© Am Ang Zhang 2012
Saturday, September 15, 2012
Friday, September 14, 2012
NHS: Faults & Fraud!
A very personal view indeed:
Our NHS is not without faults and often the faults were to do with government. Impossible targets set up by successive governments have one aim: limit access to health care.
I wrote in 2008 in The Cockroach Catcher:
The doctor’s position had over the last ten years moved nearer the bottom end with no such counter moves by politicians. Some argued that the rot started with Shipman and the move to check on doctors’ competence will soon become law. The sad truth is that incompetence was not Shipman’s problem as he was able to shield the deaths that he created with his expert medical knowledge. The incompetence was with those that regulated him. He was probably more up-to-date with medicine than most, and expert at euthanasia. Recent scandals relating to Cleveland, Bristol, Alder Hey, Kent Authority, and MMR all help to erode people’s trust in their doctors and their regulator, the GMC.
Then we have Mid-Staffordshire & Baby P amongst others that demonstrated how if you try hard to meet targets patients died and if you whistle-blow, you die professionally. Successive governments tried to pretend that the problems have nothing to do with their main aim: cutting funding to Health Care of the citizens of the land in the form of covert rationing.
So, a new sales pitch came in: Choice & Competition to improve the quality of health care plus let us involve the privateers as they are good.
Good at what!
Making money: for themselves. Remember Southern Cross and now A4E?
Then we have world class cancer hospital and third world cancer survival. No it did not make any sense at all.
So the decision was to get rid of the NHS as it was but retain the name as a brand.
But!!! And a very big BUT!!!
Why not legislate to rein in Health Insurers?
- 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.
·
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 “individual personalised budget” 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 their 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.
“……The principle of care for all from cradle to grave is worthy and wonderful. But the current reality is a cradle rocked by accountants who are incapable of even counting the number of times that they have rocked it……..” These are the very same people we pay market rate or they will go elsewhere!!!
Thursday, September 13, 2012
Private Hospital: Care to join us?
©2010 Am Ang Zhang
It is still fresh in most of the ordinary citizens’ minds that market forces were the main driver behind “dis-genuine mortgages” that eventually led to the near total collapse of the first world’s financial system. In the meantime, our government is considering the use of market forces to keep the cost of health care funding in check.
The HSCB is now HSC Act and my reading is that medicine in England will change and it is now too late for us to do much. One day, the ordinary citizens of the land will realise that they have lost what was once a very genuine style of medicine. Sad, very sad.
Allowing private providers into a relaxed competitive market funded by the tax-payers is likely to lead to escalating costs and “dis-genuine medicine” being practised. Private companies need to make profits, and if set up as non profit making, need to pay their CEOs huge salaries. Where is all that money going to come from?
Some years ago (in fact nearly 30 years ago) I was faced with caring for a highly disruptive manic adolescent at home, as none of our psychiatric units (adolescent or adult) had room for such a patient. With only a very junior social worker in attendance, I had to sedate the boy at home with injections of major tranquillizers. Our hospital secretary, having heard of my heroic attempt to manage the patient at home, decided that he should be admitted into a private psychiatric hospital. The hospital concerned was agreeable as long as I remained his consultant. They would provide the nursing and junior doctor support.
My daily visits took the better part of half a day in those days. Before then, I had never set foot in a private psychiatric hospital. When we had some spare time, the junior doctor took me round the complex. I was suitably impressed with the buildings, the décor and the apparent pleasantness of the whole milieu. Then I passed a ward where quite a number of patients were on drips and each with a nurse in attendance.
"ECT?"
"No, modified narcosis! They came from all over the world, 30 days at a time."
What, this was the late 70s and I have only read about this treatment method in ancient text books!
"What do you use?"
"Barbiturates mainly!!!"
This was well before Michael Jackson’s era.
“You can join us if you like. We are short on Child Psychiatrists and there is a huge demand in areas of anorexia nervosa. You will earn three times, if not more, than what you do now!”
Soon after, I talked to a friend and my patient was transferred to the Maudsley, where he stayed for another 9 months.
I preferred to practise “genuine medicine” in the NHS.
News came of a doctor in America giving unnecessary stent operations to patients.
Abbott Laboratories hired a Baltimore-area cardiologist as a sales consultant after he was barred from practicing at a local hospital last year for allegedly putting heart stents in hundreds of patients who didn't need them, say Senate investigators probing the medical-device industry.
Their report, to be released Monday, shines a light on one of the most lucrative procedures for hospitals and medical-device makers, at a time of spiraling health-care costs. Medicare paid some $25.7 billion for stent surgery in the six years through 2009, according to the report.
This is the danger. When doctors are paid for on a case by case basis by private health providers, they will find it hard to practise “genuine medicine”.
