BUPA & Health Insurers: NHS Strikes Back!

How the NHS can strike back!!!

1: Legislate that Insurers must pay for NHS treatment.

2: Offer Cappuccino/Green Tea if patients provide BUPA or other insurance details.

3: Patients will still be allowed to be paid by BUPA. Ha!

"In fact, to save money, government can buy insurance 

for 

the mental patients and the chronically ill."

 ©2015 Am Ang Zhang

BUPA is right now paying insured to use NHS!!!

The official letter from Bupa detailing the scheme is headlined: “Giving our members improved choice.”

The patient, speaking on condition of anonymity, said he was “shocked” to be encouraged to seek treatment on the NHS in exchange for money.

The letter said: “The payment you will receive depends on the cardiac treatment you need.

"Payments usually range from between £500 to £2,000.”

Operations can cost fives times more than the cash payments offered by Bupa. One procedure patients can pocket £2,000 for having on the NHS is for a pacemaker to be fitted.

BUPA raked in a staggering £2.57billion in revenue last year, and pocketed £139million in profit - up 26% on 2012.

Consultant oncologist Dr Clive Peedell, co-leader of the National Health Action party, accused Bupa of “cashing in on the NHS”.

He said: “It’s disgusting that a leading private healthcare company is paying patients to use the NHS.

“This is an outrageous example of how the private healthcare sector is happy to take patients’ money but then has to turn to the NHS when it realises it can’t afford to meet the high cost of treating patients privately.

“This underlines yet again that private healthcare is all about the money.”

Dr Peedell added: “It looks like Bupa have calculated that it’s cheaper for them to pay patients to use the NHS than fork out themselves for private treatment which would cost them thousands of pounds.

"They are effectively cashing in on the NHS.”

It must be very obvious that all the talk about medical cover for visitors to England never mention the need for health insurance.

Could this be because insurers have managed not to cover for everything. One need to ask the question on how one ever travel to the US where cost of medical care is extremely high.

There is of course the need to fully control Health Insurers for those that live in England if they want cover. 

Let people opt out of the NHS if it is so bad! But Insurers need to cover every thing. 

Citizens could be given a tax break and yet have the insurance policy incorporated into their NI/NHS number so that those with the tax break, the insurer will be charged for every kind of medical care they receive if they were within the NHS.

 ©2015 Am Ang Zhang

 

Summary of a popular post:

·                     Ends discrimination against people with pre-existing conditions.

·                     Limits premium spread to normal, high risk and healthy risk to say under 20% either way of normal.

·                     Limits premium discrimination based on gender and age.

·                     Prevents insurance companies from dropping coverage when people are sick and need it most.

·                     Caps out-of-pocket expenses so people don’t go broke when they get sick.

·                     Eliminates extra charges for preventive care.

·                     Contribute to an ABTA style cover.

©2015 Am Ang Zhang

We could legislate that Insurers will have to pay for any NHS treatment for those covered by them. It will stop Insurers “gaming” NHS hospitals. This will prevent them saving on costly dialysis and Intensive Care. Legislate for full disclosure of Insured status.

Insurers cannot drop coverage or treatment after a set period and even if they do they will still be charged if the patient is transferred to an NHS Hospital.

This will eliminate problems like PIP breast implants.

It will indeed encourage those that could afford it to buy insurance and in any case most firms offer insurance for their employees including the GMC.

To prevent gaming of Insurers by individual patients (I look after their interest too), the medical fee should be paid up front by the patient and then deduction taken from premiums. Corporate clients like those with the GMC should not be gaming Insurers.

Imagine the situation where those with “Personal Health Budgets ” being able to “buy” their own insurance!

In fact, to save money, government can buy insurance for the mental patients and the chronically ill.

This way there will be real choice and insurers will be competing with each other to provide the worst deal.

Why?

What Health Insurer will want the business?

