Category: UK/NHS

OECD Waiting Times Study Executive Summary

I realized that while I have a link to this study elsewhere, it is rather a pain to get to the information because the document is in pdf.

Now, this is from 2003, and so the UK/NHS data is now happily out of date. And leaders in Canada have seen the results in the UK and are pushing to end the bloc financing of hospitals that helped so much in the UK. But anyway, here is the summary:

  • Waiting times for elective surgery are a significant health policy concern in approximately half of all OECD countries.
  • This report is devoted to [analyzing waiting times]. An interesting feature of OECD countries is that while some countries report significant waiting, others do not.
  • Waiting times are a serious health policy issue in the 12 countries involved in this project (Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom).
  • Waiting times are not recorded administratively in a second group of countries (Austria, Belgium, France, Germany, Japan, Luxembourg, Switzerland, and the United States) but are anecdotally (informally) reported to be low.
  • This paper contains a comparative analysis of these two groups of countries and addresses what factors may explain the absence of waiting times in the second group. It suggests that there is a clear negative association between waiting times and capacity, either measured in terms of number of beds or number of practising physicians. Analogously, a higher level of health spending is also systematically associated with lower waiting times, all other things equal.
  • Among the group of countries with waiting times, it is the availability of doctors that has the most significant negative association with waiting times. Econometric estimates suggest that a marginal increase of 0.1 practising physicians and specialists (per 1 000 population) is associated respectively with a marginal reduction of mean waiting times of 8.3 and 6.4 days (at the sample mean) and a marginal reduction of median waiting times of 7.6 and 8.9 days, across all procedures included in the study.
  • Analogously, an increase in total health expenditure per capita of $100 is associated with a reduction of mean waiting times of 6.6 days and of median waiting times of 6.1 days.
  • In the comparison between countries with and without waiting times, low availability of acute care beds is significantly associated with the presence of waiting times. Also, evidence from this and other studies suggests that fee-for-service remuneration for specialists, as opposed to salaried remuneration, is negatively associated with the presence of waiting times. Fee-for-service systems may induce specialists to increase productivity and may also discourage the formation of visible queues because of competitive pressures. In addition, evidence from this and other studies suggests that activity-based funding for hospitals may also help reduce waiting times.

Exclusive: NHS hospital waiting times are the lowest since records began – mirror.co.uk

Exclusive: NHS hospital waiting times are the lowest since records began – mirror.co.uk:

“Hospital waiting times are the lowest since records began, Health Secretary Alan Johnson will say today as he rounds on critics of the NHS.

“Mr Johnson aims to hit back at the doom and gloom-mongers by showing how the nation’s health service has been transformed for the better in the 12 years since 1997.

“He will highlight figures showing delays for treatment have fallen in many areas.”

Some of the numbers are quite impressive. I don’t think these numbers are significantly different than US (and by that, I mean these are not intolerable waits by most standards). And remember, they hae health care for their entire population, not just those who can afford it.

EzraKlein Archive | The American Prospect

EzraKlein Archive The American Prospect

This is just too fun. Fraser Institute puts on prominent Canadian physician to dis Canadian health care, which he does, mildly IMHO, but then proceeds to dis the American system even more!

And Dr. Day (former CMA President) makes some great points:

1. Waiting times are a function of the way Canada funds hospitals, by bloc grants to hospitals rather than having money follow the patients as in the rest of the world.

2. Waiting times cost more, particualarly in terms of patients illness progression and economic costs of lost work, wages, productivity, etc.

3. Britain has essentially fixed its waiting time issues by dispensing with the bloc system.

4. “I think this is what people tend to forget. They equate alternatives to the Canadian health care system with ‘Americanization,’ which is not what we’re talking about. We’re talking about countries like Belgium, and Switzerland, and France, and Austria.”

