Wednesday, July 9, 2014

NHS Strikes Back: BUPA & Health Insurers!


Summer is here!




 ©2014 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.”

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."

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.

It may well be prudent for government to insist that non EU visitors to this country must have mandatory Health Insurance as part of the admission requirement. This should apply to students and tourists alike. After all nobody in their right mind would dream of going to the US without proper insurance.

We have managed to get people to insure their cars, why not their bodies.

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.

 ©2014 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.


©2014 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.                                                                                   

Saturday, July 5, 2014

NHS & Kaiser Permanente: Can CCG learn?

The side effect of the New NHS HSC Act with all the CCGs is that it would no longer matter if Foundation Trusts are private or not. Before long most specialists would only offer their expert services via private organisations. Why else are the Private Health Organisations hovering around!!! My reading is that the CCGs owned by Privateers will be doing what I suspected a long time ago: direct cases to their hospitals.
It is amazing how planners often overlook the most important aspect of why an organisation such as Kaiser Permanente is a success. Having looked at some of their ways of saving money in my last post, I need now look at why Kaiser Permanente is such a success.       New York Times

What perhaps the NHS should not ignore is one very important but simple way to contain cost: salaries for doctors, not fees.
The current thinking of containing cost in the NHS by limits set to  CCGswill end up in many patients not getting the essential treatments they need and GPs being blamed for poor commissioning.
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 to their philosophy. It may well be fine to make money from rich overseas patients, but there is a limit as to the availability of specialist time. Ultimately NHS patients will suffer. 
What can other CCGs do?


Do exactly what Kaiser Permanente is doing: integrate!!! Integrate primary and specialist 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 specialists; buy up the hospitals and buy back pathology and other services.
Not big enough: join up with other commissioners.
What about very special services such as those provided by Royal Marsden, Queens Square, Papworth & GOS?
This can be similar to Kaiser’s arrangement with UC for kidney transplants.
But this is like the old days of Regional Health Authorities!!!
Right, did you not notice that the old black lace is back in fashion: the old black is the new black!!!

Perhaps it is time to repeat all the Kaiser Permanente posts:


 ©2011 Am Ang Zhang
Dec 22, 2010
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

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.

Jan 02, 2011
Look at major hospitals in England: Urgent Care Centres are set up and staffed by nurse practitioner, emergency nurse practitioners and GPs so that the charge by the Hospital Trusts (soon to be Foundation Trusts) for some people who tried to attend A & E could be avoided. It is often a time wasting exercise and many patients still need to be referred to the “real” A & E thus wasting much valuable time for the critically ill patients and provided fodder for the tabloid press. And payment still had to be made. Currently it is around £77.00 a go. But wait for this, over the New Year some of these Centres would employ off duty A & E Juniors to work there to save some money that Trusts could have charged.

This is certainly not how Kaiser Permanente would run things: all integrated and no such thing as “cross charging”. In fact the doctors are not on a fee-for-service basis but like Mayo Clinic, Cleveland Clinic and Johns Hopkins Hospital, doctors are paid a salary.

Feb 23, 2011
Kaiser Permanente does not cover everybody and by being able to reject or remove the chronically ill the comparison with the NHS was at best meaningless and at worst ……well I do not really want to say.

So what would they do by 2014 when they can no longer reject pre-existing conditions.

Well, their founding fathers may well have ensured their ability to continue.

Kaiser Permanent is not a Health Insurer, it is in fact a Health Maintenance Organisation. I have no doubt in my mind that they will if need be just become a Health Maintenance Club with services by amongst others, integrated primary care and secondary care doctors.

Mar 02, 2011

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."                             


“………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.”

Thursday, July 3, 2014

NHS & ADHD: Ban & Save!

As I drove into work this morning the radio was playing Green Green Grass of Home. Must have
been years since I heard it. Tom Jones!
As soon as I stepped into the clinic, my trusted secretary asked: Have you heard, the new Health Secretary is banning ADHD and its benefits!
“Wow! Genius?”
“That’s it. He is banning the diagnosis made by private clinics. Diagnosis can only be made by NHS Child Psychiatrists and those on medication would not get benefits. Only those not on medication might be considered for some benefits. And only for school holiday time!”
“So the Daily Mail can no longer rant and rave about it!”
“Parents are up in arms because of the benefit thing. But you have always said that a third of our patients are fakes!”
“Don’t quote me or I will get the sack”
Then I heard Tom Jones again! Strange! We do not have a radio at the clinic!

