geographically, it is slightly larger than California. It is by any measure a first world country, with a labor force working primarily in industry or the service area, a GDP per capita of about $31,600 and an unemployment rate of 5.6 percent.1

For much of the 20th century, Sweden had a single-payer system of health care in which the government paid almost all health care costs. Like other nations with a single-payer system, Sweden has had to deal with the problem of ever-growing health care expenses causing a strain on government budgets. It has dealt with this problem by rationing health care - instituting waiting lists for medical appointments and surgery.

Sweden stands not merely as a warning about single-payer systems, but also as an example of what happens when market-based reform of such systems do not go far enough. In the 1990s, Sweden set about reforming its health care system by introducing aspects of privatization. These reforms were limited, however, and the old problems with waiting lists and rising costs had re-emerged by the beginning of this decade. The experience of Sweden demonstrates that when a nation adopts market-oriented reform for its health care system, the reforms will fail if the market is not permitted to work.

Structure

For much of the last fifty years Sweden has had a heavily socialized health care system. Almost all of the funding comes from government revenue, and most aspects of the health care system, such as hospitals, primary care centers and prescription drugs, are controlled by the government. Doctors could still have a private practice, although by the 1960s about 80 percent of doctors worked in government-run hospitals.2

The Swedish Parliament first tried to provide comprehensive national health insurance in 1946 with the passage of the National Health Insurance Act. Because of financial restraints, it was not actually implemented until 1955. Since that time, that national government has given increasing authority and responsibility for the health care system over to county governments (commonly known in Sweden as "county councils") to the point where they now have more power over the health care system than either the national or municipal governments. Nevertheless, the national government still plays an important role.....

Financing

In 2004, Sweden spent about 9.1 percent of its gross domestic product (GDP) on health care, which is slightly above the average for nations that belong to the Organization of Economic Cooperation and Development.4 The largest share of funding for the Swedish health care system comes from taxes. Both county and municipal governments have broad authority to levy income taxes. Since 90 percent of county revenues are expended on health care, a breakdown of the sources of county revenue give a roughly accurate picture of the revenue sources for health care provided by county councils.5 In 2003, 72 percent of the revenues for county councils came from taxes, while 18 percent came from grants from the national government, three percent came from user-fees, and the remaining seven percent came from other sources.6 Municipal government generated about 69 percent of their revenues from local taxes in 2003, and 20 percent of their revenues are spent on health care.7

Patients in Sweden pay user fees (similar to co-payments in the United States) that are set by county councils. The fee for seeing a primary care physician varies from 11 to 17 kronas (the Swedish unit of currency; $1 U.S. equals about 6.90 kronas), while the fee for seeing a specialist ranges from 22 to 33 kronas. While county councils have discretion in setting user fees, the national government limits the amount of total user fees paid per patient at 100 kronas annually for physician and specialist visits. The maximum user fee for hospital care is nine kronas per day.....

Private funding, beyond user fees, plays a small role in Swedish health care. Only about 2.3 percent of the population has supplementary health insurance, and the primary benefit of it is the ability to avoid waiting lists for treatment.9

Reform

During the 1990s, many county councils adopted market-oriented reforms of the health care system. This reform wave had its roots in an attempt in the 1980s to control the burgeoning cost of the Swedish health care system. By the early 1980s, with an aging population and increasingly expensive health care technology, the system had become unsustainable. In a ten-year period from 1972-1982, the health care portion of Sweden's GDP grew from 7.2 percent to 9.3 percent (see Figure 1).10 Until 1985, the national government reimbursed county councils for health care expenses on a fee-for-service basis. The Dagmar Reform of 1985 changed the reimbursement formula to one of "capitation," in which counties were reimbursed for the number of patients served. This led to "global budgets" - a fixed amount that each county could spend annually on health care services.

Global budgeting would prove to have serious consequences for Sweden's health care system, most notably expanding waiting lists. Waiting lists for surgery and other procedures had long been a problem in Sweden. Like most government-run systems, the Swedish health care system was already plagued by declining productivity - a consequence of which included delays in care.11 Global budgeting, however, worsened the problem of waiting lists. With county councils now operating with fixed budgets and citizens facing few restraints on demand for health care, county councils needed to ration health care services. An increase in wait times was the result. By 1988 the wait time for an angiogram - a heart X-ray - was up to eleven months. The wait time for bypass surgery could be an additional eight months.12

Although the Dagmar Reform had some success in containing health care costs, the rationing that resulted from it led to public outcry over waiting lists that grew throughout the late 1980s and early 1990s. During the 1990s, the national government shifted responsibility for funding of health care to county councils but also gave counties more freedom to structure health care delivery. This led to a number of market-oriented experiments by county councils. Of all counties, Stockholm County engaged in the most aggressive reform regimen.13 Under this reform, which became known as the "Stockholm Model," the county council still provided the funding, but health care providers could be owned by private individuals or companies. The initial results were impressive. Stockholm County encouraged doctors, nurses and private companies to take over the operation of primary health care centers. Over 60 percent of primary care centers were run privately by 2002. Costs declined, particularly for laboratory services, which dropped by 30 percent. Stockholm also privatized one of its seven hospitals, St. George's. St. George's Hospital began running a profit in 1994, and 90 percent of patients were satisfied with the care they received there.

Other county councils followed suit and initiated a purchaser-provider split, in which the government would continue to pay for health care, but the provider would become a private entity. The county council would contract services out to primary health care centers and other private providers. Providers would be paid on a "per-case" basis, and, thus the provider would be able to make a profit based on his ability to attract patients while also holding down costs. Additional reform at the national level created circumstances in which a patient could go to any hospital of his choice, even one in another county. This reform was the Patient Choice and Guarantee of 1992, which required patients to be treated within three months of diagnosis. According to Swedish economist Ragnar Lofgren, "The logic behind this reform was to let the money follow the patient. This approach would give hospitals and doctors a strong incentive to increase efficiency in order to attract patients from outside their hospital's catchment area and avoid losing patients to other hospitals."14 These reforms at the national and county levels had some early success. Waiting lists dropped by over 20 percent from early 1992 to late 1993. Furthermore, health care expenses did not increase, as health care as a percent of GDP held steady during the 1990s.

Unfortunately, waiting lists began to increase in 1994 and in late 1996 the Patient Choice and Guarantee was abandoned.15 By the early part of this decade, most counties once again faced a problem with waiting lists.16

Worse still, costs have clearly been on the rise again, as demonstrated in Figure 1. Part of the recurrence of these problems stems from the purchaser-provider split, or lack of one. First, a majority of county councils did not implement a provider-purchaser split based on a per-case payment basis or did so only partially.17 Thus, there was not sufficient pressure on providers to attract patients for fear of losing funding. Second, the split was weak to begin with. As one study of the split policy noted, the contracts between purchasers and providers often amounted to little more than "letters of intent," and the "escape route back to traditional planning and management was always open to the central county-council administration."18

Another problem was that although patients were free to choose which hospital in which they could get treatment, there were few penalties on providers that failed to attract patients. For example, in Stockholm, the county council did not permit any emergency hospital - public or private - from shutting down. Additionally, market-reform initiatives were vulnerable to the whims of politicians. In 2004, the left-leaning Social Democratic coalition, which controlled parliament, banned the privatization of hospitals and forbad the practice of private patients buying their way past waiting lists.19

One of the underpinnings of any successful market is that entities that do not adequately satisfy consumers eventually go out off business. The greatest failing of the market- oriented reform of the Swedish health care system is that they did not permit private providers to, in essence, "fail." As a result, one of the hallmarks of single-payer systems, waiting lists, are again plaguing the Swedish patients.