5. One should be able to buy private health insurance (in Canada) to supplement the Candian Medicare system.

Annals of Public Policy: Getting There from Here: Reporting & Essays: The New Yorker

Annals of Public Policy: Getting There from Here: Reporting & Essays: The New Yorker:

“Social scientists have a name for this pattern of evolution based on past experience. They call it “path-dependence.” In the battles between Betamax and VHS video recorders, Mac and P.C. computers, the QWERTY typewriter keyboard and alternative designs, they found that small, early events played a far more critical role in the market outcome than did the question of which design was better. Paul Krugman received a Nobel Prize in Economics in part for showing that trade patterns and the geographic location of industrial production are also path-dependent. The first firms to get established in a given industry, he pointed out, attract suppliers, skilled labor, specialized financing, and physical infrastructure. This entrenches local advantages that lead other firms producing similar goods to set up business in the same area—even if prices, taxes, and competition are stiffer. “The long shadow cast by history over location is apparent at all scales, from the smallest to the largest—from the cluster of costume jewelry firms in Providence to the concentration of 60 million people in the Northeast Corridor,” Krugman wrote in 1991.
With path-dependent processes, the outcome is unpredictable at the start. Small, often random events early in the process are “remembered,” continuing to have influence later. And, as you go along, the range of future possibilities gets narrower. It becomes more and more unlikely that you can simply shift from one path to another, even if you are locked in on a path that has a lower payoff than an alternate one.”

It’s actually hard to get a representative paragraph out of this article. It is definitely worthwhile reading, as is everything Gawande writes, and begins with an overview of how universal healthcare took hold in England, France and Switzerland, and then makes the case for “path dependence”, which starts the section I’ve quoted above.

Because I haven’t written it in a while, Ill repeat a story. At a debate among single payer advocates and antagonists at Duquesne University last year, I asked the representative of the very right wing Fraser institute of Canada, which of the world’s nations systems he could live with us modeling ourselves after. Switzerland was the answer, and he conceded that the hybrid of using competing insurers and providers while requiring universal coverage with subsidies may be the second best solution for America. After laissez–faire capitalism, of course.

But it does make the point that the combination of path dependence and bits of common ground could lead us to real change.

The Evidence Gap – British Balance Benefit vs. Cost of Latest Drugs – NYTimes.com

The Evidence Gap – British Balance Benefit vs. Cost of Latest Drugs – NYTimes.com

“RUISLIP, England — When Bruce Hardy’s kidney cancer spread to his lung, his doctor recommended an expensive new pill from Pfizer. But Mr. Hardy is British, and the British health authorities refused to buy the medicine. His wife has been distraught.

“Everybody should be allowed to have as much life as they can,” Joy Hardy said in the couple’s modest home outside London.

“If the Hardys lived in the United States or just about any European country other than Britain, Mr. Hardy would most likely get the drug, although he might have to pay part of the cost. A clinical trial showed that the pill, called Sutent, delays cancer progression for six months at an estimated treatment cost of $54,000.

“But at that price, Mr. Hardy’s life is not worth prolonging, according to a British government agency, the National Institute for Health and Clinical Excellence. The institute, known as NICE, has decided that Britain, except in rare cases, can afford only £15,000, or about $22,750, to save six months of a citizen’s life.

“British authorities, after a storm of protest, are reconsidering their decision on the cancer drug and others.

“For years, Britain was almost alone in using evidence of cost-effectiveness to decide what to pay for. But skyrocketing prices for drugs and medical devices have led a growing number of countries to ask the hardest of questions: How much is life worth? For many, NICE has the answer. “

What a great piece. I’ve been hearing more and more about NICE lately, with this being the most visible publication on it.

As I’ve said elsewhere under the “Rationing” label, I would much rather have a fair, national or regional, system of objective analysis by scientists deciding on what care we offer to patients than the current method. The current method being everything for everyone all the time until we can peel the oncologists (sorry, guys! Others of us are guilty, too!) off the patient. Our current method also includes allowing Lilly to lobby for new reimbursement codes to pay for Xigris, or Zimmer to get Medicare to pay twice as much for a “women’s” TKR and assorted other pieces of free market capitalism.

But the US’ favorite method of rationing care, of course, is by income. Don’t have it, don’t get it.

