Ken
So it alleged. He is also alleged to have argued that the best way to
communicate with doctors was to write messages on cheques/checks! The
Brits stuffed the mouths of primary care GPs and hospital
consultants/specialists with gold in 2004. It cost billions (see
National Audit Office reports)with no evidenced gains in hospitals and
much acclaim but seemingly modest health benefits from making GPs richer
(e.g see Fleetcroft and Cookson JHSRP Jan 2006 as opposed to the
material in the NEJM!))
A nice issue is who should deliver "primary care". The local trade
union, the British Medical Association, says GP-population list sizes
should continue to decline. The GP -Quality Outcomes Framework has been
delivered with investment in nurses. Surely the GP-population ration
should rise, and nurses if equally effective are so much cheaper!! For
some reading on such non controversial issues see Health Policy Matters
numbers 8 and 10 at www.york.ac.uk/healthsciences/pubs/hpmindex.htm
Alan
Thompson, Ken (SAMHSA/CMHS) wrote:
>
> Hi Barbara et al.
> I have my candidates for the vested interests, but wondered if you
> were willing to venture yours.
> Didn't Bevan get the NHS through by "stuffing the mouths of the
> doctors with gold?"
>
> Ken
>
> ----- Original Message -----
> From: Anglo-American Health Policy Network <[log in to unmask]>
> To: [log in to unmask] <[log in to unmask]>
> Sent: Fri Jan 09 08:41:55 2009
> Subject: Re: Reform - from Joe White
>
> I totally agree with Barbara.
> Best,
> Shirley
>
>
> Shirley Johnson-Lans
> Chair
> Department of Economics
> Vassar College
>
>
> ----- Original Message -----
> From: Barbara Starfield <[log in to unmask]>
> To: [log in to unmask]
> Sent: Thu, 8 Jan 2009 14:34:01 -0500 (EST)
> Subject: Re: Reform - from Joe White
>
> I beg to differ. We know a fair amount about many features of health
> care delivery. We know, for example, that a primary care oriented
> health system is better all around (effectiveness, efficiency,
> equity) than a specialty oriented system (which the US has in spades)
> and we also have good cluese as to why that is the case. The problem
> is that an extraordinary array of vested interests greatly prefer a
> specialty oriented system because they gain a lot from it----just the
> kind of situation that Professor Normand refers to. The vested
> interests are so strong that no one wants to even mention what they are!
>
> Barbara
>
> -----Original Message-----
> From: Anglo-American Health Policy Network
> [mailto:[log in to unmask]] On Behalf Of Adam Oliver
> Sent: Thursday, January 08, 2009 2:22 PM
> To: [log in to unmask]
> Subject: FW: Reform - from Joe White
>
>
>
> ________________________________
>
> From: Joe White [mailto:[log in to unmask]]
> Sent: Wed 07/01/2009 5:08 PM
> To: Oliver,AJ
> Subject: FW: Reform
>
>
>
> Hi Adam,
>
> Nobody ever knows what the public thinks "major reform" means.
>
> But I would disagree with Professor Normand. It depends a lot on what
> you're trying to change, and on the consequences of disruption.
>
> When the United States implemented its Medicare program that was certainly
> major reform. Yet it went fairly smoothly. It went smoothly in part
> because the reform was designed to change as little as possible at the
> operational ground level. This also meant it did not control costs
> immediately. But costs weren't controlled before, either. The goal of
> reform was to get people insured, and it worked quite well, quite quickly.
>
> Professor Normand's rule is roughly right for "reorganization," such as
> creating the U.S. Department of Homeland Security. But, for example,
> putting all of the uninsured into Medicare would be much less complicated.
> It's an add-on, not a change-over. Creating a regulatory structure to
> transform the private insurance market would be more difficult. But it is
> highly unlikely to make things worse for the first three years, simply
> because the status quo is so egregiously bad. What could the
> consequence of
> reform be? That some people slip through the cracks and don't get
> insured?
> That insurers overcharge some people? Get away with risk-rating? Get away
> with cherry picking? Those wouldn't exactly be changes.
>
> Where Professor Normand's concerns apply most clearly is delivery reform.