Waiting Lists

Gorann Persson had to wait eight months during 2003 and 2004 for a hip replacement operation. Persson was not considered to be a very pleasant person to begin with, and he became even grumpier due to the pain he endured while waiting for his operation. As a result, Persson walked with a limp, reportedly used strong pain medication and had to reduce his workload.20

What made Persson unique was not his wait for hip surgery. Despite the government promise that no one should have to wait more than three months for surgery, 60 percent of hip replacement patients waited longer than three months in 2003 (see Figure 2).21 Rather, Persson stood out because he was Prime Minister of Sweden at the time. Persson could surely have used his position in the government to gain access to private care, essentially jumping the waiting list. Yet Persson stated that he planned on waiting for his surgery like everyone else.

Whether Prime Minister Persson did this out of benevolent motives is an open question. His party, the Social Democrats, have used the phrase "equal access to health care" to attack the center-right parties on the issue of health care for many years. Persson would have greatly undermined the effectiveness of that attack had he jumped the waiting list......

Pain and anxiety are also common problems for Swedish heart patients waiting for surgery. One study found that more than half of patients waiting for heart surgery experience chest pain daily, and longer wait times were associated with increased nervousness.26 Another study found that 88 percent of patients waiting for heart surgery reported chest pains that limited their daily activities. It also found symptoms of anxiety and depression to be strongly associated with the pain.27

While rationing may permit the government to save on costs and thereby restrain health care budgets, putting patients on waiting lists is not cost-free. One study that examined over 1,400 Swedes on a waiting list for cataract surgery found that 5.2 million kronas were spent on hospital stays and home health care for patients waiting for surgery.28 That was the equivalent of what it would have cost to give 800 patients cataract surgery.

A recent study that examined over 5,800 Swedish patients on a wait list for heart surgery found that the long wait has consequences far worse than pain, anxiety or monetary cost.29 In this study, the median wait time was found to be 55 days. While on the waiting list, 77 patients died. The authors' statistical analysis led them to conclude that the "risk of death increases significantly with waiting time."30 Another study found a mean wait time of 55 days for heart surgery in Sweden and a similar rate of mortality for those on the waiting list.31 Finally, a study in the Swedish medical journal Lakartidningen found that reducing waiting times reduced the heart surgery mortality rate from seven percent to just under three percent.32

Sweden is one of several nations whose practices offer proof that single-payer health care systems lead to the proliferation of waiting lists. It also shows that waiting lists have adverse and sometimes tragic consequences for patients.

Conclusion

While Sweden is a first world country, its health care system - at least in regards to access - is closer to the third world. Because the health care system is heavily-funded and operated by the government, the system is plagued with waiting lists for surgery. Those waiting lists increase patients' anxiety, pain and risk of death.

Sweden's health care system offers two lessons for the policymakers of the United States. The first is that a single-payer system is not the answer to the problems faced as Americans. Sweden's system does not hold down costs and results in rationing of care. The second lesson is that market-oriented reforms must permit the market to work. Specifically, government should not protect health care providers that fail to provide patients with a quality service from going out of business.

When the United States chooses to reform its health care system, reform should lead to improvement. Reforming along the lines of Sweden would only make our system worse.

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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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21 June, 2007

Another blow for struggling NHS computer system

Another rat deserting a sinking ship?

Britain's highest paid civil servant has announced his resignation as head of the 12 billion pound computer project for the National Health Service. Richard Granger, 42, chief executive of NHS Connecting for Health, was responsible for upgrading information technology (IT) systems and introducing electronic patient records. Although computer systems have been improved in many trusts, the project has been criticised for delays and design flaws. The departure of Granger, who was paid 290,000 a year, will be seen as a further setback for the project. He has been credited with updating hospital IT systems from "the stone age" and ensuring that private contractors involved in the project were not rewarded for failure.

Granger will leave in the next few months and said he was considering offers to return to the private sector. "I passionately believe the programme will deliver ever greater levels of benefit to patients over the coming years," he said. The NHS project, the biggest civilian computer project, was backed by Tony Blair to deliver detailed electronic records for every NHS patient. The electronic record system is now more than two years late and Gordon Brown is expected to review its progress when he becomes prime minister.

Tony Collins, executive editor of Computer Weekly, the industry magazine, which has called for an independent inquiry into the project, said: "Without Granger the risk is that this programme will now fall apart. The programme has highlighted the need for proper electronic records in the NHS, but you have to ask what it has achieved that trusts could not have done on their own. It has also not delivered on the main objective of a centralised patient record system."

Granger was appointed head of the project in 2002 after successfully managing the introduction of the IT element of the congestion charge in London. Confronted with what he saw as the intransigence of the medical profession and the determination of IT suppliers to make high profits at the taxpayers' expense whatever their performance, Granger tried to introduce a tough competitive climate for the contractors. His metaphor for the project was a sledge being pulled by huskies. Those who fell by the wayside would be "chopped up and fed to the other dogs" to ensure that those who survived worked harder.

The former management consultant was respected by many in the industry but others were taken aback by his abrasive and demanding approach. One contemporary once described working with him as a "deeply corrosive experience".

Connecting for Health proved to be a huge challenge as NHS staff complained they had not been properly consulted and experts argued it was foolhardy to keep patient records in one central database, warning the system might be vulnerable to unauthorised users. Some of the most stringent security measures in the IT industry have been devised to protect confidential information and patients can also opt out of their records being uploaded.

To add to Granger's woes, the contractors tasked with developing the computer technology were hit by problems. Last year Accenture, the consulting and technology company, withdrew from the programme and iSoft, one of the programme's software suppliers, is being investigated for alleged accounting irregularities.

Granger will point to systems in the project which he believes have been successful. These include the "choose and book" scheme, under which patients can choose a hospital for treatment while at the GP's surgery.

Norman Lamb, the Liberal Democrat MP, said: "This is a grandiose scheme but it was not properly defined at the start. It is costing billions of pounds and we need to make sure that we are not building something that isn't fit for purpose."

Granger's resignation has surprised many in the industry. Last weekend he gave an interview in which it was said he was keen to steer the project to "calmer waters". Dr Simon Eccles, the project's national clinical lead for hospital doctors, said: "He is going to be a hard man to replace. He has brought a unique set of skills to the programme. If this had been delivered by the NHS the budgets would have been bigger and the delays would have been greater."

