- Email: [email protected]
Competition in health care
104
combination. The gentamicin/piperacillin combination, which is than netihnicinjpiperacillin, then became again the recommended regimen for empirical therapy. As was pointed out at the meeting, the message here is that periodic revision of antibiotic policy, done on the basis of antimicrobial drug sensitivity, is to be recommended.
cheaper
Reducing waiting
lists
Twenty-two health districts have been taking part in a study on the reduction of waiting lists for admission to hospital. These districts had either more than 2000 patients on the waiting list or more than 1250 waiting for more than a year and representing > 30% of the total list. The lists had been fairly stable between March, 1988, and December, 1988. The Government had set aside ,C5 44 million specifically for the study, the first six months’ results of which have now been published.! 43 specialty lists (17 trauma and orthopaedics, 14 general surgery and/or urology, 7 ear, nose and throat, 3 ophthalmology, and 2 gynaecology) were selected; only 5 lists had more than 300, and 32 had more than 500, patients waiting over a
estimated to cover these expenses in the UK (where administrative 10% of the health budget) may be
costs currently consume less than
inadequate. The report draws attention to the uncertainty surrounding the plans for the NHS, which it attributes to the Government’s
"unusual" form of policymaking--consideration of how the proposals will work after the announcement of the reforms. But it notes a softening of the Government’s approach to competition: the emphasis is now shifting, the report observes, away from costeffectiveness towards competition between doctors and hospitals as a means of improving quality of care. In the longer term, the report suggests, American ideas for improving quality of care-such as accreditation of hospitals and guidelines on clinical appropriateness of various treatrnents-may be the most useful imports, especially for NHS districts in their role of purchasers of clinical services. 1.
year.
Once the waiting lists were found to be "real" (ie, not containing "ghost" patients), the baseline workload was established. If it was at or above what was considered acceptable, negotiations were made with the district for an extra workload at a reasonable cost per case. Where the workload was considered to be low, reasons for the deficiency were sought and corrected. Measures were taken to ensure that the increase in workload led to reduction in waiting lists. Targets for reduction in waiting time, in terms of reduction in numbers of long-wait patients, were set. If these targets were not reached despite the increase in workload, the districts forfeited some of its revenue, but an exception to this claw-back was made if all long-wait patients for the specialty were treated. In the first 6 months (April to September, 1989) twenty-eight schemes were funded. In the twenty-two districts, waiting lists fell by 11% overall, and by 17% for the 43 specialty lists, between December, 1988, and September, 1989; and the number of long-wait patients fell by 16% in the districts and by 23% in the marker specialties. There was, however, considerable variation between districts, with numbers increasing in four districts but decreasing by over 40% in some others. A further evaluation is expected after March, 1990, by which time other schemes will have been funded. 1.
Examining some of England’s longest waiting lists. Half year report. Inter-Authority Comparisons and Consultancy. Health Services Management Centre, 40 Edgbaston Park Road, Birmingham B15 2RT. 1989. Pp 24. £5.
Competition in health care The proposals for a new-style health market in the UK put forward in the 1989 white-paper, Working for Patients, were based on the premise that a market system incorporating incentives for both consumers and providers of health care would lead to greater efficiency in the National Health Service. The Government claimed that the introduction of competition would make services more cost-effective, give consumers more choice, improve the quality of care, and make access to services more equitable. But how the NHS will actually perform once the major changes have been implemented is difficult to predict, for the UK has no experience of competition in the health sector. A report from the King’s Fundl suggests, however, that some useful lessons can be learned from experience in the US, despite some fundamental differences between the form of competition operating in the US health sector and the system of managed competition planned for the NHS. The main lesson learned seems to be that competition between hospitals does indeed reduce costs but does not always improve the quality of care or access to it. And the scope for efficiency savings, the report suggests, is far smaller in the UK than in the US, where spare bed capacity is greater and hospital-doctor/population ratios are higher. How much is the proposed trade in clinical services going to cost? Recording, costing, billing, and other administrative costs at present account for 20% of health care expenditure in the US, and the King’s Fund report suggests that the extra C200 million
Competition and health care: a comparative analysis of UK plans and US experience. By Ray Robinson. King’s Fund Institute research report no 6. Available from Department D/KFP, Bailey Distribution Ltd, Folkestone, Kent CT19 6PH. Price £6.95 (plus 70p postage and packing). 1990. ISBN 1870607163.