> Delivery is a lot more complicated than finance. It involves many more
> activities. They are much harder for outsiders to observe and so to
> manage
> (for example, it's easy to monitor what is charged for a service; much
> harder to monitor the course of care). It is much harder to decide what
> activities are appropriate (As an operating matter even though economists
> won't agree in theory, it's easy to decide whether a fee is
> appropriate: you
> set the fee and if they charge more that's inappropriate). The activities
> interrelate in much more complicated ways. They are entrenched in
> organizational structures in much more complicated ways. And, by the way,
> we don't have good data about better ways to deliver care, while we have
> compelling evidence about how financing can be done better than it is done
> in the United States. For all these reasons, if reform means delivery
> reform, Professor Normand could be right. Increments could be the way to
> go. But reform of insurance, and even some cost controls (e.g. reasonable
> fee restraints) are much easier and less complicated.
>
> Cheers,
> Joe White
>
>
>
> -----Original Message-----
> From: Anglo-American Health Policy Network
> [mailto:[log in to unmask]] On
> Behalf Of Charles Normand
> Sent: Wednesday, January 07, 2009 4:34 AM
> To: [log in to unmask]
> Subject: Re: Reform
>
> Adam
>
> I am not sure either what major reform is meant in this context, but
> my fear
> is always that the effect of major reform is to make so many changes
> so fast
> that the whole system takes years to recover. The three year rule is that
> it takes at least this long for the system to be no worse than it was
> before
> the changes began. In some cases this makes things so much worse that
> a need
> is perceived for another major reform. If the new team has an ounce of
> sense between them they will opt for a Norwegian style of problem solving
> rather than system reform - the main difference is that this is based on a
> clear understanding of the usefulness of each element of change and almost
> no fanfare.
>
> Charles Normand
> Edward Kennedy Professor of Health Policy & Management
> University of Dublin
> Trinity College
> 3-4 Foster Place
> Dublin 2
> +353 1 896 3075
> -----Original Message-----
> From: Anglo-American Health Policy Network
> [mailto:[log in to unmask]] On
> Behalf Of Adam Oliver
> Sent: 22 December 2008 19:09
> To: [log in to unmask]
> Subject: Reform
>
> Fyi, although can someone tell me what 'major reform' is? I have no idea -
> good job no-one rings me to ask these types of questions. I suspect
> for most
> people it means "I want cheaper health care coverage for me, now", or "I
> want the Government to do obviously good things so long as I don't have to
> pay for it.". But perhaps I'm being too cynical.
>
>
> OBAMA: Majority Supports Major Reforms to Health Care System
>
>
> A majority of U.S. adults believe that President-elect Barack Obama should
> make major reforms to the health care system, according to a recent
> Washington Post-ABC News Poll, the Post
> <https://exchange.lse.ac.uk/exchweb/bin/redir.asp?URL=http://www.washingtonp
> ost.com/wp-dyn/content/article/2008/12/20/AR2008122001498.html> reports
> (Cohen/Agiesta, Washington Post, 12/21). The poll, conducted by telephone
> between Dec. 11 and Dec. 14, included responses from a random sample of
> 1,003 adults. The poll has a margin of error of plus or minus three
> percentage points. Seventy-seven percent of adults believe that Obama
> should
> make major reforms to the health care system, compared with 20% who
> believe
> that he should not, the poll found. According to the poll, among
> adults who
> believe that Obama should make major reforms to the health care
> system, 51%
> believe that he should seek to make such changes immediately after he
> takes
> office, and 26% believe that he should wait until later in his presidency.
> Sixty-eight percent of adults believe that Obama will have the ability to
> make major reforms to the health care system, compared with 28% who
> believe
> that he will not have the ability, the poll found. Almost three-fourths of
> adults believe that Obama should increase federal funds for health
> insurance
> for children, compared with 23% who believe that he should not,
> according to
> the poll. Among adults who believe that Obama should increase federal
> funds
> for health insurance for children, half believe that he should address the
> issue immediately, compared with 24% who believe that he should wait,
> according to the poll. In addition, 52% percent of adults believe that
> Obama
> should increase federal funds for embryonic stem cell research, compared
> with 42% who believe that he should not, the poll found (Washington Post
> graphic
> <https://exchange.lse.ac.uk/exchweb/bin/redir.asp?URL=http://www.washingtonp
> ost.com/wp-dyn/content/story/2008/12/21/ST2008122100258.html> , 12/21).
>
>
>
> Please access the attached hyperlink for an important electronic
> communications disclaimer:
> http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm
>
>
>
>
>
> Please access the attached hyperlink for an important electronic
> communications disclaimer:
> http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm
>
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