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In the NHS , the words "For profit" do not exist. There is this huge pot of public money that is to be effectively managed to meet the healthcare needs , from the cradle to the grave, for the population of the UK.
So it is the responsibility of those working and managing the healthcare services to ensure that this public money is being used wisely and in the most effective way possible. So let me address a common problem for both the UK and the USA and let me discuss total hip replacement surgery as an example, in the elderly population.
Hip fractures as a result of falls in the elderly population are one of the biggest cost burdens to healthcare providers ..this is fact. Costs incurred not only include the hospital costs for hip replacement surgery, but also includes the social /care burdens that that elderly person experiences as a result of lost function for weeks/months and possibly over the longer term as that elderly person no longer feels able to manage at home. I won't bore people with figures and percentages but this is a fact.
An elderly person falling is very traumatic and it is certainly not something you want your elderly mum or dad to go through right? In addition to the physical limitations it places on mum or dad, it also impacts on their confidence, and having to go into hospital for an elderly person is pretty god damn awful for all sorts of reasons, particularly those frail souls who also have cognitive deficits. It just throws them for six when taken out of their own environment. Not to mention all those hospital borne infections..yuk. Not great for your loved one.
UK NHS action plan to improve this situation = lets try and prevent these patients from falling in the first place. Makes sense right?? For years, there have been initiatives put in place to enhance falls prevention awareness in the community...too many to list...even down to employing Falls Project managers and teams who's role includes going into homes, sheltered housing environments (ALF US equivalent) and nursing homes to assess their environments with a view to providing education and training for all concerned...even down to replacing worn out ferrels on mobility aids (the rubber end bit)
As I sat in one of my very first committee meetings at work when I first arrived here, I began my fairly lengthy list of all that could be done to work in the community and raise awareness to prevent those wee souls from falling. As my speech came to an end and I was becoming ever more consious of eyes glazing over, can you imagine my surprise when I heard "that all sounds fabulous...great ideas indeed. However why on earth would we want to prevent the elderly from falling??? Do you know how much money we make from people who fall?" At which point I was thinking what on earth have I come to!!!!...REALLY??
And that is the main difference between Universal healthcare and the USA system. Its the "for the people" vs "for profit" cultural mindset difference. In the NHS, sure you are asked to meet savings targets..and sure you are asked to provide streamlined services in order to be more efficient blah blah blah ( I know..I managed a budget of $2.6million for the services I was responsible for). But here's the thing..the sole purpose of meeting savings targets and being cost efficient are not to line the pockets of the suits and to make even more money for the organisation. Nope. The purpose is simply to have more monies available to reallocate and improve the weaknesses in the system e.g waiting times. So in the NHS the money is frequently moving around WITHIN the system to provide ever improving healthcare for its people..not going towards funding the next ferrari for the suits.
So there you have it.
Were you here during the big healthcare debates when we were trying to get legislation past after Obama was elected? One of the sound bites to scare citizens was, "Don't allow the government to come between you and your doctor." I would scream at my TV, as say, "Hell yes, better the government than the insurance companies". And the example you gave illustrates the problem with having profits in the hospitals and all healthcare delivery.
Profits in healthcare will never serve the consumer. I know hospitals do everything they can to run up the tab, as do some doctors. It has always been profits first, patient second. (with the exception of a few dedicated caring doctors) In fact patients are only viewed as a means to the financial end, without any real regard for improving anything but the bottom line.
My friends in France remark to me how the attitude towards health care there is so different than here in the US, and is much more patient oriented than the US. They also offer a lot of home social services that extend after treatment.
In the NHS , the words "For profit" do not exist. There is this huge pot of public money that is to be effectively managed to meet the healthcare needs , from the cradle to the grave, for the population of the UK.
So it is the responsibility of those working and managing the healthcare services to ensure that this public money is being used wisely and in the most effective way possible. So let me address a common problem for both the UK and the USA and let me discuss total hip replacement surgery as an example, in the elderly population.