Lord Hunt, the health minister, said the IT programme would not be adversely affected by Granger's departure. "The NHS IT programme will provide safer, faster and more efficient healthcare for patients," he said. "It is already being used by clinicians and bringing benefits for patients with digital technology, transforming diagnosis and treatment every day."

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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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20 June, 2007

Freeloaders destroy Detroit hospital

Her legs crippled by diabetes, Mary Lewis is grateful it's a short distance between her doctor's office at Riverview Hospital and the adjacent apartment tower where she lives. It will become a painful struggle next year when the hospital closes and physicians' offices are forced to move. The hospital last week said it was losing too much money and already stopped accepting inpatients, though the emergency room will remain open for now. Because roughly 90 percent of its 11,000 annual inpatients are covered under the Medicare or Medicaid public assistance programs, Riverview has struggled economically, said Bob Hoban, a senior vice president for St. John Health, Riverview's parent company.

Experts say Riverview's decision to close fits a distressing, decades-long pattern of hospital closures in older cities across the nation. The trend has left large swaths of predominantly poor, black neighborhoods in cities such as St. Louis, Philadelphia and Cleveland underserved. Many say the loss of medical facilities for low-income patients is increasingly leaving overcrowded emergency rooms to double as primary-care centers. "This hasn't been happening in the suburbs and it isn't happening in Phoenix, Arizona, where they can't build hospitals fast enough," said Bruce Siegel, a research professor at the George Washington University Medical Center in Washington, D.C. "This is occurring in older, urban inner-city areas."

New York City, Philadelphia and parts of New Jersey have seen waves of hospital closings in inner-city neighborhoods, said Siegel, who directed a 2004 report examining the phenomenon for the Robert Wood Johnson Foundation. But few cities have been hit as hard as Detroit. The number of hospitals in the city has dwindled to seven or eight from 42 in 1960, said Alan Sager, director of the Health Reform Program at Boston University's School of Public Health. Hospitals that are larger, have major medical school-affiliated teaching programs and more money in the bank tend to survive.

Siegel's report warned that Detroit's safety net was already in a "fragile" state and could collapse entirely with further hospital closures. It said Detroit had lost more than 1,200 hospital beds with the closure of four hospitals since 1998. "Some of it is population shifts and declines," Siegel said. "There's (also) more and more people without health insurance and Medicaid payments that don't keep up with the cost of providing care."

Riverview, a community hospital with 285 beds, specializes in general medical and surgical services, such as treatment of congestive heart failure, diabetes and obstetrics. The hospital finished its last fiscal year with a nearly $9.5 million deficit and expects to end this fiscal year $23 million in the red. Medicare payments to hospitals averaged 92 cents for every dollar spent providing care in 2005, the most recent figures available, according to the American Hospital Association. Medicaid's reimbursement rate was lower, at 87 cents per dollar.

Officials at other area hospitals have complained that Riverview's closing will burden them. "We're 90 percent full on average and there are many days where we're 100 percent full," said Nancy Schlichting, president and chief executive of Henry Ford Health System, which has a trauma center hospital in Detroit.

Karmanos Cancer Institute plans to spend $20 million to renovate the 20-year-old Riverview and reopen it as a clinical center next year.

But Lewis is concerned her doctor's office will be forced to move too far from her home. "I'll have to find another doctor," the senior citizen said. While waiting for a bus after a physical therapy appointment, Mary Sanders said Riverview is the closest hospital for residents of the east side, including many disabled senior citizens. The 54-year resident of the neighborhood said she doesn't know where she'll go once the clinic closes. "Point blank, we need this hospital," she said.

Source




New contract leaves another 1.4m without an NHS dentist

The NHS asks us to believe that over a million fewer people had dental problems last year. What a triumph for preventive medicine! (If you believe it)

A controversial new cash deal for dentists has left 1.4million more people without NHS treatment - and a 120 million shortfall in income. The contract was introduced 11 months ago to stop dentists charging for each procedure and to promote a more preventive approach to patient care. It prompted an exodus of 2,000 dentists from the NHS and assurances from Ministers that every patient who lost an NHS dentist would be taken on by another.

Now figures collected under the Freedom of Information Act from 152 primary care trusts in England show a sharp reduction in the amount of NHS work being done. For the first nine months of the current financial year, 51.8 million Units of Dental Activity were delivered - a figure that falls short of what the Government said was needed to maintain levels of NHS dentistry.

In 2005-6 around 24.7 million people received NHS dental care, but - calculated from the latest treatment figures - this will have dropped to 23.3 million. As a result, the income received by PCTs from patients paying NHS charges has fallen. They were expecting 541 million but will only receive 417 million.

One reason could be that "an increasing number of patients are moving to private treatment", says the Department of Health's own primary care contracting group. There are also reports that up to a quarter of NHS practices are treating too many patients too quickly, and are now being told to delay treatments until Easter.

Tory health spokesman Andrew Lansley, who obtained the figures, said they were the latest miscalculation on NHS staff contracts. Other contracts that went over budget was the GP pay and conditions deal which exceeded estimates by 407 million; the Agenda for Change contract for hundreds of thousands of workers 220 million) and the consultants' contract 90 million), he said.

Mr Lansley said: "Eight years ago, Tony Blair promised everyone would have access to an NHS dentist but in the last year, 1.4 million fewer people have access. "NHS dentistry has reached this crisis point because Labour wanted to milk dental patients through higher charges. We need a contract that will incentivise NHS dentists to see more people. One that supports a relationship between individuals and their dentist and promotes good oral health."

Susie Sanderson, Chairman of the British Dental Association's Executive Board, said: "The BDA is aware that dentists and patients across the county are experiencing significant problems with the Government's target-driven reforms to NHS dentistry. "From our own research, we know that three-quarters of dentists felt that the contracts they were allocated did not accurately reflect the amount of treatment they are able to provide. "Where patient charge revenue shortfalls are occurring, the BDA is concerned that they must not be allowed to impact on the provision of patient care."

The Department of Health said: "This survey paints a picture that we do not recognise. We do not accept that 1.4m fewer people have access to NHS dentistry. Widely available figures show that access has remained remarkably stable. "Equally it is nonsense to talk of a shortfall in investment. PCTs have put more money into dentistry than they needed to do and the access figures show this is translating into services for patients."

In March last year, Health Minister Rosie Winterton said the vast majority of dentists were signing up to the new contract. She said: "If dentists choose not to sign up, the local NHS will use that funding to buy services from other dentists."

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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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19 June, 2007

"Free" treatment at American public hospitals can suck too

Particularly in La La land -- where most ERs have been forced to close down to avoid going broke treating swarms of illegals for free. But the notorious L.A. hospital described below is something else again. It has been a disaster for years and the only response has been hand-wringing. Why? Because it is run and staffed almost entirely by blacks so it CANNOT be condemned and closed down. All they've achieved is to change its name! The mainly black patients are the big losers of course. And it's a reminder not to get sick in Africa. If the whole American educational and regulatory apparatus cannot civilize a black hospital, what must hospitals in Africa be like?