No wonder doctors are paid salaries at Mayo Clinic, Cleveland Clinic and Johns Hopkins Hospital: some of the most respected names in American Medicine.
Christmas came and went: 50% discount at the stores is now followed by 75% discount.
Would one of the private providers be offering: have one hip replacement, get the other one free! Two cataracts for the price of one etc.
Or:
We check the prices of other insurers and we will match them!
Is that what the government think will keep health care cost down?
Spring Rationing: Hospital Avoidance
Sunday, September 9, 2012
NHS & Medicare: Blowing In The Wind!
Blowing In The Wind© Am Ang Zhang 2012
Latest Medicare Fraud Dallas, Texas, USA.
Federal authorities announced charges Tuesday in the largest healthcare fraud scam in the nation's history, indicting a Dallas-area physician on charges that he bilked Medicare of nearly $375 million and accusing him of sending "recruiters" to scoop up patients and get them to sign for treatments he never provided.
Prosecutors said Roy and his office manager in DeSoto, Teri Sivils, who was also charged, sent healthcare "recruiters" door-to-door asking residents to sign forms that contained the doctor's electronic signature and stating that his practice had seen them professionally in their own homes.
They also dispatched "recruiters" to a homeless shelter in Dallas, paying the recruiters $50 every time they coaxed a street person to a nearby parking lot and signed him up on the bogus forms.
Even when officials suspended his Medicare license last June, they said, Roy found a way around that by shifting his business to another company.
Claims that there is no socialised medicine in the US is unfounded an their expenditure is scary! Yet there are very talented people trying to scam the system and unfortunately that includes doctors that will even do stents and transplants.
Why can we not learn!
Medicare is a national social insurance program, administered by the U.S. federal governmentsince 1965, that
guarantees access to health insurance for Americans ages 65 and older and
younger people with disabilities as well as people with end stage renal
disease. As a social insurance program, Medicare spreads the financial risk
associated with illness across society to protect everyone, and thus has a
somewhat different social role from for-profit private insurers, which manage
their risk portfolio to maximize profitability by denying claims.[1]
Medicare spending is projected to increase from
$560 billion in 2010 to just over $1 trillion by 2022.[20] In
response, policymakers recently have offered a number of competing proposals to
reduce Medicare costs. From Wikipedia.
Medicaid is the United States health program for certain people and families
with low incomes and resources. It is a means-tested program that is jointly funded by the state
and federal governments, and is managed by the states.[1] People served by Medicaid are U.S. citizens or legal permanent residents, including
low-income adults, their children, and people with certain disabilities. Poverty alone
does not necessarily qualify someone for Medicaid. Medicaid is the largest
source of funding for medical and health-related services for people with
limited income in the United
States
According to CMS, the Medicaid program provided health care
services to more than 46.0 million people in 2001.[12][13] In
2002, Medicaid enrollees numbered 39.9 million Americans, the largest group
being children [14] (18.4
million or 46 percent). Some 43 million Americans were enrolled in 2004 (19.7
million of them children) at a total cost of $295 billion. In 2008, Medicaid
provided health coverage and services to approximately 49 million low-income
children, pregnant women, elderly people, and disabled people. InCalifornia, about 23% of the population was
enrolled in Medi-Cal for at least 1 month in 2009-10.[15]
Medicaid payments currently assist nearly 60 percent of all
nursing home residents and about 37 percent of all childbirths in the United States
NHS:
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.
I have highlighted the problems in the US
The US
By how much? In the US
26 OCT 2009
The U.S.
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.
“The Federal Bureau of Investigation (FBI) estimates that fraudulent billings to public
and private healthcare programs are 3-10 percent of total health spending, or $75–$250
billion in fiscal year 2009.”
“Fraud and abuse” occupies the extreme end of the continuum of appropriateness of use and potential waste. While arguments can be made about the appropriateness of some of the care described in the previous section, and, therefore, its classification as waste, no reasonable argument can be made for the contribution of fraud and abuse to quality of care or outcomes. They are cases of intentional misrepresentation resulting in excess payment, including billing for services never rendered and the knowing provision of unnecessary care. Most fraudulent and abusive practices simply add cost with no value, but others actually expose patients to the risk associated with unnecessary procedures.
Practices leading to waste include:
• The intentional provision of unnecessary or inappropriate services
• Billing for services never provided, often with patients’ participation in the fraud, often for
deceased patients
• Misrepresentation of the cost of care by insurers to group plan sponsors
• Kickbacks for referrals for unnecessary services
• Misbranding of a drug by a pharmaceutical company
• Abuse of the healthcare system by patients to receive harmful services, such as Medicaid recipients with drug addictions enrolling in multiple states.
