Mitch Keamy is an anesthesiologist in Las Vegas Nevada
Andy Kofke is a Professor of Neuro-anesthesiology and Critical Care at the University of Pennslvania
Mike O'Connor is Professor of Anesthesiology and Critical Care at the University of Chicago
Rob Dean is a cardiac anesthesiologist in Grand Rapids Michigan, with extensive experience in O.R. administration.
The Bad
Many advocates of government administration of health care point to the potential efficiencies that can arise from centralizing some functions. The sad truth is that centralizing some functions simply allows for failure to occur on an even larger scale.
This is a story from the BBC from last summer:
http://www.bbc.co.uk/news/health-10740225
It’s important to note that the sums involved are somewhere between substantial and massive. The NHS is leaving very large sums of money on the table, money that it could use to provide higher quality or more timely service to the populace. How can this happen? Because those tasked with collecting this money likely have no incentive to do this well. If they got even 2% of the money involved as a bonus, they would very likely be relentless in collecting every last penny. The more energetic among them could become richer than the queen. This is likely what happens when government bureaucrats see this as a paperwork problem instead of a way to create resources for their organization. Instead, the NHS is a reliable source of windfall revenues to the pharmaceutical companies that supply these drugs. Ironically, these companies almost certainly invest a majority of their windfall into future product development, which will ultimately benefit the NHS and its patients.
The Good
There are few benefits to centrally administered or regulated health care. One of them (theoretically at least) is that the regulators can study the performance of the system, and make changes that will predictably improve outcomes. This is talked about much, much more than it happens. Why? Political considerations shape the options available to regulators. The universe of the politically possible is far smaller than the universe of the theoretically possible. Why so? Because governmental and regulatory power ultimately derives from political power and politics. Nevertheless, every once-in-a-while, a regulating body will study and analyze what it is doing, and come to a very smart decision about how to proceed. This story, also from the BBC, is a narrative of a very wise decision by the NHS to concentrate very complex pediatric cardiac surgery to a few centers of excellence. The US system has many strengths, but among its weaknesses are that it is presently completely incapable of doing something similar.
http://www.bbc.co.uk/news/health-12462913
There is a back-story to this decision. The events that compelled it that are outlined in the associated BBC stories. It is enough to say that doing pediatric cardiac surgery well is a very, very difficult undertaking.
This is an outstanding decision, and deserves to be recognized as such. I am flummoxed at the lack of interest in and coverage of this, in both the lay press and medical media.
--------------------------------------------------------------------------------------------------------------------------
This is an interesting item about a problem of our times:
http://www.nhsonline.net/news/article.asp?CategoryId=2&ArticleId=5080
The decision to only selective deploy the ability to transport the morbidly obese is an interesting one, as it seems that one ambulance crew will end up having to summon another. My guess is that, over time, every ambulance in the UK and the US will have this capability.
Comments