US healthcare costs are unsustainable and a large amount of money is being wasted on unnecessary treatment.  There was general agreement about these statements among the audience, speakers and panelists at the recent Avoiding Avoidable Care conference, held in Boston. The summit was organized by the Lown Cardiovascular Research Foundation, the New America Foundation, and co-hosted by the Institute of Medicine. more…

“We have nothing as bad as America’s worst, and nothing as good as America’s best,” wise words said to me by someone many years ago, and this principle has stood the test of time. There are certainly many dreadful things in American healthcare, but there are also wonderful services and excellent innovation with a rigorous evaluation for each of them. In my collection of ten classic articles on better value healthcare, eight come from the United States. This is a paradox. Although they have no finite budget and do not have full population coverage, the thinking and the innovation within healthcare organisations such as Kaiser, or universities such as Harvard or Dartmouth, is streets ahead of the debate in the United Kingdom. But let’s not feel too bad as we have nothing as bad as the worst, for example, the Republican views on healthcare, and the millions who are uninsured. more…

Here is my third and final blog on the USA trip: After Seattle’s integrated care organisations, we visited CalPERS. They fund $6.7bn worth of healthcare for 1.3 million people (roughly twice what we have per person in Lincolnshire). They see themselves as “active” purchasers: managing the market to reduce costs. About two thirds of their members are in capitated plans (for instance Kaiser) whilst the remainder are in a PPO plan (Preferred Provider Organisation). Simple examples of their interventions were to remove co-pay from preventative care for members, to have fiscal and chronic disease management targets and to set a tariff for knee replacement–it all felt familiar. What wasn’t was their analysis by price for knee replacement. It revealed a staggering variation from $15k to $120k. With 46 hospitals they agreed a tariff of $30k but patients could choose to use hospitals that refused the tariff – so long as they paid the difference. It made me think why a tariff for planned procedures may not be such a bad idea. more…

Following our visit to Kaiser Permanente, we travelled north to Seattle and visited the Virginia Mason hospital and Group Health. Linked but distinct, the relationship between the two provided a contrast to Kaiser Permanente – though, as organisations seeking integrated care, there were common themes.

We spent a day at Group Health and yet again I was struck by their emphasis and focus on Primary Care as the central driving force for delivering value: high quality care associated with (relatively, for the USA) lower costs. The term they use for this concept is Medical Home. As at Kaiser, there was a strong culture of medical leadership; the primary care physician is valued as a leader and integrator of care. Their Primary Care Centre (Medical Home) managers all had a clinical background, as well. more…

Here in United States, the latest must have app contains software that blocks any mention of the actor, Charlie Sheen. Until recently, Sheen was the highest paid television star in the world but was fired last week after making caustic comments about his employers in public. Subsequently, he has just been awarded the Guinness World record for having the fastest time to gather more than 1 million followers on Twitter with his devotees presumably awaiting more linguistic utterances such as #biwinning or #tigerblood.  As has been pointed out elsewhere and recently, the Internet can be an unforgiving forum to bare one’s innermost thoughts especially if they contain expletives and unflattering comments about work colleagues. The medical profession seems to be particularly sensitive about this issue and a number of professional organisations have started to publish guidelines for medical students, junior doctors, and other healthcare professionals about how to behave online. It cannot be long before another new app will be created that can vacuum up embarrassing content from Facebook and other social networking sites and destroy the evidence for ever. However, this type of app is likely to be premium priced. more…

“The UK coalition government’s proposals for health reform have generated much heat without a great deal of light. One predictable response has been the “concern” that the private sector is about to take over the running of the health service. Worse still is the prospect of turning the NHS into a clone of the US model of healthcare. more…

The theatre of politics has been on full display in Washington of late. Last week, the House of Representatives voted to repeal the Patient Protection and Affordable Care Act passed in March last year that, among many other things, will ensure that more Americans have health insurance coverage. The vote was largely symbolic for the new Republican-controlled House. For the repeal to become law, it would have to be passed by the Senate, where Democrats have held onto a slim majority, and would finally have to be signed into law by the President. Even with a Republican controlled Senate, the repeal would stall at President Obama’s desk. more…

I’m worried that in the highly charged atmosphere created by the extraordinary US debate on health care my published anxieties about the NHS might brand me as unpatriotic. Perhaps Fox News or some equally evil, right wing American media outlet will track down my words in the Journal of the Royal Society of Medicine and broadcast them. I will be obliged to go onto television in Britain and tearfully recant, rather like a hostage asking for release, saying that I’ve always adored the NHS and have no doubts that it is the best health care system in the world. more…

After the Democratic Convention last week, when healthcare featured in almost every major speech, I had been waiting all week to see whether the Republicans would talk about it at all during their Convention in Minneapolis. Yesterday, on the last day of the Convention, healthcare reform finally got a mention when John McCain took to the stage to deliver his acceptance speech. more…