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Redefining Health Care: Creating Value-based Competition on Results <http://www.amazon.co.uk/Redefining-Health-Care-Value-based-Competition-ebook/dp/B004OC0780/ref=sr_1_5?s=books&ie=UTF8&qid=1433338352&sr=1-5>24 Apr 2006 by Michael E. Porter <http://www.amazon.co.uk/Michael-E.-Porter/e/B000AQ3BBY/ref=sr_ntt_srch_lnk_5?qid=1433338352&sr=1-5> and Elizabeth Olmsted Teisberg Recommended by someone on this list. I bought it and read it. Very good, and provides clear rationale for avoiding vertical integration as implemented across the pond. Harvard press. Primary care must be uncoupled from secondary and should direct the patient flows based on PROMS / PREMS thus enabling an evolutionary pressure to exist....either get great results ....or stop doing it. Need visibility of PROMS in 1' care though. On 26 October 2015 at 18:16, Mary Hawking <[log in to unmask]> wrote: > In the USA, hospitals have been buying up private practices to provide > integrated care. > Harvard has done a study on the effects - which seem to be increased costs > and also increased use of out-patient facilities. > > http://hms.harvard.edu/news/unintended-costs-health-care-integration#.Vi0tJX > vpj1Q.twitter > I appreciate that the situation is different here, but friends who are in > private medical practice in the US tell me that what happens is that there > are other consequences as well:- > 1. the physicians owning the private practice (which is a big financial > investment) are offered employment for 3-5 years: at the end of that time > they are dismissed because they are too expensive and are replaced by newly > qualified - and cheaper - staff. > 2. there is no longer a supply of practices available for purchase - and as > the hospitals control who has admitting rights, no real possibility of > starting up new practices without hospital agreement (which won't be given) > 3. performance targets are set to the highest possible volume - which may > not be safe if the patient has a complex condition - and patients have no > choice of provider supposing a different hospital has a better service for > their particular problem. > > Will the same (apart from the purchase of practices) happen here in > vertical > integration models? > > Mary Hawking > Committee member BCS PHCSG > Retired from NHS on 31.3.13 because of the Health and Social Care Act 2012 > "thinking - independent thinking - is to humans as swimming is to cats: we > can do it if we really have to." Mark Earles on Radio 4 > > http://primaryhealthinfo.wordpress.com/2014/12/01/can-integrated-care-satisf > y-all-of-freds-needs-including-patient-empowerment/ >