Perhaps they will go back to the US and we will have our own NHS back.                                                                                   

NHS & Simon Stevens: From UnitedHealth to JCPenney!

Can you see the tree from the bark?

©2016 Am Ang Zhang 

It must be one of those funny moments when the Cockroach Catcher was very disturbed. Why would someone give up annual incomes of multi-million dollars? To safe the NHS?

Big dreams, arrogance, infighting, and delusion all collided in the disastrous attempt to fix venerable retail giant J.C. Penney. The inside story of a revolution derailed.

Originally published in Fortune, March 2014. 

When you find a savior, you don’t quibble over details. So it was that J.C. Penney, the long-stagnating mid-tier department store chain, announced in June 2011 that it was hiring Ron Johnson, the man in charge of Apple’s wildly profitable retail stores and a Steve Jobs acolyte whose golden halo also included past triumphs as an executive at Target. The news sparked euphoria, but conspicuously absent from the media coverage was any mention of how Johnson planned to save this faltering retailer in a fading industry. That’s because there were no plans. His mandate could be reduced to a single word: change. What that entailed could be figured out later.

Simon Stevens' switch to NHS 'is like Arsenal signing Mesut Özil'

• Denis Campbell, health correspondent
• The Guardian, Friday 25 October 2013 14.14 EDT

The man who helped orchestrate New Labour's massive NHS investment is seen by many as the right choice for the job

The unveiling two days ago of Simon Stevens as the new chief executive of NHS England prompted widespread relief, a broad consensus that he is the right choice and, in some quarters, an almost desperate desire for him to succeed in what is one of the toughest jobs in public life.

Partly, of course, that is due to the man himself. He may have worked in the United States for the last nine years for the private health firm UnitedHealth, but the 47-year-old is respected and remembered both at Westminster and inside the NHS for helping to orchestrate New Labour's huge investment in the service in the early part of the last decade, which rescued it after years of neglect and decline.

But wait: The Independent

PAUL GALLAGHER 

   

THURSDAY 24 OCTOBER 2013

  

UHC’s phenomenal rise – it is now ranked no 17 in the Fortune 500 list - has not come without controversy. During the 10 years Mr Stevens was a senior executive, the firm was the subject of a class action lawsuit filed by the American Medical Association after it claimed UHC used faulty claims data to underpay doctors and overcharge patients. 

New York Attorney General Andrew Cuomo said patients had been victims of “consumer fraud” for a decade in a settlement that saw UHC agree to pay $350m in compensation to the claimants. Investigators had found that insurers using the Ingenix database, a UHC subsidiary, underpaid up to 28 per cent for claims based on inaccurate or insufficient information in the system. As part of the 2009 settlement, UHC also contributed $50m to help fund a new database that would replace the old one ending a “clear conflict of interest” according to Mr Cuomo.

An updated version of Ingenix is again causing controversy today. OptumInsight, another UHC-owned data firm, which uses algorithms to find efficiencies from calculating the most expensive patients, or doctors with the fewest number of patients, has been blamed by analysts for UHC dropping thousands of doctors caring for elderly Medicare patients this month. The company claimed it wants to provide “a network of physicians who we can collaborate with to help enhance health plan quality, improve health care outcomes, and curb the growth in health care costs”.

......UHC was also under investigation by the SEC in 2006 when then chief executive William McGuire was ordered to pay back $468m as part of a partial settlement over stock options backdating. The scandal, which led to Mr McGuire’s resignation, cost the firm almost $1bn.

....Although NHS England said Mr Stevens will “divest himself of any UnitedHealth Group shares before taking up his new NHS post in April, and will comply with all public service rules related to these matters,” a review of this agreement by NHS England chairman Sir Malcolm Grant will be made after Mr Stevens’s first year. Critics argue that this could pave the way for greater collaboration between the NHS and United HealthCare, which already runs some GP services in the UK.