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.
BBC 20 May 2008
“A dentist and his wife who stole more than £30,000 from the NHS by claiming money for treatment never given to patients have been jailed.
Newton Johnson, 52, and his wife Judith, 51, also claimed for treatment for "phantom" patients, which included the name of a family pet dog.
NHS: Changes Or A Conspiracy Against The Public Interest
NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.
Email: cockroachcatcher (at) gmail (dot) com.
The book is free.
FREE eBook: Just drop me a line with your email.
Email: cockroachcatcher (at) gmail (dot) com.
The Cockroach Catcher on Amazon Kindle UK, Amazon Kindle US
Saturday, September 8, 2012
Finland: Bokeh & Light 2
© Am Ang Zhang 2012
© Am Ang Zhang 2012
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Friday, September 7, 2012
Finland: Woodland Scene.
© Am Ang Zhang 2012
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Thursday, September 6, 2012
NHS: Covert Rationing & Sunset in Finland.
Looks like COVERT RATIONING of Health Care in the NHS is not that COVERT anymore; so from Finland I am reprinting one of my posts.
© Am Ang Zhang 2012
Yes, the sun is setting in Finland and soon the NHS too.
88% of Finns are satisfied with their universal health care and suicide rate has dropped to 19th place after Switzerland & Belgium. Infant mortality is better than that of Singapore.
According to the NAO:
According to the NAO:
In 2009 the total value of the market for PH(Private Healthcare) in the UK
The total number of UK
The NHS was not perfect, far from it and yet successive attempts at fixing it has produce the opposite effect: it needs more fixing.
If you read that line again from the NAO report, it was clear where the problem was: fees to surgeons, anaesthetists and physicians!!!
Yes, that was the main recipient of Private Health income.
To become a Consultant in the NHS used to be prestigious and even those aiming to doing mainly private work will have to wait till they achieve Consultant status in the NHS.
The NHS for all its sins tried to keep every consultant as close to the MAYO ideal by insisting on the same pay-scale.
Several levels of Distinction Awards were used to keep some professors and top consultants happy. Later the name of the Awards was changed and yet it was still the same soup.
If Consultants were prepared to give up one session of pay, then there is no limit as to the private work they can take on. It was a safe way to start your private work and you keep the rather nice NHS pension.
What is generally not talked about is that you keep one foot in your NHS hospital and one in your private one.
So far so good and yet this is where the problem starts.
It does not need a genius to work out that people worry about their health and do not want to wait for a suspicious lump to stay in their body too long. They will pay. We need not even mention the manipulation of waiting lists, etc. Then big companies realise that they can attract staff by offering Health Insurance and the rest is as they say history.
Then the rules changed and every consultant can do a maximum of 10% of their NHS pay in private work without having to give up anything. Some hospitals even allow you to use their facilities for a small fee.
Why not, more private patient means less expenditure for the NHS.
Private Insurers discovered that too and they started offering a small fee if you can wait for your operation at your free NHS hospital.
There has never been any control of Health Insurers and I suspect if was not even because they have a strong lobby: just the feeling that the NHS was for everybody so no one could be excluded.
But Health Insurers are cleverer, they exclude chronic conditions, many psychiatric ones belong to that group and often they will exclude after a while.
So, indeed it was a clever move by the present government to simply hand over a portion of money to the GPs and say: get on with it, the best price or better still, why not treat them yourself. You are all doctors, forgetting one of their own just had neurosurgery done at Queen Square.
Until, now Consultants are to be excluded from the consortia. Most are not making too much noise for a very good reason.
There just are not enough of us Consultants and the reform is really COVERT rationing by any other name.
How else could the government continue to claim that competition will improve standard and bring down cost.
Private or NHS, they are the same Surgeons, Anesthetists and Physicians. Yes, the same consultants. Only in Private Hospitals you may get free cappuccinos.
It is so simple: Private Providers need to make a profit so there is going to be less money for patient care, not more.
Mark Porter: Chairman of the British Medical Association's consultants committee.
NHS services in some parts of England
The worst-hit patients would include those with chronic diseases such as obesity, diabetes and heart failure, Porter added. They would have to travel longer distances for treatment.
The government is taking unnecessary risks by imposing market measures on the NHS, as competitive healthcare cannot deliver high quality treatment to everyone.
The NHS could become "a provider of last resort" for patients whose illnesses are of no interest to private firms, added Porter. Once independent providers have signed contracts with the consortiums of GPs they could deny care to patients who would be costly to treat, Porter warned.
If we want to keep serving the best interests of our patients,
we must reject the language of the market
and embrace the language of
caring.
NHS & Market Forces: Fund Holding & Medical Ethics
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