Hip fractures as a result of falls in the elderly population are one of the biggest cost burdens to healthcare providers ..this is fact. Costs incurred not only include the hospital costs for hip replacement surgery, but also includes the social /care burdens that that elderly person experiences as a result of lost function for weeks/months and possibly over the longer term as that elderly person no longer feels able to manage at home. I won't bore people with figures and percentages but this is a fact.
An elderly person falling is very traumatic and it is certainly not something you want your elderly mum or dad to go through right? In addition to the physical limitations it places on mum or dad, it also impacts on their confidence, and having to go into hospital for an elderly person is pretty god damn awful for all sorts of reasons, particularly those frail souls who also have cognitive deficits. It just throws them for six when taken out of their own environment. Not to mention all those hospital borne infections..yuk. Not great for your loved one.
UK NHS action plan to improve this situation = lets try and prevent these patients from falling in the first place. Makes sense right?? For years, there have been initiatives put in place to enhance falls prevention awareness in the community...too many to list...even down to employing Falls Project managers and teams who's role includes going into homes, sheltered housing environments (ALF US equivalent) and nursing homes to assess their environments with a view to providing education and training for all concerned...even down to replacing worn out ferrels on mobility aids (the rubber end bit)
As I sat in one of my very first committee meetings at work when I first arrived here, I began my fairly lengthy list of all that could be done to work in the community and raise awareness to prevent those wee souls from falling. As my speech came to an end and I was becoming ever more consious of eyes glazing over, can you imagine my surprise when I heard "that all sounds fabulous...great ideas indeed. However why on earth would we want to prevent the elderly from falling??? Do you know how much money we make from people who fall?" At which point I was thinking what on earth have I come to!!!!...REALLY??
And that is the main difference between Universal healthcare and the USA system. Its the "for the people" vs "for profit" cultural mindset difference. In the NHS, sure you are asked to meet savings targets..and sure you are asked to provide streamlined services in order to be more efficient blah blah blah ( I know..I managed a budget of $2.6million for the services I was responsible for). But here's the thing..the sole purpose of meeting savings targets and being cost efficient are not to line the pockets of the suits and to make even more money for the organisation. Nope. The purpose is simply to have more monies available to reallocate and improve the weaknesses in the system e.g waiting times. So in the NHS the money is frequently moving around WITHIN the system to provide ever improving healthcare for its people..not going towards funding the next ferrari for the suits.
So there you have it.
Were you here during the big healthcare debates when we were trying to get legislation past after Obama was elected? One of the sound bites to scare citizens was, "Don't allow the government to come between you and your doctor." I would scream at my TV, as say, "Hell yes, better the government than the insurance companies". And the example you gave illustrates the problem with having profits in the hospitals and all healthcare delivery.
Profits in healthcare will never serve the consumer. I know hospitals do everything they can to run up the tab, as do some doctors. It has always been profits first, patient second. (with the exception of a few dedicated caring doctors) In fact patients are only viewed as a means to the financial end, without any real regard for improving anything but the bottom line.
My friends in France remark to me how the attitude towards health care there is so different than here in the US, and is much more patient oriented than the US. They also offer a lot of home social services that extend after treatment.
It's really good to have you on the board telling of your own experiences. There is SO much propaganda and misinformation being spread throughout the US on this subject. Many will reject anything you say, but I suspect some will listen.
As I sat in one of my very first committee meetings at work when I first arrived here, I began my fairly lengthy list of all that could be done to work in the community and raise awareness to prevent those wee souls from falling. As my speech came to an end and I was becoming ever more consious of eyes glazing over, can you imagine my surprise when I heard "that all sounds fabulous...great ideas indeed. However why on earth would we want to prevent the elderly from falling??? Do you know how much money we make from people who fall?" At which point I was thinking what on earth have I come to!!!!...REALLY??
And that is the main difference between Universal healthcare and the USA system. Its the "for the people" vs "for profit" cultural mindset difference. In the NHS, sure you are asked to meet savings targets..and sure you are asked to provide streamlined services in order to be more efficient blah blah blah ( I know..I managed a budget of $2.6million for the services I was responsible for). But here's the thing..the sole purpose of meeting savings targets and being cost efficient are not to line the pockets of the suits and to make even more money for the organisation. Nope. The purpose is simply to have more monies available to reallocate and improve the weaknesses in the system e.g waiting times. So in the NHS the money is frequently moving around WITHIN the system to provide ever improving healthcare for its people..not going towards funding the next ferrari for the suits.