Johnson demonstrated that he’d learned a thing or two about stagecraft from his legendary former boss at Apple. He had commandeered a large basement studio at Penney’s Plano, Texas, headquarters and had workers construct two rooms. (Johnson wanted to go further and install floating stages in the company cafeteria, but the fire marshal nixed the plan.) After he had made his presentation, the new CEO brought the directors downstairs to deliver the coup de grâce in the form of a sound and light show. In the first room was the taped commotion of shouting voices and visual noise: a profusion of signage, coupons, offers, and clutter. This was the off-putting cacophony of J.C. Penney at that moment. Johnson then ushered the directors into the next room, which was white, tastefully austere, and had a celestial serenity: the new JCP.

Finally Johnson led the board members into the cafeteria, where 5,000 employees, who had been waiting on their feet for hours, greeted the group with a raucous ovation. Then it was party time. Officially the fete was intended to bid farewell to Johnson’s predecessor, Myron “Mike” Ullman III, but it felt more like an ecstatic celebration of the company’s rebirth. With nary a whisper of opposition, the 109-year-old retailer had decided to abandon not only its strategy of many decades but arguably its fundamental way of doing business.

So the NHS of 60 plus years has now a genius from UnitedHealth, sorry Labour that will dismantle it and turn it into something even better than UnitedHealth that he left in Minnesota.

Just 16 months later Johnson was out. Penney was hemorrhaging cash; it lost $1 billion during his one full year as CEO. Its shares were hurtling downward. The press had turned against him. One of the two investors who installed him had fled. As fast as they had once anointed Johnson a messiah, Penney’s directors turned their backs on him.

Since his departure the company has behaved as if Johnson’s entire tenure was a coup rather than a strategy blessed by the board. The retailer has renounced his philosophy, restored Johnson’s predecessor, Ullman, as CEO, and reverted to its old ways. If we’re heading for oblivion, the board seems to be saying, let’s at least try to get there slowly. Some observers think bankruptcy is a possibility, despite improved results of late (at least compared with the previous bloodletting).

This era has seen some truly epic corporate conflagrations. There was the precipitous collapse of Lehman Brothers, which came to symbolize the greed and corruption of Wall Street, and the multidecade decline and, finally, bankruptcy of General Motors, which seemed to embody the slow death of American manufacturing. But for its stomach-churning mix of earnest ambition, arrogance, hope, and delusion – along with a series of comic and tragic miscues – it’s hard to top J.C. Penney.

“I came in because they wanted to transform,” the former CEO told me before his fall. “It wasn’t just to compete or improve.” (Johnson was interviewed for this article but declined to be quoted beyond saying, “I do not want to interfere with Penney’s attempts to succeed.”) He and his team did indeed transform Penney – from a sleepy behemoth known for serving the needs of Middle America into something quite different: an ambitious wannabe startup that fancied itself cool, with a radical pricing and merchandising model that had never been pulled off before. The outcome was doubly disastrous: Penney alienated its traditional customers without attracting new ones.

Everyone understands that the Johnson revolution ended in catastrophe. But the full story has never been told. The reality, it turns out, is even worse than many people imagine – and in a few respects, very different. What follows is the story of what actually happened at J.C. Penney, based on months of interviews with 32 current and former executives and vendors and more than 20 investors, analysts, and competitors.

It’s a saga with a swirl of overlapping forces. It stars a charismatic leader bent on radical change and features a failed attempt to Apple-ize Penney, a mission that ended up being every bit as crazy as it sounds. There’s a board of directors who sometimes seemed more concerned with what they’d be served for dessert than with the fate of the company. Then there’s the mistake that cost the company $500 million – and the fact that Penney actually began retreating from its controversial pricing strategy even before Johnson left, raising the question of whether the company can even truly be said to have tried his approach. Throw in a hedge fund titan who always knew better – except when he didn’t. The result: Billions in revenue were vaporized, and more than 20,000 people – many of whom embraced the new Penney – lost their jobs, seeming to hasten the decline of American brick-and-mortar retailing. This is a tale with very few heroes.

