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31 August, 2007

Crazy government healthcare in the USA

U.S. Sen. Robert Menendez has a question for a local Jersey City health clinic: Why no doctors? Reacting to a story in Friday's editions of The Jersey Journal, the Hoboken Democrat dashed off a letter the next day to Catherine Cuomo-Cecere, the chief executive officer of the Metropolitan Family Health Network in Jersey City, a federally funded health clinic.

"I read with great concern and disappointment reports in yesterday's Jersey Journal that the Metropolitan Family Health Network has turned away patients this week because there were no doctors available to see them," Menendez wrote. "This is simply unacceptable," Menendez added.

As of last night Menendez had not received a response, according to a member of his staff. Cuomo-Cecere couldn't be reached for comment.

"I was even more surprised (there were no doctors), given that the last update my office received from you in March was that you had been in negotiations and were working on new contracts with the doctors who had left, and you were optimistic that two or more would be back within days or weeks," Menendez added.

According to City Councilwoman Viola Richardson, the medical staff at the clinic, located at 935 Garfield Ave., plummeted from six doctors to two when doctors were told they couldn't maintain their private practices and work at the clinic. A secretary at the clinic confirmed last week that Dr. Patrick Beaty, the clinic's medical director, had been on vacation.

Source




Australia: Making an ambulance service "free" has caused huge over-use

How surprising! Result: Really urgent cases are slow in being attended to

FRUSTRATED ambulance officers say lives are still being put at risk despite taxpayers pumping more than $400 million into state coffers through a levy on electricity bills. The crisis, which has been exacerbated by a massive increase in the number of call-outs, is so severe that ambulances with less urgent patients on board are diverting to more serious cases.

One northside paramedic, who defied a media ban to speak out, revealed it took almost 20 minutes to answer a recent top priority call-out. And he claimed one major Brisbane station was left unattended on a Sunday night because of staff shortages. "I don't want people to get hurt or die," he said. He said it was not unusual for several stations to be unattended on any given night.

Taxpayers hand over $97.99 a year for a special levy, collected through electricity bills, which replaced an old subscription service that raised about $80 million in its final year. The levy raised $99 million in its first full financial year, in 2003-04, but the total ambulance budget that year rose by only $27.8 million.

Emergency Services Minister Neil Roberts said QAS funding had grown significantly in recent years. "The ambulance levy replaced a very unreliable subscription scheme," he said. Both ambulance officers and the State Government say the situation has been exacerbated by a huge jump in demand. Overall, call-outs have increased about 10 per cent every year since the introduction of the ambulance levy in 2003, with a record set this year.

Queensland Ambulance Union's Steve Crow confirmed response times were getting longer as crews struggled to attend as many as 700 code-one call-outs a day. "It used to be 68 per cent of cases took under 10 minutes, but now it's more like 62 per cent and that figure's even worse in the regions," he said. Prebs Sathiaseelan, president of the Emergency Medical Service Protection Association, which represents paramedics, said the ambulance levy was behind a jump in trivial calls. "We go to things like stubbed toes," he said. "People have got an appointment at the doctor's - they want the ambulance because it is covered under this levy. It's being abused." But Mr Sathiaseelan said the levy was not behind code-one increases. He blamed that increase on an ageing population and "phenomenal growth" in Queensland.

Mr Roberts also blamed Queensland's "growing and ageing population" for the increased demand for services. "In the 2006-07 financial year, the Queensland Ambulance Service attended 10,757 (or 9.7 per cent) more code one incidents than for the 2005-06 financial year," he said. But he said the extra demand was being addressed with the recruitment of 250 new ambulance staff this year and the purchase of 16 new vehicles. He was not concerned that some stations were unattended at night, describing the QAS as a "mobile service delivered by paramedics in vehicles".

Source





30 August, 2007

Desperate Brits going to Malta

Medical tourism is a new and rapidly growing development where prospective patients from rich Western countries go overseas to combine treatment and recovery in a holiday setting. This can also be done at a fraction of the cost they would incur for treatment at home.

A number of health service agencies have realised the market potential and more and more countries are jumping on the bandwagon to offer people competitively-priced elective surgery, cosmetic surgery and dentistry abroad. It is, therefore, not surprising that the Malta Tourism Authority is eager to tap this new market. It seems to be employing the expertise of an Indian-based company, Sahara Medical Tourism, that facilitates overseas surgery for patients from the UK, Europe and the USA and is now promoting Malta as a destination for medical tourism.

Due to lengthy NHS waits and concerns about the high risk of MRSA infections in NHS hospitals, a growing number of Britons are taking advantage of affordable, high-quality private healthcare abroad, combining it with a relaxing holiday. They save thousands of pounds compared with having the treatment done privately in the UK. Already, many British patients travel to Belgium, Hungary and Poland and even further afield to countries such as India and Brazil.

Malta offers obvious advantages. It is a close, traditional tourist destination, boasts a high standard of medical and dental care and has well-run private hospitals. With the prospective commissioning of Mater Dei Hospital, the government will have an impressive array of services on offer in a first-class environment. Added to that, Maltese medical professionals have a well-deserved high reputation and very often have post-graduate qualifications from the UK. The fact that English is easily spoken is another advantage.

To cope with their intractable waiting lists, the NHS of the UK is also seriously considering Malta as a location for its patients to travel for surgery. It seems a winning formula for all concerned. Not least, it will provide an incentive for Malta's medical, dental and paramedical professionals to remain in their own country.

It is of paramount importance that the MTA does its homework properly and gets things right from the outset. No amount of marketing will compensate for a botched or inadequate scheme. Lost reputations are not easily regained. The government has to make sure standards are rigorously upheld and only allow hospitals, clinics and operators that fulfill stringent requirements to participate. Meanwhile, it still has to be seen what impact such schemes will have on the services offered to the local population. This applies particularly if the government is an active participant in health tourism.

It is imperative that the Maltese people will not become second-class patients in their own country as paying cases from overseas are given priority. There is nothing to suggest this will happen, but as St Luke's Hospital waiting lists amply illustrate, the government-run medical service is already finding difficulty meeting the needs of its own, especially where elective surgery is involved. Will the adequate funding of the new hospital service depend to a critical extent on health tourism? As has been repeated so often, there is more to a medical service than a state-of-the-art building and equipment. Health tourism can be a godsend but mismanaging it will lead to a dual and unequal service that will prove socially and politically unacceptable.

Source




Australia: Bureaucrats want to curtail cardiac surgery in private hospitals

Even though there are no nearby government hospitals to do it! They hate private hospitals because the private hospitals show them up

The Gold Coast's 600,000 residents could be stripped of any cardiac surgery services, forcing locals with heart conditions to travel to Brisbane for treatment.

Queensland Health has advised the Coast's two private hospitals it could withdraw their approval to offer cardiac services. Queensland's chief health officer Jeannette Young is considering withdrawing approval because neither hospital performs the amount of work required under official guidelines to maintain staff competency and patient safety. Residents will not be able to turn to the public system because the local hospital has not been funded for cardiac surgery.

Health Minister Stephen Robertson said while no decision had been made, the review was about ensuring cardiac services were safe and sustainable.

Source





29 August, 2007

Amazing Socialist New Zealand: Extra hospital money ALL went on bureaucracy

(See here for the iconic case of NZ medicine)

If there's one thing that everyday New Zealanders are scared of, it's the prospect of getting sick and having to depend on the public health system to take care of them - or even save their life. Why? Because it's common knowledge now that our health system is a shambles; a chaotic mess. For instance, we now know - thanks to a Treasury report that the Government tried to keep quiet - that, despite that despite Labour spending an extra $4.5 billion a year on health, there are no extra health services. Not that we need secret internal reports to tell us that. All we have to do is ask one of the tens of thousands of Kiwis who are waiting for health treatment.

So what's the money being spent on - $4.5 billion a year is a lot, after all. Well, some of it has gone on staff. But not doctors and nurses; no, the new staff has largely been made up of pen-pushers - staffing levels at the Ministry of Health's head office has increased by around 40 percent under this government, and DHB and PHO bureaucracies now cost us more than $40 million a year. A lot of money has been spent ... but what has been achieved? Absolutely nothing, according to another Treasury report when it stated that: ". increased staff numbers have not led to higher outputs."

In plain and simple language - layman's terms, if you will - that means that there has not been a single extra operation, no extra services. As ACT's Health Spokesman I've spent a lot of time looking into the failings of the public health system, and thought there was nothing more about it that could shock me - but even I was left speechless when I found out that there are now more bureaucrats in the health system than there are hospital beds. That's right: if every single bureaucrat in the health system fell seriously ill today, there wouldn't be enough beds to treat them all - let alone anyone else.

Our health system has become a joke ... but no one's laughing. How could anyone laugh when people are living in pain and misery because they aren't being treated in a timely manner? When people are languishing on waiting lists and dying on Active Review?

Here's another sick joke: Six years ago the Labour Government set up a Health Workforce Advisory Committee (HWAC), to the tune of $3.5 million, which failed to produce a single practical recommendation. Last year it received almost one million dollars. In that year it produced one press release and six publications - one of which was its annual report. What is most telling about those reports is what they DIDN'T tell us. They didn't tell us that a third of General Practitioners are looking to change jobs within five years.

Can you blame them? While the health workforce - the doctors and nurses who do the work that matters - is stretched facing the daily nightmare of struggling to care for the country's sick, there's an entire army of bureaucrats busily monitoring each other's outputs. Outputs! - How about some input? How about patients being able to see a specialist and get the treatment they need? This, of course, is the hard question. Labour answers with what the media politely refers to as 'spin'. Out in the real world, we see it for what it really is: lying.

What else could you possibly call it when the Government cuts patients from the waiting list without treating them and then tries to claim it has solved the waiting list problem? But that's what this Government has done, and what it will continue to do. Former Health Minister Annette King did it; now current Minister Pete Hodgson has done it too, telling DHBs to send people on the waiting list back to their GP. How do we know this? We got it from a document leaked from Waitemata DHB, which was threatened with a $3 million penalty if it didn't send 800 people on its waiting lists back to their GP.

So what, exactly, are people waiting for on the waiting list? A common misconception is that they're waiting for treatment when, in reality, they're waiting to be referred back to their GP. 800 patients just wiped from the waiting list without treatment, and that's just in Waitemata. The same thing is happening in every town and city throughout New Zealand - patients are being sent back to their GPs - who have already determined they need a second opinion or specialist care. It would be laughable if it weren't so tragic.

This isn't spin; this is cruelty. The Government is culling the waiting list so it can put a 'healthy' face on its incompetence and disregard for the sick and vulnerable. But these patients aren't just numbers that Labour can manipulate; they're people; they're hard-working, taxpaying Kiwis who deserve to be treated in a timely manner. The Government might not see this, but everyone else does - is it any wonder that so many doctors are moving on? For that matter, is it any wonder that so many Kiwis live in dread of getting sick? Kiwis should be asking Mr Hodgson why he's so desperate to hide the real numbers waiting for treatment; why he's bullying DHBs into making him look good by dropping desperately sick people from their waiting lists. The only thing that's truly sick in all of this is Mr Hodgson and his Government's behaviour.

A democracy is judged by the way it cares for its least fortunate. Making people wait for health care - worse, denying those people even exist - is an outrage we should all be ashamed of, even if the present Government isn't.

Bit it needn't be this way. DHBs are only too happy to send people to private hospitals, but they can't - Labour's ideological opposition to the private sector in health means that DHBs' use of private hospitals is sorely restricted. DHBs are instructed to care for patients on waiting lists 'in-house' - in public hospitals - or taken off the lists all together. Thus, Labour's philosophical opposition to the private sector means that people - including Labour voters - suffer and wait, rather than being treated in a private hospital.

The blame however doesn't rest at the Government's feet, of course. No, government says the fault is the DHBs, the doctors, the nurses - the over-worked health professionals struggling at the coalface. So there we have it: tens of thousands of Kiwis are currently waiting for health treatment while Labour pours money into the hiring of bureaucrats who make no improvement in real service. ACT knows this is wrong. That's why we would tear down the wall - and every other obstacle - that Labour has erected between public and private healthcare; that's why we would ensure that billions of your dollars are not spent with nothing to show for it.

ACT policy will ensure that people who need treatment receive it in a timely manner - and that if they can't get it from a public hospital, they'll get it at a private one. Who knows? Maybe one day we'll live in a country where we're no longer afraid of getting sick.

Source




Dental desperation in Scotland

Desperate North-east dental patients could be bumped down the NHS waiting list if they go private. NHS Grampian has now admitted it has a policy of pushing people down the waiting list if they discover the person has signed up for private care. This follows Evening Express revelations last week that the waiting list in Grampian now stands at 25,000 (the equivalent of a 13-mile queue), meaning it could take years before an NHS dentist is available. The one big hope appears to be the proposal to build a new surgery in Tillydrone which could take 12,000 people, as reported by the Evening Express yesterday.

One North-east patient, who wants to remain anonymous, was told that by signing on for Denplan he would be shoved down the waiting list. Denplan is a form of private health insurance for teeth which gives people a guaranteed two check ups a year for a minimum monthly fee of 10 pounds. He lost his NHS dentist when he went completely private and was forced to join the long waiting list.

"As I was in need of fillings I signed up for Denplan, seeing no other option," he explained. "However, I kept my name on the waiting list as I'll be a pensioner quite soon. "When I phoned to ask how far up the list I was, I was shocked to be told that by signing up for Denplan I would drop well down."

An NHS Grampian spokeswoman said the policy existed as those who could not afford private care had to take precedence. But she added: "We do have a helpline for people who need emergency treatment and can usually fit them in within 24 hours. "The waiting list is based on time waited and need. Need is seen to be greater if somebody cannot afford private dental care."

Source





28 August, 2007

Dunkirk war veteran killed by superbug in 'dirty' NHS hospital



A Second World War veteran who survived the Dunkirk evacuation died after contracting a superbug at a NHS hospital following a routine operation. His daughter says he was dismayed by the dirty conditions he faced at the hospital in the weeks leading to his death. Former Coldstream Guard Joseph Nixon, 87, survived the battlefields of France and Belgium. But after a bowel operation he caught pneumonia and superbug clostridium difficile at Maidstone Hospital in Kent at the end of last month.

Mr Nixon, who was also a Met Police officer after the war and a "tireless" campaigner for alcoholic support groups for prisoners, was appalled at how overworked nurses were and the dirty conditions at the hospital. After spending three weeks in the hospital daughter Jackie Dixon said "hour by hour his soul was being stripped". She took the war veteran to their home in Maidstone to live his last days in comfort. He died last Friday.

Jackie said: "Joseph was just so miserable. "One time he was really sad and said 'What did I do that was so evil that I'm trapped in this awful place'. "I said to him, 'I want to stop this, I want to stop this happening to other people'. "It was one of the only times he smiled."

She felt she had to act to stop him lying in a bed with dirty sheets, saying: "I just went and got the bedding and changed him myself. "After two weeks people thought I was staff - one woman asked me if I was a nurse. "I saw one of the nurses leaning on a trolley of soiled stuff and she just said, 'I can't do any more'. "They need more people to clean up." Food was just left by his bedside as he was too weak to feed himself.

A spokesman for Maidstone and Tunbridge Wells NHS Trust said: "We are very sorry that Mr Nixon's care did not meet the family's expectations and we will be undertaking a full investigation into the issues that have been raised. "The trust takes concerns about nursing care very seriously and is actively recruiting more nursing staff."

Source





27 August, 2007

Health Care Lie: '47 Million Uninsured Americans'

Michael Moore, politicians and the media use inflated numbers of those without health insurance to promote universal coverage

Michael Moore was wrong about health insurance. So were President Bush, Sens. Barack Obama (D-Ill.) and Hillary Clinton (D-N.Y.), presidential candidates former Sen. John Edwards and Gov. Mike Huckabee and The Washington Post, New York Times, Los Angeles Times, People magazine and Time magazine, as well as CNN, CBS and ABC.

Each of these people and media outlets incorrectly claimed the number of uninsured to be 40 to 50 million Americans. The actual total is open to debate. But there are millions of people who should be excluded from that tally, including: those who aren't American citizens, people who can afford their own insurance, and people who already qualify for government coverage but haven't signed up. Government statistics also show 45 percent of those without insurance will have insurance again within four months after job transitions.

Accounting for all those factors, one prominent study places the total for the long-term uninsured as low as 8.2 million - a very different reality than the media and national health care advocates claim.

Breaking It Down: Who's Uninsured? The number of the uninsured who aren't citizens is nearly 10 million on its own, invalidating all the claims of 40+ million "Americans" without health insurance. "It's really indefensible that we now have more than 45 million uninsured Americans, 9 million of whom are children, and the vast majority of whom are from working families," said Sen. Hillary Clinton in a May 31 speech. It was typical spin and easy to find. ABC medical expert Dr. Tim Johnson cited the incorrect data as he praised a "bold" and "politically brilliant" universal coverage plan on the April 26 "Good Morning America." "It's bold because it does propose to cover all Americans, including the 47 million now who are uninsured, within five years," said Johnson.

In his propagandumentary "SiCKO" that favored the socialist health care systems of Canada, Britain, France and Cuba, Michael Moore made the fantastic claim that almost 50 million Americans are uninsured. "SiCKO: There are nearly 50 million Americans without health insurance," quoted Moore's Web site. However, the Census Bureau report "Income, Poverty, and Health Insurance Coverage in the United States: 2005," puts the initial number of uninsured people living in the country at 46.577 million.

A closer look at that report reveals the Census data include 9.487 million people who are "not a citizen." Subtracting the 10 million non-Americans, the number of uninsured Americans falls to roughly 37 million. Moore should have paid attention to that fact, since he agrees that being "an American" matters to get health insurance. "That's the only preexisting condition that should exist. I am an American. That's it," said Moore in footage aired by ABC's "Nightline" on June 13.

That isn't the only problem with the numbers currently being used. Recently, CNN's Dr. Sanjay Gupta accused Michael Moore of "fudging" some numbers in his recent film "SiCKO." This sparked a temper tantrum by Moore who threatened to become the network's "worst nightmare" if they didn't apologize and recant. CNN did "correct and apologize" for one transcription error, but stood by Gupta's statement "CNN's numbers and Moore's numbers aren't far off, but we believe ours are a fairer comparison."

In his film and television appearances, Moore left out quite a bit of information about the uninsured. On his Web site, Moore claimed the Census Bureau had "underreported" the number of people without health insurance. But Cheryl Hill Lee, a co-author of the Census Bureau study Moore was citing, told the Business & Media Institute that the data showed the exact opposite of what Moore said. The Census "underreported" the number of people covered by health insurance - meaning that more people have insurance than the report suggests. The Census also underreported the number of people covered by Medicare and Medicaid.

They Can't Afford Insurance .

Many of the same people pushing the incorrect numbers of uninsured Americans also claim that these people cannot "afford" insurance. "And when you've got 47 million people in this country with no health insurance, they don't go to the doctor because they can't afford it," Moore said on CNN's "Larry King Live" July 10. Katie Couric echoed those sentiment on the CBS "Evening News" May 23. "The number of Americans with no health insurance is continuing to grow as more and more employers say they can't afford to offer group insurance . People who try to buy insurance on their own often find the price beyond their reach," said Couric as she introduced a two-part "investigation of the health insurance industry."

But according to the same Census report, there are 8.3 million uninsured people who make between $50,000 and $74,999 per year and 8.74 million who make more than $75,000 a year. That's roughly 17 million people who ought to be able to "afford" health insurance because they make substantially more than the median household income of $46,326. On the July 13 "Larry King Live," Gupta did make that point, providing more context than Moore and most journalists about the affordability of health insurance.

Subtracting non-citizens and those who can afford their own insurance but choose not to purchase it, about 20 million people are left - less than 7 percent of the population. "Many Americans are uninsured by choice," wrote Dr. David Gratzer in his book "The Cure: How Capitalism Can Save American Health Care." Gratzer cited a study of the "nonpoor uninsured" from the California Healthcare Foundation. "Why the lack of insurance [among people who own homes and computers]? One clue is that 60 percent reported being in excellent health or very good health," explained Gratzer.

A Lie that Promotes Big Government

Moore, Clinton and Obama have used the lie about 40-some million uninsured Americans to promote universal health insurance plans. Moore asserted in his film that providing health insurance to everyone is a moral and even religious obligation. The mainstream media have played along, championing "ambitious" universal coverage plans and referring to the U.S. system as "deeply flawed." "California's ambitious plan to make health insurance available to almost everyone in the state is getting a lot of attention all over the country, and here's why. According to the latest figures, the number of uninsured Americans has grown to more than 46 million," said Katie Couric on the "CBS Evening News" January 9.

Journalists' failure to question that high figure has furthered the cause of nationalized care. "Proponents of universal health care often use the 46-million figure -- without context or qualification. It creates the false impression that a huge percentage of the population has fallen through the cracks," Gratzer told BMI. "Again, that's not to suggest that there is no problem, but it's very different than the universal-care crowd describes."

Dr. Grace-Marie Turner, a BMI adviser and president of the Galen Institute, agreed that "the number [on uninsured] is inflated and affects the debate." Turner also pointed out that "45 percent of the uninsured are going to have insurance within four months [according to the Congressional Budget Office]," because many are transitioning between jobs and most people get health insurance through their employers.

So what is the true extent of the uninsured "crisis?" The Kaiser Family Foundation, a liberal non-profit frequently quoted by the media, puts the number of uninsured Americans who do not qualify for current government programs and make less than $50,000 a year between 13.9 million and 8.2 million. That is a much smaller figure than the media report. Kaiser's 8.2 million figure for the chronically uninsured only includes those uninsured for two years or more. It is also worth noting, that, 45 percent of uninsured people will be uninsured for less than four months according to the Congressional Budget Office.

Source





26 August, 2007

Health Care Vouchers: a Market-Based Approach that Would Cost Nothing

How much does the US already spend on health care for the poor? In 2005 Newsmax.com wrote:

"The extension of taxpayer-funded Medicaid to the working poor has led to the largest expansion of a government entitlement since the Great Society was launched in the 1960s.

"The soaring costs of Medicaid - which will more than double this year to close to $330 billion since 1999 - is largely due to legislation that extended Medicaid coverage to many Americans who have low-paying jobs."

Medicaid does not include Medicare, health insurance for the elderly, so it understates health cost transfers. According to the Census Bureau, there are 302,648,273 Americans as of this writing, so let us assume 305 million this year. Thus, very conservatively, Americans spend $330,000,000,000/ 305,000,000 = $1,081 per capita on health care for the poor. If we add Medicare, which according to the Heritage Foundation will cost $454 billion in 2008, America now spends more than $784 billion on health care for the poor and elderly, or $2,570 per capita in cost ($784 billion/305 million), compared to Cuba's $250 per capita on health care for everyone.

The Cuban per capita cost for national health insurance amounts to only 10.28% of the per capita cost of current American contributions to the poor and elderly. Yet, the Democrats and Michael Moore argue that we contribute too little money to health care for the poor. Of course, much of US health care costs is due to mismanagement, unnecessary operations regarding prostate cancer, cardiac bypass and heroic end of life treatments. More fundamentally, providers and health care professionals enjoy a combination of artificially induced monopoly through licensure and other entry restrictions coupled with artificially stimulated demand. There is probably ample corruption and abuse arising from the regulated and third-party-financed system.

