Thursday, August 25, 2011

NHS Reform: Choice?

Choice? Really!!!

Incidentally, for the last 5 years I have been subject to "patient choice". Every six months my GP and my local optician send me a letter telling me that I need to have my retinas screened. Every six months I politely phone them up and tell they to take me off their marketing lists because I am seen every six months by a consultant at the hospital retina clinic. (I don't want to upset GPs or opticians, but honestly, do you really think you know more about my retinas than the specialist at the hospital?) Neither the GP, nor the optician, have shown any sign of removing me from their marketing list. Beware, AQP will open the floodgates to far more companies touting for business like this.                                     RICHARD.BLOGGER:Cost of diabetes

Anyone who cared to Google Private Health Insurers will find that many conditions are excluded from their "comprehensive" Health Care. The full list is too long and I might be infringing their copyrights. See if dialysis and intensive care treatment are covered. What kind of "comprehensive" Health Care is it to exclude both.

Choice? Really!!! Just try not to get this funny E. Coli. As when you need dialysis you may have to choose NHS. But then, you might be so ill and unconscious.....mmm interesting thought. How does one choose when very unwell?

In a previous blog post I stated: Cherry picking soon? 
©2010 Am An Zhang

When all the talk is about trying to emulate Kaiser Permanente in the NHS reform up and down the country, my observation is that unless there is some radical rethink, the new NHS may end up as removed from Kaiser Permanente as imaginable.

Ownership and integration
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.

Sacrifice choice:
It is evident that the drive to offer so called choice in the NHS, and the ensuing cross-billing, has pushed up cost.  The setting up of poor quality ISTC (Independent Sector Treatment Centres) that are hardly used is a sheer wastage of resources.  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.

Covert Rationing:
The push for near 80% of GP commissioning is to lure the public into thinking that they are going to be better served.  In fact this is a very clever way to limit health spending and at the same time leave the rationing to the primary care doctors in a very un-integrated system.

So what about the specialist doctors that we call consultants in England?  Well, some are already offering their services in a private capacity to the GPs via PCTs, who are at liberty to buy those services. The NHS pay for hospital Consultants has now lagged behind that of GPs, and many consultants supplement their income by private work. Once you have had a taste of Porsche and Ferrari, are you going to go back to Rover?  A few major insurers are poised to buy up Foundation Hospitals and offer consultants a deal they cannot refuse.  This will lead us further away from the Kaiser Permanente ideal of an integrated system.

Has anyone not noticed that you buy private insurance to get your Specialist treatment? The gatekeeper is still your friendly GP.

The total income for all Private Health Insurers is currently estimated at around £6.5 billion, a quarter of which goes to the Specialists.

The NHS is already funding 20 to 25% of the Private sector.

Internal Market
By contrast, Kaiser Permanente is in part successful by doing away with the internal market and fees for service.

"In reality, Lansley's health white paper opens the door to the comprehensive privatisation of healthcare and the end of the NHS as a national service. If the plans are taken to their logical conclusion, by 2015 the NHS will be little more than a brand. From a major public service with a million employees, it will have become a central fund with a minimal workforce, commissioning services from a string of private companies in a fully-fledged healthcare market.

"'The bottom line of this is the abolition of the NHS,' Dr David Price of Edinburgh University argues. "It will remove the government's duty to provide a universal healthcare service." His colleague, Professor Allyson Pollock, believes it will lead to "full privatisation".

"Meanwhile, all hospital trusts are to be turned into freestanding businesses outside the NHS. They will be allowed to go bust or taken over, encouraged to form "partnerships" with profit-making private companies and obliged to remove all limits on private provision. These new, independent trusts are supposed to be not-for-profit "social enterprises", but health policy experts scoff at the distinction when profits can be distributed as "surpluses" or extravagant salaries to directors.

"Why should anyone worry who provides healthcare? Because the weight of evidence is that private markets in health bring exorbitant administrative costs, lead to cherry picking of more profitable patients, increase inequity and the postcode lottery gap, generate conflicts of interest, are unaccountable, and increase pressure for top-up payments and "care package" limits.

"The scandalous costs of creeping privatisation are already clear enough, from PFI projects to independent treatment centres. This year the Commons health select committee found administration costs had risen from 6% to 14% by 2005 as a result. They're certainly higher now – and are double that in the US, by some estimates. But now the coalition wants to put the NHS in the hands of the very health corporations that fought Barack Obama to a standstill over his attempt to bring universal health coverage to the US."


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