Just before each general election, I am always intrigued to see how the Economist will cast their vote. Although I don’t always agree with their decisions on this or any other matter they address, it’s always a stimulating read.  Actually the article that really caught my eye this week (1st May, 2010) was the analysis of how some US healthcare providers are controlling costs whilst improving quality.

The involvement of patients is clearly a key part of this cost containment and quality improvement – perhaps a little like we have seen with petrol stations, supermarkets and banking.  Odd really, as I loathe using any of them.  The Economist article (which highlights the strategy taken by Kaiser Permanente, well studied by many policy wonks on this side of the pond) sees four features in a sustainable health care system. 1) enabling patients to genuinely consult the system using simple IT; 2) vertical integration from specialist care through to self-care and prevention; 3) innovation: systematic improvement of value, efficiency and outcome by changing traditional practice (sometimes transformationally);  4) aligning incentives to improve real prevention and minimise those investigations and interventions that add little value.  Two thoughts:  a) when I worked in China, some people seemed to pay their health care workers until they got sick and then stopped paying them.  Quite an incentive.  Secondly, the sustainability Kaiser Permanente’s approach is more than just financial; their system, like that of Cuba, seems much more compatible with a low carbon future.