Four months ago I called the Cigna Insurance Company in New York and learned that Cigna offered New Yorkers individual coverage coverage for $198 per month ($2,376 per year), with family coverage costing roughly twice as much. We are already paying for a version of national health insurance that is mismanaged so that it does not include all Americans, but it costs enough that it ought to. As Phil Orenstein of Democracy Project has blogged, Rudolph Giuliani has proposed tax incentives of $7500 in exemptions to individuals and $15,000 to families to help pay for the costs of private health coverage that they choose themselves. Tax credits could be paid for via the termination of Medicare, Medicaid, government employee plans and through avoidance of double counting via the termination of corporate health insurance deductibility. A tax credit or dollar for dollar tax abatement or voucher would replace Medicare, Medicaid, government employee plans and corporate tax deductions. For individuals who pay less in federal taxes than the voucher amount, a reverse or negative income payment could cover it. This would not cost taxpayers a dime because Medicare, Medicaid, government employee plans and the corporate tax deduction exceed the total cost of a tax credit that would cover everyone. Even if average costs are $7,500 per person, and exceed savings from terminating Medicaid, Medicare, government employee plans and corporate tax deductions, additional savings could accrue by encouraging insurance schemes that limit payments for unnecessary treatments and bureaucracy.

The cost and coverage problems associated with health insurance are primarily managerial. They could be solved through market competition and redistribution of the monies already expended on health care, much of which is wasted and mismanaged. The waste and mismanagement could be reduced because the vouchers could be set at a level for a plan that excludes various kinds of waste, such as unnecessary operations and futile end of life care.

Source




NHS Doctors to be replaced by nurses

Back to the past for childbirth in Britain

The Health Secretary has approved plans to close “vital” hospital services, which will cost lives, an MP has said. A long-running review of NHS services in Greater Manchester and Cheshire ended yesterday with Alan Johnson’s endorsement of an independent panel’s recommendation to close maternity units at Fairfield in Bury, Rochdale Infirmary, Trafford and Salford Hope. Salford will also lose its neonatal intensive-care unit. The Independent Reconfiguration Panel has also backed plans to down-grade Rochdale’s accident and emergency unit and end emergency surgery at Fairfield Hospital. The changes are expected to happen within five years and are likely to mean more home births and deliveries in units staffed by midwives.

Paul Rowen, the Liberal Democrat MP for Rochdale, accused Mr Johnson yesterday of “wielding the axe” in Greater Manchester in a cost-cutting exercise. Tens of thousands of people had signed a petition against the closure of the hospital’s maternity unit, he said. “I am furious that we have been ignored.”

The reconfiguration panel said that local NHS trusts should consider creating stand-alone midwife-led units at Bury, Salford and Trafford. But the Royal College of Midwives said that midwifery staff might not cope with the work demands. Margaret Morris, chairwoman of Salford Royal Hospitals NHS Trust, said that she was bitterly disappointed. “While we have always supported the principle of having fewer, larger maternity units and developing three major neonatal units, we believed that Greater Manchester would benefit more by retaining and developing services at Salford Royal,” she said.

Ministers defended the changes. Hazel Blears, the Communities Secretary and MP for Salford, said that she was “very pleased” that her constituency was in line to have a stand-alone midwife-led unit. In December Ms Blears joined picket lines to protest over proposals to close the maternity unit at Hope Hospital, despite supporting the national policy on maternity changes. She said yesterday: “As a local MP I have made representations at every stage to ensure that babies can still be born in Salford, and this is still the case.”

The Department of Health said that the changes to the region’s emergency services would be supported by investment of 38 million. An additional 60 million will be invested in maternity, the department added.

Andrew Lansley, the Conservative Shadow Health Secretary, called on the Government to put the hospital cuts on hold until it could “produce the evidence to justify them”. He said: “These cuts have been justified on the basis of what are safe staffing levels, but in other areas similar-sized units are allegedly under no threat. Doctors said yesterday that the changes could save up to 30 babies a year, while NHS managers denied cost-cutting, saying that new services would require more investment, not less.

Source





25 August, 2007

Why the U.S. Ranks Low on WHO's Health-Care Study

The New York Times recently declared "the disturbing truth ... that ... the United States is a laggard not a leader in providing good medical care." As usual, the Times editors get it wrong.

They find evidence in a 2000 World Health Organization (WHO) rating of 191 nations and a Commonwealth Fund study of wealthy nations published last May. In the WHO rankings, the United States finished 37th, behind nations like Morocco, Cyprus and Costa Rica. Finishing first and second were France and Italy. Michael Moore makes much of this in his movie "Sicko." The Commonwealth Fund looked at Australia, Canada, Germany, New Zealand, the United Kingdom and the United States -- and ranked the U.S. last or next to last on all but one criterion. So the verdict is in. The vaunted U.S. medical system is one of the worst. But there's less to these studies than meets the eye. They measure something other than quality of medical care. So saying that the U.S. finished behind those other countries is misleading.

First let's acknowledge that the U.S. medical system has serious problems. But the problems stem from departures from free-market principles. The system is riddled with tax manipulation, costly insurance mandates and bureaucratic interference. Most important, six out of seven health-care dollars are spent by third parties, which means that most consumers exercise no cost-consciousness. As Milton Friedman always pointed out, no one spends other people's money as carefully as he spends his own.

Even with all that, it strains credulity to hear that the U.S. ranks far from the top. Sick people come to the United States for treatment. When was the last time you heard of someone leaving this country to get medical care? The last famous case I can remember is Rock Hudson, who went to France in the 1980s to seek treatment for AIDS.

So what's wrong with the WHO and Commonwealth Fund studies? Let me count the ways. The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries. That's not a health-care problem. Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada. When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation. Diet and lack of exercise also bring down average life expectancy.

Another reason the U.S. didn't score high in the WHO rankings is that we are less socialistic than other nations. What has that got to do with the quality of health care? For the authors of the study, it's crucial. The WHO judged countries not on the absolute quality of health care, but on how "fairly" health care of any quality is "distributed." The problem here is obvious. By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution.

It's when this so-called "fairness," a highly subjective standard, is factored in that the U.S. scores go south. The U.S. ranking is influenced heavily by the number of people -- 45 million -- without medical insurance. As I reported in previous columns, our government aggravates that problem by making insurance artificially expensive with, for example, mandates for coverage that many people would not choose and forbidding us to buy policies from companies in another state.

Even with these interventions, the 45 million figure is misleading. Thirty-seven percent of that group live in households making more than $50,000 a year, says the U.S. Census Bureau. Nineteen percent are in households making more than $75,000 a year; 20 percent are not citizens, and 33 percent are eligible for existing government programs but are not enrolled. For all its problems, the U.S. ranks at the top for quality of care and innovation, including development of life-saving drugs. It "falters" only when the criterion is proximity to socialized medicine.

Source




Don't have a stroke in Britain

Patients who suffer strokes receive worse treatment in Britain than anywhere else in Western Europe. More die and more are left disabled, a leading expert says in this week's British Medical Journal, even though Britain spends as much as, if not more than, other countries on stroke care. The gap is wide, according to Hugh Markus, of St George's University of London medical school. One study showed that 15 to 30 per cent more stroke patients were left dead or disabled in Britain than in other countries.

Professor Markus identifies several possible reasons for the failure. European countries with better results tend to focus more on the care of patients immediately after a stroke, while in Britain the vast majority of money is spent on nursing and hospital overheads, and little on investigations or treatments. Stroke care is a "Cinderella subject" in Britain, falling between neurology and general and geriatric medicine, he says, whereas elsewhere it is an integral part of neurology. This lack of interest may have led to underinvestment and, therefore, poor outcomes.

New treatments that can help patients to recover from a stroke make the failings even more significant. In strokes caused by clots blocking the blood supply to the brain (ischaemic strokes) the use of clot-busting drugs is effective, but patients must first be scanned to determine what sort of stroke they have suffered. All hospitals have scanners, but struggle to scan stroke patients within 24 hours. For a patient to be treated with clot-busting drugs, the scan must be performed within three hours.

In many countries in Europe, and in North America and Australia, 20 to 30 per cent of patients get these drugs. In Britain the figure is less than 1 per cent. Britain also treats fewer patients in dedicated stroke units than other countries, though setting up such units costs nothing and there is abundant evidence that they improve outcomes.

The audit by the Royal College of Physicians found that fewer than two thirds of stroke patients were treated in stroke units, and only a little more than half spent more than half of their stay in such a unit. The benefits include early rehabilitation, access to physiotherapy and staff experienced in stroke care.

Jim Whyte, who had a stroke ten years ago at the age of 55, spent 27 weeks in hospital - only the last five in a specialist unit. Mr Whyte, from Enfield, North London, was treated at Chase Farm Hospital. "Once I got into the specialist unit I had physiotherapy twice a day, speech therapy and training on how to manage for myself." The best help he gets these days, he says, comes from a local stroke club, whose members help one another with advice. He said: "That's something the NHS didn't think of. When I left hospital I was given nothing in the way of information, about how to avoid a second stroke, that sort of thing. Things may have got better since, but we've still got a long way to go."

A significant challenge, Professor Markus says, is to change the perception of stroke among doctors and the public. Scanning units should be available 24 hours a day, and to achieve this regional specialist centres may be needed. Such changes have been achieved for heart care, so it is not impossible, he says, but it calls for commitment and a reorganisation of services, which have so far been lacking.

Joe Korner, director of communications at the Stroke Association, said that the present situation was unacceptable. "For many years the Stroke Association has been concerned about the UK's poor record in stroke care compared to other countries," he said. "That is why we have been campaigning hard to try to improve stroke services. "The Government, with a new stroke strategy in development, has shown a commitment to improving the future of stroke care across the UK. But it is vital that stroke gets the priority and investment it needs. "Without investment hundreds will die needlessly. Public awareness of stroke also needs to be increased so that people can recognise the warning signs."

Dawn Primarolo, the Health Minister, said: "In the last ten years the treatment of stroke in the NHS has progressed rapidly - more patients than ever before are being seen by stroke specialists, numbers of stroke deaths are falling and advancing medical understanding gives every prospect for a real revolution in stroke treatment over the next few years. "The National Stroke Strategy - setting out proposals for modernising stroke prevention, treatment and care - is currently out to consultation. "It was developed with the Stroke Association and stroke survivors and carers, and was debated by Parliament. It follows 20 million pounds invested in improved research into stroke and additional tools and support for hospitals on stroke prevention. "Although we have more improvement to make to the numbers of people given clot-busting thrombo-lytic drugs, there are hospitals, such as King's College, that are matching the best in the world."

Source




The Australian Leftist solution to health-service shortages: More bureaucracy

Kevin Rudd has started to show his interventionist side. The toon below notes that the State governments would be glad to unload responsibility for their problematical hospital systems onto the Feds



VOWING to take personal responsibility for fixing Australia's public hospital system, Kevin Rudd has given away his administrative bent, backing it up with a small carrot and a big stick. In dollar terms, a pledge to spend an extra $2billion over four years is small change in the context of the total healthcare budget. The potential meat in Labor's plan is the establishment of a National Health and Hospitals Reform Commission to sort out the cross jurisdictional healthcare mess that allows each level of government to blame the other for its shortcomings. The proposed reform commission will negotiate a framework to clearly define the state and federal responsibilities in healthcare.

On one hand, the Opposition Leader's plan could amount to no more than an election-year promise that lacks substance and is designed to foil John Howard's opportunistic pledge to prop up a small Devonport hospital in Tasmania as part of a strategy to muscle up against Labor state governments. On the other hand, Labor's plan could represent the first concrete evidence of the highly interventionist style we could expect from Mr Rudd.

Mr Rudd has a history of heavy involvement shaking up health and education bureaucracies from his time as former Queensland premier Wayne Goss's top public servant. As well as cutting back public sector spending, Mr Rudd helped create a 10-year plan to refurbish Queensland's major hospital buildings. His process-driven reform pedigree is showing in the proposed reform commission, to be established in the first 100 days of a Labor win. Labor has pledged to provide financial incentive payments to state and federal governments who deliver better outcomes to patients. The big stick is the threat of a commonwealth takeover of Australia's 750 public hospitals if state and territory governments can't agree to a national reform plan by mid-2009.

Mr Rudd has proposed a referendum to secure a public mandate for any takeover, after which local communities would have a direct say in management of public hospitals with responsibility for the quality of patient care and funding resting with the commonwealth. In a Whitlamesque refashioning of commonwealth responsibilities, states would effectively be cut out of the loop on health. Mr Rudd says this would put an end to the blame game between Canberra and the states on health and hospital funding.

Mr Rudd has taken personal responsibility for the plan, declaring that as prime minister the buck would stop with him. While Queensland Premier Peter Beattie was quick to welcome a commonwealth takeover of what has been a continuing political train wreck for his Government, other state leaders were not so quick to embrace it. West Australian Premier Alan Carpenter rejected the plan, saying he did not believe the federal Government could do the job better than the states. South Australian Premier Mike Rann pledged to work with Mr Rudd to eliminate duplication and plug gaps in service delivery but stopped short of endorsing a commonwealth takeover of responsibility. So did Victorian Premier John Brumby, who said it was a good plan but a takeover would not be necessary. NSW Premier Morris Iemma said he welcomed a more results-based funding system.

While another bureaucracy is the last thing Australia's already cumbersome public health industry needs, properly focused, a reform commission might well be necessary to find what has proved to be an elusive solution to an obvious problem. As it is, the commonwealth is accused by the states of avoiding its responsibilities in aged care, leaving elderly people stranded in public hospital beds. The states are accused of shunting hospital costs from hospital budgets onto commonwealth-funded GPs. The public is wise enough to know that however healthcare is delivered, the full cost comes from the public purse.

The sensible thing is to make the healthcare system as streamlined and efficient as possible. This includes encouraging those who can afford it to take out private hospital insurance to take pressure off the public system. It includes making sure the public properly understands that the Medicare levy at its present level funds only a small fraction of the total healthcare bill and that, because of the enormous sums involved, no system will ever be capable of providing full treatment on demand for any ailment.

No one understands the political ramifications of taking the eye off the public hospital ball more than Mr Beattie, which probably explains why he was quick to support Mr Rudd's plan for a commonwealth takeover of responsibility. Queensland's health dilemma is made more acute by the fact it has a rapidly growing population, including many retirees to remote coastal locations where few if any health services are available. The reluctance of other state leaders to lose direct control will hopefully ensure they will co-operate with the reform commission process.

Traditionally, health is recognised as a strong suit for Labor. Mr Rudd appears to have embraced the challenge and deserves encouragement to get it right. It would be disappointing, however, if Labor's promise turned out to be little more than the creation of a new body designed primarily to strengthen Canberra's hand when it comes to indulging in the blame game with the states over health.

Source





24 August, 2007

Don't get cancer in Britain

Cancer patients in almost all European countries survive longer after diagnosis than those in the UK. Only Eastern Europe does worse. The results are bad news for the NHS Cancer Plan, implemented in 2000. Some of the latest results include patients treated after the plan began, but fail to show significant changes in relative success rates. The Lancet Oncology, in which the new data is published, does not pull its punches. "So has the cancer plan worked?" it asks. "The short answer is seemingly No."

The new information comes from a group called Eurocare, which organises the largest cooperative study across Europe of cancer patients. In The Lancet Oncology, the group publishes two analyses, one covering patients whose disease was diagnosed between 1995 and 1999, and the second covering those between 2000 and 2002. In general, five-year survival (generally a proxy for "cure") is highest in Nordic Countries and Central Europe, intermediate in southern Europe, lower in the UK and Ireland, and lowest of all in Eastern Europe.

Countries that spend more on health generally do better, but Denmark and Britain have lower survival rates than other countries that spend comparable amounts. The study finds that the gaps have narrowed since the last survey but they remain significant.

Europe's survival rates are lower than in the US, where 66.3 per cent of men and 62.9 per cent of women survive for five years, compared with 47.3 per cent of European men and 55.8 per cent of women. These figures may represent earlier diagnosis.

Source




Healthcare reform Hillary voted against

Karl Rove took a stab at Hillary Clinton on Sunday. He points out that Hillary's vision of healthcare reform is to "let the government do it all." Here's a recent list from Rove, outlining all of the positive reforms Hillary has voted against ... simply because it takes power away from government and gives it to the individual.

* She voted against providing seniors with a prescription drug benefit.

* She voted against allowing people to save tax free for their out-of-pocket medical expenses.

* She voted against medical liability reform so that docs are not forced out of practice by junk lawsuits.

* She opposes leveling the playing field so that people who pay for health insurance out of their own pocket get the same tax break the big corporations get for providing health care benefits to their employees.

* She's against allowing people to shop for health insurance across state lines like we do with auto insurance so the consumers would have more choices and there'd be competition to get your business, give you more for less.

* She's voting for penalizing seniors who have those private health care plans through Medicare.

Take a look at the list. Think about all of those items. Every one of those reforms would have empowered the people. Every one of those reforms would have allowed people to take a bit more responsibility for their own health care. That is precisely why Hillary voted against each and every one of them. As on most issues, Democrats are anti freedom control freaks. They don't trust the market and they keep pushing things to make the market not work.

Source




Australia: Patients walking out of government hospital emergency rooms untreated

After many hours of waiting. Some are just too ill to sit it out any further

PATIENTS are more likely to leave the Sunshine Hospital's emergency department before treatment than any other Melbourne ER. Figures tabled in State Parliament show 4657 patients walked out of the Sunshine emergency department last year, a rate of 7.6 per cent. The average across Melbourne during 2006 was 5 per cent, or 31,437 people. This was an increase from 30,152 patients in 2005. The official figures show fewer than 1 per cent of patients walk out, against medical advice, after treatment has started.

Opposition health spokeswoman Helen Shardey said Melbourne's major hospital emergency departments were not coping. "People are giving up and walking out," Ms Shardey said. "Of more concern is the fact we don't know what happened to these people." Ms Shardey said the figures were in contrast to claims by Health Minister Daniel Andrews that Victoria had a first-class health system. "He is failing to recognise that Victorians are just not getting the treatment they deserve in urgent situations because our major hospitals are simply not coping," Ms Shardey said.

Australian Medical Association Victorian president Doug Travis said hospitals lacked the resources to cope with demand. "(Patients) wait half an hour, one hour, two hours, and they walk out," Dr Travis said. "What we need is a commitment from the Government to understand the fact we don't have enough capacity in the system."

A spokesman for the Health Minister said Victoria's emergency departments were rated as the best in Australia. "More than half of all patients were seen by a doctor or nurse in a Victorian hospital within 19 minutes of arrival compared to the national average of 24 minutes," spokesman Tim Pigot said. [What amazing bull! The wait is 3 to 8 hours]

Source





23 August, 2007

The gravely ill man who beat the NHS

But only with the dedicated help of his wife. Excerpt:

And what she does is extraordinary. Right, she says to herself, 14 of the country's top neurologists have given up on Nigel. I'll find one who won't. And bugger me she does.

6am, Heathrow airport, a few days later: Michele is waiting for the man considered to be the world expert on brain diseases, Dr Patrick Kelly, to arrive from New York. He is flying to Stockholm to pick up some prize from an obscure body called the Nobel Institute, but after one telephone call from Michele he's agreed to see her during his stop-over at Heathrow to examine my notes and scans instead of wandering off for a cup of coffee and a bagel.

In the process, of course, Michele has come up against good old British jobs-worth work-to-rule, we-do-it-our-way-whoops-another-one-for-the-body-bag bureaucracy. The hospital wouldn't let her have my notes or scans. They weren't her property, they were theirs. So ya-boo sucks. Turns out they were worried she might lose them.

She was dumbfounded. Lose them? The details on her husband's condition? The stuff they needed to keep him alive? The hospital bosses held their legally correct, morally disgusting ground. [Fear of their incompetence and negligence being exposed. Better for the patient to die] By this point it was 8pm. Kelly's plane was due to land in 10 hours. So she nicked [stole] them. And at around midnight she crashed into the drunken, dying embers of a dinner party at the only friends of ours who had a photo-copying machine, to copy them - before heading off to the airport at around 4am. My uncle drove, partly out of kindness, partly because as an ex-copper he was keen to keep death off the roads.

So there they are, at the gate, watching the New York redeye disgorge its tired passengers. By now the plane is almost empty and Michele has bobbed up to a dozen startled men in smart suits, all of whom have backed away from this crazed little blonde thing. Then there is a tap on her shoulder. A leprechaun in a flat cap stands before her, barely reaching her chin. His stubby little hands jab at the notes. "Are they for me?"

So, by the light of the Avis rent-a-car sign this little, slightly railroaded surgical genius makes two pronouncements: 1. This is not a tumour. 2. If I'm wrong, and it is, it's not inoperable. I'll prove it by operating.

They shake hands; he says good-bye and scuttles off to get the next flight to Stockholm and sanity. The effect of his diagnosis on me is magical. It is the first good news. And there is a galvanising effect on the medical team. Blimey, I am worth saving. WE'RE entering the realms of experimental medicine now. Science fiction, almost. The machine that's wheeled in looks more like a tea trolley, the love child of a milk float and an Austin Allegro. They've bought it off Del Boy, surely. They can't really expect me to get hooked up to this piece of - oh. They've hooked me up to it. Via ugly, bloody tubes going into my groin.

Not to be too scientific, I think the idea is to calm down my hyperactive white cells by taking them on the equivalent of a holiday to Center Parcs. The entire procedure takes just under an hour. The first bottleful is removed/ replaced okay. There's a slight ache in my left side. Shell and my uncle are here and I try not to upset them by going Ouch too much. The second bottleful makes my left side stiff and sore. I can take it. The third bottleful and I stop telling jokes. I start to shake. I snatch a look at Michele. She's biting her lip....

I have six more of these procedures over the next couple of months. I always stop after the fifth bottle. Instead of taking yet another predictable daily turn for the worse, I wake up one morning to find - Ha! The fingers on my left hand are freer. Okay, it's not ideal - my fingers are bending the wrong way for a kick-off, but I've finally got their attention!

FOUR months later: another hospital, but this time I'm not the patient, although by the time I get there I probably should be. It's two days since I moved back home. I'm not better: I live on 500ml batches of Jevity ("Complete, balanced, isotonic liquid with mixed fibre and FOS") from a drip.

More here





22 August, 2007

Medicare wises up

Medicare is adopting the Pottery Barn Rule for doctors and hospitals: You break it, you bought it. The federal health insurance plan for people 65 and older no longer will reimburse doctors and hospitals for fixing the mistakes they make on patients. Hallelujah.

Medicare will stop paying the costs of treating infections, falls, objects left in surgical patients and other things that happen in hospitals that could have been prevented. The rule change announced this month is among several initiatives that the administration says are intended to improve the accuracy of Medicare's payment for hospital patients who receive acute care and to encourage hospitals to improve the quality of their services. "Medicare payments for inpatient services will be more accurate and better reflect the severity of the patient's condition," Herb Kuhn, the acting deputy commissioner of the federal Centers for Medicare and Medicaid Services, said in a statement.

The rule identifies eight conditions - including three serious types of preventable incidents sometimes called "never events" - that Medicare no longer will pay for. Those conditions are: objects left in a patient during surgery; blood incompatibility; air embolism; falls; mediastinitis, which is an infection after heart surgery; urinary tract infections from using catheters; pressure ulcers, or bed sores; and vascular infections from using catheters.

The Centers for Medicare and Medicaid Services said it also would work to add three more conditions to the list next year. "Our efforts in this arena and in other payment rules are to ensure that CMS is an active puchaser, not passive payer, of health care," Jeff Nelligan, a spokesman for the agency, said Saturday. He said the rule "underscores our drive toward quality, efficiency and integrity in the hospital setting."