Parents against tobacco One in five 15-year-olds in Britain smoke regularly, and 75% of adult smokers are hooked on tobacco before they are 18. Armed with these daunting statistics, a group of more than a hundred well-known British parents have launched a one-year campaign to protect their children from the threat to health posed by the tobacco industry. Parents against Tobacco, launched on Jan 9, is intended to create a "tobacco blockade" between children and the industry, and it draws its legitimacy from the right of parents to protect their children. The campaign has the support of Europe Against Cancer and more than fifty organisations concerned with child care, health, and education. More than 50 MPs have committed themselves to its broad aims. Under the Protection of Children (Tobacco) Act 1986, sales of tobacco products to children under 16 are illegal, and the campaign aims to show how inadequately the Act is being enforced. The campaign also intends to press for a ban on sales of tobacco products from vending machines, except in premises specifically reserved for people over 18, to campaign for a rise in the maximum fine for selling cigarettes to under-16s from C400 to £ 1000 for a first offence, C2500 for second, and £ 10 000 for a third; to expose "the pretence behind the tobacco industry’s own efforts to discourage sales to under-16s"; and to urge the Government to raise taxes on tobacco products. Many of the campaign’s objectives will be pursued by means of a private member’s Bill. For further details contact Jane Dunmore, National Compaigner, PaT 1990, 46 Arundel Street, Brighton BN2 5TH (telephone 0273 601312, fax
0273 681418). A general
practice ’Filofax’
Where is useful information kept in general practice? The partners and practice manager/receptionists probably commit much of it to memory and lose the rest. There is now a fairly comprehensive system for the storage and retrieval of facts-the Systemed.l The file includes space for various entries: language interpreter (eg, Urdu); tasks not undertaken by practice partners (eg, referral of patients for termination of pregnancy); and where to find things in the practice (eg, batteries). The space given to entries is rather erratic, with 1 page for developmental assessment and 12 for the practice management of diabetes. Systemed offers some suggestions for practice policies such as factors affecting the decision to investigate (acceptability, disability, and even uncertainty) and objectives of postnatal care (update the problem list, complete the paper work, and claim item-for-service fees)--those compiling an age-sex register are advised to begin with the letter A. Much of this should be superfluous to the needs of the partners but might be useful for trainees and non-medical staff. Systemed may prove to be the general practice answer to ’Filofax’, but it is far too big for the
pocket. 1.
information system for general practice. Ben Essex. London: British Medical Journal. 1989. Pp 403. UK £37.50, overseas
Systeme—an
£42.50 (including postage).
combination. The gentamicin/piperacillin combination, which is than netihnicinjpiperacillin, then became again the recommended regimen for empirical therapy. As was pointed out at the meeting, the message here is that periodic revision of antibiotic policy, done on the basis of antimicrobial drug sensitivity, is to be recommended.
cheaper
Reducing waiting
lists
Twenty-two health districts have been taking part in a study on the reduction of waiting lists for admission to hospital. These districts had either more than 2000 patients on the waiting list or more than 1250 waiting for more than a year and representing > 30% of the total list. The lists had been fairly stable between March, 1988, and December, 1988. The Government had set aside ,C5 44 million specifically for the study, the first six months’ results of which have now been published.! 43 specialty lists (17 trauma and orthopaedics, 14 general surgery and/or urology, 7 ear, nose and throat, 3 ophthalmology, and 2 gynaecology) were selected; only 5 lists had more than 300, and 32 had more than 500, patients waiting over a
estimated to cover these expenses in the UK (where administrative 10% of the health budget) may be
costs currently consume less than
inadequate. The report draws attention to the uncertainty surrounding the plans for the NHS, which it attributes to the Government’s
"unusual" form of policymaking--consideration of how the proposals will work after the announcement of the reforms. But it notes a softening of the Government’s approach to competition: the emphasis is now shifting, the report observes, away from costeffectiveness towards competition between doctors and hospitals as a means of improving quality of care. In the longer term, the report suggests, American ideas for improving quality of care-such as accreditation of hospitals and guidelines on clinical appropriateness of various treatrnents-may be the most useful imports, especially for NHS districts in their role of purchasers of clinical services. 1.
year.
Once the waiting lists were found to be "real" (ie, not containing "ghost" patients), the baseline workload was established. If it was at or above what was considered acceptable, negotiations were made with the district for an extra workload at a reasonable cost per case. Where the workload was considered to be low, reasons for the deficiency were sought and corrected. Measures were taken to ensure that the increase in workload led to reduction in waiting lists. Targets for reduction in waiting time, in terms of reduction in numbers of long-wait patients, were set. If these targets were not reached despite the increase in workload, the districts forfeited some of its revenue, but an exception to this claw-back was made if all long-wait patients for the specialty were treated. In the first 6 months (April to September, 1989) twenty-eight schemes were funded. In the twenty-two districts, waiting lists fell by 11% overall, and by 17% for the 43 specialty lists, between December, 1988, and September, 1989; and the number of long-wait patients fell by 16% in the districts and by 23% in the marker specialties. There was, however, considerable variation between districts, with numbers increasing in four districts but decreasing by over 40% in some others. A further evaluation is expected after March, 1990, by which time other schemes will have been funded. 1.