“Then I awake and look around me, at four grey wall surround me
and I realize that I was only dreaming.”
Yes, I have retired! 

Then I read in The Guardian

“According to data obtained exclusively by Education Guardian under Freedom of Information legislation, there has been a 65% increase in spending on drugs to treat ADHD over the last four years. Such treatments now cost the taxpayer over £31m a year.”                          More>>>>


Neurologist Richard Saul 

“ADHD Does Not Exist: The Truth About Attention Deficit and Hyperactivity Disorder” (HarperWave)

After a long career treating patients complaining of such problems as short attention spans and an inability to focus, Saul is convinced that ADHD is a collection of symptoms, not a disease, and shouldn’t be listed in the American Psychiatric Association’s Diagnostic and Statistical Manual.

Related:
ADHD, Heart Risks, Kinko and Jetblue

ADHD:All Posts.

©2012 Am Ang Zhang 

Feb 19, 2013
Adult A.D.H.D. is open to faking and more so by medical students. In children, it was my experience that often parents would report symptoms in order to secure disability benefits.
Aug 14, 2012
Over the last ten years or so, I kept meeting friends in the U.S. whose children seemed to progress from one psychiatric diagnosis to another with frightening regularity, the most common being from ADHD to Bipolar.
Aug 03, 2012
It has long been held that there is no alternative treatment to ADHD! Stimulant in its various forms is the answer. In life nothing is easy or indeed straightforward.
Sep 18, 2011
“According to data obtained exclusively by Education Guardian under Freedom of Information legislation, there has been a 65% increase in spending on drugs to treat ADHD over the last four years.

Sep 23, 2011
First came ADHD. The use of stimulants benefits mainly teachers during school hours. Parents and doctors soon find a quick fix in antipsychotics, and for good measure the newer ones, believing that they have fewer side ...
Sep 20, 2011
Is the piano China's answer to the problem that is facing many parents in the west, i.e. ADHD? Could it be a novel substitute for Ritalin and other stimulants?
Oct 21, 2008
Results: Children with ADHD concentrated better after the walk in the park than after the downtown walk or the neighborhood walk. Effect sizes were substantial and comparable to those reported for recent formulations of ...
May 15, 2008
On April 21, 2008 A News Release came through: “Children with ADHD should get heart tests before treatment with stimulant drugs”
Jul 28, 2008
I have in my travels met other psychiatrists who often ask why there is such a discrepancy in the diagnosis of ADHD in the US and the rest of the world. WHY! Perhaps it is something they have in the diet.
Sep 26, 2011
Has everything got to be ADHD, Bipolar or psychosis. Especially ADHD for a 39 year old?! In this week's ... But why should the patient not have pheochromocytoma and ADHD and paranoid psychosis and a touch of bipolar.
Aug 31, 2012
Over the last ten years or so, I kept meeting friends in the U.S. whose children seemed to progress from one psychiatric diagnosis to another with frightening regularity, the most common being from ADHD to Bipolar.

Jul 24, 2008
So Sharon brought this boy to see him. It happened to be his first ADHD assessment. He came out to see me after an hour. He did not think the boy suffered from ADHD but every answer Sharon gave on Conners would point ...

Wednesday, July 2, 2014

MRSA & NDM-1: Doctors or Vets???


The past several years have seen a number of reports of superbugs: methicillin-resistant Staphylococcus aureus, the so-called ESKAPE organisms (an acronym for Enterococcus faecium, S. aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and enterobacter species), and others. For the most part, these organisms owe their superbug status not to enhanced pathogenicity or virulence (although some are capable of causing overwhelming disease in the proper setting) but to their resistance to multiple antimicrobial agents.

The most recent reports of superbugs in the professional and lay literature discuss NDM-1, which stands for New Delhi metallo-beta-lactamase  and actually refers not to a single bacterial species but to a transmissible genetic element encoding multiple resistance genes that was initially isolated from a strain of klebsiella obtained from a patient who acquired the organism in New Delhi, India. Subsequently, organisms in the Enterobacteriaceae family containing this genetic element (or variants thereof) have been found widely throughout India, Pakistan, and Bangladesh and are now turning up in Britain and, in rapid order, many other countries around the world. The spread of these organisms has prompted widespread concern because some of them are resistant to all antimicrobial agents except the polymyxins.




