NYTimes: Britain Plans To Decentralized Health Care System

[IllTestYourGirls]

http://www.nytimes.com/2010/07/25/wo...n.html?_r=2&hp

Britain Plans to Decentralize Health Care
By SARAH LYALL

LONDON ? Perhaps the only consistent thing about Britain?s socialized health care system is that it is in a perpetual state of flux, its structure constantly changing as governments search for the elusive formula that will deliver the best care for the cheapest price while costs and demand escalate.

Even as the new coalition government said it would make enormous cuts in the public sector, it initially promised to leave health care alone. But in one of its most surprising moves so far, it has done the opposite, proposing what would be the most radical reorganization of the National Health Service, as the system is called, since its inception in 1948.

Practical details of the plan are still sketchy. But its aim is clear: to shift control of England?s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level. Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use the money to buy services from hospitals and other health care providers.

The plan would also shrink the bureaucratic apparatus, in keeping with the government?s goal to effect $30 billion in ?efficiency savings? in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.

In a document, or white paper, outlining the plan, the government admitted that the changes would ?cause significant disruption and loss of jobs.? But it said: ?The current architecture of the health system has developed piecemeal, involves duplication and is unwieldy. Liberating the N.H.S., and putting power in the hands of patients and clinicians, means we will be able to effect a radical simplification, and remove layers of management.?

The health secretary, Andrew Lansley, also promised to put more power in the hands of patients. Currently, how and where patients are treated, and by whom, is largely determined by decisions made by 150 entities known as primary care trusts ? all of which would be abolished under the plan, with some of those choices going to patients. It would also abolish many current government-set targets, like limits on how long patients have to wait for treatment.

The plan, with many elements that need legislative approval to be enacted, applies only to England; other parts of Britain have separate systems.

The government announced the proposals this month. Reactions to them range from pleased to highly skeptical.

Many critics say that the plans are far too ambitious, particularly in the short period of time allotted, and they doubt that general practitioners are the right people to decide how the health care budget should be spent. Currently, the 150 primary care trusts make most of those decisions. Under the proposals, general practitioners would band together in regional consortia to buy services from hospitals and other providers.

It is likely that many such groups would have to spend money to hire outside managers to manage their budgets and negotiate with the providers, thus canceling out some of the savings.

David Furness, head of strategic development at the Social Market Foundation, a study group, said that under the plan, every general practitioner in London would, in effect, be responsible for a $3.4 million budget.

?It?s like getting your waiter to manage a restaurant,? Mr. Furness said. ?The government is saying that G.P.?s know what the patient wants, just the way a waiter knows what you want to eat. But a waiter isn?t necessarily any good at ordering stock, managing the premises, talking to the chef ? why would they be? They?re waiters.?

But advocacy groups for general practitioners welcomed the proposals.

?One of the great attractions of this is that it will be able to focus on what local people need,? said Prof. Steve Field, chairman of the Royal College of General Practitioners, which represents about 40,000 of the 50,000 general practitioners in the country. ?This is about clinicians taking responsibility for making these decisions.?

Dr. Richard Vautrey, deputy chairman of the general practitioner committee at the British Medical Association, said general practitioners had long felt there were ?far too many bureaucratic hurdles to leap? in the system, impeding communication. ?In many places, the communication between G.P.?s and consultants in hospitals has become fragmented and distant,? he said.

The plan would also require all National Health Service hospitals to become ?foundation trusts,? enterprises that are independent of health service control and accountable to an independent regulator (some hospitals currently operate in this fashion). This would result in a further loss of jobs, health care unions say, and also open the door to further privatization of the service.

The government has promised that the new plan will not affect patient care and that the health care budget will not be cut. But some experts say those assertions are misleading. The previous government, controlled by the Labour Party, poured money into the health service ? the budget is now about three times what it was when Labour took over, in 1997 ? but the increases have stopped. The government has said the budget will continue to rise in real terms for the next five years, but it is unlikely that the increases will keep up with the rising costs of care and the demands of an aging population.

?The real mistake that is being made by the health secretary is to drive through an ideologically determined program of reorganization which is motivated by the principle of efficiency savings,? said Robin Durie, a senior lecturer in politics at the University of Exeter. ?History shows clearly that quality will suffer as a consequence.?

Dr. Durie added, ?The gulf between the rhetoric of the white paper and the technicalities of what is involved in the various elements of the overall reorganization being proposed is just extraordinary.?

For example, he asked, how will the government make good on its promise to give patients more choice ? a promise that seems to require a degree of administrative oversight ? while cutting so many managers from the system?