An inner-city hospital is struggling to survive amid a new report of breakdowns in patient care, the replacement of its chief medical officer and an ultimatum to correct long-running problems or close. Newly released tapes of 911 calls reveal that a woman who lay bleeding on the floor of the emergency room died last month after dispatchers refused to contact paramedics or an ambulance to take her to another facility. The woman’s treatment was “callous, it was a horrible thing,” Los Angeles County Supervisor Yvonne Burke said Wednesday.

Earlier this week, the county Board of Supervisors grilled health officials about conditions at Martin Luther King Jr.-Harbor Hospital. It ordered them to return in two weeks with a plan to deal with a hospital shutdown if it is unable to correct deficiencies laid out in a federal inspection that concluded emergency room patients were in “immediate jeopardy.” The federal review was based, in part, on a report that a man with a brain tumor waited four days in the emergency room when he needed to be transferred to another facility for lifesaving brain surgery.

After the inspection last week, the federal Centers for Medicare and Medicaid Services gave the hospital 23 days to correct problems or face a loss of federal funding. That could force it to close.

Burke said the county-run hospital is a crucial facility and that nearby hospitals could not handle its patient load. “I can’t tell you whether it can be fixed but ... the community can not stand to lose another emergency room,” she said.

Dr. Roger Peeks, the hospital’s chief medical officer, was placed on “ordered absence” Monday and replaced on an interim basis by Dr. Robert Splawn, senior medical officer for the county health department. Department spokesman Michael Wilson confirmed the change but declined to elaborate Wednesday, saying it was a personnel matter.

Health officials are “doing everything in our power to help MLK-Harbor meet national standards,” Dr. Bruce Chernof, director of the health department, said in a statement. In a report to the supervisors on Tuesday, Chernof said quality of care had improved but warned that there was no “roadmap” for what he called the most difficult effort to “reinvent a failing hospital” ever undertaken in the United States. The hospital has served “thousands of patients well and a few very poorly,” he said. The hospital, formerly known as King-Drew, was built several years after the 1965 Watts riot to provide medical care in the South Los Angeles area. It has been cited more than a dozen times in 3½ years for inadequate care that has led to patient deaths and injuries.

Source




MRSA endemic in NHS

See also here

A WOMAN who confronted Tony Blair on television over the failings of the National Health Service has lost her father to MRSA, the hospital superbug. During the 2001 election campaign Carol Maddocks described on the BBC’s Question Time programme, where Blair was a panellist, how the health service was letting down her daughter Alice, who had a rare blood condition. Blair later met Maddocks at Downing Street and pledged NHS funding to improve registries of bone marrow donors to help to save Alice’s life.

Now, however, Maddocks has described how Harry Lister, her 74-year-old father, died an agonising death after contracting MRSA following “awful” care in their local hospital. “My father was let down by the NHS and we, as a family, are really angry about it. Society now accepts that when we go into hospital we could contract MRSA, but this should not be a risk we run,” Maddocks said.

Maddocks, a former nurse, had seen many patients die, but she said her father’s death last June was the most horrific she had ever seen. “MRSA had got into my father’s bloodstream and it had taken hold of his whole body, his heart and his other organs,” she said. “I have never witnessed anyone die in so much pain and that will stay with me for ever.”

Lister died of MRSA at Dewsbury and District hospital in June 2006 after going in for examination of a bowel problem. The family say that he contracted the superbug from an endoscope, an instrument used to examine the bowel. Maddocks says that, while in hospital, her father was left to become dehydrated, lay in dirty sheets and the family had to battle with nurses to get him a bath. He told his family that other elderly patients were left unable to eat meals and that nurses congregated round a desk while patients were left without care.

“Although what Tony Blair did for bone marrow registries was extremely positive, that has not been reflected in our experience of the NHS,” said Maddocks. “We feel the care our father received in our local hospital was awful.”

By contrast, Maddocks is happy with the way Alice was treated at the same hospital where Lister died. She did not approach the media to discuss her father’s treatment but the nature of his death emerged while she was being interviewed about Blair’s time in power. Mid-Yorkshire Hospitals NHS Trust, which runs Dewsbury and District hospital, said that it could not comment on Lister’s death as his medical notes were in transit.

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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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18 June, 2007

California health care plans are shaky

The political hoopla about extending health insurance to the 6.5 million Californians who lack it escalated this week -- including a much-hyped visit to the Capitol on Tuesday by propagandistic filmmaker Michael Moore, whose latest production, entitled "Sicko," deals with the issue.

Gov. Arnold Schwarzenegger has a plan, or at least an outline of a plan, Assembly Speaker Fabian N£¤ez has a plan, Senate President Pro Tem Don Perata has a plan and those to the left of the legislative leaders are backing still another plan by Sen. Sheila Kuehl for "single-payer" coverage. Even conservative Republicans are presenting health care plans of a sort.

Schwarzenegger continued to tout his version of universal care this week, telling a "town hall" meeting in Chico that "the bottom line is, we will do it (because we) all agree that it is a broken system and that we will fix it this year." The pledges from Schwarzenegger and Democratic leaders raise hopes among the uninsured and fears among the many factions in the state's $150 billion-plus health care industry.

The politics of the situation, however, are Byzantine, with "who pays" the central stumbling block, thus making it a full-employment situation for Capitol lobbyists. Schwarzenegger has adopted a "shared burden" strategy that taps consumers, employers and health care providers but shuns general taxes while N£¤ez and Perata would hit employers, and Kuehl's plan relies on broad income tax increases.

Even if one assumes that the countless political ramifications of health care could somehow be compromised -- a faint hope at best -- none of the principal political players wants to even talk about two immense legal impediments, one state and one federal, to any major expansion of health coverage in California.

Proposition 13, adopted by voters in 1978, not only reduced and limited property taxes, but imposed a rigid two-thirds legislative vote requirement for any increase in state taxes. That means that votes from stalwartly anti-tax Republican legislators would be needed to pass a health care plan that includes new taxes.

Schwarzenegger and legislative leaders have insisted that the billions of dollars in new levies on employers or health care providers they propose are "fees" and therefore exempt from the two-thirds vote mandate. But the argument is shaky on its face, and now the Legislature's own legal counsel has sided with Republican legislators and business groups in their contention that the levies are taxes.

Assemblyman Rick Keene, R-Chico, sought the legal analysis of Schwarzenegger's health plan from the legislative counsel's office. Deputy Legislative Counsel Linda Dozier responded with an 11-page dissection, concluding flatly that the levies on employers and health care providers "constitute a tax" under the state constitution and therefore would require two-thirds legislative votes. Dozier didn't analyze the Legislature's plans but there's no reason to believe that her conclusion wouldn't apply to them as well.