Hospitals in the future will be expected to pick up the cost of additional treatment required by a preventable condition acquired in the hospital. "The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication," the final rules say.

Congress in 2006 gave the Centers for Medicare and Medicaid Services the power to prevent Medicare from giving hospitals higher payment for the extra costs of treating a patient when infections and other preventable conditions occur during a hospital stay.

Hospitals are to begin reporting secondary diagnoses present on the admission of patients starting with discharges on October 1. Then, starting exactly one year later, cases with these conditions would not be paid at the higher rate unless they were present on admission, the agency said.

Last year, Mark McClellan, then director of the Medicare and Medicaid programs, said the government could save hundreds of millions of dollars a year if the Medicare program stopped paying for medical errors such as operations on the wrong body part or mismatched blood transfusions. Medicare provides coverage for about 43 million elderly and disabled people. The Medicare program's expenses totaled about $408 billion in 2006; costs are expected to rise rapidly in coming years.

Well good for the government. Physicians have raked in plenty over the years from Medicare. They didn't all use to drive Mercedes. And doctors earn the money as most of them put in long hours. But dang, surgeons are paid too much money to leave instruments inside patients.

Source




Long ambulance trips kill people

But the British government plans to make the trips longer

People are more likely to die in emergencies if they have to endure long ambulance journeys to hospital, research suggests. As plans to close some accident and emergency departments and district hospitals in favour of larger but fewer specialist units come under increasing attack, a study finds that patients with breathing difficulties have more chance of dying the longer they stay in the ambulance.

A team from the University of Sheffield traced the results of more than 10,000 life-threatening 999 calls and concluded, in a report in the journal Emergency Medicine, that the longer the distance, the greater the likelihood of death. The risk of death for people who were unconscious, not breathing or suffering chest pain rose by one percentage point for every 6.2 miles (10km) travelled. The researchers said that the findings could affect government plans to reconfigure emergency care into a limited number of specialist centres.

The research, which is published today and is based on data taken between 1997 and 2001, coincides with the launch of a Conservative campaign against the closure of maternity services and A&E units. Promising a "bare- knuckle" fight with the Government, David Cameron, the party leader, said yesterday that people did not understand why these services were being shut down when emergency admissions and births were rising.

Previous research, cited in government reports backing the shift to bigger, specialist emergency units, failed to find any evidence that taking patients further by ambulance had an effect on survival. The new study, by contrast, finds that they do. Those most likely to be affected are patients with severe breathing problems. Their chances of dying were 13 per cent if the distance to hospital was between 6 and 12 miles, but 20 per cent if it was more than 12 miles.

The Sheffield team, led by Professor Jon Nicholl, traced the outcome of calls to four ambulance services. Using the grid references of the call and the hospital to which the patient was taken, they worked out the straight-line distance between the two, and then compared that with the outcome for each patient. The distance to hospital varied from less than one mile to as much as 36 miles. The median was just over three miles. Of the 10,315 patients traced, 644 had died. The results show that deaths increase with distance. Overall, 6.2 per cent of the patients died, but for the shortest journeys - fewer than six miles - the death rate was lower, at 5.8 per cent. For distances between seven and twelve miles, 7.7 per cent died, and for distances of more than 13 miles the figure was 8.8 per cent.

Other factors need to be included in any decision to relocate A&E services. For example, bigger specialised units might make up for the greater distance travelled by offering better care on arrival. Professor Nicholl said: "Decisions regarding reconfiguration of acute services are complex and require consideration of many conflicting factors. Our data suggests that any changes that increase journey distances to hospital for all emergency patients may lead to an increase in mortality for some."

Source





21 August, 2007

British mother forced to give birth alone in toilet of 'flagship' NHS hospital

A young mother had to deliver her own baby in the lavatory of a flagship hospital because there were no trained midwives available. Surveyor Catherine Brown had made the agonising decision to undergo a chemically-induced abortion after being told her 18-week pregnancy was risking her life. But when the time came to give birth she was on an ear, nose and throat ward and had only her mother to help her through the ordeal. Her premature son Edward died in her arms minutes later.

The traumatised mother-of-one said: "I just howled and howled. I remember sitting there looking at him and thinking, 'What do I do next?'. I just sat there on the toilet looking at my dead baby. "It was dreadful - a terrible nightmare. Then I started crying my eyes out and repeating, 'I'm sorry baby, I'm so sorry'. I still can't believe the hospital had no trained staff who could help me." To compound Miss Brown's agony, the body of her child was almost discarded with hospital waste.

Her MP has called for an independent review of what he called "one of the most harrowing medical cases I have ever had to deal with". The catalogue of errors unfolded at the 238million pound Queen's Hospital in Romford, Essex, which opened last December. Eleven weeks into her pregnancy, Miss Brown, 30, started suffering abdominal pains. She was told she was suffering from a urinary infection which would not affect her pregnancy. But on the evening of February 21 she started bleeding and was rushed into hospital.

Her condition was stabilised with intravenous antibiotics and in the early hours of the following morning she was moved to a mixed-sex ear, nose and throat ward where a bed was available. She was placed in a doorless annexe of the ward and told to expect a scan in the morning. By 5pm that evening she had still not had a scan. The procedure was only arranged at 7pm after her mother, Sheila Keeling, 51, threatened to make an official complaint. Doctors discovered there was no amniotic fluid around the baby, meaning his chances of survival were minimal. Miss Brown was told her own life was threatened by her condition and, following a consultant's advice, she took the devastating decision to undergo a chemically-induced abortion late that evening, after which she was moved into a private room.

At 4am on the following morning she went into labour but complained she had to wait an hour for gas and air to help with the pain. With no professional help available, she decided to go to her en suite bathroom and stand over the toilet, which had a disabled bar for support, because she had given birth to her son, 18-month-old Matthew, in an upright position. Her mother spoke of her fears that she was going to lose her daughter as well as her grandson, because she was bleeding so heavily. "I was running around frantically trying to find gas and air for her and pleaded with nurses, who seemed very matter of fact, to assist," she said.

"The staff I did find told me they did not have the training to help. Catherine was left to deliver the baby alone with just me for help before cleaning herself up and going back to bed. It was horrific."

But their trauma was still not over. Miss Brown said staff almost took Edward's remains away for disposal despite her informing the hospital she wanted to hold a funeral. "They didn't even record the details of Edward's birth. But he did exist. And more than that, he was a very special little boy. "Hopefully he has made sure that other families won't have to go through what we did. We'll never forget him."

Tests later revealed Miss Brown had septicaemia, possibly caused by the placenta failing to implant properly. Miss Brown, who lives in Hornchurch and has split with Edward and Matthew's father, said the mental and physical toll of her experience meant she had to stop work as a utility surveyor and is only now close to recovering.

Fighting back tears, her mother said: "It was really hard watching my daughter go through that. No one was there to reassure us and make us think they knew what they were doing."

Miss Brown's MP, Conservative James Brokenshire, said: 'The catalogue of errors and blunders is quite disturbing. There appear to have been systemic issues and potentially issues about individual members of staff. "While changes have been made by the hospital it is such a horrific story I want everything to be closely scrutinised. "This has to be one of the most harrowing medical cases I have ever had to deal with. "Catherine almost died and she later discovered the baby had nearly been disposed of with medical-waste."

Queen's Hospital was opened at the end of last year, taking over maternity services from Oldchurch Hospital in Romford. Women more than 20 weeks pregnant who experience complications are seen by A&E and sent to the maternity unit if necessary. Those under 20 weeks also go through A&E but are referred to gynaecology if problems continue. However, there was not a dedicated gynaecology unit when Miss Brown was admitted, meaning patients were sent to a ward where a bed was available.

The Barking, Havering and Redbridge Hospital NHS Trust offered its "sincere condolences" to Miss Brown. A spokesman said: "We have now established a separate gynaecological A&E service, staffed by gynaecological, medical and nursing staff with access to the Early Pregnancy Assessment Unit. "From the end of this month, there will be a dedicated gynaecological ward, with the Early Pregnancy Assessment Unit situated within it. This will ensure dedicated and appropriate care."

Source




Australia: Urgent need for nurses in government hospital

Tiny babies endangered

THE agonising wait is over for the parents of four-week-old Ryan Kelly, who last week received lifesaving heart surgery after two operations were cancelled. The Prince Charles Hospital blamed bed and intensive care nursing shortages for the delay.

But Ryan's father, Damien, said he was angry at the abusive treatment he witnessed towards hospital staff, who were bearing the brunt of public frustration. "It's ridiculous. Yesterday, I saw a nurse getting abused by a relative of one of the patients," Mr Kelly said. "I walked out with this nurse . . . and she burst into tears. Why should these people cop it for bed shortages? It shouldn't be directed at them. Let's direct it at the Premier (Peter Beattie) and his Health Minister (Stephen Robertson)."

As Ryan lies in intensive care after nine hours of surgery, eight-month-old Elijah Nganeko is still waiting for a bed. Elijah, who goes blue when he cries, was born with a hole in his heart. He's been on the waiting list for almost three months. His mother, Jackie, said without surgery, her only child would die, but doctors at the Prince Charles Hospital had been unable to say how long they would have to wait. "They said it could be days, weeks or months," Mrs Nganeko said. "The reason he hasn't had his surgery yet is a lack of intensive care nurses. "They're doing the emergency cases first and then the children that basically come after that."



Mrs Nganeko said the uncertainly over Elijah's operation was putting huge stresses on her and her husband Aaron. "We just don't let him cry at all. I don't get much sleep," she said. "If he cries, within a minute of starting he'll be blue." Despite the strains, Mrs Nganeko said she was not asking for Elijah to jump the queue. "We're saying that we want other people in the same situation to come forward so that Peter Beattie knows how bad it really is," she said.

Prince Charles Hospital acting medical services director Don Martin said children were prioritised for surgery on the basis of medical need. Last week Matthew Kuhne received surgery after a wait of nine days at the Princess Alexandra Hospital with severe spinal injuries also because of nursing shortages.

Source





20 August, 2007

Canada's 'universal' health care

We finally have good operating understanding of "universal" health care: somewhere in the universe there may be a place for you to get treatment. And if you are lucky enough to live near the United States before Hillary Care II takes hold, you may even get treated.

Canada welcomes the birth of the newest set of quadruplets born to proud Canadian parents. Karen and J.P. Jepp. However, the Jepp quads will be eligible to run for the presidency of the United States when they reach the age of 35, having been born in Benefis Hospital in Great Falls, Montana, 325 miles from their home in Calgary, capital of the Canadian oil industry.

The precious gift of American citizenship comes to the Jepp Quads because there were no hospital facilities anywhere in Canada able to handle 4 neonatal intensive care babies. Not in Calgary, a city of over a million people, the wealthiest in Canada, or anywhere else in Canada. Local officials looked. However, Great Falls, a city of well under one hundred thousand people, apparently had no problem with unusual demand for such facilities.

As Don Surber points out, the United States functions as Canada's back-up medical system, enabling it to run with less investment in facilities. America's evil, heartless private medical care system saved the day. In any capital-intensive field, whether it be electric power generation or medicine, gearing up for peak demand costs a lot of money. California discovered this a few years ago when it started to experience rolling blackouts in the wake of bungled partial deregulation of power.

America spends significantly more on medical care than Canada. Socialized medicine advocates frequently claim that this shows we are getting a bad deal: less care for more money. But the fact is that illegal alien mothers walk into hospital emergency rooms and give birth to babies requiring intensive neonatal care costing hundreds of thousands of dollars on a regular basis, and it makes no headlines. We do not send them over the border to Canada or Mexico and use their medical systems as a back-up, even when the mother might be a citizen of that country. We treat them, and pick-up the bill, too, without so much as a citizenship check or a call to immigration officials.

Steven M. Warshawsky demonstrates today on AT that there is no such thing as "free" medical care. Having the government pay means having other people pay your medical bills, and that leads to endless demand, which leads to rationing, which leads to insufficient capacity to handle peak demands, like, say, the birth of quadruplets. If and when Hillary Care II comes, of course there will be no back-up capacity available for Americans (unless you believe Michael Moore and think Cuba's medical system can provide anything to anyone).

Canada's vaunted socialized medical system depends on America for more than peak capacity back-up, of course. When was the last time you heard about a new drug being developed by a Canadian pharmaceutical company? Under the price control system in Canada it makes no sense to develop drugs there. Canada lets the United States bear the major burden of drug development (and so does the rest of the world). Our high drug prices and federal research subsidize the world's medical R&D.

Source




Australian patients going private in emergency

MORE patients are turning to private hospitals for emergency treatment as pressure on public hospitals mounts and queues to see GPs lengthen. Although there are only a handful of private hospitals in each state with emergency departments -- which usually charge between $150 and $200 per visit -- many say they are busier than ever, with patient numbers rising 10 per cent or more in the past three years. In one case, numbers rose by nearly 30 per cent in five years. The increases are evident in the "graveyard shift" from 10pm to 6am, when many better-off patients are willing to pay extra to avoid having to wait for hours in a public emergency department while staff attend to more urgent cases.

The Howard Government's report on public hospitals, published last month, found patient numbers at public emergency departments were soaring. The percentage of patients seen within recommended times fell in five of the eight jurisdictions. At the same time, GPs are abandoning after-hours services, with more than half referring patients to a deputising service or emergency departments. Although 24-hour GP clinics were common 10 years ago, a clampdown in the late 1990s on the Medicare rebates they could charge reduced profitability, and many folded or cut their hours.

Andrew Singer, president of the Australasian College for Emergency Medicine, said the increase in private emergency patients was caused by the combination of difficult access to after-hours GP services and the problems people experienced when they attended public emergency departments. "In the main, private hospitals provide a pretty good service -- there's usually a lot less waiting, and you usually get a reasonably experienced doctor, if not a specialist-level doctor," Dr Singer said. "Patients tend to prefer it, if they can afford it. "I know people who work in private emergency departments, and a lot of them think things are getting busier these days," he said. "The reality is that all EDs are getting busier."

A spokeswoman for Brisbane's Greenslopes Private Hospital -- the biggest private hospital in the nation, with 580 beds -- said its emergency attendances had risen 10 per cent in 2004-05 on the previous year. They rose a further 8 per cent in 2005-06, and a further 5 per cent in 2006-07. The spokeswoman said the latest increase would have been even higher had the figure not been artificially lowered by a change in the contracting arrangements for military veterans, which meant fewer received free treatment at the hospital.

A spokeswoman for Melbourne's 530-bed Epworth Hospital said it was "certainly seeing more patients", and that annual numbers had jumped from about 22,000 in 2002 to about 29,000 this year. And patient numbers at the emergency departments of the John Flynn Private Hospital on the Queensland Gold Coast and the Hobart Private Hospital have risen by about 10 per cent in the past three years. Numbers at Perth's St John of God, Murdoch Hospital have risen by more than 20 per cent, from 20,540 in 2004-05 to 24,898 in 2006-07, although numbers at its sister hospital in Ballarat, Victoris, have climbed only slightly.

Leon Clark, chief executive of the 452-bed Sydney Adventist Hospital on Sydney's upper north shore, said although numbers of emergency patients had remained stable over the past three years at about 20,000 patients annually, the doctors were much busier because patients coming in had more complex care needs. "Our staff are much busier than they were three years ago because of the increased complexity," Dr Clark said.

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19 August, 2007

Elderly people suffering abuse and neglect in British residential care homes

Elderly people are suffering from abuse, neglect and malnutrition in hospitals and care homes, according to a report by peers and MPs. The report, published today by the Joint Committee on Human Rights, calls for changes in the law to safeguard the care of older people, and for a "complete change of culture" in health and care services.

More than a fifth of care homes have been found to be failing basic standards for privacy and dignity, with the most vulnerable residents struggling to eat without proper help, being subjected to verbal and physical abuse or being left to lie in their urine or excrement.

Two thirds of NHS hospital beds are occupied by the over65s, while the number of older people in the population is growing such that, by 2050, there will be twice as many Britons aged over 80 as there are today. Although the committee was told that some patients received excellent care, it said "there are serious concerns about poor treatment, neglect, abuse, discrimination and ill-considered discharge".

It also found evidence of "historic and embedded ageism" within healthcare services, causing a failure to "respect and protect the human rights of older people". The report includes the example of an 80-year-old woman who was sexually assaulted by a fellow resident in a care home in 2004: "It was recorded in a log book but no action taken . . . It was only reported to the resident's daughter in July 2005. She reported the matter to the police."

Another woman, who had difficulty feeding herself, "appeared to be slowly starving to death" because visitors who could have helped her were discouraged from staying during meal times. In other cases, bed sores were not treated because staff said "it was not their job". The charity Age Concern estimates that 500,000 older people are subject to abuse at any one time, mostly in healthcare settings.

The committee's report adds: "In our view, elder abuse is a serious and severe human rights abuse which is perpetrated on vulnerable older people who often depend on their abusers to provide them with care. Not only is it a betrayal of trust, it would also, in certain circumstances, amount to a criminal offence."

It also cites problems with malnutrition, dehydration and the abuse of medication as a means of controlling older patients. The Alzheimer's Society said that up to 40 per cent of patients with dementia were being prescribed powerful sedative drugs, despite the risks to their health. Other examples of neglect included a lack of hygiene in some hospitals that encouraged potentially deadly infections such as Clostridium difficile.

Some 21 per cent of care homes failed to reach minimum standards for privacy and dignity last year, the Commission for Social Care Inspection told the committee. Problems included the use of mixed-sex wards and, a lack of confidentiality in discussing medical problems. Despite this, the committee was "alarmed" that the Government's planned new healthcare inspectorate would not be given powers to investigate individual complaints from patients or their families.

It criticised the Department of Health and Ministry of Justice for failing to "provide proper leadership" and guidance on the Act to providers of health and residential care. Local authorities are increasingly referring elderly patients to homes run by the private and voluntary sector, which are exempt from the Human Rights Act. The committee calls for care standards regulations to be amended so that all care homes are brought under the terms of the Act.

Ivan Lewis, the Minister for Care Services, said: "We recognise this anomaly and will continue to work closely with the Ministry of Justice and all other interested parties to ensure that people cared for by the NHS and councils have the protection of the Act." Kate Jopling, head of public affairs at Help the Aged, said: "The shocking examples highlighted by this report provide all the evidence this Government needs to justify urgent action."

Source




Paramedics being used instead of doctors in New South Wales (Australia)

Another government health system downgrading its services because it cannot provide enough doctors and hospital beds

AMBULANCE officers will be trained to treat non-critical patients and take them to GPs or non-hospital services under a controversial plan. The shake-up of health care roles, kept secret by the NSW Health Department, is aimed at easing the workload of hospital emergency departments. It is part of a growing trend to generalise health care, as seen in the creation of practitioner nurses, community health and hospital-in-home teams.

A draft Ambulance Service of NSW document, obtained by the Herald, said ambulance officers could "safely assess and manage certain conditions in the home without the need to convey patients to hospital for care". Like regular ambulance officers, extended-care paramedics would respond to emergency calls and treat critical patients. However, they would also be required to administer simple drugs such as antibiotics and arrange x-rays and other diagnostic tests as well as make direct patient referrals to GPs and community nurses. "It is becoming increasingly recognised that the emergency department may not necessarily be the most appropriate . destination for the patient to have their health care needs met. However, [it] is often the only current option provided," the draft said.

But emergency experts say the plan is a stop-gap measure in a failing health system, while GPs are concerned the plan may add more pressure to practices.

Extended-care paramedics will be chosen from the ranks of the NSW Ambulance Service and undergo eight weeks of training. Program trials are due to start next month and will involve 12 ambulance officers from western Sydney, where attendance at emergency departments rose more than 9 per cent last year. About 20 per cent of NSW emergency calls attended by ambulances do not result in the patient being taken to hospital, according to the draft proof of the concept document.

Modern ambulance services were facing challenges which included an ageing population, the rise of chronic disease, unpredictable delays at hospital emergency departments and increased demand due to the reduced availability of after-hours GPs, the draft document said. Dr Tony Joseph, chairman of the NSW faculty of the Australasian College for Emergency Medicine, said the new system could put pressure on paramedics to keep patients at home or refer them to non-acute care instead taking them to hospital. "If you delay someone going to hospital who needs to go, when they do eventually get admitted . they are often sicker, they stay longer in hospital and there will be increased cost to the community," Dr Joseph said. "If we are going to do it right, do it the first time."

Dr Joseph said the program appeared to be another "stop-gap measure for a failing health system". The chief executive of the Nepean Division of General Practice, Michael Edwards, said the plan would "extend an already over-extended workload" for GPs.

Source





18 August, 2007

Canadian woman has to come the the USA to give birth to quads

A 35-year-old Canadian woman has given birth to rare identical quadruplets, officials at a Great Falls hospital said Thursday. Karen Jepp of Calgary, Alberta, delivered Autumn, Brooke, Calissa and Dahlia by Caesarian section Sunday afternoon at Benefis Healthcare, said Amy Astin, the hospital's director of community and government relations. The four girls were breathing without ventilators and listed in good condition Thursday, she said. ''These babies are doing grand,'' said Dr. Tom Key of Great Falls, the perinatologist who delivered the girls. The babies were born about two months early and were conceived without fertility drugs, he said. They weighed between 2.6 pounds and 2.15 pounds.

Jepp and her husband, J.P., declined to be interviewed by The Associated Press. ''The parents have been a little bit shy about the press. ... We agreed to handle it in a way they were comfortable with,'' Astin said. The couple have a 2-year-old son, Simon. J.P. Jepp works for Shell Oil Co., and both worked for nonprofit groups until recently, Astin said.

The chances of giving birth to identical quadruplets is about one in 13 million, Key said. ''This is a very big medical event,'' he said. ''Identical quadruplets are extremely rare.'' Medical literature indicates there are less than 50 sets of identical quadruplets, said Dr. Jamie Grifo, director of the NYU Fertility Center in New York. The last reported set were born in April 2006 to a 26-year-old Indian woman.

The Jepps drove 325 miles to Great Falls for the births because hospitals in Calgary were at capacity, Key said. ''The difficulty is that Calgary continues to grow at such a rapid rate. ... The population has increased a lot faster than the number of hospital beds,'' he said.

Two of the girls were to be transferred to a Calgary hospital later Thursday. The other two could be moved Friday if their conditions remain favorable, Key said. They will likely remain hospitalized for four to six weeks, he said. ''These quads are special,'' Astin said. ''The fact that she carried them 31 weeks and three days is excellent.''

Source

Don Surber comments:

The Dionne quintuplets were born on May 28, 1934, to a humble, French-speaking couple in a farmhouse outside of Callander, Ontario, Canada. They were identical sisters and for the first 10 years of their lives, the five girls were the No. 1 tourism attraction in Canada. Then came free health care for all Canadians. Which is why the four identical Jepp sisters were born in Great Falls, Mont., instead of Calgary this weekend. The Canadian parents flew 325 miles to get to an American hospital.

Can you imagine being about to go into labor for four births, and then flying 325 miles to get to the hospital in another country? Incredible. Michelle Lang, Calgary Herald, reported:

Their mother, Calgarian Karen Jepp, was transferred to Benefis Hospital in Montana last week when she began showing signs of going into labour, and no Canadian hospital had enough neonatal intensive-care beds for all four babies.

73 years ago, a poor French Canadian mother was successfully able to give birth to five girls in a farmhouse in Ontario, but then the Canadian government took over the health system and - voila - Karen Jepp has to go to an American hospital 325 miles away.