?How will the delivery of all this choice be funded?? Dr. Durie asked. ?And how will the management of the delivery of choice be funded??

Dr. Vautrey said the country needed to have a ?mature debate about what the N.H.S. can and cannot afford.?

He said: ?It is a sign of the mixed messages that government sends out. They talk about choice and competition and increased patient expectations at the same time as they tell the service they need to cut costs and refer less and prescribe less. People need to understand that while the needs of everyone may be met, their wants will be limited.?

As they prepare for the change, many doctors are wondering whether it will be permanent this time around.

?Many of our colleagues have seen this cycle of change repeatedly,? Dr. Vautrey said. ?Many would look at previous reorganizations and compare it to this one and wonder how long the current change will last before the next one comes along.?

[$5 submissions]

Cutting down bureaucratic layers = lower cost, higher efficiency, and more responsive medicine.

[kane]

This actually sounds like a good idea. One of the main criticisms of government healthcare (or healthcare in general) is that bureaucrats control treatment, not doctors. It looks like this is a step toward changing that.

[Vendzilla]

first the UK< then the US

[marketsmart]

Originally Posted by $5 submissions

Cutting down bureaucratic layers = lower cost, higher efficiency, and more responsive medicine.

notice that the govt never puts lowering the amount of govt on the table only cutting costs of govt benefits to its people...




.

[TheDoc]

We can only hope our new healthcare system can grow to the level that the UK provides.

[DaddyHalbucks]

Privatizing is the way to efficiency.

[Vendzilla]

Originally Posted by TheDoc

We can only hope our new healthcare system can grow to the level that the UK provides.

right, keep dreaming, it will fail, too much government never works

[Relentless]

In case anyone hasn't noticed....

There is an enormous gap between the way the current American system of profiteering necessary medical expenses works and the UK's centralized socialized system. Within the next 10-20 years both countries will wind up with a system that is somewhere between what each country has presently. Not a 100% socialized system with any and all care paid for by a single government plan... and not a price gouging privatized insurance system based on scamming consumers and bilking health care providers.

[tony286]

Originally Posted by kane

This actually sounds like a good idea. One of the main criticisms of government healthcare (or healthcare in general) is that bureaucrats control treatment, not doctors. It looks like this is a step toward changing that.

If u have health insurance, the health insurance company dictates your healthcare.

[kane]

Originally Posted by tony299

If u have health insurance, the health insurance company dictates your healthcare.

Yep, they sure do. I have seen it in action myself. My mom had some serious health issues a few years back. Her doctor found a medicine that worked great for her, but it was expensive so the insurance company said they wouldn't pay for it unless she had already tried two others from a list they had provided. she had tried one and it didn't work. Her doctor had to take her off the one that worked and try another for 30 days. It didn't work as well as the good one so only then would they pay for it but now the will only pay for it every 30 days. Not 29 days. So if the 30th day falls on a sunday when her pharmacy is closed, she is out of luck for that day.

Pretty wild.

[TheDoc]

Originally Posted by Vendzilla

right, keep dreaming, it will fail, too much government never works

Exactly, which is why the UK changed it... be glad ours doesn't have that issue, even though ours still has the extreme corp control issue.. but maybe one day ours can be changed as easily as UK did without one side going all nuts that it won't work out when it works out all over the world already.

[Paul Markham]

Originally Posted by TheDoc

We can only hope our new healthcare system can grow to the level that the UK provides.

That would be a good target.

Both systems of health care systems, private and State funded, are controlled by the money they receive. One is controlled by a Government and it's administrators the other by an insurance company. Both flawed. Who would you trust more, your Government looking to get re elected or a board looking to make a big profit?

[james_clickmemedia]

Originally Posted by Relentless

In case anyone hasn't noticed....

There is an enormous gap between the way the current American system of profiteering necessary medical expenses works and the UK's centralized socialized system. Within the next 10-20 years both countries will wind up with a system that is somewhere between what each country has presently. Not a 100% socialized system with any and all care paid for by a single government plan... and not a price gouging privatized insurance system based on scamming consumers and bilking health care providers.

One can hope this is so.

[ottopottomouse]

The NHS carries a huge amount of staff that just float along doing fuck-all once they are in so knocking them out of the picture would be good.

But handing control over to GPs who already have a surgery to run doesn't make a lot of sense to me especially as they already like to fuss and moan and claim they are overworked.

[Sausage]

Originally Posted by DaddyHalbucks

Privatizing is the way to efficiency.

Nope. Privatizing health never works out.

Having a private system alongside a public system is ok, but privatizing health entirely is a disaster waiting to happen. It then becomes profit driven.