So there you have it.
Great post, and up until the ACA began penalizing hospitals for excessive readmission rates, hospitals were actually happy to see re-admissions to the consternation of some physicians. Dr. Richard Mackiewicz, a hospitalist in New York city wrote this in 2008:
Quote:
A recent MedPAC analysis of 2005 Medicare Provider Analysis and Review data found 6.2% of patients discharged from hospitals are readmitted within seven days. This percentage grows to 11.3% at 15 days and 17.6% at 30 days. That 17.6% translates to roughly $15 billion in Medicare spending.
Data for patients with end-stage renal disease (ESRD) are even more staggering. Hospitalized ESRD patients are readmitted within seven days at a rate of 11.2%. Within 15 days, that becomes 20.4%. Within 30 days, 31.6% of patients with ESRD are readmitted to the hospital.
Surprised at the high numbers? I was. It’s not just patients of this type. Some of my patients get readmitted for reasons that have nothing to do with previous admissions. How can we prevent that? MedPAC ran numbers with only “potentially preventable hospital readmission rates.” The readmission rates for all comers were 5.2% at seven days, 8.8% at 15 days and 13.3% at 30 days. This translated to $5, $8, and $12 billion dollars, respectively, in potentially unnecessary spending of Medicare dollars.
If unnecessary hospital readmissions are so bad, why haven’t hospitals and hospitalists placed a bigger emphasis on preventing them? There are several reasons. One is a lack of awareness of the problem, but the main reason likely is lack of financial incentive to do so.
Most hospitals receive Medicare payment regardless of readmissions. In some states, CMS contractors and quality improvement organizations aggressively have denied payment for readmissions within 30 days, but these are the exceptions, not the rules. In many parts of the country, hospitals have no financial incentive to reduce readmissions unless they can fill the unused beds with more “profitable” patients.
Under the case-based DRG payment model, Medicare actually rewards hospitals for shorter lengths of stay. Hospitals have developed systems to encourage providers to discharge patients as quickly as possible. In fact, many hospitals even look at physicians’ inpatient length of stay as a measure of performance.From the physician perspective, why not discharge the patient as quickly as medically appropriate? The hospital commends you for doing so and if the patient is readmitted, you get to bill a higher admission code rather than a lower-paying subsequent day visit code. More admission and discharge billing means more money.
In the article Dr. Mackiewicz indicates he believed in the future Medicare would make a change in how they reimbursed hospitals with regard to re-admissions.
People in the industry know that the financial motive drives administration whether they are a "profit" making operation OR a "non-profit." In fact administrative expenses in non-profit hospitals have been rising faster than in profits driven in part by the rapid increase in CEO pay in order to "catch up" to the profit side of the business.
Keep preaching your message. With the exception of a few on these threads most others are being enlightened by the posts of an insider who has worked in both systems.
Were you here during the big healthcare debates when we were trying to get legislation past after Obama was elected? One of the sound bites to scare citizens was, "Don't allow the government to come between you and your doctor." I would scream at my TV, as say, "Hell yes, better the government than the insurance companies". And the example you gave illustrates the problem with having profits in the hospitals and all healthcare delivery.
Profits in healthcare will never serve the consumer. I know hospitals do everything they can to run up the tab, as do some doctors. It has always been profits first, patient second. (with the exception of a few dedicated caring doctors) In fact patients are only viewed as a means to the financial end, without any real regard for improving anything but the bottom line.
My friends in France remark to me how the attitude towards health care there is so different than here in the US, and is much more patient oriented than the US. They also offer a lot of home social services that extend after treatment.