It's not like Great Falls, Mont., is a teeming metropolis. With 56,215 people, it is slightly larger than Charleston, W.Va. Calgary has more than a million people. This is like being demoted from the Milwaukee Brewers to the Charleston Alley Cats. (OK, they changed the team's name to West Virginia Power.)

There is a difference between health care and health insurance. In capitalistic America, the concentration is on health. In socialistic Canada, the emphasis is on paying the bills. The story ended with how much the American hospital charged. Looks like a quarter-million bucks for a 5-day stay. Given that it was the quadruple birth of 2-pound babies two months premature, I'd say it was a bargain.

This is not to piss all over Canada. Nice nation. Great people. I'm sure most Canadians like their health system. Just remember, though, that Canada's backup system is in Montana. Americans spend 15% of their income on health care. That's why Great Falls has enough neo-natal units to handle quadruple births - and a "universal health" nation doesn't. After all, they didn't fly Mrs. Jepp to Cuba, did they?





17 August, 2007

Health insurance blues: Give choice a chance

The nation’s largest health insurer, UnitedHealth Group, wants to buy up Sierra Health Services in Nevada. The merger would give the new company a virtual monopoly over health insurance in the Silver State, reducing competition, which usually means increasing costs. Supporters, however, say the merger will actually reduce costs and improve service due to the efficiencies of scale the giant conglomerate will enjoy. Hmm. That doesn’t exactly seem to be the case when it comes to the publik skools now, does it?

Nevertheless, being a free-market kinda guy I haven’t yet heard any compelling reason for the government to block this merger of two private companies. And the fact that the self-serving Culinary Union is now in open opposition to the takeover tends to weather-vane me in the opposite direction.

No, the answer to legitimate concerns about giving UnitedHealth a virtual monopoly over the health insurance market in Nevada isn’t to block the takeover of Sierra Health Services, but to open Nevada’s market to interstate competition. In this age of Amazon and eBay, it makes no sense whatsoever that Nevadans are prohibited from buying health insurance from a company located in another state.

And yet, thanks to an anachronistic law passed in 1945, the McCarran-Ferguson Act, combined with the lobbying power of Big Insurance, there is no competitive interstate insurance market similar to the highly competitive interstate banking market. For example, Nevadans can deal with a relatively small local bank or choose to deal with a big interstate bank such as Bank of America or Wells Fargo. Both entities thrive in Nevada and consumers, armed with market choice, benefit greatly.

Not so when it comes to health insurance companies. Why not? Because state legislators want to retain the ability to force insurance companies to foot the bill and cover expensive benefits which they don’t have the guts to sock directly to taxpayers. These are called “mandates” - as in, the legislature makes it mandatory that the insurance company cover them or the insurance company doesn’t get to operate in Nevada. Yes, legal extortion.

Around the country, many states force insurance companies to cover benefits ranging from acupuncture to marriage counseling; from contraceptives to hearing aids to hairpieces; from podiatry to osteopathy; from chiropractors to even massage therapy. All in all, there are over 1,800 such mandates found across the country. And these mandates jack up the cost of insurance, creating a huge difference in premium costs between some states. For example, a recent e-HealthInsurance.com study showed that a healthy 25-year-old male could pick up a basic health insurance policy in Kentucky for $960 a year. That same policy in New Jersey, however, would set the lad back a staggering $5,880 a year.

And the Wall Street Journal noted that the same study “found that a typical insurance policy - $2,000 deductible, 20% co-insurance – for a family of four could be had for as little as $172 per month in a reasonably regulated locality like Kansas City, Missouri. But in New York that family’s only option – managed care – would run $840 per month, and in New Jersey family policies run a whopping $1,200-plus.” Why shouldn’t a family in New York be able to purchase that far less expensive policy from the Missouri company?

If you want to shrink the ranks of the uninsured, perhaps it’s time to open the market and reduce the cost so that average people can afford basic coverage without all the government mandated frills. Instead of blocking the mergers of health insurance companies in one state, perhaps it’s time to open up the competition among all 50 states?

Rep. John Shadegg, Arizona Republican, has proposed just such legislation in Congress; however, Congress in the hands of pro-union/anti-free market Democrats and is unlikely to act favorably on such a common-sense, cost-free solution to the health care insurance problem. Which is why state legislatures should take the lead and open up their own markets without waiting for the feds. Let’s give choice a chance.

Source




Filthy NHS kitchens

Nearly half of all hospital kitchens and canteens in England could be failing to meet basic standards of cleanliness and hygiene, according to official inspection reports. Cockroaches, medical waste on food-handling equipment, mouse droppings and poor hygiene among catering staff were all cited as problems.

The findings were revealed after a freedom of information request for health inspection reports from a quarter of all local authorities.Of the 377 hospitals included, 173 displayed poor cleanliness and 68 fell below the legal requirements for food storage. A total of 107 did not have correct food safety documentation, 66 stored food at incorrect temperatures, 25 had inadequate staff training and 57 had staff with poor personal hygiene.

Norman Lamb, the Liberal Democrats' Shadow Health Secretary, who collected the findings, said that they painted a shocking picture. "It is simply unacceptable that such terrible practices are taking place in an environment where hygiene and safety should be paramount," he said."The worst performers should be named and shamed - while those doing well would stand as an example to drive up standards."

In six hospitals, inspections high-lighted five or more areas of concern. The institutions were: Farnham Road Hospital in Guildford; Churchill Hospital in Oxford; Blackpool Victoria Hospital; Derby City General Hospital; Ipswich Hospital and Norfolk and Norwich University Hospital in Norwich. At the William Harvey Hospital in Ashford, "full-grown adult" cockroaches were found in kitchens according to the 2006 report. The 2007 report stated that there had been "regular reports of an infestation of oriental cockroaches in the kitchen". At the Countess of Chester Hospital in Chester, milk was found stored in the drug freezer in the radiology department and inspectors found a syringe on a supper tray at the May-day University Hospital in Croydon.

An official from the Department of Health said: "Failure to meet hygiene standards is unacceptable and where there are problems we expect the local authorities responsible for inspecting and enforcing food hygiene regulations to take action." The trust that runs Derby City General defended its hygiene regime, suggesting the report may have been based on out-of-date results. Julie Acred, chief executive, said: "Based on the report we have had most recently we don't have any significant cleanliness issues in the hospital."

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16 August, 2007

The universal distraction

By Arnold Kling

"Nobody is talking about a free-market approach in health care. The spectrum today is between fascism and Communism."
--John Graham

The Pacific Research Institute's John Graham offered this glum assessment during a brief chat recently when he came to Washington, DC for a meeting. He points out that the focus of health care policy is on how to get to "universal coverage." In this context, the conservative approach involves mandatory health insurance. The liberal approach involves expanding government coverage. Hence, it is either fascism or Communism.

The main proponents of "universal coverage" want to throw more money at the current health care system, which strikes me as unwise. I believe that the "universal coverage" mantra is dysfunctional for the same reason that "more money for public schools" is a dysfunctional mantra for education. When your current approach is digging you into a hole, the sensible thing to do is not to dig faster. It is to stop digging.

Later in this essay, I will offer my thoughts about the uninsured. First, I want to present free-market approaches to reform our health care system. I mention the assumptions that I make in offering these proposals.

Raising the Age of Eligibility for Medicare

I propose that, for people under the age of 50 today, the age at which they will become eligibile for Medicare will be raised to, say 72, rather than 65. Note that this is the opposite of what some liberals propose, which is "Medicare for all." I want to see fewer people on Medicare, not more. My assumptions are:

1. Medicare is the fiscal equivalent of the Titanic. An Issue Brief issued by the American Academy of Actuaries offers a typically dire analysis of the outlook. The iceberg to which Medicare is headed is trillions of dollars of unfunded liabilities. Before it runs into the iceberg, it makes more sense to take people off the Titanic than to put additional people on board.

2. As the actuaries and other sober observers point out, the sooner that Medicare is put on a sustainable path, the better. There are cuts in Medicare benefits looming for Americans under the age of 50 today. But no one knows what form those cuts will take, or how they will affect particular individuals. Changing the age of eligibility would take away the uncertainty, enabling people to plan for the future.

3. Medicare's unsoundness is the most important problem in health care policy today. Focusing on other health care issues, including the uninsured, amounts to fiddling while Rome burns.

Health Insurance Tax Neutrality

I would like to see the abolition of the tax break for company-provided health benefits as well as the tax break for Medical Savings Accounts. Company-provided health benefits ought to be included with personal income and taxed at the personal income rate. There should be no special benefits for savings accounts labeled "medical." (I think that all saving ought to be tax-free, but that's another topic.)

I assume that people would be better off with real insurance, rather than insulation. Real insurance would mean low premiums, high deductibles, and rare claims. Insulation means high premiums, low deductibles, and frequent claims. See this essay or the relevant chapter in Crisis of Abundance.

Although I prefer real health insurance to insulation, I do not want to impose my preferences on others. All I ask is that we reform our tax code so that it is neutral. Today, our tax code sends contradictory messages. It steers some people toward real health insurance, but it steers most people toward insulation. On the one hand, for employees of large companies, the tax code recommends insulation. Company-provided health benefits are tax free, so that the more compensation that you receive in the form of health care services, the lower your tax bill.

On the other hand, for the self-employed or for employees of small businesses that do not provide health insurance, our tax code encourages real health insurance. Medical Savings Accounts, which allow individuals to obtain medical services in a tax-advantaged way, are tied to health insurance plans with high deductibles, where the consumer pays out of pocket for the first few thousand dollars of medical expenses.

I assume that using the tax code to influence health insurance choices is bad social policy. Tax breaks always benefit high earners more than low earners, and the tax breaks that people get for company-provided health benefits or individual Medical Savings Accounts are no exception. Moreover, it is absurd that the tax code encourages one form of insurance for employees of large firms and the exact opposite form of insurance for everyone else. I assume that with a neutral tax system, more people would join the individual health insurance market rather than use employer-provided insurance, and this would lead to better choices than exist today in the individual market. I also assume that tax neutrality would lead more people to shift away from insulation and toward real health insurance.

I assume that with a tax neutral system, employer-based health insurance would unravel. Rather, it would unravel even more quickly than it is unraveling today. But even union leader Andy Stern believes that employer-provided health insurance is not a tenable system for the modern age.

Alternative Licensing

There is an artificial scarcity of service providers in health care, due to the need to obtain licenses to practice medicine, provide physical therapy, and so on. Licensing rules, while enacted in the name of protecting the consumer, typically serve the interests of providers, who enjoy membership in a cartel propped up by the government.

We certainly need some medical professionals who go through rigorous classroom training. We need some doctors who know biochemistry and who can keep up with the latest journal articles. However, not all doctors need to have this knowledge base. I believe that we could have a lot of competent professionals in medicine, from physical therapists to surgeons, who learn their trade as apprentices rather than in classrooms. Doctors and others who obtain degrees under the current system ought to retain their status to display their unique credentials. But providers with apprentice-based training should have the right to offer services to consumers, with full disclosure to consumers.

I assume that allowing for alternative licensing would eventually remove some of the bottlenecks and reduce costs in health care. It would allow for re-engineering of the health care system. Clay Christensen, a best-selling business author, sees the potential for what he calls "disruptive innovation" to lower the cost of health care, provide that licensing restrictions can be overcome. Christensen says

"When you bring technology to the experts to do more sophisticated things, in fact, it does bring a lot of cost into the system. But when you deploy the technology to commoditize the caregiver, to enable a lower-cost provider to do something that historically had required higher cost, then it actually takes cost out of the system."

Cost-Effectiveness

An old business lament is, "I know that half of my advertising budget is wasted. I just don't know which half." A similar lament applies to health care. Many studies show large cumulative improvements in the health of the U.S. population, but almost every careful comparison of similar groups of people receiving different levels of services shows no benefit to the higher-spending population. We appear to be making extravagant use of medical services with high costs and low benefits.

I was at a dinner a few weeks ago at which a man firmly asserted that health care should not be considered a commodity. It should be considered a "right." That sounded convincing, and many people at the dinner nodded their heads. But many, perhaps most, of the medical services that we obtain nowadays are not so clearcut. In Michael Moore's Sicko, one of the cases was a man whose kidney cancer was past the point where conventional treatments would work, and doctors offered a bone marrow transplant, an expensive treatment with no track record of success. Should expensive, desperation therapies be a "right"? If so, then the already-high share of medical spending that takes place in the last year of life is going to rise further.

Does a patient have a "right" to an angioplasty, when the evidence suggests that treatment with drugs may be just as effective? Does someone who hurt his back have a "right" to an MRI that probably will not affect the treatment plan? Does someone aged 50 with no symptoms have a "right" to obtain a colonoscopy to screen for colon cancer, and, if so, why do so few people in the industrial world exercise this right?

The reality is that many medical services have low value. And with health care now accounting for more than 15 percent of our economy, the cost of these low-value services can no longer be ignored. Accordingly, there are several health care policy pundits, myself included, who recommend that a commission be chartered to evaluate the costs and benefits of various medical protocols. I assume that such a commission could produce studies that would lead to greater use of cost-effective treatments and reduced use of treatments with high costs and low benefits. I assume that such a commission could maintain a consumer orientation, rather than be captured by interest groups representing providers.

The Uninsured

By drawing attention away from these more pressing problems, the "universal coverage" mantra has greatly distorted the health care debate. In response, my Cato friend Michael Cannon has formed a "club" of health policy analysts opposed to universal coverage. Although I agree with his sentiments, I think that the longer that the issue of the uninsured goes unaddressed, the more it will dominate the policy agenda. I would be willing to see one of the "universal coverage" proposals enacted, if doing so would enable us to move on and face up to the larger issues, such as Medicare's fiscal problems and the cost-effectiveness of medical protocols.

However, if I could pick any policy approach I wanted for dealing with the uninsured, I would try to move toward universal availability of health insurance, not universal coverage. I would encourage states to offer health insurance to the uninsurable. That is, there are people with pre-existing conditions that lead them to be turned down by ordinary health insurance companies. Many states address this problem by setting up "high-risk pools" that provide subsidized coverage for the uninsurable. That seems to me to be a sensible approach.

On the other hand, most of the people who are uninsured today are reasonably healthy. They just do not want to pay for their own health insurance. In my view, they ought to be allowed to make that choice, but they should face the consequences. If they require health care, the cost should not be shifted onto other people who have insurance.

Just because health care is expensive does not mean that we need insurance to pay for it. You can get a loan to pay for a car. You can get a loan to pay for college tuition. If you don't want health insurance but you need health care, then you may need to take out a loan.

My objection to "universal coverage" is that it reinforces our cultural taboo against individuals paying for medical services. This cultural taboo about paying for medicine is what led me to draw a parallel between health insurance and prostitution insurance. If medical service providers, particularly hospitals, could become less paranoid about dealing with the uninsured, then I would consider doing without insurance myself.

Politics and Economics

"Universal coverage" is a popular solution in health care. Too bad it does not address the important problems. Even economists on the liberal side of the spectrum recognize that broader reforms are needed. See Jason Furman or Brad DeLong. In politics, the victim status of the uninsured is overstated. Meanwhile, the health policy debate is ignoring some important victims:

--The future victims of the financial unsoundness of Medicare

--the victims of the licensing cartel, which lowers productivity and raises costs

--the victims of the wasteful medical expenditures promoted by consumer insulation from cost, which in turn is promoted by incentives embedded in the tax system

Economists see these victims. Politically, they are invisible. That is why free-market health care reforms are so difficult to sell.

Source





15 August, 2007

Sick, Sicker, and Sicko

Some patients just aren’t willing to sit back and take it anymore. The nation’s health system is long on promises and short on delivery. The litany of delays in care due to limited access grows by the day. In one instance, a patient sued her insurer because she was forced to wait four months for an MRI for her brain tumor and then months more to see a neurologist. In one metropolitan area, waiting times in the ER average four hours, while one in ten waits more than 12 hours.

One in three households surveyed tried and failed to gain timely access to at least one health service within the previous three months. And in one study, the total waiting time between referral from a general practitioner and specialty care averaged nearly 18 weeks. Even the Supreme Court has weighed in on the unacceptable delays in care. But the lawsuit is not against a dreaded American HMO and the events did not happen in the U.S. All were byproducts of the Canadian health care system.

In the movie Sicko by Michael Moore, several socialized health systems are held out as exemplars for the U.S., including those in Canada, Great Britain, France, and Cuba. The American health care system is a complete shambles, the sickest of the lot, according to Mr. Moore. Escalating numbers of uninsured, disproportionate access to health services, long ER waiting times, rapidly growing insurance premiums, denials of insurance coverage, high infant mortality rates, and profiteering by the greedy pharmaceutical companies fuel growing public dissatisfaction. U.S health care just doesn’t measure up when you look at all the money being spent according to Moore.

What you do not see in Mr. Moore’s movie are the inconveniences experienced by patients in those model socialized systems. In 2005, Canada’s Supreme Court ruled that, “access to wait lists is not access to health care,” which struck down key laws in Quebec that have prohibited private medical practice and private health insurance. Suits have been filed to enable Canadian citizens to “opt out” of the mandatory, government-run Canadian system, which some citizens even consider dangerous.

How dangerous? A cardiologist at the University of Ottawa reported on how delays affected Ontario heart patients. In a single year, 71 Ontario heart patients died before they were able to have surgery and 121 were removed from the surgery list permanently because they had become too ill to operate on. So for 192 people, the wait either led to their death or they became too sick to have surgery before they could work their way to the front of the line. Another 44 who could afford to bear the cost on their own left the province to have surgery – most in the U.S.

Since the mid-1980s a Vancouver-based think tank has been tracking how long patients are required to wait for medical care in Canada where by law many private alternatives have been banned. In its 16th annual report published in 2006, the Fraser Institute notes that the average time to receive treatment after referral from a general practitioner was 17.8 weeks. Patients waiting to see a neurosurgeon waited an average of 21 weeks, while actually getting treatment required another 11 weeks. The wait for an orthopedic surgeon averaged 16 weeks, and treatment required another 24 weeks. Total wait times are now 91 percent longer than they were in 1993.

Sicko holds the Canadian system out as a model for proponents of universal coverage where health care costs are lower and everyone has free care at the point of service. "While many proclaim Canada's Medicare program to be one of the best in the world, or suggest it should be the model for reform in the United States," says one of the Fraser Institute’s study authors, "the reality is that health spending in Canada outpaces that in most other developed nations that, like Canada, guarantee access to care regardless of ability to pay, and yet access to health care in this country lags that available in most of these other nations."

Because health care is largely free in Canada, demand is likely to exceed supply. It’s just human nature. Thus, waiting lists become the principal way of rationing medical care and holding down spending. And after 16 years of tracking growing waiting lists, the Fraser Institute observes that the problem is probably not a temporary one that can be fixed with a little more money or time. They note that provinces with higher spending per capita do not experience shorter wait times.

Just as we saw in the old Soviet system with its long lines for food and basic services, government central planning does not efficiently match supply with demand. And human beings will always seek more of something that is free. As one free market advocate states, "Long waits and widespread denial of needed care are a permanent and necessary part of government-run systems.”

And it’s not the care-givers who are at issue. Canadian physicians and nurses are among the best in the world. To paraphrase, “It’s the system, stupid.” That is, a mandatory system of care to which there are few alternatives. The rationale that no one is denied care when everything is free ignores the fact that everyone waits, and a considerable number even die in the process.

What about other socialized systems? Surely others have gotten it right and can serve as a model for America. In France, the health system failed spectacularly during the summer heat wave of 2003 when 13,000 people died, mostly from dehydration. Hospitals simply stopped answering the phones and ambulance services told citizens they were on their own.

Things are not much rosier in England which launched its National Health Service (NHS) in 1948. At that time, the government nationalized more than 3000 independent hospitals, clinics, and care homes. The government promised that it would provide its citizens with all the “medical, dental, and nursing care” needed so that “everyone – rich or poor – could use it.” It didn’t quite work out that way.

Source





14 August, 2007

Another NHS experience

Life was going rather well for Smith in November 2001. True, he'd recently been made redundant from his job at Carlton television, where he was in charge of developing new sitcoms. On the bright side, though, there was interest from the BBC in a medical comedy he was writing and, best of all, his wife was expecting their first child together.

The only thing that was bothering him, in fact, was an unusual numbness down his left side. It was the first sign of the neurological illness that would leave him in hospital for five months. During that time he contracted MRSA; he had a tube inserted into his stomach because he couldn't swallow; he stopped breathing and had a tracheotomy; he suffered a morphine overdose, and the steroids he was given to stop his brain swelling caused such bad hallucinations that he once thought he was appearing with Les Dennis in Celebrity Squares. "Every time I thought `it can't get any worse' it did," he says. Five years later he still feels pain on his left side. But he has managed to write a blackly humorous book about his ordeal, along with Vent, and is working on an ITV sitcom with Ade Edmondson.

Most people emerge from life-threatening illnesses full of platitudes about "marvellous" doctors and nurses. What is remarkable about Smith's book is its warts and all style. He certainly gives grateful credit where it is due, but he also describes pen-pushing indifference, incompetence, and some members of the caring professions who were deliberately unpleasant.

Here he is on nurses. "No one who has spent any length of time in hospital has any illusions about angelic nurses," he writes. "Some are good, some incompetent, a few cruel, a handful brilliant, but almost all are competent but indifferent. And know what? Whisper it, but their pay is good. Better than mine. Overtime is lucrative, private work more so. They're doing less and less hands-on work and wouldn't pick up a J Cloth if their lives depended on it."

And if the tone is a blackly comic romp when it describes Smith's time in Charing Cross hospital, it gets much darker and angrier when he is discharged into the care of the Wolfson rehabilitation centre in southwest London. "Living as a disabled person when you've been healthy is a very difficult adjustment to make," he says. "Fighting for your life is kind of easy. The people I really take my hat off to are people struggling with long-term disability because they just go through battles all the time.

"If you think it's tough inside hospital, well, it's tougher outside because that's when the care really stops. You just get forgotten about. "You pester, and they hope you go away. Well, I just don't go away. I'm a writer: I'm used to rejection. If anybody thinks I'm just going to bugger off, they are sadly mistaken."

When he first came home, he needed help to wash. Now he has a carer who comes to his house in Hastings, East Sussex, to help with the household chores he can't manage, ensuring he and his wife, Michele, a theatrical agent, can still work.....

His hard-won relative good health comes and goes. "I was almost hospitalised last week with a bad bout of pneumonia but I refused to go to hospital. I don't like it. My veins are like Keith Richards's after a bad night out, so unless you're an expert at finding a vein in my body you won't find one. What I'll get in hospital is a junior doctor going bodge, bodge - and I'll get MRSA again."

More here

More detail on the case above:

Wednesday, November 14, 2001. So I'm in the surgery talking to this locum GP, an urbane old duffer who looks like Colonel Sanders. I tell him why I'm here; I have this numbness thing going on. Left side of tongue is numb, ring and fourth finger of left hand, left half of left foot, oh yeah, and left side of my face is heading that way too. I'm turning into Igor.

"Ramsay Hunt syndrome, old boy," he chuckles, like I'm his naughty nephew with a grazed knee. He does everything but ruffle my hair as he ushers me out. He's busy, he's got 4,000 chickens to batter and stuff into stripy buckets. "Couple of days and it'll sort itself out." He was right about that. Two days later and I certainly wouldn't have been back for a second consultation with anyone but God. For whom I'd have a few questions.....