UK – OECD Summary

Summaries of summaries of healthcare systems based on the Commonwealth Fund reports.
Author(s) of the originals are:
Karsten Vrangbaek, Isabelle Durand-Zaleski, Reinhard Busse, Niek Klazinga, Sean Boyle, and Anders Anell

UK/NHS
• The UK, along with Sweden, is a prototypical socialized system.
• Essentially everyone is covered and all the funding takes place through a federal government taxes.
• General taxes account for 76% of the funding and then there are national insurance contributions to account for 19% of the funding. (I do not understand what the national insurance contributions are or where this money comes from.)
• User charges also account for a further 5% of the funding.
• Cost-sharing amounts to small drug co-pays of $14 but this is only for about 12% of all prescriptions written so it is therefore relatively small amount. In other words 80% of prescriptions require no co-pay.
• Dental requires up to $400 per year out of pocket before reimbursement occurs (I think).
• Out-of-pocket expenses account for 12% of the total health care expenditure.
• Primary care physicians are paid directly by the primary care trusts through capitation, salary, and fee-for-service arrangements.
• Hospitals are run by national health service trusts.
• Consultants and specialists are salaried.
• The private system in Britain covers approximately 12% of the population. It is a mix of profit and not-for-profit providers as well as supplementary insurance.

BBC NEWS | Health | GP salary surge goes into reverse

BBC NEWS | Health | GP salary surge goes into reverse:

“Inflation-busting pay rises for many GPs in recent years have been halted – with the average salary falling in 2006/07, NHS figures show.

The average salary for 85% of GPs was £104,000, a fall of 2.4%.

This comes after sharp rises following a new GP contract in 2004 – as much as 58% on average , according to a spending watchdog.

The British Medical Association said most earned under £100,000, and further falls could risk damaging morale.”

The exchange rate is about two to one, so, GPs are making the equivalent or $200K. Not too shabby. The downside is that their salaries seem to be so much more dependent on the prevailing political and economic winds than are ours. But, as we saw with the recent battle to prevent across the board Medicare cuts, we face this pressure as well.

Out of curiosity, I checked to see where this income fits in British households. The top quintile for household income in the UK starts at £72.9K

Health Care System Profiles

Health Care System Profiles:

“The work of the Commonwealth Fund’s international program highlights the valuable lessons the U.S. can learn from the health care systems in other industrialized countries. These country profiles provide overviews of the health care systems of several countries, including Denmark, France, Germany, the Netherlands, Sweden, and the U.K. Each profile includes descriptions of how each country organizes, finances, and delivers health services and highlights quality, efficiency, and cost-controlling policy initiatives and reforms”

Follow the link to this page at the Commonwealth Fund website to download individual country profiles or the whole thing.

Here is a remarkable slide presentation from the Commonwealth Fund aggregating in PowerPoint form, a large quantity of data on systems around the world.

Continuing my education in international comparative health policy…

Need Some Botox With that Flu Shot? : NPR

Need Some Botox With that Flu Shot? : NPR:

“Primary care doctors say they’re having more and more trouble making ends meet. They’re drowning in required paperwork and getting paid less than specialists. So, a growing number of general practitioners are adding cosmetic procedures to their offerings as a way to bring in more money.”

No surprizes in this story, except at the end there is a bit of discussion of the reimbursement differential among procedure-based specialties and the rest of us.

And NPR really seems to be giving healthcare the full coverage blitz lately. Lots of stories about healthcare including this one on Morning Edition documenting the travails of two patients with MS. The first in the “new and improved” NHS in Britain and the other, a man in Philadelphia who thought he had good healthcare insurance.

And here is a link to their “Health Care for All” home page.

FRONTLINE: sick around the world: five capitalist democracies & how they do it | PBS

FRONTLINE: sick around the world: five capitalist democracies & how they do it PBS:

“Each has a health care system that delivers health care for everyone — but with remarkable differences.”

Summaries of the five countries covered in the Frontline episode: UK, Germany, Japan, Taiwan and Switzerland.