Absolutely Modhatter Healthcare delivery is also so much more than just hospitals and doctors. In previous posts I've alluded to Community Health Partnerships that NHS healthcare providers have formed with Social Services to ensure that it is not just the health and wellbeing of the folk accessing healthcare when they are sick...its a whole systems approach. That includes care and support in the community, health promotion, preventative medicine, education ( Look up NHS Education Scotland - ensures that health care professionals are given every opportunity to continue to develop their knowledge and skills and that they are competency trained on a regular basis and provision of opportunies for furthering academic knowledge , thereby enhancing their clinical skills and forming links and funding for modules of post graduate training with Universities), NHS QI Scotland ( The NHS organisation set up to ensure quality improvement agendas are implemented throughout all healthcare services and they develop frameworks from which healthcare services use to guide that process). NHS 24 Scotland-designed to offer 24/7 telephone support and guidance for healthcare issues and concerns. Community clinics, mobile services to help those living in remote areas. This is what Universal Healthcare is in Scotland. Not bad value for your 13% income tax is it?!?!? Particularly when that 13% also includes your social benefits and retirement state pension
I am a compassionate person and I console myself with the fact that I currently work with a group of people within an organisation who are open to change , are listening to what I have to say and are welcoming some of the small yet beneficial initiatives that I implement. Granted I can't influence the big financial picture and I am learning to say " it is what it is" at times. What I CAN do is ensure the patient experience is the very best it can be because by god, you guys are paying for it! I am encouraged by the reception I have had over recent years and the positive attitudes of senior managers. I have had some really encouraging conversations with the new CEO who genuinely appears to be a compassionate man who wants the best for people - patients and employees alike. Of course I may be being naive and I have no doubt he has other agendas he has to follow too! However I'm pretty intuitive when it comes to people, and I'm convinced he is a good guy with his heart in the right place And to me, that is what healthcare should be about.
As I said in previous posts there are too many fingers in the pie who are making billions of dollars out of American citizens and they will never allow that to change and I don't know what the answer is to that. It is too deeply embedded and has gone on for too long. I don't blame American people for being so close minded to change. You aren't given the truth and are therefore not being allowed to make informed choices about the future of your healthcare system. And how can you believe that Universal Healthcare isn't the devil incarnate that it's made out to be if you have never experienced it?
If I could package up the "peace of mind" and "no hassle" factor that Universal Healthcare can offer (certainly that of Scotland!! and gift it to you all, even if just for one year, then I would. It never fails to amaze me how much time and effort people have to put in to worrying about/arguing with their insurance providers, spending countless hours wading through insurance packages to select "coverage that suits your needs", and god alone knows how the elderly population cope with reading and understanding all that, particularly when they don't have family close by to help them. But it is the only system that the American people know and therefore it is hard for them to imagine there is anything else out there that might be better, particularly when they are only given skewed information that fits the purpose only of the suits in their million dollar homes.
I could write hundreds and hundreds of posts with examples and scenarios of how the systems differ, but every day I go on a quite little rant at work with those who allow me too. I receive a sympathetic pat on the back, a "dude, we hear yah, but welcome to America, it isn't right, it isn't humane, but that's how we roll here". So I quite frequently feel drained and tired out by it all!!
I was speaking with a nurse from Albania yesterday. She has been in the States for 4 years because she fell in love with and married an American. She was very upset. She had just returned from her home country. Over recent months, she had underdone tests here in the USA to the cost of $10,000 out of pocket expenses and had been told she had a tumour in her uterus. She had returned home to spend time with her family in Albania and had visited her own family doctor who organised further tests for her...to the cost of $300. With the result that she doesn't have a tumour. She has cysts. That nurse feels let down and deceived, not to mention $10,000 lighter in her bank account...money that she could ill afford.
Apparently though, "that is how we roll here".
At the end of the day, I am enjoying my time here and I love the American people. The people are what makes America great. I arrived here not knowing a soul and myself and my family have had only the warmest of welcomes. Brits tend to be miserable folk who don't know nor appreciate what they have and they love to complain. So in referring to my earlier posts, I really do pray for something better for the American people in the healthcare system, because you deserve it.
, she had underdone tests here in the USA to the cost of $10,000 out of pocket expenses and had been told she had a tumour in her uterus. She had returned home to spend time with her family in Albania and had visited her own family doctor who organised further tests for her...to the cost of $300. With the result that she doesn't have a tumour. She has cysts.
I am in no way trying to argue costs, here, but since she has two different opinions, both the results of tests, how is she so sure the Albanian family doctor is the one that made the correct diagnosis?