THURSDAY: I get up. I fall over. Not a good start to a Thursday, I think, as I proceed to chuck up. The wife would be quite justified in telling me off for not listening to her as she bundles me into the car, but she's being nice. Now I'm worried. As we stop again for me to stagger about and throw up in the gutter, she's passing up a gilt-edged opportunity to say she told me so. I put my now insane dizziness and sickness down to my not having had any breakfast and her driving, which is, I perceive, quite fast.

We pull up outside a private doctor's in South Kensington. He took half a look, did a brief touch-your-nose-with-your-finger-no-that's-your-eye-try-again-ow-now-that's-my-eye, and pointed us in the direction of the Cromwell hospital. Go straight to the MRI scanner, do not pass go, do not collect œ200 (in fact, hand over a couple of thousand).

Magnetic resonance imaging enables neurologists to see parts of your brain that were previously only available to them postmortem, sliced on a Petri dish. Probably with some fava beans and a nice chianti. But if it's so damn smart, why is it so bloody noisy in there? It's like shoving your head in the bass bin as a death metal band warms up.

But there it was. Deep in my medulla, the signal junction of my brain, the top end of the spinal cord, the vital link between the thought and the action, the area that controls everything from temperature to erections, from heartbeat to breathing, from eyes to feet, in there, was something. And something wrong. What it was was another question, and one unanswerable from this type of scan, but what it was doing was clear.

It was killing me. Here's something I only learnt later. When the radiologist was handed the scan, he asked, "Righto, where's the body?" He was quickly shushed as I was sitting about 10ft away. Shame I missed that cos I could have done with a laugh. The verdict came quickly - unlike paying off the bill for the scan, which I only did about a month ago . . .

The lovely old boy who delivered the news was one of those proper old-fashioned consultants with a bow tie, Rumpole nose, a bootful of golf clubs and a basement chocka with Montrachet. He was adamant about three things: that I needed to go into hospital yesterday, that the thing - now given the scientific name of "lesion" - in my brain wasn't a tumour, and that we were, however, in for "a rocky ride"....

I'm seen by a variety of polite junior doctors who really don't want to get involved with this at such a delicate stage in their career and dash off to find some real doctors. Who do the same thing until eventually someone senior enough not to give a monkey's takes the decision to begin treatment. Because there's no diagnosis apart from "holy s***, he's going to die", they decide to give me everything. In drips. A tip: the only people you should let near you with a needle are the overworked middle-aged West Indian nurses with six kids, or the anaesthetists. Everyone else needs at least five botched attempts.

I don't know this yet. I get the junior doctors with their Cambridge accents and trembling hands and eventually up go the drips. They block 10 minutes later. Then along comes another chinless doctor with a saline syringe to shove in until the veins in my hand start to desiccate. After several goes and some polite shouting by Michele I finally get an overworked middle-aged West Indian nurse with six kids who does it properly.

There is a moment at 8pm called "the handover" when nurses smoothly change shifts. In reality it results in complete inertia from about 6.30 to 9.30. Some time towards the end of this limbo I was shifted to a ward. A bed was free at the end of the room because it was next to a broken radiator. Broken in an impressively extreme way - blowing out freezing air at about 30 knots. Straight on to my left side, which was freezing up of its own accord, thank you very much.

Michele called a nurse. Who already knew about the problem. The radiator was broken, she informed us, and stood there for a bit sympathising. It had been like that for days. Terrible, isn't it? Unfortunately she was not authorised to call the engineers. Michele got another nurse. Same thing. Michele got the staff nurse. She also agreed it was broken and agreed it was terrible. She was not allowed to call the engineers. Michele demanded to see the night administrator. He would be allowed to call the engineers. She knew there was a night (or duty) administrator because she used to work in the health service. There are certain code words you have to know in the NHS. This is one of them. It was a good card to play and it threw the trio into action.

By now my core temperature was close to that of a frozen fish finger stuck to the back of the freezer. Finally, up minced the deputy night administrator, a man so limp I thought he'd donated his spinal column premortem. He was in a nice suit, which was a worry. In the NHS, the nicer the clothes the less the work. He also agreed the radiator was a problem, but in a more chippy and less appeasing tone. The engineers had gone home. Michele's blue touchpaper, which had been nicely fizzing, expired. Ozzy Osbourne would have blushed. And so . . . the duty engineer appeared, as if by magic. He took the top of the radiator off, turned a knob from "blow out freezing air" to "off", and put the cover on. It took under a minute. "Why didn't anyone call me before?" he asked, puzzled.

FRIDAY: My left side is failing. My left hand is turning into the Claw. I'm being switched off, room by room, like a man turning the lights off in his house as he prepares to leave. Why me? As I'm wheeled about I see people, old people in gowns chatting away, looking much better than me. Why are they here? Why are they trying to get better, the old f******? They've had a life. I'm 36.....

Back to the ward and they think it's all over. No, it's time for a lumbar puncture. Two words that go together like "root" and "canal". A lumbar puncture draws off fluid from your spinal cord. The only way to get at this very necessarily protected, fragile area is to shove a needle in between two vertebrae in your lower back - the lumbar region. It's worse than it sounds. I had been dreading this ever since my uncle Bryan, a bear-like 6ft copper, told me of his, years ago when he had meningitis. He went white just talking about it. He said even now, when he sits funny, he can still feel it.....

SATURDAY: Today the flowers start coming in. From my work-mates. How ill must I be? I'm only being told I've got flowers, because I've just been moved to a "high dependency ward" and I'm not allowed flowers. They might compromise my immune system. This is getting silly. How knackered is my immune system if a couple of begonias could see me off?

The high dependency unit was designed by a Ba'ath party inquisitor. To make sure I haven't died and messed up their statistical averages, two Filipino nurses come round every two hours, day and night, to take blood pressure, Sats (oxygen levels) and temperature readings. But they also make me hold their hands, squeeze, and answer the same damn questions. "What is your name?" "Where are you?" "Who is the prime minister?" About 2am I've had enough. My name is Tony Blair, I am being held prisoner by the security services and the prime minister is an impostor from the planet Arse. They start observing me every hour after that.

SUNDAY: Weekends in hospital are scary times. No one important is about. Other people's visitors arrive and some take an interest in me. I'm the youngest in the ward by about 12 decades. Suddenly I'm a kid with a grazed knee again, being clucked over by a bunch of grannies just itching to spit on their hankies and rub my face.

MONDAY: So the bastards only go and tell me. A demyelinating lesion of the brain stem. Of unknown origin. Probably viral. Which sounds impressive but is really modern medicine's version of "evil spirits"; they don't know where they come from, how they work, or how to get rid of them... So that is the first problem. The second is the positioning of this patch of demyelin, the thing they call a lesion. It is in the brain stem, or medulla. The medulla is the grapefruit-sized ball of nerves hanging below the brain proper. It is the signal box linking the brain to the central nervous system.

Tests have eliminated bacterial infections, which can sometimes cause these symptoms, so my best hope of survival is that it is a virus. Treatment, I am told, is simply to tackle the symptoms and hope the virus will go away.

More here





13 August, 2007

Some Brits need to win the lottery to get their knees fixed

Being in pain doesn't count, of course. The NHS was supposed to eliminate the gap between rich and poor but after nearly 60 years the gap is still a chasm. The poor are still reduced to the role of charity supplicants

For the lottery multi-millionaire, it must be a difficult choice. Which little luxury should we go for first - the mansion, the limo or the world cruise? But for Tony and Greta Dodd, the decision was a little more prosaic. After recovering from the shock of taking a 2,438,155 pound share in a rollover jackpot, they got straight on the phone to the nearest private hospital to book themselves in for four replacement knees.

The couple, aged 67 and 69 respectively, are both on the NHS waiting list for operations and suffer constant pain. "We're ecstatic," said Mr Dodd, a retired taxi driver. "As soon as it sank in that this money was for real we decided the first thing we want is a new pair of knees each. I've been on the NHS list for six months and up to now I've heard nothing - not even a proposed date for an operation. "Greta has only just gone on the waiting list so we were concerned that she would have even longer to wait. Now we are thrilled to be able to sign a cheque. "We have both been told that our knees are worn out. Mine went first and now Greta's have gone the same way. Walking any distance can be agony."

The couple have booked assessments with an orthopaedic surgeon for next week. A private knee operation costs between 8,000 and 10,000 pounds and even four won't make too much of a hole in their 2.5 million. "The doctors have told us we could have the operation within a few days if we wish but we will probably hold off a week or two because we have got some serious celebrating to do."

The win came after Mr Dodd changed his regular numbers for the first time since he began playing the lottery when it was launched in 1994. He said: "When I went to the newsagent I was a bit flummoxed because I'd lost the form with the numbers filled-in on it. "It meant I had to write a new one and for the life of me I couldn't remember all the numbers - only the first five - so I just picked 49 as the last one at random. "It was the greatest stroke of luck and I still can't think where it came from. I can only say that fate was on my side."

The couple, who live in Wallasey, Merseyside, have never won more than 10 pounds on the weekly draw. Mr Dodd said: "You could have knocked me over with a feather when I realised we had the winning line. When you see that you have crossed off those six numbers it's unreal. It's awe-inspiring."

After her operation Mrs Dodd, 69, who survived breast cancer seven years ago, plans to splash out on a holiday to Las Vegas with her best friend. The couple who have a daughter, Jane, 42, enjoyed breaking the news to her over the phone. Mr Dodd said: "I phoned my daughter and started singing, 'Who wants to be a millionaire...' She told me to stop messing around but when I told her it was for real she was jumping for joy."

Source




Diabetic ethnic minorities lose out in Britain

Patients from ethnic minorities are not only more likely to suffer from diabetes, but also receive lower quality care from the National Health Service (NHS), claims a paper published in the online open access journal, International Journal for Equity in Health.

Michael Soljak, together with colleagues from Imperial College, London, UK, investigated the treatment received in 2002 by 21,343 diabetic patients in three North West London Primary Care Trusts (PCTs): Ealing, Hammersmith & Fulham, and Hounslow. The researchers also compared the patients general health, shown by factors such as blood pressure and cholesterol levels, and diabetes control, to the patients treatment.

General practitioners (GPs) were encouraged to record new patients ethnicity by providing training and support to the practices. Of the diabetic patients in the three PCTs, 70 percent had a valid ethnicity code, obtained through patient questionnaires and entered by practice staff.

The authors found that although diabetes control was worse among the South Asian population, a smaller proportion of South Asians were prescribed insulin. They also found that although the White population studied was older, blood pressure differences between the groups were small, indicating poorer control in non-White ethnic groups.

The poorer quality of care for Asian diabetic patients could be explained by patient factors- such as poor understanding of the disease- or by the standard of care their GPs offered. Institutional racism is unlikely to be a major cause, as many South Asian patients are registered with GPs from their own ethnic group.

"This study highlights the need to capture ethnicity data in clinical trials and in routine care, to specifically investigate the reasons for these ethnic differences. But we don't just need to know more about both the practice and patient factors involved," says Soljak, "there should be more intensive management of diabetes and education about the disease in South Asian patients. The best option would be trials comparing different types of such interventions. Our study also shows that in future these trials can be carried out using routinely collected clinical information".

Source





12 August, 2007

Girl dies of brain tumour after NHS doctor tells her 'headaches are caused by stress'

When I requested an MRI in Australia a couple of years ago, I got it next day. They were apologetic that they could not do it same day. But I have private insurance -- like about 40% of Australians. It's only 10% in Britain



A woman who had complained to her GP of severe headaches for almost a year collapsed and died of an undiagnosed brain tumour. Jennifer Bell, 22, had been told she was suffering from stress but after months of illness had finally been referred to a neurologist. She then faced a 13-week wait before a 'relatively urgent' MRI scan could be carried out. Three days before the long-awaited appointment she collapsed at home and died later in hospital.

Her parents, Colin and Joyce Bell, want to know why Jennifer's MRI referral was logged only as 'relatively urgent'. Yesterday at an inquest in Norwich, Coroner William Armstrong agreed that an early scan would have led to much faster intervention.

Jennifer, of Thorpe End, Norwich, developed severe headaches, nausea, a stiff neck and diarrhoea in August 2005. Her health became so poor she gave up her job as a passenger service agent at Norwich airport. She visited her GP for the first time on November 4, 2005. Between then and April 10, 2006, she had five GP appointments. She also had six physiotherapy sessions. Her GP, Dr Helene Barclay, of Thorpe Medical Group, had recorded her symptoms as stressrelated.

But eight months on and still no better, Jennifer was referred to the Norfolk and Norwich University Hospital. There a neurologist discovered that her periods had stopped, a symptom not usually associated with headaches and decided she needed a scan. But on July 3 last year - only three days before her appointment, Miss Bell collapsed at home. She was taken to the N&N hospital and then transferred to Addenbrooke's Hospital, Cambridge, where she died.

At the inquest, Dr Barclay defended her decision to prescribe painkillers and physiotherapy for Miss Bell's stiff neck. "She did not show any sensory symptoms and I feel the routine referral to the N&N was appropriate," she said. Dr Jeffrey Cochius, consultant neurologist and clinical director at the N&N, said it was a credit to the neurologist who had referred Jennifer for the MRI as many would not have asked questions about her menstruation.

Coroner Mr Armstrong recorded a narrative verdict, saying: "I think there is no doubt that the tumour caused her death but it is also quite clear that early detection would have resulted in medical intervention of some kind. "The expression 'relatively urgent' is inherently ambiguous and the hospital might consider whether its use is helpful or appropriate. "Jennifer died as a consequence of a progressive undiagnosed brain tumour of a rare type and location urgent is a dangerous term because it is a contradiction."

Source




A British dentistry expansion that instead became a contraction

In the best tradition of bureaucratized medicine

The government's scheme to expand NHS dentistry led to fewer patients being treated by fewer dentists in the first year of operation, official figures revealed yesterday. Ministers had expected local NHS commissioners to buy extra capacity to make it easier for people to register for regular dental treatment. Dentists were put on a new contract that was supposed to let them escape the "drill and fill" treadmill and provide time for preventive work.

But the Department of Health acknowledged that the reform did not bring quick benefits. It said 28.1 million people went to an NHS dentist in England in the year to March - 50,000 fewer than in the previous 12 months. And the number of NHS dentists fell from 21,111 to 21,038.

Health minister Ann Keen said the reform helped the NHS create services, citing examples in Cumbria, Lincolnshire and Cornwall. "Putting right nearly two decades of deterioration in NHS coverage is not the work of 12 months. It will take longer to develop services to a position where all primary care trusts are able to meet local requirements fully," she said.

But Liz Phelps from Citizens Advice said: "Even by the government's own estimate there are still two million people trying to get NHS dental treatment who can't find a dentist."

Peter Ward, chief executive of the British Dental Association, said: "This first year report on the new untested contract for dentists justifies our concerns and will do little to rebuild trust ... The government must start listening to the profession [What an optimist! Doesn't he realize that bureaucrats know best?] and patients if local commissioning is to provide the services that local communities deserve."

Source





11 August, 2007

Universal Care Is Not Life-Effective

Post lifted from Democracy Project. See the original for links

Health care cost savings do not require government-run universal care to accomplish them. All that government-run universal care adds to the equation is rationing and lesser quality care. David Leonhardt's column in The New York Times, "Free Lunch on Health? Think Again," dissects the claim that more preventive care will save health dollars.

In fact, studies have shown that preventive care - be it cancer screening, smoking cessation or plain old checkups - usually ends up costing money. It makes people healthier, but it's not free..

For a new program to work, it has to reach people who are not being helped by whatever exists now - and who thus will be among the most difficult and expensive patients to treat. The program would also have to treat a whole lot of people who never would have gotten sick..

Persuading people otherwise - persuading them that basic care is sometimes cheaper and better - will be difficult. Sometimes insurance plans will simply have to say no to questionable care, over the opposition of doctors' groups with a financial interest in the status quo. But it's the only way to "save money and improve quality and cover everybody," as Mrs. Clinton says.

She and her rivals, John Edwards and Barack Obama, deserve a lot of credit for laying out such detailed, promising reform plans. Mrs. Clinton has gone so far as to say that "too much of the money we spend is wasted on care that doesn't improve health." But the candidates are still avoiding the toughest part of the discussion: when and how to say no.

"Fundamentally, if you're going to control health care costs, it involves denying people care they want - or things they've been trained to think they want," Mr. Gruber [an M.I.T. economist who helped design the universal-coverage plan in Massachusetts] says. "There is no easy answer."

The Left's young booster of universal care, Ezra Klein, likes Leonhardt's column, because he sees it as affirmation of his meme, but adds his "easy answer" anyway:

Instead, the more achievable goal is to move towards a universal system that's more cost-effective, which is, in fact, very much the same thing as saving money, and towards an integrated system that readies the ground for tougher cost control mechanisms down the road.

In other words, the "tougher cost control mechanisms" inherent in universal care are rationing, a la other nations' universal schemes.

The Kaiser Family Foundation's latest primer on "Key Information on Health Care Costs and Their Impact," concludes that U.S. health care costs grow faster than our economy overall because:

* Wealthier countries can afford to spend more on health care technologies; * The U.S. population is getting older and disease prevalence has changed; * Insurance coverage has increased; * Americans pay a lower share of health expenses than they used to.Between 1970 and 2005, the share of personal health expenditures paid directly out-of-pocket by consumers fell from about 40 percent to 15 percent.

The Kaiser report discusses various difficult efficiencies "such as increasing the use of electronic medical records, and other information technology, promoting evidence-based medicine, provider pay-for-performance, consumer-directed health care, or disease management":

Successfully implementing these policies, which is not an easy task, would likely reduce the amount that we pay on average for care, but they are likely not a longer-run solution for addressing the rate of cost growth.

Further, Kaiser's report says:

Over the long run, bringing health spending growth closer to the rate of overall economic growth would likely require finding ways to slow the development and diffusion of new health care technologies and practices..although such interventions present serious practical and philosophical challenges.

The report reminds us of the "widespread criticism" of Britain's national health system for excluding treatments. In short, the only promise that government-run universal care will deliver is rationing, not better care. At least Klein and Kaiser are (sort of) honest about it. Our presidential prospectives might try the same (at least sort of).




British patients leave hospital half-starved and the NHS is chucking food in the bin. Surely there is a solution

How lucky we are to have meals provided in hospitals. In some countries all you get is your treatment and the bed, and your family has to traipse in with your dinners. Bad luck if you don't have a family. But bad luck over here as well if you don't have a family, because droves of NHS patients are leaving hospital with malnutrition, particularly the elderly. Yes they get their dinners, but the food is either too ghastly to eat, or they can't feed themselves.

Nothing new in that; it has been going on for years. The bad news is that it's getting worse. The number of people leaving hospital starving has gone up by two-thirds and 13m meals worth 162m pounds have been thrown away over the past five years. Why bother to provide food in the first place if no one can eat it?

I had to slog into hospital with snacks for my mother, to make sure that something went into her mouth, otherwise she too may have pegged out from malnutrition. True, my mother was a fusspot over her food, it takes a lot of time and patience to feed a sick and grumpy person and the nurses are run off their feet, but it has to be done by someone, because when one is poorly, the most important thing to do is eat properly and get your strength back. You need lots of lovely chicken soup, or broths, or soothing rice pudding, or jellies for sore throats, tempting morsels to perk up the jaded appetite. If every parent or grown-up knows this, why doesn't the NHS?

Luckily, my mother was in hospital just up the road, so I could nip backwards and forwards, supervising her food and drink intake, and - even better - she was forthright. To be properly fed in hospital you need to speak your mind and have a bossy daughter or friend around to back you up. If you're on your own, heaven help you. And it's no good being too meek, polite and sensitive.

Rosemary's aunt was in hospital with an injured arm; she couldn't stretch it out, reach her food or get it into her mouth, but she was much too polite to bother the nurses. Rosemary was worried she might starve to death, but she couldn't feed Auntie, because she and all the other visitors thought Auntie didn't want to be spoonfed. "It's too humiliating," said Rosemary, and wouldn't spoon in the dinner. The nurses didn't have time, and if they asked Auntie why she'd eaten practically nothing, she would say very politely that she'd had quite enough, thank you. Auntie made it home. Just.

So it's not always the hospital's fault. And on an up note, not all of the food is bad. I know because I finished my mother's hospital dinners off, and the kosher meals were even better. You can always pretend to be Jewish.

Better still, the NHS could perhaps cut down on administrators and pay proper dinner ladies instead, who would have time to sit down next to people for five minutes, chat to them and help them to eat and drink, save their lives and save all that money on wasted dinners.

Source





10 August, 2007

Scottish patients tiring of health staff shortages

STAFF shortages have led to a surge in the number of complaints about NHS services in the Lothians. An average of nearly five formal complaints were made every day in the first three months of the year, new figures show. The most common concerns related to clinical treatment, the attitude and behaviour of staff, and the date of appointments. But there was a big rise - from four to 25 - in complaints about the shortage or availability of staff.

One hospital worker today told how her department rarely has enough staff, which she said lowers morale and affects patient care.

The level of dissatisfaction was higher than last year, when an average of four complaints were received every day - the highest number in Scotland.

Margaret Watt, chairwoman of the Scotland Patients Association, said she was not surprised. "We have a shortage of nurses and doctors, and patients have come to us with complaints about the shortages," she said. "Staff morale is low and this needs to be addressed across the country. It is a frightening time for the NHS."

Last week it was revealed how Scots doctors have been forced to quit the UK because they cannot find permanent posts in the NHS. Recent figures also showed how wards at the ERI [Edinburgh Royal Infirmary] maternity centre were left short-staffed on 30 occasions in the first three months of the year.

NHS Lothian has one of the lowest rates of sickness for health boards in Scotland - although the problem has worsened at the ERI in recent years - and has also managed to recruit dozens of new nurses to fill gaps. It now has one of the lowest number of nursing vacancies in the country, at 137.

One worker at the maternity unit in St John's Hospital, Livingston, said the service there was poorly staffed. She said: "Very rarely do we have the full complement of staff and we commonly work without adequate breaks. "This causes a great deal of stress, with more staff becoming demoralised and disillusioned, having a direct impact upon the standard of patient care"

Between July and September last year, 351 complaints were made, rising to 377 in the last quarter, and up to 440 in the first three months of this year. Among the most recent batch, 84 related to clinical treatment, 54 to the attitude and behaviour of staff, and 50 to the date of an appointment. There were also complaints about communication, hospital delays, and the catering and cleanliness in buildings. Of the 440 complaints, 44 were upheld, 178 were partly upheld and 136 were dismissed, with 37 still outstanding. NHS Lothian has taken action on a range of issues as a result.

Heather Tierney-Moore, director of nursing with NHS Lothian, said: "We are committed to transparency and see every aspect of patient feedback, be it complaint or compliment, as an opportunity either to learn what we are doing well or identify where improvements may be required. "We are concerned when we receive complaints, even if those complaints are subsequently not upheld. The winter months are traditionally a period where our hospitals and facilities are very busy, and we saw just under 260,000 patients in hospitals during January to March this year. We received 440 complaints - 0.104 per cent of patient activity. "In order to fully examine our service, our policy is to use a very wide definition for complaints and this can include situations where people are seeking further clarification on our service.

She added: "Wherever staff shortages or the perception of staff shortages are raised, the issue is investigated and addressed if necessary. We have increased the number of nurses we employ, and have made a tremendous effort in recruitment and in developing family-friendly flexible working arrangements. We also have a very active system for monitoring and maintaining safe staffing levels."

