....southern California perhaps?
-----Original Message-----
From: Anglo-American Health Policy Network [
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On Behalf Of Michael Gusmano
Sent: Tuesday, May 22, 2012 3:48 PM
To:
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Subject: Re: 'integrated care'
Following on that, has anything that looks like heavily regulated market
competition among integrated care organizations ever been established
anywhere?
Cheerfully,
Michael
Sent from my iPad
On May 22, 2012, at 12:38 PM, "Calum Paton" <
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wrote:
> Chris,
>
> No offence - was having fun being Mr. Grumpy.
>
> Re the serious debate: I do feel strongly that the health reform
> industry in England has (what's the quote from Harold Wilson) taken
> minutes* and wasted years.
>
> (*in this case, produced myriads of policy changes in cyclical and
> indeed circular direction of travel)
>
> I know you can have 'integrated care' in a market context, or shall we
> say in a 'post-purchaser/provider split' politics. Competing
> HMOs/Enthoven's original model of managed competition (for Bismarck
> rather than Beveridge
> contexts): in England, citizens could choose among 'HMOs' ie
> commissioner/provider organisations with no geographical catchment
> basis as PCTs/CCGs had/have.....OR.....HAs/ PCTs/CCGs could be the
> purchaser/commissioner choosing among 'integrated care organizations'
> ie the citizen is still with the geographical purchaser, which chooses
> among different 'integrated' providers.
>
> But to me these are Heath Robinson-esque, tortuous means of ticking
> the 'market' box. This is done either on the grounds of ideology or
> out of pragmatism (ie Old Tory/ New Labour/Coalition neo-liberalism is
> the only show in town) ....OR on the grounds that integrated care
> without competition is bound to lead to what Simon Stevens calls
> doctors colluding behind the bike-sheds.
>
> But the 'empirical' question then becomes: is 21 years of market
> economics moderated by 'garbage-can' (Cohen, March and Olsen) politics
> more efficient/effective than a planned, integrated health service
> with appropriate targets and outcome criteria? Put it another way: if
> all the investment' in commissioning/the market/whatever had been
> applied instead to improving and integrating a non-market NHS, would
> we have got just as much benefit or more?
>
> Best, Calum
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