Sunday, December 19, 2010

NHS-Kaiser Permanente: The Good Bits!!!

We may not catch a cold!!! Or we NEED not catch THE cold!!!
 ©2010 Am Ang Zhang
It is amazing how planners often overlook the most important aspect of why an organisation such as Kaiser Permanente is a success. Having looked at some of their ways of saving money in my last post, I need now look at why Kaiser Permanente is such a success.       New York Times
What perhaps the NHS should not ignore is one very important but simple way to contain cost: salaries for doctors, not fees.
The current thinking of containing cost in the NHS by limits set to GP Commissioning will end up in many patients not getting the essential treatments they need and GPs being blamed for poor commissioning.
Foundation Trusts will be expected to balance books or make a profit. Instead of controlling unnecessary investigation and treatment Trusts would need to treat more patients. This is not the thinking behind Kaiser Permanente and is indeed the opposite to their philosophy. It may well be fine to make money from rich overseas patients, but there is a limit as to the availability of specialist time. Ultimately NHS patients will suffer. 

The side effect of the current drive of GP Commissioning is that it would no longer matter if Foundation Trusts are private or not. Before long most specialists would only offer their expert services via private organisations. Why else are the Private Health Organisations hovering around!!!
What can GP Commissioners do?

Do exactly what Kaiser Permanente is doing: integrate!!! Integrate primary and specialist care. Pay doctors at both levels salaries, not fees! In fact both the Mayo Clinic and the Cleveland Clinic pay their doctors salaries as well as the VA and a number of other hospitals including Johns Hopkins.
Yes, employ the specialists; buy up the hospitals and buy back pathology and other services.
Not big enough: join up with other commissioners.
What about very special services such as those provided by Royal Marsden, Queens Square, Papworth & GOS?
This can be similar to Kaiser’s arrangement with UC for kidney transplants.
But this is like the old days of Regional Health Authorities!!!
Right, did you not notice that the old black lace is back in fashion: the old black is the new black!!!
Merry Christmas.


Anonymous said...

Just remember that Kaiser's success was based, in part, on their ability to rule out coverage for those with pre-existing conditions. In the US, this is referred to as "skimming" and is used by managed care organizations to fill their membership with healthy members. Kaiser's FAQ site directs those with pre-existing conditions to seek other coverage options. I don't believe that the NHS has that luxury.

Cockroach Catcher said...


I tried to cover that in the previous post.

NHS is where everybody else direct to in the end!!!

Cockroach Catcher said...

What, Anonymmous,will happen in 2014 when no one can turn away pre-existing conditions?