One of the key downsides of market-based health care — that if your costs regularly exceed your income you go out of business — is not typically associated with the National Health Service in the U.K. That is about to change. It has just been announced that the three hospitals that constitute the South London Healthcare Trust in London, England are to be effectively declared bankrupt, the board suspended, and the organization put under a special administrator. He or she will have just 45 days to provide the Secretary of State with recommendations on what to do with an organization that provides emergency an elective services to about 750,000 Londoners but has racked up nearly $100 million of debt in 2011–12 alone.
Why is this of interest to U.S. readers, aside from adding to the long-running debate on the pros and cons of operating a market in health care? It is because one option is to privatize one or more of the hospitals. By privatize, I mean a whole range of options from franchising out the management to a private company to taking over the assets lock, stock, and barrel and then providing services back to the NHS.
As is always the case when I return from working abroad, it takes me longer, metaphorically speaking, to unpack my bags. I was ostensibly in Brazil to teach and consult about innovations in our population health management movement in America. But, as I expected, I was surely the greater beneficiary of teachings from leaders of the wellness movement in Sao Paulo, the business nexus for the world’s sixth largest economy.
Leaders of population health programs in Sao Paulo offer a self-assessment of being a decade or more behind the United States in the maturation of employee health benefits such as employee assistance programs (EAP), disease management, pharmacy benefits management (PBM), and wellness. I anticipated we would be discussing the “leapfrog” opportunities that come with later adoption of trends. For example, developing countries garnered advantage by skipping much of the costly infrastructure of cable by embracing wireless communications.
So I came to Brazil thinking about what aspects of American health care innovation I would skip over if I had a chance to learn from the trials and errors of America’s health reforms. For example, I found it curious that the Brazilian health care system is likely the closest to America’s with respect to the proportion of employer versus government financing, yet the country had yet to mobilize anything resembling a buyers’ coalition or a business group focused on health or health policy. When I happened upon Brazil’s health commissioner, he told me his main message for employers was to become more proactive with the government in setting health policy. I said “Be careful what you ask for.” It was advice borne out of an American sensibility that public/private partnerships are fraught with ideological perturbation.
Amanada Bennett, a Pulitzer Prize winning journalist, chronicles the poignant journey that she and her now deceased husband, Terrence Foley, traveled in his seven-year battle with a rare form of kidney cancer. The Cost of Hope puts into sharp focus the convoluted compexity of our health care system even for two well educated, well insured individuals with superior skills to acquire, parse and synthesize information and data.
The May 17 New England Journal of Medicine 200th Anniversary edition article The Evolving Primary Care Physician highlights key structural, financial, and cultural challenges that confront primary care in the United States. Some of these include training and education that emphasizes ever greater subspecialization, reimbursement that rewards volume versus value, and an increasing reliance on testing versus well-honed history taking, physical diagnosis, and counseling and coaching of patients and their family members/care givers.
The article touches upon research conducted by Christine Sinsky and Thomas Bodenheimer, supported by the American Board of Internal Medicine Foundation, in which they visited and observed 23 primary care practices.A compelling distillation from Dr. Sinsky:
What I’ve really seen is a lot of waste within the health care system at the level of utilization of physician skills. I think two thirds of many [primary care] physicians' days are spent on documentation, administrative tasks, paper work completion, rote inbox management, data gathering, and data entry. It’s something that is hard to recognize when you’re the one doing it.
To re-invigorate primary care, training needs greater emphasis on history taking skills, motivational interviewing, physical diagnosis, synthesis of information, more judicious use of testing and imaging, and engaging patients in their health care.
I expect the next 10 years of policy debates, action, and inaction concerning how to curb our obesity epidemic to be an accelerated version of the last 30 years of public policy related to fighting tobacco.
This week’s HBO documentary, The Weight of the Nation, landed a flourish of solid blows against the wrong-headed notion that obesity is simply about lack of will power. The broadcast is based on the report “Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation.” It’s the product of an extraordinary, even historic coming together of the Institute of Medicine, the Centers for Disease Control, and the National Institutes of Health. The report and the documentary make one point exceedingly clear: Obesity is a multifaceted problem that will require multifaceted solutions.
At age 89, Dr. John Sarno has retired from his clinical practice at the Howard A. Rusk Institute of Rehabilitation Medicine at New York University School of Medicine where he is a professor of rehabilitation medicine. I consider John a friend, a thought-creator in the field of mind body medicine, and someone to whom I owe a profound debt of gratitude in that my wife, Suzanne, was cured of seven years of debilitating back pain by embracing the etiology of her pain as psychologically based.
The collective sigh heard earlier this month came from frazzled physicians and medical groups relieved that the Centers for Medicare & Medicaid Services issued a new deadline for implementing ICD-10, pushing it back to Oct. 1, 2014. Implementing the codes — about 155,000 of them, as opposed to the approximately 17,000 for ICD-9 — has been giving providers nightmares.
On April 4, the American Board of Internal Medicine Foundation launched Choosing Wisely, a campaign to educate health care professionals and consumers about tests or procedures that should be questioned because of lack of evidence that they’re needed and/or because of evidence that says the tests or procedures should not be done in the context that is delineated. http://www.abimfoundation.org/.
One of the four 2011 Malcolm Baldridge National Quality Award winners in health care is Southcentral Foundation, a nonprofit organization established in 1982 to serve Alaska Natives who live in and around Anchorage. The Southcentral Foundation (SCF) describes itself as a Nuka system of care — Nuka being an Alaska native name given to strong, honorable structures or living things.
I love my colleagues in Information Technology. I also love greasy doughnuts. Why then, do I not love it when I.T. people bring in a big crate of greasy doughnuts to reward each other for their hard work? They only do this occasionally. Still, my latest way to chide them about it was to put a recent section of the Wall Street Journal right alongside their gloriously globby booty.