For her sake, I sure hope so.
, she had underdone tests here in the USA to the cost of $10,000 out of pocket expenses and had been told she had a tumour in her uterus. She had returned home to spend time with her family in Albania and had visited her own family doctor who organised further tests for her...to the cost of $300. With the result that she doesn't have a tumour. She has cysts.
I am in no way trying to argue costs, here, but since she has two different opinions, both the results of tests, how is she so sure the Albanian family doctor is the one that made the correct diagnosis?
For her sake, I sure hope so.
I would imagine that any doctor worth his salt who has a patient coming into his office saying "Ive been told I have a tumour" will go out of his way to ensure the accuracy of tests carried out . But yep, I hear what you're saying.
I am a compassionate person and I console myself with the fact that I currently work with a group of people within an organisation who are open to change , are listening to what I have to say and are welcoming some of the small yet beneficial initiatives that I implement. Granted I can't influence the big financial picture and I am learning to say " it is what it is" at times. What I CAN do is ensure the patient experience is the very best it can be because by god, you guys are paying for it! I am encouraged by the reception I have had over recent years and the positive attitudes of senior managers. I have had some really encouraging conversations with the new CEO who genuinely appears to be a compassionate man who wants the best for people - patients and employees alike. Of course I may be being naive and I have no doubt he has other agendas he has to follow too! However I'm pretty intuitive when it comes to people, and I'm convinced he is a good guy with his heart in the right place And to me, that is what healthcare should be about.
As I said in previous posts there are too many fingers in the pie who are making billions of dollars out of American citizens and they will never allow that to change and I don't know what the answer is to that. It is too deeply embedded and has gone on for too long. I don't blame American people for being so close minded to change. You aren't given the truth and are therefore not being allowed to make informed choices about the future of your healthcare system. And how can you believe that Universal Healthcare isn't the devil incarnate that it's made out to be if you have never experienced it?
If I could package up the "peace of mind" and "no hassle" factor that Universal Healthcare can offer (certainly that of Scotland!! and gift it to you all, even if just for one year, then I would. It never fails to amaze me how much time and effort people have to put in to worrying about/arguing with their insurance providers, spending countless hours wading through insurance packages to select "coverage that suits your needs", and god alone knows how the elderly population cope with reading and understanding all that, particularly when they don't have family close by to help them. But it is the only system that the American people know and therefore it is hard for them to imagine there is anything else out there that might be better, particularly when they are only given skewed information that fits the purpose only of the suits in their million dollar homes.
I could write hundreds and hundreds of posts with examples and scenarios of how the systems differ, but every day I go on a quite little rant at work with those who allow me too. I receive a sympathetic pat on the back, a "dude, we hear yah, but welcome to America, it isn't right, it isn't humane, but that's how we roll here". So I quite frequently feel drained and tired out by it all!!
I was speaking with a nurse from Albania yesterday. She has been in the States for 4 years because she fell in love with and married an American. She was very upset. She had just returned from her home country. Over recent months, she had underdone tests here in the USA to the cost of $10,000 out of pocket expenses and had been told she had a tumour in her uterus. She had returned home to spend time with her family in Albania and had visited her own family doctor who organised further tests for her...to the cost of $300. With the result that she doesn't have a tumour. She has cysts. That nurse feels let down and deceived, not to mention $10,000 lighter in her bank account...money that she could ill afford.
Apparently though, "that is how we roll here".
At the end of the day, I am enjoying my time here and I love the American people. The people are what makes America great. I arrived here not knowing a soul and myself and my family have had only the warmest of welcomes. Brits tend to be miserable folk who don't know nor appreciate what they have and they love to complain. So in referring to my earlier posts, I really do pray for something better for the American people in the healthcare system, because you deserve it.
I'm not buying it. A nurse, presumably working, had a plan with $10,000 deductible/co-insurance...nope, not buying it at all. Sorry. I also agree, how does she know that this new diagnosis is correct? Maybe that doctor isn't worth his salt and she just wanted to believe the better diagnosis.