Last January, ruling on a Maryland plan, a federal appeals court said that a plan, aimed at Wal-Mart, requiring large employers to provide health care or pay into a health system violates the federal Employee Retirement Income Security Act, which was enacted in 1974 to protect employers from differing state-by-state benefit rules. Tellingly, Maryland Attorney General Douglas Gansler decided not to appeal to the U.S. Supreme Court, saying he could not win. Thus, state-level "pay or play" schemes such as those being proposed in California are likely illegal. Ultimately, all of the promises and hoopla expanding health care could be merely that -- and something of a cruel joke on those whose hopes for coverage have been raised.

Source




Dangerous to get sick outside normal working hours in Britain

The British government is aware of the problem but has no idea how to deal with it

The shake-up of out-of-hours GP services was condemned as a 'shambles' yesterday. Patients who become ill at night or weekends have been left battling to find proper NHS care since GPs handed over responsibility to primary care trusts. Only one in 50 services is meeting the performance targets set to ensure patients get proper advice and treatment. The result, according to a damning report from MPs, is that patients have been left worse off.



Only doctors have 'done well' out of the deal, it says. Confusion over availability of out- of-hours services has also resulted in a ten per cent increase in emergency calls for ambulances in the past year. More patients, simply unsure where to turn, are arriving at hospital A&E departments.

The report, from the influential Commons Public Accounts Committee, says the Health Department took a back seat in negotiations over the new system that allowed GPs to stop working unsocial hours in return for relatively small pay cut of 6,000 pounds. Although the service introduced three years ago is now starting to improve, the performance of trusts against key targets is 'still not good enough', it says. Just 2 per cent of services comply with standards such as answering calls promptly.

The report follows concern over pay deals struck by the Health Department which have seen GPs' pay break the 100,000 pound barrier. The report also reveals soaring costs took the shake-up 70 million over budget - at a time when the NHS is axing jobs and patient services to save money. Before April 2004, GPs were responsible for out- of-hours patient care - between 6.30pm and 8am on weekdays and 24 hours at weekends and bank holidays. Now primary care trusts are responsible for around nine million patients receiving care out of hours in England each year. These services are provided by a range of organisations, including in-house trust teams, GP cooperatives and private companies. But they have been plagued with problems from the start, with patients complaining of delays and disorganisation.

One service came to prominence last year during the inquest into the death of Penny Campbell, a 41-year-old journalist from North London, who died of multiple organ failure in 2005. In the four days leading up to her death, she had six telephone consultations and two face-to-face meetings with doctors working for the service Camidoc. A coroner ruled that the doctors she saw contributed to her death by failing to recognise the seriousness of her illness. The PCT and Camidoc are undertaking a review.

The Public Accounts Committee chairman Edward Leigh, Tory MP for Gainsborough, said the new system had increased financial pressure within the NHS and the Department had failed to get value for money for the taxpayer. Costs have risen from the original estimate of 322 million to 392 million a year. The cross-party committee's report said: "We found that preparations for the new service were shambolic, both at the national and local level. "The department took part in the negotiation of the new General Medical Services contract only as an observer, and only the doctors did well out of the deal on out- of-hours costs." Mr Leigh added: "The new service is getting better. But the needs of patients are not best served by the ending of Saturday morning surgeries. "They are not best served where access to advice and treatment is often extremely difficult and slow."

Joyce Robins, co-director of Patient Concern, said: "It's a muddle. Patients have no idea what the service is supposed to be doing so they end up going to A&E."

Dr Hamish Meldrum, chairman of the British Medical Association's GPs' Committee, denied family doctors had benefited at the expense of patients. "We would reject the implication that GPs were the only ones to do well out of this deal and that the Government was not really involved. Family doctors had been taken advantage of for years, working long hours on the cheap."

A spokesman for the Department of Health said: "We are aware that some areas face more challenges than others, including in very rural and very urban areas, and we are determined to ensure that out-of-hours services in every area match the standards of the best."

Source

Prof Brignell comments:

Now that the Englishman has joined sufferers in our Out-of-hours club, it is a suitable time to launch our very own neologism. Number Watcher Graham Dawson, having taken the precaution of marrying a classicist, is able to provide the word that Number Watch recently requested. It will not mean much to those who live outside Blair's Britain, but it means an awful lot to those who live under the tender care of the National Health Service (except those who did not survive, of course). Anyway, thanks to the negotiating skills of the Blair Team, this is the system that we now enjoy. So rally round you lexicographers and insert this in your entries:

Acairasthenephobia, Ah-kai-ras-then-eh-phobia, n, a fear of falling ill out of hours (Gr negative prefix A; cairo (or kairos) - right time; asthenes - ill; and phobia, qv).

Now the Greeks have a word for it. We hope that makes you all feel better.

Your bending author typed out the above piece, uploaded it and trundled off to bed. As eyes drooped and it was time to put the ancient paperback thriller under the pillow, a sudden thought intruded. My God! The BMA really DO think they put one over on the Government! After all these years they really think they are negotiating with the Government! They are so na‹ve that they still do not realise that negotiations are not just two-way; they are a sandwich, one that it arranged like this:

The Government - Sir Humphrey - The Rest

Like a farmed trout, they leapt at the luxurious barbed fly, rather than the scanty but nutritive live midge, just as they were meant to. A wily native fish would have been more circumspect. Why would they be offered a mere 6,000 pounds to provide an out of hours service? It was so derisory that it was never meant to be accepted. The BMA, being a trade union, were only thinking about money, but Sir Humphrey was thinking about power. What does it matter that the alternative is to provide a ludicrously expensive chauffeur driven, if ineffective, service. It is only money, and not even real money, just taxpayers' money. The alternative is to have medical professionals, rather than bureaucrats, in control of a vital part of the health service. Unthinkable!

The Government, in their turn, think they are negotiating with the medical profession, when they too are actually also negotiating with Sir Humphrey. Why are these bastards so intractable? We'll show 'em! We will set up our own system, however much it costs. What is a bit of misery and a few deaths when principle is involved?

The way the modern political system works is that ministers, who have never run anything in their lives, suddenly find themselves plunged into a jungle inhabited by, to catch the mood of the moment, feral beasts. It is particularly true of those women, the so-called Blair babes, whose token presence is an affront to the just cause of the liberation of women. They are lost, they fail, they are inadequate. People experience pain, they suffer, they die. So what? The system rolls on.

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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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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17 June, 2007

HARE-BRAINED "PRESIDENTIAL CONTENDER" WANTS TO DESTROY THE DRUG INDUSTRY

Democratic presidential candidate John Edwards wants to reduce the cost of U.S. health care by removing patents for breakthrough drugs and requiring health insurance companies to spend at least 85 percent of their premiums on patient care.The former North Carolina senator was expected to discuss details of a universal health care proposal he released in February during an appearance Thursday at the Riverside Health Center. Edwards’ plan would remove long-term patents for companies that develop breakthrough drugs and then reap large profits because of the monopolies those patents provide, according to a statement by Edwards obtained Wednesday evening. Edwards said offering cash incentives instead would allow multiple companies to produce those drugs and drive down prices.