 Fortune reported , March 2014. 

So getting the best guy from Apple was a disaster for JCP, now back to being J.C. Penney.

Will NHSEngland revert back to just NHS? I doubt. But Simon can blame his American wife and young children if he wanted  to go back to Minnesota. After all there is Mayo Clinic there and they have never changed.

Would we some day read that: Big dreams, arrogance, infighting, and delusion all collided in the disastrous attempt to fix NHS England!

We learn little or nothing from our successes. 

They mainly confirm our 

mistakes, 

while our failures,

 on the other hand, are priceless experiences

 in that they not only open up the way to a deeper truth, 

but force us to change our views and methods. 

C.G. Jung

UnitedHealth & Simon Stevens: Your NHS! Your Money!

An Entrepreneur!         

UnitedHealth & Big Profits             

NHS & Mayo Clinic: Spring!

NHS & Wine: Simon Stevens ...

Finland: Health Care De-centralisation.

Finland: an amazing country!

© 2012 Am Ang Zhang

It looks like we could be learning a lot from the rather catastrophic decline of the Finnish Health Care system that has been admired round the world for its efficiency especially with the low level of medical staffing. It looks as if de-centralisation is one of the main reasons for the failure. It looks as if England is copying such catastrophic decentralisation with its adoption of CCGs.

Recent History:

Many analysts would state that during the past 3–4 years, the Finnish health centres are either in a state of crisis or at least on a path that may lead into crisis if they now fail to attract enough young doctors and dentists and will later have severe difficulties in recruitment of nurses.

But why would a primary care system, which has been often admired internationally, drift into the difficulties that have been described here?

The beauty of a centralised health service:

Finland launched its health centre based primary care with rather idealistic goals at a time, when the country was much centrally steered. The government held the power through the instrument of tailoring the state subsidies to the local municipalities and thus also to the health centres.

When the national policy called for adding resources to health promotion, rehabilitation, mental health or similar lines of services, the local level complied, since the funding received in return was significant.

Decentralisation:

When the pendulum took its rapid swing from central steering to extreme decentralisation, the course of development changed within a few years. Services that could be characterized as being less attractive or appealing to the middle-aged and often middle-class local decision-makers, suffered. Substance abuse services, long-term care, rehabilitation and similar were easiest among those sectors that experienced cuts.

The Lesson:

This means that one main lesson from the Finnish experience could be that decentralization can lead to loss of coherent health policy making.

The local scenes are occupied by stakeholders who defend the local interests, fight for local jobs and behave in unsustainable ways if they see ways to make savings.

Failure:

But the government has not been able to prevent the turning of primary health care into a battleground on which the future of the Finnish municipal structures and also of the ways that municipal services operate will be settled.

In the name of integration, or creation of structural efficiency or building of networks or getting rid of disturbing borders, Finland now sees changes that are seriously threatening to dissolve the whole identity of primary health care as it has been known in the country for almost 40 years.

Moral dilemma:

Should primary health care remain loyal to its fundamental principles of prevention, health promotion and provision of equitable services, which would mean a special emphasis on those who are disadvantaged? Or should primary health care seek to please the general public and the decision-makers by offering whatever is in demand? It would be unwise to forget either side, but self-analysis is much needed.

The short history of Finnish primary health care shows a wave-like development where enthusiasm is followed by pessimistic visions. Unfortunately, it seems that many difficult years may now be ahead.

Material taken from: Integrated primary health care: Finnish solutions and experiences           Simo Kokko, MD, 

NHS: Failure of Internal Market!

There is little doubt that since the failed experiment with Fund Holding the move to the internal market has resulted not in a better NHS but a sometimes disastrous one for the unlucky ones caught in the fight for where the money should be coming from. I came back from a most relaxing time in Panama and still find myself reading Medical Protection Society Journal as I am still hopeful the our NHS will be better integrated. 

