Wednesday, October 19, 2011

NHS: A different animal?

Private sector have huge NHS opportunity - minister
7 September 2011 

Lord Howe: To be honest I don't think it should matter one jot whether a patient is looked after by a hospital or a medical professional from the public, private or charitable sector”

"The NHS isn't a place to earn a fast buck. There are some outstanding performers in the NHS and they will not give up their patients easily."

He said that the changes being made presented "huge opportunities" to private groups who could provide high quality care.

And he added: "In the coming months and years, the NHS is going to evolve and grow into a very different animal."

Like this one?

                                                        ©2005 Am Ang Zhang

In the current push for applying market principles, the NHS is in serious danger of paying dearly for unnecessary treatment and worse, fraudulent claims by the new “suppliers” in the market place.

But it is already happening in NHS Dental:

Reforms brought in five years ago were meant to improve dental health and access to dentistry. They were meant to make life more straightforward for dentists and patients, turning a fee-per-item system into one with three bands of treatment, and three rates for the patient to pay. But while the changes have increased the number of people seeing an NHS dentist, in many instances they have had damaging repercussions. Some dentists have found themselves unable to give up the time for the procedures their patients need, and out of pocket if they try. For some it is now simply a question of working a flawed system as best they can, but as experts and insiders show, the fundamentals of good NHS care and full disclosure are being badly compromised.

Our reporter needed a root canal treatment for an infected molar tooth, one of the most common procedures on the NHS. Despite checking in as an NHS patient, he was encouraged to go privately wherever he went - with dentists waiting until he was in the operating chair before advising that the only option for safe and successful care was to pay far more than the NHS rate. Others warned that going on the NHS would be impossible unless a patient was referred to hospital, or if they went for the extreme fix of having the tooth extracted. None were clear about the prices that our patient should have been paying.

UK Dental Fraud: 2007200820102011

Do we ever learn?


Now the sums are simple, we have about 1/5 of the population of the US, so that is $150 Billion, around £100 Billion depending on how RBS & other banks fare.

Oooops, that looks like our total Health Budget.

GP Commissioners, watch out!!!

I have highlighted the problems in the US before. Fraud is seen as more profitable than drug dealing.

The US Medicare and Medicaid systems are in a way very similar to what the new market style NHS will be like. Tax-payers pay for them! The much hyped saving, if there is going to be any, will be swallowed up by paying for unnecessary treatment and fraud.

Medicare did not detect that more than one-third of spending for wheelchairs, oxygen supplies and other medical equipment in its 2006 fiscal year was improper, according to the report. Based on data in other Medicare reports, that would be about $2.8 billion in improper spending.

Arrests in three separate cases in Brooklyn, Detroit and Miami included a Florida doctor accused of running a $40 million home health care scheme that falsely listed patients as blind diabetics so he could bill for twice-daily nurse visits.       Also>>>

But hospitals too:

>>>How about My bill from ….. for a $540 tongue depressor. Or one for a $270 2oz. cup of liquid Motrin?

>>>While she was in the hospital a few days old, we were charged for 11 pacifiers at a cost of $121.00 each.

>>>My 70 year old father was hospitalized with Legionnaires Disease. His hospital bill included a bill for a pap smear! His first name was Faye – the hospital must have assumed he was a woman and could scam the insurance company for the charge.

By how much? In the US:

26 OCT 2009

The U.S. healthcare system wastes between $600 billion and $850 billion annually, according to a white paper published by Thomson Reuters.

The report identifies the most significant drivers of wasteful spending - including administrative inefficiency, unnecessary treatment, medical errors, and fraud - and quantifies their cost. It is based on a review of published research and analyses of proprietary healthcare data.

"The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's healthcare bill," said Robert Kelley, vice president of healthcare analytics at Thomson Reuters and author of the white paper. "The good news is that by attacking waste, healthcare costs can be reduced without adversely affecting the quality of care or access to care.

UNNECESSARY CARE (40% of healthcare waste): Unwarranted treatment, such as the over-use of antibiotics and the use of diagnostic lab tests to protect against malpractice exposure, accounts for $250 billion to $325 billion in annual healthcare spending.
FRAUD (19% of healthcare waste): Healthcare fraud costs $125 billion to $175 billion each year, manifesting itself in everything from fraudulent Medicare claims to kickbacks for referrals for unnecessary services.
ADMINISTRATIVE INEFFICIENCY (17% of healthcare waste): The large volume of redundant paperwork in the U.S healthcare system accounts for $100 billion to $150 billion in spending annually.
HEALTHCARE PROVIDER ERRORS (12% of healthcare waste): Medical mistakes account for $75 billion to $100 billion in unnecessary spending each year.
PREVENTABLE CONDITIONS (6% of healthcare waste): Approximately $25 billion to $50 billion is spent annually on hospitalizations to address conditions such as uncontrolled diabetes, which are much less costly to treat when individuals receive timely access to outpatient care.
LACK OF CARE COORDINATION (6% of healthcare waste): Inefficient communication between providers, including lack of access to medical records when specialists intervene, leads to duplication of tests and inappropriate treatments that cost $25 billion to $50 billion annually.

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