More here

So where are the companies going to get the half-a billion dollars it costs to get a new drug approved? And where are they going to get the millions that lawyers regularly squezze out of them when a new drug is found to have side-effects (as all drugs do)? I guess the government will become the chief drug innovator! Heaven help us if that happens! The U.S. government can't even keep equipment up to its soldiers in Iraq and that is a task way simpler than deciding on the healing prospects of a molecule. How many of the drugs we use today were discovered and developed in Soviet Russia?




Australia: Major government hospital boss: We're in crisis

THE chief of one of Queensland's biggest hospitals has branded the facility "in crisis" and urged staff they must discharge patients quicker. In a damning leaked email, Princess Alexandra Hospital senior clinical chief executive officer David Theile warned staff that the hospital was not coping with demand. The admission by Dr Theile is a massive blow to the State Government's claim that Queensland's health system is "turning the corner" after a massive funding injection.

"The hospital is in a crisis situation with beds unavailable and emergency department access block," Dr Theile wrote in the email late last month. "Could all effort be applied to discharge all clinically suitable patients as rapidly as possible. Such effort is required now and needs to be sustained."

Meanwhile, the hospital's ability keep its two operating theatres open for urgent surgery is being compromised by Queensland's chronic shortage of radiographers. Another leaked email from director of medical imaging Wayne Nuss warned because the hospital needed 10 additional radiographers, only one would be rostered on outside business hours. There had been occasions outside normal working hours when two theatres that required radiographers were simultaneously requesting a radiographer, he said. "In most circumstances, unless considerable notice is provided and staff are available, we unfortunately will not be able to provide that level of coverage." Princess Alexandra staff said the hospital would now struggle to deal with multiple trauma cases needing X-rays.

Similar problems are occurring in other hospitals across Queensland with the Royal Brisbane and Women's Hospital having difficulty keeping its CT scanners functioning. Figures obtained by The Courier-Mail show the radiographer shortage is causing a big blowout in waiting times for cancer victims needing chemotherapy.

Dr Theile yesterday admitted the PA Hospital was "desperately short of beds" and the need to discharge patients quicker occurred "reasonably frequently". But he said there was "virtually no chance" of compromising patient care as doctors were required to speed up administrative rather than clinical work. The dire situation with radiographers had improved with five hirings but on weekends only one remained, Dr Theile 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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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16 June, 2007

NHS: Go blind, you peasants! We've got clerks to pay!

It's much more important to pay the vast army of NHS bureaucrats than give the sick the drugs they need. The NHS has 1.3 million employees, of whom less than 70,000 are doctors. Bureaucrats don't stop people going blind but the latest medications might. So what is the NHS for, exactly?

Thousands of people face severe loss of sight after a decision by the health watchdog to deny two leading treatments to NHS patients. The drugs Lucentis and Macugen have been shown to be the most effective means of halting the onset of wet age-related macular degeneration (AMD), the only treatable form of the most common cause of blindness in Britain. The condition affects about 250,000 people and claims 26,000 new sufferers each year. It damages the central part of the retina called the macula and leaves one in ten sufferers blind.

The National Institute for Health and Clinical Excellence has been under intense pressure to approve the drugs. Its draft guidance recommends that Macugen should not be used at all on the NHS in England and Wales, while Lucentis is recommended only for a small group of patients who have already gone blind in one eye and whose disease is progressing in their second. The guidance is open to consultation but is based on NICE’s appraisal of cost-effectiveness, which is rarely overturned.

Campaigners said that the decision was “cruel” and “appalling” and added that they hoped the watchdog would reconsider its position for a final ruling, which is expected in September. Patients in Scotland can already get both drugs after rulings by the Scottish Medicines Consortium, although there is concern that this will be overturned in light of NICE’s decision.

Thousands of patients who need urgent treatment to save their sight say that they have already been let down by local health authorities refusing to fund the drugs, known as antiVEGF treatments, on the ground of cost. Lucentis, the most effective, can cost up to 28,000 pounds for a course of 14 monthly injections, while Macugen costs 4,000 a year.

A study, published in the New England Journal of Medicine and reported by The Times in October, found that Lucentis can prevent vision loss and even improve sight in nine out of ten patients. The total cost to the NHS of treating all newly diagnosed patients with the drug would be about 400 million, experts say.

Andrew Dillon, chief executive of NICE, said: “When treatments are very expensive we have to use them where they give most benefit to patients. “Most people with AMD only seek help once the disease is beginning to affect their second eye. “Because of this, and based on the evidence they have seen, our independent advisory committee believes the right thing to do is to treat and try to save as much sight as possible in the better-seeing eye.”

The Royal National Institute of Blind People (RNIB) said that it was “outraged” by the guidance, which meant that patients would be treated only once they had irrevocable loss of vision. Steve Winyard, head of campaigns, said: “This preliminary guidance is worse than we ever imagined it could be. It is simply unacceptable that NICE is recommending that only a small minority of patients within England and Wales will benefit from these ground-breaking treatments.” The Macular Disease Society, along with the RNIB, will be submitting a response to NICE “to encourage a reanalysis”.

Source




Australia: Call for surgeon report cards

Long overdue. If the profession refuses to police itself, information should at least be made available, imperfect though it may be

REPORT cards for surgeons showing patient death rates should be introduced to help people make decisions about which doctor to choose for an operation. The recommendation from bioethics expert Justin Oakley includes making mortality rates available to the public on an internet database that lists every surgeon and hospital in Australia.

Professor Oakley, from Melbourne's Monash University, has called on federal and state governments to help fund the development of a public reporting system following the Bundaberg Hospital scandal, in which Jayant Patel was linked to at least a dozen deaths and dozens of injuries through incompetence. Professor Oakley said the national database should start with report cards for cardiac surgeons, a system that has recently been set up in Britain. It should then be expanded to include all surgeons. He said the report cards, which could also include surgery complication rates, would keep surgeons more accountable to the public. "The mortality rates of each surgeon should be made available to patients so they have a better idea of their surgeon's track record," Professor Oakley said. "It also improves the safety and quality of care. If surgeons know their performance will be seen by the community, that is a powerful incentive for surgeons to maintain their performance."

The Patel scandal at Bundaberg Hospital had shown that internal peer review was not enough to keep the profession accountable, he said. Professor Oakley, who heads Monash's Centre of Human Bioethics, said any mortality rate for surgeons would have to be adjusted based on the risk of the operation. "They would adjust the mortality rate depending on the mixture of patients," he said. "It would take into account patient profile. If a surgeon performs on a lot of patients that are high risk, like those that are a bit sicker or older, that is factored in to the rate."

Professor Oakley, who has co-edited a book on the subject due out in August, said governments would need to invest significant resources to make a report card system viable and it should be set up sooner rather than later. "I don't think we should wait for a scandal to occur to allow patients to get access to the track records of surgeons," he said.

