©2010 Am Ang Zhang
Not quite perhaps: the money will always be there, only in someone’s pocket.
Re quoted from Abetternhs’s Blog:
……..If you think we are going to be endlessly decommissioning and recommissioning services according to cost and quality, you are mistaken. Commissioning is a time-consuming, expensive, complicated business. We have been offered £20 per patient to do the administrative business that our PCT was doing for £60. We do not have the time or the money. You need us in our consulting rooms.
But the government say…
“You can choose any hospital in England
……Today we looked at our costs for our patients attending outpatients at different hospitals, including ones with services we did not commission. There are enormous differences between them.
There is a large shiny hospital not so far away which is spending large, but undisclosed amounts of taxpayers money on marketing. Down the road is another hospital which appears to be spending a lot less on marketing. The shiny hospital is costing us a lot more money and there is very little we can do about it.
Here is how.
A patient referred to our commissioned antenatal service is seen 8 times, but a patient seen at the shiny hospital is seen 14 times. A patient seen for their first antenatal appointment at the shiny hospital had 5 separate health professional interactions for blood and urine tests, blood pressure etc. each of which was coded and generated a bill.
The average number of outpatient follow-ups at the shiny hospital is 4.12 compared to 2.8 at the hospital down the road. Even if the tariff was the same, a hospital can increase its profits by calling patients back more often.
The tariff for the same ENT outpatient appointment at the shiny hospital is higher, £200 vs £170 for the hospital down the road. This is supposed to cover the costs of all the polishing needed in a central london
More ways of making money:
The re-referrals. A patient referred to a commissioned gastrointestinal service with bleeding from the bowel would be properly investigated and managed by the commissioned service. If one of our patients chooses to go to the shiny hospital they need one referral to the gastroenterologists for the top end, and another referral for the bottom end. Since a referral costs approximately twice what a follow-up appointment costs, this is another way of making money.
Another way the shiny hospital makes money is by telling my patients that I need to refer them to a different specialist at their hospital. Then I have to say, “look I know Professor Spratt said you need to see his delightful colleague, Mr Nibbs, but I really don’t think it’s necessary” And the patient replies, “that’s just because you’re trying to save money” …
If you never get better:
Shiny hospitals hang on to their patients with an iron grip. Most notoriously the London Integrated Hospital
Problems of internal and external billing:
Billing has created a whole new bureaucracy in the NHS costing millions, perhaps billions every year. When a patient chooses a service we have not commissioned, there is an additional burden of a complex cross-charging mechanism. The latest changes to NHS bureaucracy completely dwarf what we had before. The very opposite of what the government promised.
If we object to the bills the shiny hospital are sending us we can challenge and complain. Sometimes an agreement is reached, but sometimes arbitration is threatened. This is far too expensive and so the threat effectively results in us coughing up. Providers like the shiny hospital have the cards in one hand, our balls in another and enormous PFI debts hanging over them. No wonder they’re squeezing.
What is obvious to everyone, apart it would seem, from the government, the department of health, health policy think tanks, health economists, the majority of journalists … in fact anyone who does not have to look after patients, is that patients do not choose on the basis of quality of clinical outcomes, or choice, or efficiency. They choose shiny, like their i-widgets.
Expanding health care markets in the NHS will see costs escalate rapidly as they have done in the Netherlands. Hospitals and other providers will ‘play the game’ and draw patients in, just like any other provider of any other commodity.
The reforms will divert money away from where it is needed and will render the NHS unsustainable in a very short time. I believe that this might very well be the government’s intention.
Dr Tony Jewell, Chief Medical Officer for Wales
“The end of the internal market in health is part of the wider Welsh Assembly Government determination to make co-operation, rather than competition, the bedrock of public service delivery in Wales
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