Source




Minister admits NHS is failing on dementia

About 600,000 people afflicted by dementia are being let down by the NHS and local authority social services, a health minister admitted yesterday. Ivan Lewis, minister for care services, said the disease "strikes fear into the hearts of all of us". The number of sufferers is set to double over the next 30 years as more people survive into their 80s and 90s. Mr Lewis promised a new strategy to improve dementia services by next summer to increase awareness of the disease, provide earlier diagnosis and better treatment.

The high court will rule on Friday on a challenge to a decision by the National Institute for Health and Clinical Excellence that those suffering from moderate dementia should not have access to a range of drugs on the NHS. But Mr Lewis said the row over medication was not the main issue. "We know too many families feel the current NHS and social care systems are not meeting their needs. The current system is failing too many dementia sufferers and their carers," he said when announcing the strategy at St Charles hospital in North Kensington, London. It was time to lift the disease "out of the shadows", providing much better information to help people detect the first signs of dementia, and specific training for healthcare staff.

Mr Lewis was supported by Barbara Pointon, whose husband Malcolm, a pianist and composer, suffered from dementia. Some of his final days were documented for the controversial ITV programme, Malcolm and Barbara: Love's Farewell, which will be screened tomorrow. She said the new strategy was "wonderful".

Gordon Lishman, director general of Age Concern, said he strongly welcomed the announcement. But Help the Aged's head of policy, David Sinclair, said the strategy failed to give enough priority to research into prevention and treatment.

Source





9 August, 2007

Hygeine discipline everywhere except in the NHS

In the week that Bournemouth council banned the issuing of armbands at its swimming pools, for fear of spreading germs, we are told that 60,000 hospital patients this year will catch the superbug Clostridium difficile. While one part of the public sector is infected with a virulent strain of health and safety disease (let's call it HSD), another - the part that is supposed to look after our health - seems strangely immune.

No one has ever been knowingly infected by blowing up a rubber ring. But the head of the Institute of Sport and Recreation Management was unrepentant, stating: "I don't think it's health and safety gone mad to say that something should be clean and safe." He is surely the perfect candidate to run one of the quarter of hospitals that are not meeting even the basic requirements of the hygiene code.

Even though there is not much hand-washing going on in the NHS, there is plenty of hand-wringing. Cases of "C diff", as it is known in the trade, have risen by 22 per cent in the past year, affecting more than 15,500 people over 65. It is not always lethal: in 2005 it was mentioned on 3,697 English death certificates (MRSA was mentioned on 1,512). But those figures understate the problem, because hospital-acquired infections often go unmentioned as a factor in death. The campaign group MRSA Action UK believes that many deaths that are listed as organ failure will also have involved MRSA. It is generally agreed that the UK's performance in combating these bugs lags behind every other European country except - oh, here's a comfort - Romania. The good news this week was that MRSA rates have started to fall, by 6 per cent in three months. But even this must be seen in the context of a sixfold increase over the past decade.

When superbugs first invaded hospitals in the Netherlands in the early 1990s, the Dutch took a zero-tolerance approach. They used an age-old tactic of infection control: isolating patients in dedicated wards. Their relatively clean hospitals were spruced up even further, and staff who came into contact with infected patients were tested. Mark Enright, an epidemiologist at Imperial College, London, says that NHS managers thought the Dutch had overreacted. But 15 years on, their MRSA rates are 50 times lower than ours.

It is trickier to isolate patients in the NHS because it has far fewer empty beds than almost any other Western health service. That is a direct consequence of the determined reduction in hospital beds from almost 300,000 20 years ago to 175,000 last year. At Stoke Mandeville, where at least 33 and possibly 65 people died from C. difficile in 2004, staff claimed that they could not isolate patients because of budgets and waiting-time targets.

This lack of beds and conflict between targets is critical for ministers to address. But it has been largely obscured by the focus on hand-washing. The problem is that, while hospitals remain dirty, it is hard to see the bigger issue. Ministers must also realise that all these "Wipe Out!", "Saving Lives" and "clean your hands" initiatives, unusually self-explanatory for this acronym-laden bureaucracy, have been staggeringly ineffective.

It is quite clear that a package of measures is needed to combat these infections: it includes isolation of patients, much more careful use of antibiotics in the case of C. difficile, and proper hygiene. The Health Protection Agency this week produced figures showing that some hospital trusts are doing quite well. But they will not permit us humble patients to know the success or failure rates for individual hospitals. The discrepancies must be far too revealing.

The fact is that a clean hospital is a well-managed hospital. Infection control is not impossible. What it really boils down to, in the words of Georgina Duckworth, of the Health Protection Agency, is "running a tight ship". Only a well-managed hospital will get a grip on superbugs. And the fact is that there are still far too many poorly managed hospitals.

The superbugs are not only a problem in themselves - they are also a symptom of what is wrong with the NHS culture. When voters said that they wanted to bring back matron, they did not mean "appoint someone with the title of matron and ask her to build partnerships with team members towards a better future", which is pretty much what happened in 2001. They wanted someone with the authority and willingness to tell others what to do.

The Healthcare Commission report published this week contains some telling quotes from NHS employees. "It's difficult to enforce authority like it was in the past," says one. "Staff have so many rights, unions, human resources," says another. And the report concludes that "overly authoritarian or hierarchical styles of management" can now be perceived as "bullying".

On recent visits to hospitals I have watched as staff turn a blind eye to nurses who do not wash their hands and cleaners who do not clean. Two weeks ago, a postoperative colleague complained about a huge splotch of blood on the wall of the toilet. "Oh," said the nurse, "we hoped you wouldn't notice."

Talk to former members of the nursing profession, such as my great-aunt and my mother-in-law, and they will tell you how they quaked when the infection control man made his daily visit to the ward and ran his finger along the top of every bed curtain. They would not have made excuses about outsourced cleaning contracts. They just got on with saving lives.

Outside the NHS, health and safety is being enforced maniacally. There is no shortage of bossy enforcers to remove your rubber ring. I never thought I'd say it, but we need a bit more of that in the NHS.

Source




Cutting Hospitals Out Of Surgery

When someone has minor outpatient surgery in a hospital, payment includes the cost to cover the procedure, plus an extra few thousand dollars in so-called facility fees. If Rock Rockett has his way, more doctors will ditch the hospital and stitch out of their own offices--in theory capturing a fraction of those facility fees that insurers no longer have to pay.

Happy result: Docs make more dough, insurers save money and, just maybe, the overall cost of health care drops. A 30-year health-insurance industry vet, Rockett is now the head of San Ramon, Calif.-based Validare, a small firm formed in 2001 to help physicians apply for formal accreditation to perform. Today the company also negotiates pricing with insurance companies and even handles doctors' back-office payment services.

If that sounds like a boring business, the opportunities are scintillating. There are now hundreds of different types of procedures--a bunion shaved or a chin tucked--done in an office setting. And the stakes just got higher. Prompted in part by some well-publicized office-surgery deaths, last week the state of New York passed a law mandating that all doctors who perform in-office surgeries have to be accredited within the next two years, or face penalties from the state medical board. (Until now, accreditation had not been required, though doctors who boasted the designation generally commanded higher fees from insurance companies.) Similar legislation is up for debate in Arizona and other states.

All of this could be a boon to Validare, now with just $2 million in revenues. Rockett estimates that there are roughly 2,000 office-surgery facilities in New York, of which Validare services only 100. Meanwhile, the Joint Commission--one of three regulators of office-surgery facilities in the U.S.--estimates that only 5% of the nearly 40,000 physicians' offices where surgeries are performed have the necessary accreditation. "This is a huge shot in the arm for us," says Rockett, 55.

Better yet, the overall pool of customers has been growing. Between 2000 and 2005, the number of freestanding outpatient surgery centers in the U.S. increased 76%, to 5,063, according to a report by Verispan, a health care research outfit. Credit the trend to overcrowded hospitals, better technology (allowing more surgical procedures to be done safely in an office setting) and the doctors' desire to get paid. "Physicians can control their time more if they're doing it in the office," says Michael Kulczycki, executive director for the Ambulatory Accreditation Program at the Joint Commission. "Also patients prefer to have surgeries at a time and place convenient for them."

Dr. Richard Delmonte, a Manhattan podiatrist, is a big believer in office-based surgery. With Validare's help, he recently spent six months worth of nights and weekends adding equipment, overhauling his record-keeping processes and updating his operations manual--all to snag accreditation to perform minor surgeries in his office.

Accreditation isn't cheap. Upfront costs for the certification: $11,000, including $6,000 for Validare's consulting services and $5,000 in fees to the Joint Commission. In addition, Delmonte pays Validare a kingly 15% on the fees he generates in excess of what he would have earned performing surgery in a hospital. All well worth it, says Delmonte, who claims he now pulls in an extra $1,000 or so per procedure and is able to perform more surgeries by avoiding costly hospital delays.

Insurance companies like this strategy too. Health Insurance Plan of New York, the state's largest health maintenance organization, typically forks over $3,000 in hospital facility fees for basic outpatient surgeries, says Eddy Reynoso, the HMO's director of ancillary contracting. "It's a big plus in terms of reducing the cost," says Reynoso, whose company is working with Validare on a trial basis. "The fact that the legislation was approved [also helps] in terms of quality. One of the concerns was that even though the trend was to move procedures from the hospital to an office, we were concerned about the quality of care."

Validare is cultivating relationships with giant insurer UnitedHealth Group and GHI, another New York HMO. Rockett also works with other surgery-pricing consultants, such as Omniplan and Concentra, to get the best deals for his doctor clients. Some big carriers like Aetna still refuse to reimburse for office-based surgeries. And Medicare and Medicaid are so big and standardized that they don't need a middleman like Rockett.

Dr. Scott Tenner, a Brooklyn-based gastroenterologist, signed on with Validare in 2005. A year later, he says, revenues shot up 50%, to $1.5 million, and net income jumped about a third. (He had to add staff and equipment to handle the flow of new patients and to meet more stringent safety standards.) "This has revolutionized my practice," he says. And that New York law has revolutionized Rockett's fee structure. Starting on Aug. 1, Validare will boost its upfront fees 50%, to $9,000 per accreditation. Sounds like this rocket is ready for launch.

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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8 August, 2007

Health Care: Government vs. Private

Sometimes the advocates of socialized medicine claim that health care is too important to be left to the market. That's why some politicians are calling for us to adopt health care systems such as those in Canada, the United Kingdom and other European nations. But the suggestion that we'd be better served with more government control doesn't even pass a simple smell test.

Do we want the government employees who run the troubled Walter Reed Army Medical Center to be in charge of our entire health care system? Or, would you like the people who deliver our mail to also deliver health care services? How would you like the people who run the motor vehicles department, the government education system, foreign intelligence and other government agencies to also run our health care system? After all, they are not motivated by the quest for profits, and that might mean they're truly wonderful, selfless, caring people.

As for me, I'd choose profit-driven people to provide my health care services, people with motives like those who deliver goods to my supermarket, deliver my overnight mail, produce my computer and software programs, assemble my car and produce a host of other goods and services that I use.

There's absolutely no mystery why our greatest complaints are in the arena of government-delivered services and the fewest in market-delivered services. In the market, there are the ruthless forces of profit, loss and bankruptcy that make producers accountable to us. In the arena of government-delivered services, there's no such accountability. For example, government schools can go for decades delivering low-quality services, and what's the result? The people who manage it earn higher pay. It's nearly impossible to fire the incompetents. And, taxpayers, who support the service, are given higher tax bills.

Our health care system is hampered by government intervention, and the solution is not more government intervention but less. The tax treatment of health insurance, where premiums are deducted from employees' pre-tax income, explains why so many of us rely on our employers to select and pay for health insurance. Since there is a third-party payer, we have little incentive to shop around and wisely use health services.

There are "guaranteed issue" laws that require insurance companies to sell health insurance to any person seeking it. So why not wait until you're sick before purchasing insurance? Guaranteed issue laws make about as much sense as if you left your house uninsured until you had a fire, and then purchased insurance to cover the damage. Guaranteed issue laws raise insurance premiums for all. Then there are government price controls, such as the reimbursement schemes for Medicaid. As a result, an increasing number of doctors are unwilling to treat Medicaid patients.

Before we buy into single-payer health care systems like Canada's and the United Kingdom's, we might want to do a bit of research. The Vancouver, British Columbia-based Fraser Institute annually publishes "Waiting Your Turn." Its 2006 edition gives waiting times, by treatments, from a person's referral by a general practitioner to treatment by a specialist. The shortest waiting time was for oncology (4.9 weeks). The longest waiting time was for orthopedic surgery (40.3 weeks), followed by plastic surgery (35.4 weeks) and neurosurgery (31.7 weeks).

As reported in the June 28 National Center for Policy Analysis' "Daily Policy Digest," Britain's Department of Health recently acknowledged that one in eight patients waits more than a year for surgery. France's failed health care system resulted in the deaths of 13,000 people, mostly of dehydration, during the heat spell of 2003. Hospitals stopped answering the phones, and ambulance attendants told people to fend for themselves.

I don't think most Americans would like more socialized medicine in our country. By the way, I have absolutely no problem with people wanting socialism. My problem is when they want to drag me into it.

Source




Australia: Sydney public hospital patients pay up to beat chronic health queues

PATIENTS are paying up to $600 for private treatment to avoid queues at crowded public hospital emergency departments as the state's casualty crisis deepens. Baulkham Hills Private Hospital and Sydney Adventist Hospital, two of three Sydney private hospitals with emergency facilities, reported a 30per cent rise in the number of admissions this year. On Thursday it was reported that most patients were forced to wait an average of eight hours in public hospital emergency rooms.

The nurse unit manager at Baulkham Hills Private, Lea Mitchell, said the number of patients visiting its emergency department had risen by nearly one-third compared with the same period last year. "There are patients who come here because they're not prepared to wait," she said. "We get that all the time. Patients are seen very quickly by the nurse and then they may have to wait a short while for the doctor. The longest anyone has had to wait is three hours." Ms Mitchell said that at the busiest periods, there would be between four and six people waiting. "That's when we're really, really, really busy."

State Opposition health spokeswoman Jillian Skinner said the numbers flocking to private hospitals were a reflection of the lack of community trust in the public sector. "It's a degree of the frustration of the community," she said. "They know that sometimes you are stuck in an ambulance or a waiting room for hours."

At Sydney Adventist Hospital, which has the state's largest private emergency section, doctors see 21,000 patients a year. Its director of emergency care, Greg McDonald, said most patients pay between $300 and $350 for treatment, with Medicare giving a rebate of about $100. Fees can reach $600 in cases such as heart attacks, which require specialist care and invasive procedures. "People ring us up from the public hospitals and they go, 'I've been waiting here five or six hours and it doesn't look like I've got a chance', and we say, 'Come here. You'll be able to see a doctor sooner'," Dr McDonald said. "We are more generous, more liberal in the way we deal with patients, in the way we try to find them beds."

But in winter, the emergency department is 10 per cent busier, mostly with patients aged older than 75 or younger than 16. Dr McDonald said the hospital treated the same extensive range of emergencies as a public hospital, and often saw trauma cases even though they were officially not meant to. "Sometimes the ambulance brings them to us because they think they need more urgent attention," he said. Dr McDonald is lobbying the Federal Government for funding of the private emergency sector so that they could better supplement the public health system.

However, a spokeswoman for Federal Health Minister Tony Abbott ruled it out, saying hospitals should talk with the State Government instead. Meanwhile, elective surgeries have been postponed at public hospitals in northern Sydney and the Central Coast due to staff shortages caused by a flu and viral outbreaks. The acting chief executive at the region's area health service, Terry Clout, said surgery would be rescheduled as soon as possible.

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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7 August, 2007

Don't get arthritis in Britain

Thousands of arthritis sufferers will be denied treatment with proven benefits by a decision not to pay for a new drug. Guidance issued by the National Institute for Health and Clinical Excellence (NICE), the watchdog that controls access to drugs on the NHS, will recommend today that the drug does not represent value for money, although it has been shown to improve dramatically the severest symptoms of arthritis in almost half of patients.

The draft ruling comes on the day that Alan Johnson, the Health Secretary, will announce that he is tearing up a price-fixing agreement with pharmaceutical companies in an attempt to reduce unneccessary waste of drug funds. The Times has learnt that the Health Secretary has decided to take on pharmaceutical giants as the NHS’s 8 billion pound annual drugs bill comes under pressure from expensive new medicines.

Abatacept, which has the brand name Orencia, is the latest of a new generation of drugs to be blocked by NICE on the ground that it is not cost-effective. About 400,000 people in the UK have rheumatoid arthritis, of whom a tenth (40,000) have a severe form. Many benefit from a class of drugs called anti-TNFs but about a third do not. This group, of around 12,000 patients, could potentially benefit from new drugs such as abatacept. Its manufacturer, Bristol Myers Squibb, estimated in its application to NICE that around 3,500 patients a year would benefit. Published data shows that in trials abatacept produced a 50 per cent reduction in symptoms in about 40 per cent of the patients who used it in conjunction with an older drug, methotrexate.

The cost would be about 9,300 a year for an average patient, but all would be sufferers who had already been treated unsuccessfully with anti-TNF drugs, which are equally expensive. Those who gained no benefit would have been taken off the drug swiftly. The NICE decision was described by patient groups as devastating. Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society (NRAS), said: “This is extremely bad news for people living with severe rheumatoid arthritis. “Denying patients the option of abatacept leaves some of them with the unacceptable choices of being put back on to treatments they have already failed on, palliative care or taking large doses of steroids, which have unacceptable side-effects over the long term.”

The NICE ruling will be open to consultation, and final guidance is not expected until the end of the year. A spokesman said: “Having examined cost-effectiveness analyses on the drug against a range of comparators, the committee concluded that abatacept could not be considered a cost-effective use of NHS resources.” The problems of balancing drug costs against benefits have led a growing number of patients who are denied treatments to resort to legal action.

The Government hopes to free more money for treatments by renegotiating the five-year profit control agreement that it signed with drug companies just two years ago. The move comes after a report by the Office of Fair Trading recommended that the NHS move to a new system that matched the price it pays for drugs to how effective they are, after finding widespread evidence of overcharging.

Some of the most inflated prices are for treatments for blood pressure, cholesterol and stomach acid, which are prescribed to millions of patients a year. Although some cost ten times as much as alternatives they offer little or no extra benefit, the report found. It concluded: “We have identified hundreds of millions of pounds of expenditure per year that could be used more cost-effectively under value-based pricing, allowing patients greater access to drugs and other healthcare benefits they are currently being denied.” Representatives of pharmaceutical firms were warned by Mr Johnson that he was intending to tear up the agreement. A statement from the Department of Health will seek to strike a conciliatory tone, emphasising the contribution made by drugs giants to the economy and in developing new medicines.

Nevertheless, the drugs industry is likely to fiercely resist attempts to renegotiate the price regulation scheme. In the wake of the competition watchdog’s report this year Richard Barker, the director-general of the Association of the British Pharmaceutical Industry, said: “The UK gets its life- improving and life-saving medicines at a fair and reasonable price.” A Department of Health official told The Times that Mr Johnson could not ignore the findings of an independent watchdog after a thorough 18-month investigation that compared the prices paid in Britain with those paid abroad. He added that the Health Secretary had not yet decided whether to accept the recommendations in full.

Source




Moronic NHS salary management

A DAMNING official report to be published this week will show doctors are working significantly fewer hours for more pay. The GPs' Workload Survey, the first such study for 15 years, has found that after the introduction of a new contract three years ago, doctors are working on average about 15% fewer hours. During the same period pay has risen by nearly a quarter. The report is likely to generate a backlash among nurses, who the study found are taking up much of the slack.

Gordon Brown is set to accelerate moves to force GPs to open weekend surgeries and to hold more early morning and late evening sessions. The report will show that although GPs tend to spend longer with each patient, it is nurses who are filling in on many occasions.

Another finding is that almost one-third of GPs, who earn an average of more than 100,000 pounds a year, are working part-time. The public is becoming increasingly concerned that GPs have received such large pay increases while many patients still struggle to book advance appointments and are unable to consult a family doctor out of hours. Some doctors have argued that the pay rises are to the detriment of patient care because they permit GPs to work fewer hours.

The figures will strengthen Brown's determination to make GP appointments more convenient for patients. The prime minister is understood to be concerned that patients are currently forced to take half a day off work to attend a GP surgery. Businesses say they lose 3.5m working days a year because of doctors' appointments.

A government survey found that a quarter of patients still cannot book an appointment more than two days in advance. Katherine Murphy of the Patients Association, said: "The huge pay rises they are now getting have not been reflected in the care patients are receiving.

Source




That wonderful government "planning" again

Delay in autopsy reports on SIDS in Australia

DISTRAUGHT parents of children who have died from Sudden Infant Death Syndrome are waiting up to a year for final autopsy reports due to a chronic shortage of forensic pathologists. The shortage is also causing increasing delays for relatives waiting for adult autopsy results through the coroner's court system.

Doctors specialising in SIDS say the situation is causing anguish for parents who desperately need emotional closure after a child's death. But they would speak only anonymously because their area of highly specialised work depends entirely on state and federal funding.

The latest figures from the Royal College of Pathologists Australasia show there is one pathologist for every 15,500 Australians. The situation for child forensic pathologists is much worse: 10-12 pathologists for the entire population. About 30 per cent of these pathologists are aged 60 and over. To train a pathologist takes five years on top of a regular medical degree and one year's hospital experience.

Professor Roger Byard of the University of Adelaide told The Sunday Mail: "There just aren't enough pathologists, full stop. It's a workforce issue that's only going to get worse." Dr Debra Graves, CEO of the Royal College of Pathologists, describes the situation as "woeful". She said a 2003 Australian Medical Workforce Advisory Committee report, signed off by both state and federal health ministers at the time, recommended an extra 500 training positions over five years. But to date only 80 positions have been created, well short of the 400 traineeships that should have been in place by the beginning of 2007. According to College data, the Commonwealth has committed to funding an extra 30 positions in the private sector.

But it is the states that are dragging the chain. To date Queensland has committed to 21 positions, the ACT two, Western Australia 11, South Australia two, Tasmania one, and Victoria and New South Wales six each. The number of SIDS deaths in Australia has fallen from 500 a year to around 100 annually since the "safe sleeping" campaign began in 1991.

Source




Australia: Queensland hospitals stretched to limit

A moronic government was not prepared for an upsurge of winter flu -- more of that wonderful government "planning"



With a burning forehead from a raging fever and his tiny chest heaving with every cough, Tyson Penrose slumped into his dad's lap. As exhausted Matthew Penrose, of Petrie, tried to make himself comfortable on the cold steel seat, he wrapped his arms around his sickly 11-month-old son and waited . . . and waited. "We were told there would be a two-hour wait when we got here," Mr Penrose said as he took his late-night place among the scores of other anxious parents who cradled their sick babies in the emergency room of Royal Brisbane Children's Hospital. By midnight, the wait time was nearly three hours. By then the children were drained by their illness and exhaustion, their desperate parents willing to do anything to get their kids better again.

The hospital staff are understanding of each parent's plight, those in the wait room said, but they are chronically undermanned and the flood of patients sickened by the current flu outbreak appears overwhelming. And this is a scene repeated in emergency rooms and hospital wards across the state as Queensland plunges into its worst flu crisis in six years.

Influenza A killed a four-year-old boy at Mater Children's Hospital last week and nurses yesterday flew home yesterday with 48 children stricken with the influenza A virus during a school trip to Canberra. The Year 7 students from Marymount College on the Gold Coast were required to wear face masks as they boarded a bus in Canberra which left for Sydney airport early yesterday morning. Two of their classmates remained in hospital in Canberra, but are reported to be satisfactory.