Simon Stevens, someone told me is doing that. But I have my grave doubts. The truth is that some of us, our relatives or friends or even ourselves may one day need very specialised cutting edge medical care. Simon Stevens vision seem more like either a money saving one to rid hospitals of certain long term patients or as a way of part selling off bits of our NHS. 

Cutting edge care cannot be provided in Community Hospitals. It is not social prescription some of us may need. Or are these hospitals going to be reserved for the elite? Only time will tell. 

Dawn anyone?

Laguna Azul, Bocas del Toro©Am Ang Zhang 2013

There is much to commend about the integrated health care that Kaiser Permanente is famous for.

When I was working, I used to know every single GP in my locality and every consultant that worked in our Hospitals. Monday lunch time was when we had our clinical presentations and GPs turned up regularly and it was a good time to know them over drug firm sponsored lunches.

We would often pick up the phone and talk to the referring GPs or they would talk to us about someone they worry about.

No need to get clearance from anyone. Until later that is.

It was not written anywhere about the need to avoid XYZ because of money.

We did what is best and often we would initiate prescriptions and even repeat them if we see the patient for regular follow-ups. More often with adult psychiatrists than with child psychiarists.

But now: we have to let the GPs prescribe as it is going to cost the trust XYZ more otherwise.

How sad!!!

In the MPS Casebook:

Mrs B was a 49-year-old deputy headteacher who, for 18 months, had been increasingly troubled by heavy irregular menstrual bleeding. She was referred to a gynaecologist who carried out a pelvic US and an endomentrial biopsy. In her follow-up appointment with the gynaecologist, Mrs B was told that her investigations had been normal and hormone replacement therapy (HRT) was suggested to regulate her bleeding. The gynaecologist told Mrs B that he would be writing to her GP with his opinion and treatment recommendations.

Mrs B was therefore advised to go and see her GP to get a prescription for HRT in two weeks, which was thought to be sufficient time for the clinic letter to reach the GP. In the meantime, the gynaecologist scribbled down the name of the recommended HRT and gave it to Mrs B.

Unfortunately she was prescribed unopposed oestrogen.

………… Dr T realised that for many months Mrs B had been mistakenly prescribed an unopposed oestrogen and now had heavy bleeding. Dr T apologised to Mrs B and also explained that she needed to be quickly referred back to the gynaecologist for investigation. She was referred urgently and in view of her history of increasingly heavy bleeding and prolonged exposure to an unopposed oestrogen, a hysteroscopy was carried out. This led to a diagnosis of endometrial cancer. Mrs B had a hysterectomy and made a full recovery.

She made a claim against all the doctors involved in her care at the GP practice.

MPS:

The confusion could have been avoided if the consultant had issued the first prescription. In shared care situations there is a reduction in risk if the initial prescription is commenced by secondary care.          Read the whole story here>>>>>>

This would probably not happen in Kaiser Permanente nor in the good old days of our NHS.

Can someone do something before it is too late! 

From one of their own advisers: Prof Chris Ham

Parliament debate: Public Bill Committee

Chris Ham"May I add something briefly? The big question is not whether GP commissioners need expert advice or patient input or other sources of information. The big problem that we have had over the past 20 years, in successive attempts to apply market principles in the NHS, has been the fundamental weakness of commissioning, whether done by managers or GPs, and whether it has been fundholding or total purchasing."                             

Developing integrated care in the NHS: adapting lessons from Kaiser

“………The barriers include government policies that risk further fragmenting care rather than supporting closer integration. Particularly important in this respect are NHS Foundation Trusts based on acute hospitals only, the system of payment by results that rewards additional hospital activity, and practice based commissioning that, in the wrong hands, could accentuate instead of reduce divisions between primary and secondary care.”

NHS: The Way We Were! Free!

Related:

NHS-Kaiser Permanente: Integration?

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