[GetSCORECash]

I have recieved 50 letters in last mnth detailing all the claims my doctors did for a three day stay in the hospital. 50 letters, 6 of which I have not opened, and a quarter of them are denial of payments.

I pay $600 a month for what? The insurance company tells me who to see, and I need to ask permission for every doctor I want to see.

It wasn't like this 10 years ago, it wasn't like this five years ago.

[sperbonzo]

Originally Posted by Sausage

, but privatizing health entirely is a disaster waiting to happen. It then becomes profit driven.

It's hilarious to me that everyone thinks that profit as a driving motive, is a bad idea.

Profit causes more efficient, and more customer (i.e. market) driven services.


Without profit as a motive, you end up with things like the DMV, where nobody could care less about efficiency or customer service. In fact, that is how government, with no profit motive, works in general. There is actually an incentive to be LESS efficient, because if you can show cause that you need a bigger budget next year, you get it.


One of the problems with the health care system in the US, is that with health insurance, the customer NEVER looks at the actual bill to see if they are getting a good deal, it just gets passed to the insurance company and thats the end of it.

Look at the one sector that is TRULY market driven. Plastic surgery. Insurance does not cover it, so the free market takes control. People are looking for the best surgery for the best price. Thus in the last 30 years, cosmetic surgery procedures have DROPPED in price, while the technology and techniques have gotten better. This is the free market in action.

During the same time, prices for insurance covered procedures have shot up.... because the providers know that the customers don't look at the price, they just pass the bill to insurance.


.

[kane]

Originally Posted by sperbonzo

It's hilarious to me that everyone thinks that profit as a driving motive, is a bad idea.

Profit causes more efficient, and more customer (i.e. market) driven services.


Without profit as a motive, you end up with things like the DMV, where nobody could care less about efficiency or customer service. In fact, that is how government, with no profit motive, works in general. There is actually an incentive to be LESS efficient, because if you can show cause that you need a bigger budget next year, you get it.


One of the problems with the health care system in the US, is that with health insurance, the customer NEVER looks at the actual bill to see if they are getting a good deal, it just gets passed to the insurance company and thats the end of it.

Look at the one sector that is TRULY market driven. Plastic surgery. Insurance does not cover it, so the free market takes control. People are looking for the best surgery for the best price. Thus in the last 30 years, cosmetic surgery procedures have DROPPED in price, while the technology and techniques have gotten better. This is the free market in action.

During the same time, prices for insurance covered procedures have shot up.... because the providers know that the customers don't look at the price, they just pass the bill to insurance.


.

While profit motives often cause most businesses to get better and to streamline and compete, in health care they cause providers to skimp on services and deny claims in the sake of profit.

Here is a perfect example. My uncle just had a knee replacement surgery. He is 60 years old. His doctor told him that he would probably spend 2-4 weeks in a nursing home while he recovered and did the physical therapy. His insurance denied him and told him he only got 4 days in the nursing home because they felt 4 days was enough then he could go home and just travel to his therapy. Luckily, his daughter lives near him so he is staying with her for a few weeks and she is driving him to his therapy every day.

Of course we could do away fully with the insurance industry and just have medical care as something you pay for out of pocket as you go. This might drive down the cost, but probably not that much. First off, I doubt employers would be paying their employees that extra money they are saving on not having to buy insurance. They would keep it as added profit so the cost of health care would just become another cost on an already burdened and over-extended middle class. Even if they did give some of it as raises people would be required to save it for it to do any good. If you are an average healthy person you might be able to save that money for years and never use much of it then if something major happened you could afford to pay for it. But if you are someone who has long term care needs and has taken medicine much of your life you may burn through that money as you get it and a major illness could destroy you financially.

Sadly, gone are the days when things were affordable and the free market has shown that people will sit by and let costs rise and do nothing about it. Housing is a great example. In 1950 the average worker made $250 per month and the average home cost around $7000. Today the average working makes $2500 a month, but the average home now costs $183,000. So wages have increased 10 fold, but the cost of the average home is now 26 times higher. Did the middle class demand lower cost housing and only buy cheaper houses? Nope they bought the higher priced houses. Why would health care be any different?

[TheDoc]

Originally Posted by sperbonzo

It's hilarious to me that everyone thinks that profit as a driving motive, is a bad idea.

Profit causes more efficient, and more customer (i.e. market) driven services.


Without profit as a motive, you end up with things like the DMV, where nobody could care less about efficiency or customer service. In fact, that is how government, with no profit motive, works in general. There is actually an incentive to be LESS efficient, because if you can show cause that you need a bigger budget next year, you get it.