©2010 Am An Zhang

Do we continue to blame the doctors when animals are given antibiotic to help them grow?

Germany:  Der Spiegel 'Bigger Profits than Cocaine Dealers'


"Some veterinarians' profit margins are bigger than those of cocaine dealers," says Nicki Schirm, who has been a veterinarian in the state of Hesse for more than 25 years. When a veterinarian finds a sick chick among 20,000 other chicks, he treats the discovery as justification to preventively treat the entire flock with antibiotics, says Rupert Ebner, a veterinarian from the Bavarian city of Ingolstadt. "Nowadays, flock or herd health monitoring is the code name for the generous administration of drugs," says Ebner. In many cases, he adds, fake diagnoses are used to provide a justification for the use of antibiotics.

In large veterinary practices, profits from the sale of drugs can account for up to 80 percent of revenues. This is mainly due to the volume discounts offered by the pharmaceutical industry and the sweet privilege known as the right to dispense -- a special provision for the pharmaceutical monopoly. For more than 150 years, veterinarians have been allowed to both prescribe and sell medications -- with almost no supervision whatsoever.

Some 900 tons of antibiotics were fed to animals in Germany in 2010. This is 116 tons more than in 2005, and more than three times as much as the entire German population takes annually. Pharmaceutical producers were required to report their 2011 sales of veterinary drugs by the end of March. A number of companies did not comply, prompting the Federal Office of Consumer Protection and Food Safety to request the information in writing.

According to The Union of Concerned Scientists:
Microbial Drug Resistance 13(1):69-76.Akwar et al. 2007.
Risk factors for antimicrobial resistance among fecal Escherichia coli from residents on forty-three swine farms.
"Akwar et al. found that people living and working on swine farms where antibiotics were used in feed had increased chances of carrying resistant E. coli. In some cases, the risk of resistance for the farm workers was higher than if they had taken antibiotics themselves. Once farm workers are colonized by resistant bacteria they can transfer them to family members and others in their community."

The use of antibiotics in farm animals is widespread and is not restricted to the treatment of infections but for the enhancment of weight gain. In business terms it is the conversion ratio of feed to weight that matters. The Obama government may well be taking steps to control it due to the rising incidents of Hospital Infections. Chicken and other animals can grow up to twice as fast as 30 years ago when antibiotics were not in the feeds. Scary!

It may therefore require more than "washing hands" if we do not want more outbreaks like this and other ones.



About 70 percent of all antibiotics used in the United States are given to healthy farm animals.



That is scary!

The Obama administration is at last taking on the ever powerful farming industry-good luck!
The New York Times leader today:

Farms and Antibiotics

July 24, 2009 New York Times
"The Union of Concerned Scientists estimates that 70 percent of the antibiotics used in this country are fed to farm animals. These animals do not receive these drugs the way humans do — as discrete short-term doses. Agricultural antibiotics are a regular feed supplement intended to increase growth and lessen the chance of infection in crowded, industrial farms.

"These practices are putting both humans and animals increasingly at risk. In an environment where antibiotics are omnipresent, as they are in industrial agriculture, antibiotic-resistant strains of diseases quickly develop, reducing the effectiveness of common drugs like penicillin and tetracycline.
"Despite that danger, the Food and Drug Administration had been reluctant to restrict routine agricultural use of antibiotics. The F.D.A.’s principal deputy commissioner, Dr. Joshua Sharfstein, signaled a welcome change in direction recently, testifying on behalf of a new bill, the Preservation of Antibiotics for Medical Treatment Act. It would allow veterinarians to prescribe antibiotics to treat individual animals or prevent disease, but it would sharply restrict the routine feeding of antibiotics to farm animals — the practice most closely associated with the development of drug-resistant pathogens.
"The legislation is drawing strong opposition from the farm lobby since the restrictions would make it much harder for industrial farms to crowd thousands of animals together in confined, inhumane and unhealthy quarters. But the current practice is dangerously self-defeating: treating more and more animals with less and less effective drugs and in turn creating resistant strains of disease that persist in the soil and water. Congress should stop this now before an entire class of drugs becomes useless."

Dr Margaret Mellon of The Union of Concerned Scientists testified before the House Rules Committee in a hearing on H.R. 1549, the Preservation of Antibiotics for Medical Treatment Act (PAMTA).


First appeared: July 24, 2009


Related: New York Times

Hospital Infection: Quorum Sensing