Examining some of England’s longest waiting lists. Half year report. Inter-Authority Comparisons and Consultancy. Health Services Management Centre, 40 Edgbaston Park Road, Birmingham B15 2RT. 1989. Pp 24. £5.
Competition in health care The proposals for a new-style health market in the UK put forward in the 1989 white-paper, Working for Patients, were based on the premise that a market system incorporating incentives for both consumers and providers of health care would lead to greater efficiency in the National Health Service. The Government claimed that the introduction of competition would make services more cost-effective, give consumers more choice, improve the quality of care, and make access to services more equitable. But how the NHS will actually perform once the major changes have been implemented is difficult to predict, for the UK has no experience of competition in the health sector. A report from the King’s Fundl suggests, however, that some useful lessons can be learned from experience in the US, despite some fundamental differences between the form of competition operating in the US health sector and the system of managed competition planned for the NHS. The main lesson learned seems to be that competition between hospitals does indeed reduce costs but does not always improve the quality of care or access to it. And the scope for efficiency savings, the report suggests, is far smaller in the UK than in the US, where spare bed capacity is greater and hospital-doctor/population ratios are higher. How much is the proposed trade in clinical services going to cost? Recording, costing, billing, and other administrative costs at present account for 20% of health care expenditure in the US, and the King’s Fund report suggests that the extra C200 million
Competition and health care: a comparative analysis of UK plans and US experience. By Ray Robinson. King’s Fund Institute research report no 6. Available from Department D/KFP, Bailey Distribution Ltd, Folkestone, Kent CT19 6PH. Price £6.95 (plus 70p postage and packing). 1990. ISBN 1870607163.
Parents against tobacco One in five 15-year-olds in Britain smoke regularly, and 75% of adult smokers are hooked on tobacco before they are 18. Armed with these daunting statistics, a group of more than a hundred well-known British parents have launched a one-year campaign to protect their children from the threat to health posed by the tobacco industry. Parents against Tobacco, launched on Jan 9, is intended to create a "tobacco blockade" between children and the industry, and it draws its legitimacy from the right of parents to protect their children. The campaign has the support of Europe Against Cancer and more than fifty organisations concerned with child care, health, and education. More than 50 MPs have committed themselves to its broad aims. Under the Protection of Children (Tobacco) Act 1986, sales of tobacco products to children under 16 are illegal, and the campaign aims to show how inadequately the Act is being enforced. The campaign also intends to press for a ban on sales of tobacco products from vending machines, except in premises specifically reserved for people over 18, to campaign for a rise in the maximum fine for selling cigarettes to under-16s from C400 to £ 1000 for a first offence, C2500 for second, and £ 10 000 for a third; to expose "the pretence behind the tobacco industry’s own efforts to discourage sales to under-16s"; and to urge the Government to raise taxes on tobacco products. Many of the campaign’s objectives will be pursued by means of a private member’s Bill. For further details contact Jane Dunmore, National Compaigner, PaT 1990, 46 Arundel Street, Brighton BN2 5TH (telephone 0273 601312, fax
0273 681418). A general
practice ’Filofax’
Where is useful information kept in general practice? The partners and practice manager/receptionists probably commit much of it to memory and lose the rest. There is now a fairly comprehensive system for the storage and retrieval of facts-the Systemed.l The file includes space for various entries: language interpreter (eg, Urdu); tasks not undertaken by practice partners (eg, referral of patients for termination of pregnancy); and where to find things in the practice (eg, batteries). The space given to entries is rather erratic, with 1 page for developmental assessment and 12 for the practice management of diabetes. Systemed offers some suggestions for practice policies such as factors affecting the decision to investigate (acceptability, disability, and even uncertainty) and objectives of postnatal care (update the problem list, complete the paper work, and claim item-for-service fees)--those compiling an age-sex register are advised to begin with the letter A. Much of this should be superfluous to the needs of the partners but might be useful for trainees and non-medical staff. Systemed may prove to be the general practice answer to ’Filofax’, but it is far too big for the
pocket. 1.
information system for general practice. Ben Essex. London: British Medical Journal. 1989. Pp 403. UK £37.50, overseas
Systeme—an
£42.50 (including postage).