At the Gold Coast Hospital 23 children have been diagnosed with suspected Influenza A virus in the past two weeks, 10 of them requiring admission. That's five times the number of flu cases among children in the same period last year, a trend doctors say is occurring across the state. "It's strikingly unusual. I assume it has something to do with a change in the strain (of the virus)," said Professor John Gerrard, the Gold Coast Hospital's director of medicine.

Dr Steve Hambleton, a GP spokesman for the Australian Medical Association, agrees the current strain of influenza is unusually virulent. "It also spreads very easily. The virus can actually be transmitted within two hours of shaking hands with an infected person," he said.

The flu crisis is taking a staggering toll across the state. A Queensland Health source told The Sunday Mail that on Monday the state had run out of intensive care beds, coronary care beds and higher dependency beds - although a spokeswoman for Queensland Health disputed that. Queensland Nurses Union secretary Gay Hawksworth said critically ill patients were being dumped on trolleys in hospital corridors because there were no beds.

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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6 August, 2007

Only a government body could be this dumb

The number of maternity beds available for expectant mothers has fallen by almost 20 per cent over the past decade, despite an increase in the number of births on hospital wards. There are now about 1,900 fewer hospital beds for women giving birth than there were in 1997 in England, according to official figures obtained by the Conservatives and released yesterday.

Ten years ago there were 10,781 maternity beds, but in 2005-06 there were 8,883. The 18 per cent reduction cannot be explained by a small increase in the number of home births in recent years, as the number of hospital deliveries also rose; from 585,000 in 1997-98 to 593,400 in 2005-06. The statistics lend weight to claims that maternity services are becoming dangerously overstretched as they fail to keep pace with rising birth rates and an ever-increasing number of Caesarean sections.

Ministers have already admitted that the number of midwives fell last year – now, for the first time, the national reduction in maternity beds during the past decade is revealed. The Government was forced to deny that there was a maternity crisis this year when the National Patient Safety Agency examined 60,000 maternity ward errors in a three-year period ending last year. It found that 17,676 women had been injured, about 1,000 of them seriously.

Eight out of ten heads of midwifery say that they do not have sufficient staff to cope, according to the Royal College of Midwives. “We have seen too many service cuts, too many midwives lost, and too many mothers and babies getting a service that should shame the fourth richest country in the world,” Dame Karlene Davis, the RCM’s General Secretary, said this year.

David Cameron, the Conservative leader, released the figures as he promised a “bare-knuckle fight” to save local district hospitals threatened with closure because of NHS reorganisation. “There are 40 maternity units currently under threat and 90 accident and emergency units under threat,” Mr Cameron said on a visit to a hospital in his constituency yesterday. The Conservatives have chosen to take the battle over the future of local district hospitals to Gordon Brown after the man he selected to review the NHS suggested that many district hospitals should close. “We need fewer, more advanced and more specialised hospitals,” concluded Professor Ara Darzi after an investigation into London’s healthcare that he is now carrying out nationally.

A spokesman for the Department of Health denied that the review would lead to “wholesale closures of district hospitals”. “The NHS is also looking at the safest and most effective way of delivering care,” he said. “This does not mean wholesale closures of district general hospitals but it does mean that NHS clinicians and managers need to work with local communities to decide on the best organisation of services for patients in their areas. “Any decision on significant changes to services will be made only after full public consultation with local people.”

Source




Australia: Patient dies in hospital hallway

A 43-YEAR-OLD woman has died on a stretcher at Brisbane's Logan Hospital because no beds were available. The Woodridge woman was brought in by paramedics suffering shortness of breath. She waited more than four hours but died before being admitted.

Queensland Ambulance sources said the woman's life could have been saved but a shortage of beds at the hospital, in Brisbane's south, meant she had to wait in a hallway for treatment that never came in time. "Logan Hospital is always at capacity - we take patients there and wait and wait, sometimes four, five, six or seven hours," one paramedic told The Sunday Mail yesterday. "This woman was taken in and she died on the stretcher waiting for help. It's wrong."

Queensland Health refused to comment. The Queensland Ambulance Service yesterday issued an unprecedented public statement yesterday about the death, saying it had referred the case to the Coroner for investigation. Ambulance Commissioner Jim Higgins said the woman was taken to Logan Hospital on July 18. While waiting at the hospital, she became unresponsive and resuscitation attempts failed. "This is a sad incident and I extend my condolences to the family of the patient," said Mr Higgins. "Such cases are always fully investigated. "The cause of the death is unknown and that's why this matter has been referred to the Coroner. "Until the Coroner makes a determination in this matter it would be inappropriate to comment further. "However, I can say that the patient was under the care of paramedics at all times." Mr Higgins said he had also referred the death to the independent watchdog, the Health Quality and Complaints Commission.

The ambulance source said Logan Hospital had been at capacity almost every night for the past fortnight. Gold Coast and Tweed Heads hospitals were on bypass - which meant no beds were available and ambulances were directed to take patients to the already over-stretched Logan Hospital.

The woman's death was similar to that of father-of-four Greg Hayes, 47, who died in June after being turned away from Tweed Heads Hospital and paramedics were forced to transport him another 22km to the Gold Coast Hospital. Health and ambulance officials tried to absolve themselves of blame over the death of the heart attack victim, saying a radio fault caused the tragedy.

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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5 August, 2007

Sink that SCHIP!

GWB seems set to veto it, fortunately

Let’s revise the old saw about knowing when politicians lie. Instead of “when his lips are moving,” it should be “when he says it’s ‘for the kids.’ ” Exhibit A is the debate on reauthorizing the State Children’s Health Insurance Program. This Clinton administration creation provides tax-paid health insurance for families earning up to 200 percent of the official poverty level but who aren’t covered by Medicaid. SCHIP originated as “Kids First,” the backup plan to the Hillarycare monstrosity of 1993. The Clintonistas calculated that, if Hillarycare’s complete socialization of U.S. health care was rejected, their fallback position was a long march to the same end, starting with Kids First.

As usual, spineless Republicans in Congress approved a watered-down version of the Kids First program — hence the SCHIP acronym — in 1997. They should have instead passed a consumer-choice system guaranteeing access for everybody to private health insurance, then dared Hillary’s hubby to veto it.

Now that Democrats control Congress, they want to double SCHIP spending and cover families making up to 400 percent of the poverty baseline. This would put up to three-fourths of all families under a government-run health care program, marking a major step toward Hillarycare’s original goal.

Democrats should ’fess up that their real goal is to socialize American medicine. Then they won’t have to hide behind such transparent falsehoods as Rep. Frank Pallone’s “this is not an expansion of the program.” As chairman of a House health subcommittee, the New Jersey Democrat knows full well that “expansion” is exactly the right term to describe his party’s SCHIP proposal.

They also should admit they’ve spun their budget projections to conceal the fact they will have to raise taxes to pay for their proposal, regardless of whether they ultimately go with the House Democrats’ $50 billion expansion or the $60 billion hike being debated this week in the Senate. Senate Democrats in particular are blowing smoke by claiming they can pay for their SCHIP expansion with a new tax on tobacco products.

Finally, wouldn’t it be refreshing to hear something besides the usual green-eyeshade GOP offer of a token budget increase — $5 billion in this case — while threatening to veto a far more generous Democratic proposal? For a change, why don’t Bush and the Republicans say something like this: “Let’s get government out of our doctors’ offices and give every American family a tax credit so they — not some Washington bureaucrat — can decide what health insurance works best for them.” Do that now, and in a few years SCHIP will be Hillarycare history.

Source




NHS kills two more patients

Understaffing makes this sort of thing a certainty.

Two cancer patients died after hospital staff gave them an overdose of a drug used to ease the side effects of chemotherapy. Baljit Singh Sunner, 36, and Paul Richards, 35, died within hours of each other after treatment in an oncology ward of Birmingham Heartlands Hospital on July 20. It is believed they were given up to five times the correct dose of medication.

The hospital confirmed that a “mistake” was made over the men’s treatment and said that it was carrying out a detailed investigation. A hospital spokesman said: “The doctor and two nurses involved have not been suspended but are currently not working within the area and are deeply upset by the deaths. “It has already been established that the two men received a higher dosage than normal. The coroner will look at whether the mistake made was directly responsible for the patients dying or a causational factor.”

In a statement, Mark Goldman, the hospital chief executive, said: “Following the deaths of two patients we are carrying out a detailed investigation into the clinical care given to them. This will be presented to both families and to the coroner, and it will form part of the coroner’s inquiries.”

Source




Your medical regulators will protect you -- again

The regulators are a useless lot in South Australia, too

The Health Department will investigate how a privately run public hospital employed an overseas-trained forensic pathologist as a specialist. The inquiry was launched yesterday after State Coroner Mark Johns found the Iraqi-trained doctor failed to order tests on a patient who died from a brain aneurism despite a written request for a CT scan from the man's doctor.

An inquest into the death of Peter Roy Gillam, 44, of Tea Tree Gully, heard Dr Al-Khalfa had not practised medicine for almost 20 years before he was employed by Modbury Hospital in December, 2004. His curriculum vitae revealed he graduated with a medical degree from Baghdad University in 1984 but only served as a medical intern before studying to become a full-time forensic pathologist. Mr Johns said it was "therefore open" to find he had not practised medicine "in a clinical sense between 1984 when he worked in a Baghdad teaching hospital and 2004 when he commenced working in Modbury Hospital in South Australia". "If that is correct, it is difficult to escape the conclusion that he was a relatively inexperienced clinician when he saw Mr Gillam," he said.

Mr Johns said that, while forensic medicine "is, of course, a most highly skilled discipline, it involves a quite different set of medical skills from those required in dealing with patients in an ordinary clinical setting". "I have considerable reservations about the adequacy of Dr Al-Khalfa's experience as a clinician to perform the role assigned to him at Modbury Hospital," Mr Johns said. He said coronial police officers had been unable to find Dr Al-Khalfa to question him about Mr Gillam's death.

Modbury Hospital did not keep records on doctors' movements after they resigned. "It has been assumed by Modbury Hospital that Dr Al-Khalfa is no longer in Australia," he said. "I believe that is a reasonable assumption. "It is most unfortunate that Dr Al-Khalfa was no longer in Australia and could not be called upon to explain why he acted as he did on 17 December, 2004."

The inquest heard Mr Gillam first was taken to Modbury Hospital by his father, Thomas, after 5pm on December 16, 2004, after he had been to his GP, who wrote a note requesting a brain scan. A male nurse, however, told the pair the X-ray department was closed and they would have to pay for it to be reopened or return the next morning.

Mr Gillam returned to the hospital and was seen by Dr Al-Khalfa who, rather than ordering a brain scan, told him he was suffering from depression and said he should see a psychiatrist. Mr Gillam saw his GP again on Monday, December 20, before collapsing the following day in his bedroom. He was again taken to Modbury Hospital before being rushed to the Royal Adelaide Hospital. He died there following emergency surgery for internal brain damage.

Mr Gillam's father last night said the recruitment procedures for overseas-trained doctors needed to be overhauled. "This bloke had many qualifications but, unfortunately, they weren't the right ones to be working where he was," he said. "All doctors have certain basic training and it doesn't matter which field they follow, they are still doctors. "But 20 years as a forensic pathologist isn't the type of person who should be working in the emergency department of a public hospital. "He just shouldn't have been in that job."

Mr Gillam said he had received a letter from Modbury Hospital detailing changes it had implemented following his son's death. A Health Department spokeswoman said Dr Al-Khalfa had been employed at Modbury Hospital when it was operated by a private contractor, Healthscope. "Given that the employment of this doctor occurred when the hospital was run by the private operator Healthscope, the SA Health Department will need to investigate the reasons behind Healthscope employing the doctor, as recommended by the Coroner," she said.

The adverse findings against Dr Al-Khalfa come amid intense national scrutiny of the recruitment of overseas-trained doctors following last month's detention of alleged terrorism suspect Dr Mohamed Haneef in Queensland.

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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4 August, 2007

How the NHS "helps" the seriously ill elderly

Even clued-up people have great difficulty getting any help at all out of it

Today I phoned two GPs and asked them how soon my parents were likely to die. Do I hate my Mum and Dad? On the contrary, I adore them. My beloved and devoted parents are in their late eighties. January 3 this year was their 64th wedding anniversary. It was also two years almost to the day since they were forced to live apart.

In December 2004 they seemed fit and well, living comfortably and independently in their home of 40 years in the Midlands. We are a close and loving family and spend a lot of time together; I had noticed nothing seriously amiss. Then Dad fell over and cracked his head on a windowsill. There was a lot of blood. We spent Christmas Day gathered round his bed in an A&E unit 20 miles away. The hospital was hideous: uncaring, unkind, understaffed.

Dad had a chest infection and was very confused. He was also going through alcohol withdrawal – it turned out that his GP had known for a year that he was alcohol-dependent, but had been unable to convince him to get help.

We moved Mum in with me, 15 miles from her own home in the opposite direction from the hospital, while we all got over the shock. Another was to follow. Her forgetfulness was dementia. She asked the same question six times in 30 minutes. I had to label my kitchen cupboards and write out for her every night where she was and what was happening the next day. My sister Pam and I juggled our jobs with caring for Mum and visiting Dad, a two-hour round trip.

Exhausted by the distance, we got Dad moved to a private hospital in our town. He improved mentally and physically and was having physiotherapy to get him back on his feet. But soon his consultant told us that he no longer needed active medical treatment and his insurer declined to go on paying. We moved him to a short-term private nursing home. He deteriorated; his confusion returned, he repeatedly tried to get out of bed and fell, he developed leg ulcers and got MRSA. He became wheel-chair-bound and doubly incontinent. Then they too declined to keep him and advised us to look for a long-term nursing home.

Complete strangers to the welfare state, Pam and I turned to the internet to try to establish what financial help might be available. The answer seemed to be none, if my parents had substantial savings, which they did – Dad had astutely, or so he thought, raised 50,000 pounds recently via an equity release on their house and put it in the building society for their future care needs. So Pam and I visited six nursing homes in and around our town, all of them costing well over 600 a week. In four of them the smell of urine hit us as soon as the front door was opened. Dribbling residents were ranged round three sides of a sitting room while giant TV screens blared at them incessantly. Of the remaining two, one had a high turnover of foreign staff.

The only one that looked remotely civilised enough for a former international sales director was also the most expensive – more than £900 a week. We filled out a hugely detailed financial statement of his assets and income, confirmed that he was self-funding, and moved him in. Winter turned to spring. We moved Mum back to her own home, got her a referral to a memory consultant and, after much phoning, form-filling and investigating, found an agency to supply carers to visit her three times a day.

I tentatively contacted her social services office, having read on the internet that everyone is entitled to a needs assessment even if they are self-funding; they sent an ineffectual chap who told us little beyond agreeing that she was self-funding. I got back on the internet to find out what benefits she might nonetheless be entitled to; there were one or two, it transpired.

I called in on Mum as many weekday evenings as possible on my way home from work; Pam visited Dad as many afternoons as she could. At the weekends one of us collected Mum and took her to have lunch with Dad at the nursing home; the other one took her home again afterwards, a 90-minute round trip each time. Mum’s daily carers were variable and the agency was unreliable. Mum lost a lot of weight. My sister and I rang her every day; she was tearful and confused. We rang each other eight times a day: Have you seen Dad? Can you get to Mum – the agency can’t find anyone to visit tonight. Have you phoned their solicitor? Can you get to their building society? Have you rung Mum’s GP to organise a medicines box from the pharmacy (a friend of a friend told us about this)? Can you buy Dad more pyjamas? Who’s collecting Mum on Saturday? Have you rung social services? Can you look for a gardener and cleaner for Mum? Have you paid her chiropodist’s bill? Can we get together to fill out these funding forms tonight? Who’s taking a day off work this week to get her to the memory clinic?

We put our own lives and families on hold and irritated our work colleagues with the long list of phone calls we had to make day in, day out. It was relentless, depressing and utterly exhausting – and that was with two of us to share the load.

At Easter the nursing home rang – Dad had internal bleeding and an ambulance had been called. Another understaffed, uncaring hospital, another nightmare. He was pushed, pulled, prodded, hauled about. Somehow he survived and returned to the nursing home. The saintly staff wept when they saw the condition he was returned in – confused, dirty, and with his leg ulcers opened up again because the dressings hadn’t been changed.

I grabbed the chance of a week’s holiday. The day I arrived home Pam rang – Mum had had a fall at home and was on her way by ambulance to the same hospital that Dad had left three weeks before. It was just as grim. We watched the A&E clock tick round hour after hour while the staff gossiped at their station with their backs turned.

Eventually an X-ray showed a fractured pelvis. Our hearts sank. They put her to bed in a disgusting mixed ward. A nurse rang me late one night to say that my church mouse of a mother was trying to kill the other patients and could I go immediately. She was incoherent and trembling; I put my arms round her and we sat for four hours, into the small hours, in a cold corridor while a nurse phoned other wards trying to find the antipsychotic drug that they thought she needed. We were both crying. Nobody explained what was happening. (Much, much later I was told that she had a urinary tract infection that can induce psychosis in the elderly.)

Fit from years of tennis, Mum recovered physically and returned home. But spring turned to summer and her memory worsened. We went back to the internet and found another agency to supply live-in carers – mainly wonderful South African women who cooked her fresh food and played Scrabble with her. She put weight back on (but not before her own mother’s engagement ring slipped off her thin finger and was lost) and I felt confident enough to skip some weeknight visits, although I still phoned her every day.

Meanwhile, Dad was calmer at the nursing home. We found a wheelchair-transport charity that took him midweek to Mum while her carer cooked them both lunch. They were permanently distressed by their enforced separation but at least we knew that they were secure and well looked-after. Then the money ran out. By January 2006 they were broke – or, in the distasteful social services jargon, wealth-depleted. The 50,000 pounds had gone on nursing home and carer fees, as had the money we raised from Dad’s few stock holdings and an income bond.

Their only asset now was their house, their only income their state pensions and Dad’s two small occupational pensions. By the time we discovered (from the internet again, of course) that social services will step in when savings diminish to 20,500, they were already well below that and fast approaching the next threshold of 12,500. Both social services offices said they were now contributing the maximum, yet Mum and Dad still had a combined monthly short-fall of about 2,300 pounds. Moving Dad into a cheaper nursing home was unthinkable; he’d been shunted around enough. We appealed to the charitable trust that runs Dad’s wonderful home, and mercifully they agreed effectively to waive his top-up. Mum’s dementia appeared to be temporarily stalled with the aid of a memory drug, and she was secure and calm in her own home; my sister and I were managing between us to top up her finances to pay her live-in carers. By last autumn we were back on an even keel.

Then the next crisis hit. In January Mum had two strokes in succession and was taken back to hospital. She got a bed in another appalling, old-fashioned “Nightingale” mixed ward. She had lost the swallowing reflex, couldn’t talk, couldn’t walk. After four weeks on intravenous fluids, a stomach tube was inserted to feed her by. My sister and I bounced between Mum’s hospital and Dad’s nursing home. He was desperate to visit her but the hospital was unsurprisingly in the grip of a superbug and we couldn’t risk it.

Mum was gradually shunted to the farthest end of the ward from the nurses’ station. Sometimes she was hoisted from the bed to a chair and left unsupervised; once when I visited, in February, she was in the chair in bare feet and just her nightie, next to an open window. Mostly she had her eyes closed; occasionally she would look at us, but it was impossible to know if she knew who we were. Then the hospital started to ask what our plans for her were; they couldn’t do any more for her and she was bed-blocking. We had to decide between a nursing home and her own home. If we moved her into a nursing home, social services would then require us to sell the house after 12 weeks to pay for her care; as the house is jointly owned, Dad, too, would then be deemed to be self-funding again. At a combined rate of up to 1,800 a week for their nursing home fees, the money would soon be gone. We toyed with reuniting them in their own house, although we’d need to install a downstairs bathroom and hoisting equipment for Dad. He is wheelchair-bound, doubly incontinent and increasingly confused. He hasn’t seen Mum since her strokes, and we believe he would be devastated if he were faced daily with the reality of his adored wife’s pitiful condition. Better, we think, to keep him in the caring environment that has been his home for two years.

So we took Mum home. We bullied, cajoled and pleaded with assorted authorities to provide a hospital bed, a hoist, a pressure mattress, incontinence supplies, the food bags, visits from district nurses. My sister and I and her carers were taught how to administer her food, water and medicines via an electric pump and the stomach tube. She had a catheter but pulled it out twice, so now it stays out. I have acquired other skills too nauseating to describe.

The NHS has accepted her for continuing care, meaning that it takes over all the payments from social services, which should be cause for celebration; however, at the time of writing it has yet to devise a means of paying her live-in carers, as it seems it is against the rules for the NHS to make payments to individuals. The only suggestion forthcoming to date is that my sister and I might like to set up a company to which the NHS could make the payments. We being oddly disinclined to give ourselves this extra little burden, a stand-off has been reached. We are therefore still topping up the care package to the tune of 130 a week, although we are promised we will eventually be reimbursed by the NHS. My eyes water at the thought of the red tape that is going to involve.

So now I have two parents in a condition that can only be described as pitiful. My once-immaculate and elegant mother is shrunken, withered, bedbound, incontinent, unable to communicate, fed through a stomach tube; she has no teeth, her cheeks are sunken, her skin is grey, her eyes, when open, are rheumy and unfocused. She pulls her knees up to her chest and claws at her blankets.

My handsome, globe-trotting businessman father is in a wheelchair, confused, incontinent, speaks with difficulty and has recently had shingles that swelled up his face and closed up his eyes. They are both being kept alive by modern medicine far beyond the point of decency, humanity or dignity. Where is pneumonia, once called “the old man’s friend”, when you need it? You wouldn’t, you really wouldn’t, do it to a dog. I’m crying as I type these words, but if I had the courage I would pick up a pillow and help my mother towards that better life promised to Christians. Both their GPs are sympathetic to their, and our, plight, and both have agreed in principle to let nature take its course rather than strive officiously to keep them alive, but nature is taking its time. Hence my phone conversations with them today. Beyond reaffirming that agreement, however, they cannot help me.

I am so angry that we have arrived here. I am angry with Dad for not telling us about Mum’s dementia. I am angry with Mum for not telling us about Dad’s drinking. I am angry with myself for being powerless to make it all better for them with a wave of a magic wand. I am angry with the NHS for the disgraceful treatment of both my parents in two large hospitals. I am angry with the Government for its callous underfunding of care for the elderly. I am angry with social services for the apathy, the lack of help, the misleading or contradictory information that repeatedly dribbled our way. I am angry with God for drawing out their end in this demeaning way. If He does it to me, I shall sue.

Every single thing we have learnt about the care our parents have needed and its funding we have discovered slowly and with difficulty for ourselves, and often too late. (Example: when Dad’s nursing home fees had virtually wiped out the 50,000 he raised via equity release for them both, we approached his social services office for a financial assessment, and only then did they point out to us that the building society account was – most unusually – in Mum’s name, and so the money should never have been used for Dad’s fees. Our mistake, we hadn’t noticed – but we were amateurs, and we needed help, and none was forthcoming.) There is no quality to their lives, and little to mine and my sister’s for the past two and a half years that we have struggled to do our best for them. But the very, very worst thing is that our golden memories of two wonderful, loving parents have been all but obliterated by the sheer, unmitigated, unending misery of their last months on this earth.