However, Royal Australasian College of Surgeons president Andrew Sutherland said there were immense practical difficulties in implementing report cards, calculating a mortality rate and making risk adjustment. "It's a terrific idea but the risk assessment (of mortality rates) is very difficult," he said. Factors such as high-risk operations would make it almost impossible to determine a fair rating. "We are totally against report cards because there is so much opportunity for unfairness," Dr Sutherland said. "The practicalities are not possible at this time."

Dr Sutherland said the college had started conducting audits of surgery deaths in some states and said there were plans to expand the program nationally. Deaths were reviewed by specialists with the aim of trying to prevent problems from recurring, but the findings were not made public, he said. "Pretty soon we'll have an audit of surgical mortality in every state."

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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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15 June, 2007

LEGAL ISSUES AND FDA INHIBIT USE OF HIGHLY BENEFICIAL ANAESTHETIC DRUGS

Below is a report from one of my regular correspondents, an American anesthesiologist

An anesthesiologist from a prestigious institution gave a talk on "conscious sedation" today. Conscious sedation has become a "hot" issue because more and more non-qualified people are performing sedation in remote locations (worst are doctor's and dentist's offices, but also emergency rooms, GI lab (colonoscipy), clinics, x ray etc.), sometimes with deadly results. Most deadly results occur when drugs cause airway obstruction and respiratory depression; many of those administering conscious sedation have limited experience with airway management..

Some believe that only anesthesia providers (MD, trained nurse anesthetists) should do this sedation - these providers have extensive experience with airway management, administering general anesthesia daily. This is the ideal, done in a few places (U Pittsburg hospitals do this because liability is thought to be greater than cost). But in the real world, there simply are not enough anesthesia providers to do all this sedation. So most institutions have instituted policies for conscious sedation, with anesthesiologists writing policies on training, and writing guidelines.

For many children or retarded adults, general anesthesia is used, at great expense. Equipment is expensive, and postoperative recovery time is required. For other patients, providers use old drugs like pentobarbital - gives sedation, preserves respiration, but lasts a long time - hangover may last 24 hours, and recovery time in hospital may be hours. Combination with opiates (narcotics) given for pain relief may lead to airway obstruction and/or respiratory depression. Less experienced providers may have difficulty handling these complications.

Dexmedetomidine is an alpha 2 agonist, a lot like clonidine.
But Dexmedetomidine is expensive. Not used much.

FDA rules require separate application, at great expense to manufacturer, for "pediatric use", so drug companies write disclaimer ("not approved for pediatric use") in instructions. Most providers are reluctant to use it "off label" (against recommendations of drug company) in children, mostly for medicolegal reasons. If a complication occurs, drug company will not back up provider.

Because dexmedetomidine provides some advantage for conscious sedation in children, it has been increasingly used "off label". Recent rules introduced under the Bush administration have increased pressure and have tightened the requirements to seek approval for drugs with more common use in pediatrics. Now, the company is funding FDA-required studies of dexmedetomidine, which has been done in the institution the lecturer was working.. .

Almost magical results - dental cleaning of a retarded 18 year old in the dentist's office, and the patient was awake and walking minutes after the procedure; in the past, general anesthesia was needed in an operating room for such patients ($ 25/minute) and recovery room (> $200/hr). The health insurance company happily paid the $1000 anesthesiologist's fee for enabling the procedure in the dentist's office because they saved thousands compared to doing the same in a hospital.

But here you have an older drug that has obvious advantages - but it has simply not been used because many are reluctant to try any new drug in children because there is so much liability. Likewise, if someone wanted to do similar procedures in pregnant women, they would be reluctant to use new drugs as well.

In addition, companies are reluctant to introduce new drugs for pediatric use because of the expense of seeking approval; competition by small players simply doesn't occur.

And Sens Schumer and Kennedy are smiling all the way to the cash register - they are introducing legislation to require drug companies to pay an additional 25% (above the present nearly 1 Billion (yes, with a B) cost for approval) for approval, to "guarantee safety". [Classic Leftist thinking - if something is simply not attainable (like equal outcome education), throwing money at it will solve the problem].

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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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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14 June, 2007

BIG PROGRESS IN TREATING ARTHRITIS -- BUT CAN THE NHS AFFORD IT?

It's much more important to pay the vast army of NHS bureaucrats. The NHS has 1.3 million employees, of whom less than 70,000 are doctors. Bureaucrats don't heal the sick but the latest medications might. So what is the NHS for, exactly?

Tens of thousands of patients crippled by rheumatoid arthritis can expect dramatic improvements in their treatment with the arrival of a new class of “smart” drugs, scientists said today. A study of three medications has shown that they can reduce the symptoms of rheumatoid arthritis, the debilitating joint disease, by about 50 per cent. Experts say the drugs will help liberate many sufferers with severe disease from pain and allow them to lead a near-normal life.

However, doubts remain over patients’ chances of getting the new drugs, which have yet to be approved by the National Institute for Health and Clinical Excellence (NICE), the government watchdog, and could add around 250 million pounds a year to the NHS drugs bill. Britain lags behind other European countries and the US in introducing new medicines. Drugs launched in the past five years, including this new class, make up 27 per cent of the bill for medicines in the US, 24 per cent in Spain, 22 per cent in France, but 17 per cent in the UK.

Trials have shown that the three drugs – MabThera (rituximab), Orencia (abatacept), and tocilizumab – can have a marked impact on symptoms of rheumatoid arthritis, which include joint pain, stiffness and swelling. The disease, which occurs when the immune system attacks the joints, affects an estimated 400,000 people in the UK, 4,000 seriously. Each new drug consists of molecules that target different parts of the immune system.

MabThera and Orencia are licensed in the UK; the latter was launched this month, while tocilizumab is undergoing later-stage clinical trials. Professor Paul Emery, a leading British specialist and co-au-thor of the review in today’s online edition of The Lancet, said: “They are strikingly effective and they work on different targets from the existing drugs, that’s the joy of it .”

The research showed that all three slowed progression of the disease and reduced its symptoms. All achieved the best results when used in combination with the standard treatment, methotrexate. Not all patients respond, and there can be serious side-effects in some, but 30 to 40 per cent of patients do see big improvements. Drugs that do not work for one patient may do so for another, enabling rheumatologists to tailor the treatment to the patient.

Scientists said that the new drugs would raise the chances further of patients finding an effective treatment. “A new era has started in the treatment of rheumatoid arthritis,” Professor Josef Smolen, who led the team, said. Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society, said: “It means that we have some choices, and that’s very important if you are 22 and facing a lifetime of the disease.” Traditional treatments include nonsteroidal antiinflammatory drugs, glucocorticoid steroids, and disease-modifying antirheumatic drugs. All have limited effectiveness, but treatment has greatly improved by the introduction of drugs that target tumour necrosis factor (TNF), a major source of the inflammation at the heart of the disease. Three antiTNF drugs are already licensed and approved by NICE for patients with severe disease.