One of the problems with the health care system in the US, is that with health insurance, the customer NEVER looks at the actual bill to see if they are getting a good deal, it just gets passed to the insurance company and thats the end of it.

Look at the one sector that is TRULY market driven. Plastic surgery. Insurance does not cover it, so the free market takes control. People are looking for the best surgery for the best price. Thus in the last 30 years, cosmetic surgery procedures have DROPPED in price, while the technology and techniques have gotten better. This is the free market in action.

During the same time, prices for insurance covered procedures have shot up.... because the providers know that the customers don't look at the price, they just pass the bill to insurance.


.

When your stocks and investments are based on growth and profits made, you do everything you can to keep growing, to keep making more profits, or you get no more investments. This includes cutting costs, forcing others to pay more so you keep more, things that they're doing - because they need more profits.

The example of plastic surgery being cheaper shows perfectly how much more expensive and controlling insurance is to the actual market.

[whoops]

Originally Posted by ottopottomouse

The NHS carries a huge amount of staff that just float along doing fuck-all once they are in so knocking them out of the picture would be good.

But handing control over to GPs who already have a surgery to run doesn't make a lot of sense to me especially as they already like to fuss and moan and claim they are overworked.

Yea, this is retarded, Labour did great things with the NHS and it's all too easy to just say cut our administration without really specifying what this is. Labour invested much time and effort into setting up the primary care trusts and such in order to cope and cut costs, to change now after such a huge period of transition is just going to kill efficiency for another few years. Moving more work to GPs, who don't have the previous experience and expertise in these matters won't help either.

edit:

It's hilarious to me that everyone thinks that profit as a driving motive, is a bad idea.

It is when it comes to healthcare, due to the public nature of the good being provided and pretty much the rest of the world agrees.

[IllTestYourGirls]

Originally Posted by TheDoc

When your stocks and investments are based on growth and profits made, you do everything you can to keep growing, to keep making more profits, or you get no more investments. This includes cutting costs, forcing others to pay more so you keep more, things that they're doing - because they need more profits.

The example of plastic surgery being cheaper shows perfectly how much more expensive and controlling insurance is to the actual market.

Well clearly a government run program has the same problem since the UK is about to start rationing some services. I guess the next step is to enslave the doctors and make them work for free.

[L-Pink]

Originally Posted by marketsmart

notice that the govt never puts lowering the amount of govt on the table only cutting costs of govt benefits to its people...
.

Real good point, in effect you are just reducing the workload of government employees. The challenge is to lower the cost of government as well.


.

[TheDoc]

Originally Posted by IllTestYourGirls

Well clearly a government run program has the same problem since the UK is about to start rationing some services. I guess the next step is to enslave the doctors and make them work for free.

Aye, when it's bloated and ran incorrectly, you have to restructure things - that's what they're doing. How the UK system was being ran and how ours is setup to operate, is not the same thing. However, I know it's not perfect - and I can only hope that our healthcare system can shift directions as easily as the UK did without one side pretending that anyone would enslave doctors.

[IllTestYourGirls]

Originally Posted by TheDoc

Aye, when it's bloated and ran incorrectly, you have to restructure things - that's what they're doing. How the UK system was being ran and how ours is setup to operate, is not the same thing. However, I know it's not perfect - and I can only hope that our healthcare system can shift directions as easily as the UK did without one side pretending that anyone would enslave doctors.

Can you name one government run program that is not bloated and broke?

I was being sarcastic about enslaving the doctors

[TheDoc]

Originally Posted by IllTestYourGirls

Can you name one government run program that is not bloated and broke?

I was being sarcastic about enslaving the doctors

Heck any Company or large program is a bit bloated in some areas, it's impossible to name one that doesn't have some bloat and slow downs some place, even in our own corporations.

None of it is broke, money wise... Americans still produce wealth, as long as that happens the Country will never be broke.

I don't feel the mail system is bloated, it works great...it doesn't need to make money either, it offers a service nothing else does and does a damn fine job doing it.

The Military is pretty good run program, organized as can be and it sells the hell out of stuff. That doesn't mean that money is put back on the books for the Country, but it is sold either way. The GI Bill is amazing and works. Social Security was perfectly fine before another president adjusted it. Park Services and the Interior Department do a wonderful job with the little money they have. Lots of gov control in power regulation, they do fine. The National Do Not Call Registry works great. The Census does a good job. The Interstate system went very well and was an amazing job, and still goes today. Federal prisons don't have people escaping all the time. Water is clean, air in most places is clean, ground is clean, sewage is taken care of.

I'm sure plenty more does well, works well, and isn't bloated... not everything the fed touches turns to dust.