Yellowstone © 1985 Am Ang Zhang
From the home of Capitalism it is perhaps very telling that it would legislate against any commercial exploitation of one of their country’s most important assets: natural beauty.
Over the course of more than 150 years, a once-radical idea has evolved into a cohesive national parks system, with a sometimes conflicting two part-mission: to make the parks accessible to all and to preserve them for future generations.
Is there anything else we could learn?
Why has the might of McKinsey not been able to privatise some of the US National Parks? Should there not be Time Shares in these most beautiful of places?
Could our National Health Service be like the US National Park?
Providing world class medical care to all and preserving it for future generations!
It is amazing how planners often overlook the most important aspect of why an organisation such as Kaiser Permanente is a success. We need to now look at why Kaiser Permanente is such a success. New York Times
Dr Zorro in his latest post: Private practice
The Earl Howe amendment to the Health & Social Care Bill was announced, with perfect timing, just before the Christmas break. This is the amendment to allow English NHS Trusts to raise half their income from private practice. At present only 2% of their funds may be derived privately.
This could be used to insist that you do this work as part of your NHS contract, for your basic NHS pay, while the Trust charges the patient or insurer premium rates for your work, and makes a profit on you.
The alternative is even worse. They could allow consultants to charge these private patients in the traditional manner.
This would be hugely divisive. The almost complete unity of the profession in opposition to the bill would evaporate, as a considerable proportion would suddenly see great potential financial benefit, and switch sides. And we all know how much bitterness, backstabbing and conflict is caused by consultants competing for as big a slice of private pie as they can get their grasping paws on.
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 of their philosophy. It may well be fine to make money from rich overseas patients, but there is a limit as to the availability of Consultant time. Ultimately NHS patients will suffer.
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.
What perhaps the NHS should not ignore is one very important but simple way to contain cost: salaries for doctors, not fees.
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 Hospital Consultants 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 GP and Consultant 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 Hospital Consultants; buy up the hospitals and buy back pathology and other services.
Not big enough: join up with other commissioners.
But Kaiser is not without problems:
When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/her initial health status questionnaire. In most states’ individual insurance market, insurance companies can retroactively cancel the entire policy if any condition was missed – even if the medical condition is unrelated, and even if the person was not aware of the condition at the time. Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition.
The government and Kaiser may well argue that its not-for-profit status engenders different behaviour. But in the
, the not-for-profits use the same tactics as the for-profits when the environment gets competitive. Kaiser actively seeks younger, healthier members and imposes different rates for employer groups based on their history and risk of healthcare. US
Sometimes their competitive behaviour gets them into trouble. The
branch of Kaiser has had cumulative fines of $1.6m, 63% of all the fines levied by the Californian department of managed healthcare. The activities for which they have been fined include denial of care, use of unqualified staff and inadequate staff-patient ratios. From: NHS-Kaiser Permanente: Which Bits? California
IT COULD INDEED BE:
’S BEST IDEA. GREAT BRITAIN