Health yarns

There is a piece in the NYRB of August 15th about the bad state of health in the US.

One might describe it as provision by an oligarchy of self servers, with one tribe of health insurers and another tribe of health providers, with some of them described as not for profit but this does not seem to constrain behaviour very much. Then there are the customers, who with due regard for US notions of freedom, are largely free to decide for themselves whether or how to get themselves insured, or not, which complicates the model.

A lot of what is wrong with this system revolves around the practise of charging by the procedure or by the pill. Everything that is done to you or that is put into you is carefully itemised and presented as a bill to your insurance provider, giving every incentive to the health provider to do as many things as possible and to charge as much as possible for each one. The insurance providers get their rather large slice of the cake on turnover so they have little incentive to damp all this down. Another rather large slice of the cake goes on all the transaction costs of all this itemisation, although to be fair, modern computer systems should make this itemisation rather cheaper than it might otherwise have been, perhaps even integrated with the record keeping which is a properly valued part of the modern medical process. Nevertheless, no-one in the US system seems to have either the power or inclination to manage all these slices.

Bottom line being, as I have said here on more than one occasion, is that the citizens of the land of the free pay a lot for a not very good outcome, a situation which looks unlikely to change any time soon. A much worse performance than that of the rest of what used to be called the free world; an example of where the market does not come up with a good solution all by itself and where most countries have gone for something much closer to our tax model than their insurance model, a model in which it is much easier to manage both costs and outcomes.

However, all change here, with the introduction of competition among for-profit health providers, which may push us down the itemised bill road, on which subject this week's Epsom Guardian runs a not very encouraging story about a health provider terminating provision rather abruptly, amid an unseemly spat about value for money.

As readers may know, the commissioning of health care in this country has been taken out of the hands of primary care trusts, which looked and smelt far too much like a nationalised industry for the taste of Cameron and his friends, and has been placed in the hands of commissioning groups, groups which for the moment are dominated by general practitioners, although I dare say ordinarily greedy business people of the sort in the health chair in the US will get in on the act in fairly short order. Not to mention all the professional purchasing types who will weigh in with all their tiresome baggage and make as big a deal out of contracting out as they possibly can. So our shiny new commissioning group called SDCCG (so shiny new that it does not appear to have a web site, let alone one commensurate with its importance in our world) is having a public & unprofessional row with a provider called EDICS (http://www.edics.co.uk/), a company in which a sizeable chunk of the GPs in SDCCG are said to have a pecuniary interest. Conflict of interest even. All very unsatisfactory - and all rather a shame as it seems to be generally agreed that EDICS had been providing a popular local service, to be replaced by a somewhat less local hospital service.

I note in passing that my lefty dentist father avoided all these moral hazards by working as a salaried dentist for public dental services for more or less his whole career. No itemised bills for him.

PS: I see that the wrong SDCCG has a web site at http://www.southernderbyshireccg.nhs.uk/. Are they of a different breed to our one?