. Funny - every time I mention something like that here about the US - I'm accused of being heartless . But it's hard enough to take care of people who are legally in developed countries - especially older people - much less those who are illegal.
Don't know how old you are. But - at my age - 66 - well my family has 2 distinct sides. Paternal was everyone lived almost forever (grandfather died at 96 - grandmother at 103) with a minimum of muss and fuss or health care (although they did need help as they got older and were unable to take care of themselves in terms of cooking/getting dressed/etc.). Maternal was everyone died young (55-65 or so) from heart disease. Again - with a minimum of muss and fuss or health care.
Modern health care brought an end to that. Now - people on the maternal side of my family live into their 80's - or even 90's - as a result of things like coronary artery bypass surgery. Very expensive - and their quality of life after extensive medical intervention isn't necessarily the greatest. My late mother - who probably would have died in her 60's from heart disease a generation before - wound up dying of colon cancer in her early 80's. At great cost (and she wasn't in the best of shape either for perhaps a decade before her death). My late uncle was ditto my mother - except he wound up with 10 years of Alzheimer's (my mother had signs of early Alzheimer's when she died - that's another thing that runs on the maternal side of my family) - again at great cost and with not a great quality of life for a long time.
Note that most of this isn't lifestyle related - income related - or similar - it's just genes for the most part. My father is still alive at 95 - and 2 of his 4 siblings are still alive too at 90+. Even my uncle who smokes a lot of cigars.
It's a conundrum to be sure. For individuals - families - and countries. I don't want to spend the last 5 years of my life pooping in adult diapers in a nursing home because I've forgotten what a toilet is for. OTOH - I get sufficient pleasure out of various intellectual pursuits that I'll be content to indulge them as I age - if I can - as my body gets worn out. Don't know what the future holds for me - nor do any of us.
In all honesty - I don't think any developed country has figured out the answer to these things at this point. China - a second world country - is now pretty much allowing 2 children - to deal with elder care problems. But I doubt that will work in many first world countries where there's no tradition of children taking care of aging parents. Robyn
I'm a compassionate man for sure, but I'm not a complete soft touch and folk who are not entitled to use the system certainly does pee me off quite frankly. The UK has a similar immigration problem to the US, where illegal immigrants literally arrive in droves in order to benefit from the FREE healthcare (I CAPS that word "free" in this case because for those who have never contritubted into the system for a single day in their life, it most certainly IS free!..happy days!!!!) and education.
There are other pet peeves alongside the immigrants..there are folk back home who have literally never worked a day in their lives..whole families living off the state and will never do anything more than just that.(which is a whole different thread!!)
When you are lying in your hospital bed in an NHS hospital, and you are a regular middle class or working class citizen paying your 13% NI tax, then in the bed next to you, you have a complete no-hoper who is PROUD of the fact that he has never worked a day in his life, then you get pee'd off for sure!!.Because that man next to you will get exactly the same quality care..no more, no less. So the middle/working class man will sit there quietly fuming! The consolation is however, that regardless of what you have paid in tax vs what the man next to you has paid (ie nowt), you at least have the no hassle, no bills, no extra cost incurred aftermath that is Universal Healthcare.
What I DO agree with though in a more socialised system, is that for those who have contributed when they can into the public pool of monies for health and social care, but find themselves no longer able to contribute for genuine reasons, then of course I'm all for supporting that person. That person might be me some day.
I'm not buying it. A nurse, presumably working, had a plan with $10,000 deductible/co-insurance...nope, not buying it at all. Sorry. I also agree, how does she know that this new diagnosis is correct? Maybe that doctor isn't worth his salt and she just wanted to believe the better diagnosis.
What would you have me say Golfgal, that the whole conversation was just a figment of my imagination, that I wasn't actually standing at work yesterday talking with the nurse while on her break and that she's telling complete porkies?? Or are you inferring that an Albanian doctor surely isn't up to par with their knowledge and skills in comparison to the US one
I am not going to get into a debate about "how good" the standard of medicine is in the USA vs "how good" it is elsewhere because ..well just because. I'm not even going to go there.
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. But it's hard enough to take care of people who are legally in developed countries - especially older people - much less those who are illegal.
I'm not even going to go there.