The Lancet review focuses on the next generation of antibody medicines, which home in on targets other than TNF. MabThera targets immune system cells called B cells, which are known to be involved in the development of the disease. In trials it reduced symptoms by more that 50 per cent in more than a third of patients. Oren-cia targets immune system T cells and, when combined with methotrexate, also reduced symptoms by 50 per cent, in 40 per cent of patients. Tocilixumab targets inter-leukin-6, a cytokine (signalling compound) that activates the T-cells. It is not yet licensed but in trials has shown similar benefits to the other two drugs. With annual treatment costs per patient likely to be between 3,000 and 10,000 pounds, the cost of treating 40,000 patients (the number who have the disease sufficiently severely to get antiTNF drugs) is likely to be about 250 million.

Source




Australia: Staff crisis hits public hospital CT scans

MAJOR Queensland hospitals could be forced to sideline one of their key diagnostic tools because of chronic staff shortages. The Government's failure to retain and attract radiographers is impacting heavily on the ability of some hospitals to conduct CT scans on patients. The scanners, operated by radiographers, help doctors to diagnose ailments from cancers to the internal injuries of accident victims. A leaked email obtained by The Courier-Mail has exposed the dire situation faced by one of the state's biggest health facilities, Royal Brisbane and Women's Hospital. In the email to Queensland Health's radiology steering committee, RBWH director of medical imaging Peter Scally warns the hospital is struggling to maintain CT scanning of patients. "We are experiencing difficulties keeping the CTs functioning because of the numbers of trained radiographers. Have lost two lately," he said.

A Queensland Health spokesman said options were being considered to ensure CT scans continued. "All urgent patients and inpatients will continue to take priority," he said. [Big deal! Don't they anyway?] The spokesman said the shortage of radiographers was not unique to RBWH or Queensland Health. The revelation comes after The Courier-Mail exposed how cancer victims are being forced to wait more than three times longer than recommended for radiation treatment.

Premier Peter Beattie yesterday said the Government was addressing the problems. Mr Beattie said millions of dollars was being invested in extra cancer-fighting equipment, a new pay deal was being negotiated and Queensland Health was "aggressively recruiting" new staff. "We are also recruiting within Australia and overseas for more doctors, nurses and medical radiation staff," he said.

But an internal Queensland Health document shows the so-called "Work for Us" campaign has attracted few new staff. By January 25, Queensland Health had received 5224 expressions of interest but appointed fewer than 300 new staff. Only two of these were medical imaging professionals. The QH spokesman said the internal report was misleading because it did not include radiographers appointed directly by each district.

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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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13 June, 2007

Lazy and arrogant NHS midwives kill baby

Staff at one of London’s top teaching hospitals ignored a man’s pleas for help as his newborn baby died, an inquest was told yesterday. Iain Croft, 42, a journalist for the BBC’s World Service, told the inquest that staff at the Royal Free Hospital left him to monitor his child’s faltering heart rate after his wife, Heather Paterson, 43, had begged to see a doctor. Their son, Riley, died of asphyxia 35 minutes after being born, on March 25, 2005, after a ten-hour labour.

Giving evidence at St Pancras Coroner’s Court, Mr Croft said that the couple were initially turned away from the hospital when they reported to have their baby induced. He said: “They said no beds were available. In fact we were taunted by some staff who said, ’There’s no room at the inn, you’ll have to go home’.” The couple waited nearly eight hours the next day to see a doctor, before a midwife who induced the birth told Ms Paterson that she was a “silly girl” who was not really in pain.

Mr Croft said that a midwife had told them, “very firmly” that she would induce the birth herself, by applying the gel Prostin, which immediately left his wife in crippling pain. He said: “Heather’s arms and legs were convulsing because of the intense pain. “Heather was becoming very distressed because of the pain and was literally screaming for someone to come and help her with pain relief or give her a Caesarean section. “I asked several times if my wife could be seen by a doctor and we were refused. The midwife kept saying to her that her pain was not real. She said ‘no pain, no gain. This is what you have to go through, this is what it’s like’. . . . At some time she said to my wife, ‘You are a silly girl. You don’t deserve this baby. I’m going to take it off you’. Six hours later the baby was dead.”

Mr Croft said that two midwives, Ine Toby and Beverly Blankson, ignored the couple’s pleas for help. He was then told to monitor the baby’s heart-rate himself, and to trigger an alarm button if it fell below a certain level. He said: “It did drop three times and I pressed the button each time. In the end I had to go out into the corridor to bring her back in to look at it. She kept telling us not to be so fussy.”

The couple did not see a doctor until shortly before the baby was finally born. Mr Croft said: “All of a sudden the room was filled with doctors attending to the baby and at 8.28am they asked for permission to stop. Our baby was dead.” A postmortem examination, which Mr Croft said staff tried to “bully” him out of having, showed that the child died from asphyxia.

Source




Australia: State cancer care in crisis

SECRET waiting lists have revealed how Queensland Health consistently exposes cancer victims to deadly treatment delays. Internal hospital documents show hundreds of victims are routinely forced to wait more than three times longer than recommended for potentially life-saving radiation treatment. The "Report on Delay for Treatment" documents show there has been little or no improvement since The Courier-Mail obtained the same figures 10 months ago.

At the time, Health Minister Stephen Robertson downplayed the figures as a week-to-week prospect and insisted the Government was addressing the problem. There is now growing concern in Queensland's hospitals that efforts to address the radiation therapy waiting times have failed.

Coalition health spokesman John-Paul Langbroek yesterday said there was clearly an ongoing problem the Government must urgently address. "People are dying in our system because of these poor services," he said.

According to the figures for the Princess Alexandra, Mater and Townsville hospitals, priority-two patients, who have been diagnosed with aggressive cancers and internal bleeding, are now waiting up to 49 days for radiation treatment. Queensland Health's recommended maximum waiting time is 14 days to avoid "a significant adverse effect on outcomes". Priority-three patients, who predominantly suffer breast and prostate cancers, are waiting up to 69 days for treatment. The recommended maximum waiting time is 28 days. The Royal Brisbane and Women's Hospital was the only cancer-treating facility in Queensland at or below recommended treatment times.

However, hospital sources said this was because of a shortage of oncologists to refer patients for treatment. A Queensland Health spokesman admitted therapy waiting times were yet to show improvement. "Despite an overall improvement in elective surgery waiting times through the $10 billion health action plan, radiation therapy waiting times continue to be exacerbated by a national shortage of specialist nursing staff and oncologists," he said. The spokesman said Queensland Health would continue to pursue radiation professionals to reduce waiting times.

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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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12 June, 2007

Vast sums spent on NHS record-keeping but records useless when needed

Women wrongly told they are not pregnant but nobody knows who they are

Thousands of women in Britain may have been given faulty pregnancy tests that wrongly indicate they are not having a baby, the Independent has learned. Up to 50 hospitals across the country are seeking to trace women who may be unaware they are pregnant because of a faulty batch of Clearview HGC. There are believed to be 44 potentially erroneous tests but tens of