Wednesday, December 22, 2010

NHS-Kaiser Permanente: Integration?

Ray of hope from California?

 California©2007 Am Ang Zhang 
When all the talk is about trying to emulate Kaiser Permanente in the NHS reform up and down the country, my observation is that unless there is some radical rethink, the new NHS may end up as removed from Kaiser Permanente as imaginable.
Ownership and integration has undoubtedly been the hallmark of Kaiser Permanente and many observers believe that this is the main reason for its success, not so much the offering of choice to its members. Yes, members, as Kaiser Permanente is very much a Health Club, rather than an Insurer.  Also, a not so well known fact is that Kaiser doctors are not allowed to practise outside the system.
It is evident that the drive to offer so called choice in the NHS, and the ensuing cross-billing, has pushed up cost.  The setting up of poor quality ISTC (Independent Sector Treatment Centres) that are hardly used is a sheer wastage of resources.  When Hospital Trusts are squeezed, true choice is no longer there.  Kaiser Permanente members  in fact sacrifice choice for a better value health (and life style) programme.

The push for near 80% of GP commissioning is to lure the public into thinking that they are going to be better served.  In fact this is a very clever way to limit health spending and at the same time leave the rationing to the primary care doctors in a very un-integrated system.

So what about the specialist doctors that we call consultants in England?  Well, some are already offering their services in a private capacity to the GPs via PCTs, who are at liberty to buy those services. The NHS pay for hospital Consultants has now lagged behind that of GPs, and many consultants supplement their income by private work. Once you have had a taste of Porsche and Ferrari, are you going to go back to Rover?  A few major insurers are poised to buy up Foundation Hospitals and offer consultants a deal they cannot refuse.  This will lead us further away from the Kaiser Permanente ideal of an integrated system.

The most conservative estimate is that Consultant income will increase by 300% in the new private provider dominated specialist service. Has anyone not noticed that you buy private insurance to get your Specialist treatment? The gatekeeper is still your friendly GP.

The total income for all Private Health Insurers is currently estimated at around £6.5 billion, a quarter of which goes to the Specialists.

The NHS is already funding 20 to 25% of the Private sector.

By contrast, Kaiser Permanente is in part successful by doing away with the internal market and fees for service.

I know, the abolishment of internal market and cross charges will mean job losses for the accounting department, but we may then get more nurses and other clinical staff.

The conclusion?  There is an alternative: full integration via Foundation Trust Hospitals.

There is no reason why Foundation Trust Hospitals, once free of central control, cannot be responsible for training doctors (medical schools) and offer an integrated service from Primary to Secondary care.  A sort of “Free” Hospital (as in “Free” School) concept.  Ownership will be by us, the people.

This will be like the old NHS, more integrated!!! 

Yes, the old black is the new black.

NY Times: 

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