Source




Now it's the Ambulance service of South Australia in a mess

We have recently heard of the dire state of the Queensland and NSW services

AMBULANCE officers claim crews are not reaching life-threatening emergencies on time because of chronic staff shortages. In another potential industrial relations headache for the Rann Government, the union is planning to refuse non-urgent patient pick-ups and implement overtime bans. Free rides for patients are also being considered.

The Ambulance Employees' Association says crews reached life-threatening emergencies within seven minutes in only 20 per cent of cases during the past three months - a breach of national guidelines. "I'd say the ambulance service staffing was in crisis," Ambulance Employees' Association secretary Phil Palmer said yesterday. It's a mess - a huge mess."

The SA Ambulance Service maintains the response times are similar to the equivalent period last year but concedes several strategies are being examined to increase staffing levels.

The ambulance officers' threat of industrial action comes just weeks after its paramedics unanimously accepted a 25 per cent pay rise over three years, starting with a 16.7 per cent "catch-up". Also last month, teachers, nurses, dentists and psychiatrists were locked in industrial disputes with the State Government. The ambulance union now warns:

THE AMBULANCE service is short by one crew every day, and as many as three crews on some occasions.

SINGLE-OFFICER crews in station wagons are improving response times but potentially increasing risks for officers and patients.

A GROWING reliance on inexperienced student interns is adding to the workforce strain.

OVERTIME is now about 40 shifts per week - it blew out to 120 shifts per week in late June.

PROFESSIONAL development workshops for paramedics have been cancelled to free up staff to work on road shifts.

Mr Palmer blamed the ambulance service's inability to maintain minimum crewing numbers comes on years of poor planning, which had resulted in a dangerous blow-out in response times. "Patients with life threatening conditions - cardiac arrest, unconscious collapse, vehicle trauma - are having to wait longer," he said. "This is not only distressing, it is potentially life threatening."

Industrial action will be discussed at a union shop stewards meeting next week, amid new management plans to double the number of student interns placed with single instructors. There are 54 student interns in the system - about 10 per cent of the on-road workforce - and another 32 are due to begin next January. Instructors are expected to reject the doubling-up plan at a meeting on Thursday, because of concerns their ability to supervise, mentor and teach will be restricted.

Ambulance service director of state operations Ray Creen said response times had improved during the past two years, with arrivals at half of all emergency cases within 9.4 minutes and 90 per cent within 15.6 minutes. In the past three months, response times had remained constant compared with previous years, despite a 16 per cent increase in emergency calls to 000. "We are currently looking at a number of strategies to increase our staffing levels . . . to ensure effective and appropriate measures are introduced," Mr Creen said. "One measure we have recently introduced is the establishment of two extra crews to cover peak periods in the middle of the day in the metropolitan area." Mr Creen said the Ambulance service, "among multiple measures", was looking at increasing the number of student interns taken into the organisation each year.

Health Minister John Hill was unavailable for comment but his spokeswoman said the Government had employed an extra 118 ambulance officers since 2002. "Ambulance officers are a critical part of our health system and they are responding to increasing demand for their services," she said. "And recruitment is being stepped up again with a target of recruiting a further 56 paramedics to be deployed on emergency crews over the next 12 months. "The State Government is also recruiting students to ensure we are building a workforce for the future, but they will be appropriately supervised in their roles."

Source



A new health entitlement for illegal immigrants to the USA

Unsatisfied with thwarting a Republican effort to authorize $3 billion for a border fence, congressional Democrats are trying to enhance the incentive for illegal aliens to enter the United States by removing the citizenship requirement from the popular State Children's Health Insurance Program (SCHIP). The Republican Congress in 1996 passed legislation blocking people who are in the country illegally from claiming benefits from the federal government, and when SCHIP was created in 1997, states were required to verify citizenship. But Democrats want to take that sensible requirement for Medicaid and SCHIP and leave it to the discretion of each state.

This reflects the Democrats' eagerness to offer free services to illegals at taxpayer expense, undermining the principles of both immigration law and good governance. And it is also a step Democrats want to take toward expanding SCHIP, like their plan to expand its coverage to include children from middle-income families that make up to $83,000 per year — a plan encompassing more than 70 percent of American children. (When SCHIP first came into being it was only for families with incomes up to double the poverty level, or $40,000 for a family of four.) Expanding the program will cost $50 billion over five years; expanding it by giving states the option to not enforce the citizenship requirement pushes the price tag up even higher — although just how much would depend on how many states decide to include illegals in the program.

This doesn't come as much of a surprise, of course, from the perspective of either immigration or health-care policy. Recall that SCHIP was born out of a failed attempt at government-run universal health coverage. Indeed, the Democratic expansion of SCHIP will actually allow children who currently have private health insurance to switch to the federally subsidized program, saddling taxpayers with yet another entitlement burden. In the wake of the defeat of the immigration amnesty bill last month, open-borders advocates are attempting to implement their agenda using a piecemeal approach. (Last week, for example, Democrats were looking for support for an agriculture-worker bill that included a path to citizenship for workers in the country illegally.) They should not be permitted to get away with using SCHIP to funnel more taxpayer assistance to illegals.

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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3 August, 2007

Canadian Doctor Describes How Socialized Medicine Doesn't Work

I was once a believer in socialized medicine. As a Canadian, I had soaked up the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people. My health care prejudices crumbled on the way to a medical school class. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care.

I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic - with a three-year wait list; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks. Government researchers now note that more than 1.5 million Ontarians (or 12% of that province's population) can't find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who'd get a doctor's appointment. These problems are not unique to Canada - they characterize all government-run health care systems.

Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled - 48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. In France, the supply of doctors is so limited that during an August 2003 heat wave - when many doctors were on vacation and hospitals were stretched beyond capacity - 15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren't available. And so on.

Single-payer systems - confronting dirty hospitals, long waiting lists and substandard treatment - are starting to crack, however. Canadian newspapers are filled with stories of people frustrated by long delays for care. Many Canadians, determined to get the care they need, have begun looking not to lotteries - but to markets.

Dr. Jacques Chaoulli is at the center of this changing health care scene. In the 1990s, he organized a private Quebec practice - patients called him, he made house calls and then he directly billed his patients. The local health board cried foul and began fining him. The legal status of private practice in Canada remained murky, but billing patients, rather than the government, was certainly illegal, and so was private insurance.

Eventually, Chaoulli took on the government in a case that went all the way to the Supreme Court. Representing an elderly Montrealer who had waited almost a year for a hip replacement, Chaoulli maintained that the patient should have the right to pay for private health insurance and get treatment sooner. A majority of the court agreed that Quebec's charter did implicitly recognize such a right.

The monumental ruling, which shocked the government, opened the way to more private medicine in Quebec. Though the prohibition against private insurance holds in the rest of Canada for now, at least two people outside Quebec, armed with Chaoulli's case as precedent, are taking their demand for private insurance to court.

Consider, too, Rick Baker. He isn't a neurosurgeon or even a doctor. He's a medical broker - one member of a private sector that is rushing in to address the inadequacies of Canada's government care. Canadians pay him to set up surgical procedures, diagnostic tests and specialist consultations, privately and quickly.

Baker describes a man who had a seizure and received a diagnosis of epilepsy. Dissatisfied with the opinion - he had no family history of epilepsy, but he did have constant headaches and nausea, which aren't usually seen in the disorder - he requested an MRI.

The government told him that the wait would be 4 1/2 months. So he went to Baker, who arranged to have the MRI done within 24 hours - and who, after the test revealed a brain tumor, arranged surgery within a few weeks. Some services that Baker brokers almost certainly contravene Canadian law, but governments are loath to stop him.

Other private-sector health options are blossoming across Canada, and the government is increasingly turning a blind eye to them, too, despite their often uncertain legal status. Private clinics are opening at a rate of about one a week.

Canadian doctors, long silent on the health care system's problems, are starting to speak up. Last August, they voted Brian Day president of their national association. Day has become perhaps the most vocal critic of Canadian public health care, having opened his own private surgery center and challenging the government to shut him down.

And now even Canadian governments are looking to the private sector to shrink the waiting lists. In British Columbia, private clinics perform roughly 80% of government-funded diagnostic testing.

This privatizing trend is reaching Europe, too. Britain's Labour Party - which originally created the National Health Service - now openly favors privatization. Sweden's government, after the completion of the latest round of privatizations, will be contracting out some 80% of Stockholm's primary care and 40% of its total health services.

Since the fall of communism, Slovakia has looked to liberalize its state-run system, introducing co-payments and privatizations. And modest market reforms have begun in Germany. Yet even as Stockholm and Saskatoon are percolating with the ideas of Adam Smith, a growing number of prominent Americans are arguing that socialized health care still provides better results for less money.

Politicians like Hillary Clinton are on board; Michael Moore's new documentary, "Sicko," celebrates the virtues of Canada's socialized health care; the National Coalition on Health Care, which includes big businesses like AT&T, recently endorsed a scheme to centralize major health decisions to a government committee; and big unions are questioning the tenets of employer-sponsored health insurance.

One often-heard argument, voiced by the New York Times' Paul Krugman and others, is that America lags behind other countries in crude health outcomes. But such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use and cultural values. It pains me as a doctor to say this, but health care is just one factor in health.

Americans live 75.3 years on average, fewer than Canadians (77.3) or the French (76.6) or the citizens of any Western European nation save Portugal. Health care influences life expectancy, of course. But a life can end because of a murder, a fall or a car accident. Such factors aren't academic - homicide rates in the U.S. are much higher than in other countries. In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don't die in car crashes or homicides outlive people in any other Western country.

And if we measure a health care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50%; the European rate is just 35%. Esophageal carcinoma: 12% in the U.S., 6% in Europe. The survival rate for prostate cancer is 81.2% here, yet 61.7% in France and down to 44.3% in England - a striking variation.

Like many critics of American health care, though, Krugman argues that the costs are just too high: health care spending in Canada and Britain, he notes, is a small fraction of what Americans pay. Again, the picture isn't quite as clear as he suggests. Because the U.S. is so much wealthier than other countries, it isn't unreasonable for it to spend more on health care. Take America's high spending on research and development. M.D. Anderson in Texas, a prominent cancer center, spends more on research than Canada does.

That said, American health care is expensive. And Americans aren't always getting a good deal. In the coming years, with health expenses spiraling up, it will be easy for some to give in to the temptation of socialized medicine. In Washington, there are plenty of old pieces of legislation that like-minded politicians could take off the shelf, dust off and promote: expanding Medicare to Americans 55 and older, say, or covering all children in Medicaid.

But such initiatives would push the U.S. further down the path to a government-run system and make things much, much worse. True, government bureaucrats would be able to cut costs - but only by shrinking access to health care, as in Canada, and engendering a Canadian-style nightmare of overflowing emergency rooms and yearlong waits for treatment.

America is right to seek a model for delivering good health care at good prices, but we should be looking not to Canada, but close to home - in the other four-fifths or so of our economy. From telecommunications to retail, deregulation and market competition have driven prices down and quality and productivity up. Health care is long overdue for the same prescription.

Source




Australia: Major government hospital turns elderly away

STAFF at one of Queensland's biggest hospitals are being told to reject sick, elderly people transferring from nursing homes, and hastily discharge all other patients. In a further sign the health system is getting worse rather than improving, Princess Alexandra Hospital's emergency department has been likened to a M*A*S*H scene and its chief said the bed situation was "critical". PA senior clinical chief executive officer David Theile warned staff last week the emergency department backlog was putting lives at high risk. "Along with patient risk there is inordinate pressure on staff in some areas," Dr Theile told staff in an email. "Please maximise and expedite discharges, exercise heightened discernment about accepting transfers or admissions from nursing homes and seek to shift elective admissions to day-only where possible."

A day earlier, a report found almost 144,000 Queenslanders were waiting to see a specialist. Some patients' files were marked "never" to see a specialist. Other recent health problems have included a dire shortage of radiographers, with cancer victims forced to wait long times for treatment; and diagnostic equipment being shut down.

One PA source yesterday said the hospital's situation was so dire that the radiography unit was last week converted into a makeshift emergency room; describing the situation as "like a scene from M*A*S*H". While Dr Theile could not be contacted yesterday, a PA spokeswoman said his emails were to ensure staff were aware of the situation and worked together to resolve the issues.

Coalition health spokesman John-Paul Langbroek said the situation in Queensland hospital emergency departments was now desperate. Some patients might not be getting optimal care if doctors and nurses were being forced to discharge them faster than normal. The Coalition yesterday sought a federal investigation into "never to be seen" patients, claiming the practice might be in breach of the Australian Health Care Agreement.

Health Minister Stephen Robertson said Mr Langbroek should be asking about the shortfall in federal funding. "Had the Commonwealth kept pace with the states' funding we would have had another $2.6 billion over five years to spend on health," 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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2 August, 2007

Is there a doctor in the house?

Post lifted from Democracy Project. See the original for links

What happens if "universal healthcare" is decreed, and there's no doctor in the house? What happens when the proponents of "universal healthcare" also castigate the best and brightest who choose to endure the rigors of medical training by reducing their financial incentive? A report in the Wall Street Journal says that the Massachusetts experiment in "universal healthcare" may founder on the lack of enough primary care physicians:

State officials have acknowledged the problem. "Health-care coverage without access is meaningless," Gov. Deval Patrick said in March.

As it happens, primary-care doctors, including internists, family physicians, and pediatricians, are in short supply across the country. Their numbers dropped 6% relative to the general population from 2001 to 2005, according to the Center for Studying Health System Change in Washington. The proportion of third-year internal medicine residents choosing to practice primary care fell to 20% in 2005, from 54% in 1998.

A principal reason: too little money for too much work. Median income for primary-care doctors was $162,000 in 2004, the lowest of any physician type, according to a study by the Medical Group Management Association in Englewood, Colo. Specialists earned a median of $297,000, with cardiologists and radiologists exceeding $400,000.

At the same time, the workweek for primary-care doctors has lengthened, and they are seeing more patients. The advent of managed care in the mid-1990s added to the burden as insurance companies called on primary-care doctors to serve as gatekeepers for their patients' referrals to specialty medicine.

An op-ed in USA Today, by an immigration lawyer, delves further, with attention to the British experience with terrorist doctors. Strict screening is the key.

Why haven't we heard any links of these foreign physicians to terrorism in the USA? Most likely because of the extensive background checks that all skilled workers, including doctors, undergo before being admitted. British security clearances for skilled workers are not as extensive, and the process is under review. It might help to know some basic data:

* Physicians in the USA: 794,893.

* Foreign graduate doctors in the USA: 185,234 (from 127 countries).

* Percentage of doctors in U.S. training programs who are foreigners: 24%.

This is not a new phenomenon. Foreign physicians have made up about this percentage of our doctor population for years. A sizable portion work in medically underserved communities and small towns. This at a time when a shortage of doctors in the USA is expected to grow to as much as 200,000 by 2020. Why is this shortage happening?

First, the USA has opened almost no new medical schools in the past 25 years. So you have a physician population that has remained flat serving a U.S. population that is expected to grow by 25% between 2000 and 2025.

Major demographic changes in the physician population also must be considered. Nearly one-third of doctors are older than 55, with more choosing early retirement. Fifty percent of all medical school graduates are now women. That is affecting both the total hours worked each year as well as the number of specialists. Family demands are causing many women to reduce their hours or to leave the profession when they have children. Some women doctors avoid fields with difficult call hours, such as anesthesiology and radiology.

Then there are our own demographic changes. The number of Americans older than 65 will increase to 54 million by 2020. As we age, our need for medical care increases.

Finally, as more treatment options are available and new technology is developed, Americans are more likely to seek out the services of a physician or specialist.

NHS neglects kids

Children with cancer are less likely to survive in Britain than in other European countries, two specialists have claimed. The reason could be slower detection of the cancers or less aggressive treatment once they are diagnosed, according to Alan Craft, of the Institute of Child Health at Newcastle University, and Kathy Pritchard-Jones, of the Institute of Cancer Research in Sutton, southwest London.

Writing in The Lancet Oncology, Professor Craft and Professor Pritchard-Jones say that, despite a National Service Framework for Children that sets standards for care, there are no targets and children "continue to be a low priority for the NHS".

They highlight trials carried out on Wilms's tumour - a childhood condition - in Germany, which showed that, between 1994 and 2001, 27.4 per cent of patients had a cancer that was first identified during a visit to a health professional for an unrelated problem, or by routine surveillance.

By comparison, in Britain, only 11 per cent of patients treated at the Royal Marsden Hospital, London, and 4 per cent of those referred to Newcastle General Hospital or the Royal Victoria Infirmary, Newcastle upon Tyne, were identified in this way. This suggests that GPs, and possibly some specialists, are slow to detect the cancers, thereby delaying treatment. In Germany, early diagnosis by routine or incidental examination is linked to increased survival, they say.

Routine health surveillance systems and opportunities for diagnosis for children may also be worse in Britain. In Germany most children have a primary-care paediatrician who provides regular check-ups, whereas in Britain the guidelines are not as thorough, the authors say. They conclude: "Sub-optimum survival for childhood cancer is just one example of the worse state of children's healthcare in the UK compared with many other countries. "The perinatal mortality rate puts the UK in fifteenth position in Europe and there is clear evidence that children with diabetes are [also] not receiving optimum care."

However, Professor Alex Markham, a former chief executive of Cancer Research UK and now its senior medical adviser, said that overall survival rates from childhood cancer in Britain had reached 77 per cent, and for some types of the disease survival was more than 90 per cent. "The data discussed in this comment in Lancet Oncology were collected between 1977 and 1997. Some of these apparent survival differences might be down to variations in the way data are collected in different countries," he said.

Roisin Trehy, senior nurse with Cancerbackup, said: "Any evidence to suggest that children are not a health priority is hugely concerning. However, this research does not seem to take account of the fact that, until the end of the trial period in 1997, the UK did not have a multidisciplinary team approach to cancer care."

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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1 August, 2007

Shortsighted British attitude to IVF

If a country wants to keep its population up, it should promote IVF

INFERTILITY is normally seen as a private matter. If a couple are infertile and wish they were not, that is sad. But there is understandable resistance in many countries to the idea that treatments intended to deal with this sadness--known collectively as assisted reproductive technologies, or ARTs--should be paid for out of public funds. Such funds are scarce, and infertility is not a life-threatening condition.

However, two papers presented to the "State of the ART" conference held earlier this month in Lyon argue that in Europe, at least, there may be a public interest in promoting ARTs after all. The low fertility rate in many of that continent's more developed countries means their populations are ageing and shrinking. If governments want to change this, ARTs--most significantly in-vitro fertilisation (IVF)--could offer at least part of a way to do so.

As the conference heard, IVF does seem to be keeping up the numbers in at least one country. Tina Jensen of the University of Southern Denmark has just finished a study of more than 700,000 Danish women. She found that young women in Denmark have a significantly lower natural conception rate than in past decades. That is partly, but not entirely, because they are having their children later in life. The rest of the cause is unknown, though reduced sperm quality in men may be a factor.

Whatever the cause, she also found that the effect has been almost completely compensated for by an increasing use of ARTs. Denmark's native population is more or less stable, but some 3.9% of babies born there in 2003 (the most recent year for which figures are available) were the result of IVF. The comparable figure for another northern European country, Britain, was 1.5%. Without IVF, then, the number of Danes would be shrinking fast.

That it is not may have something to do with the fact that in Denmark the taxpayer will cover up to six cycles of IVF treatment. In Britain, by contrast, couples are supposed to be entitled to three cycles. In practice, many of the local trusts that dish the money out do not pay for any cycles at all.

Jonathan Grant, the head of the Cambridge branch of the Rand Corporation (an American think-tank), believes this is shortsighted. His paper showed that if Britain supported IVF at the Danish level then its birth rate would probably increase by about 10,000 a year. The cost of offering six cycles to couples (and doing so in practice, rather than just in theory) would be an extra GBP250m-430m ($500m-860m) a year. That is not trivial, but Dr Grant reckons it is cheaper than other ways of boosting the birth rate.

Some countries, for example, have tried to bribe women into having more children by increasing child benefits. According to his calculations, raising such benefits costs between GBP50,000 and GBP100,000 a year for each additional birth procured. Ten thousand extra births each year would thus cost between GBP500m and GBP1 billion. There are, of course, some disadvantages to promoting IVF. In particular, women who use it tend to be older than those who conceive naturally, and that can lead to congenital problems in their children. But if the countries of Europe do wish to keep their populations up, making IVF more widely available might be a good way of doing so.

Source




NHS tells woman of 108 told to wait 18 months for hearing aid



A woman aged 108 has been told she must wait 18 months before the Health Service will give her the hearing aid she needs. Former piano teacher Olive Beal, one of the oldest people in Britain, has poor eyesight and uses a wheelchair. The delay could mean she will be unable to communicate and listen to the music she loves.

Now her family have said that realistically Mrs Beal is unlikely ever to receive the digital hearing aid that will save her from isolation. The one-time suffragette is one of hundreds of thousands of older people made to wait up to two years and sometimes more for modern digital hearing aids that make a dramatic difference to their ability to hear and communicate.

The case of Mrs Beal comes just a few days after the Mail revealed how another centenarian, Esme Collins, has been threatened with eviction from the nursing home where she has lived for ten years in a dispute between home owners and the local council over her fees. The Daily Mail's Dignity for the Elderly campaign has highlighted the way the elderly are made to pay high bills while their needs and interests are sidelined in the system meant to care for them.

Mrs Beal, who lives in a care home in Deal in Kent, has used an old-fashioned analogue hearing aid for the last five years. She has now been assessed as needing a more modern digital hearing aid which cuts out background noise and makes it easier to hear conversation or music. These cost around 1,000 pounds on the private market. But Eastern and Coastal Kent Primary Care Trust have told her family she must wait 18 months before she gets one on the NHS. By then Mrs Beal will be aged 110. She said yesterday: 'I could be dead by then.'

Her grand- daughter Maria Scott, 52, said: 'I spoke to her doctor some time ago about getting her a new hearing aid, as the existing one did not seem to be working for her. 'After a hearing test they said, "Yes, she does need a digital hearing aid, but there is an 18-month waiting list". 'I would have thought they would take her age into account as she probably has not got 18 months to wait. 'Olive worked hard from the age of 16 to her late 60s and paid taxes. She has been healthy all her life and lived with her daughter until 15 years ago - she has never sponged off the state. 'Her eyesight is falling, and if she cannot hear then she will be isolated from the outside world. 'Her analogue hearing aid does not filter out background noise so it makes it very difficult for her to hear clearly. But the digital one would allow her to hear people talking to her and to CDs. She loves music hall numbers.'

Mrs Beal went to school in London with Christabel Pankhurst, daughter of suffragette leader Emily, and helped at suffragette demonstrations. She brought up four children but only her eldest son, now in his eighties, survives. Her youngest son was a World War Two soldier killed in Normandy on the day after the D-Day landings. She was widowed 45 years ago.

Donna Tipping of the Royal National Institute for the Deaf said: 'I am afraid this is a common problem. 'In some parts of the country waiting times are more than two years, which is shocking. 'The new digital hearing aids can really transform people's lives. 'It is an issue of quality of life, with isolation, frustration and withdrawing from society caused by loss of hearing, and it is sad because this is reversible.'

A spokesman for Eastern and Coastal Kent Primary Care Trust said: 'We are reducing waiting times. 'The priority is given to patients who do not have an existing hearing aid, but we accept our service needs improving. We apologise to any patient kept waiting for a new or replacement hearing aid.'

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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