No doubt the development of integration is better than unintegrated
care.
US reforms happened a decade ago; I have a book on integrated
delivery systems from the 1990s, and the much praised Kaisers and Mayos
have their origins many many years ago. All this is so much history.
Surveying commissioning bodies, health professionals is also well and
good but these groups remain trapped in the current paradigm of
powerlessness otherwise they would have done something. I make the simple
point that if these bodies thought integrated care were such a good idea
why is it proving so hard to achieve?
The former CEO of Kaiser made a point, gosh 10 years ago perhaps,
that only the patient has the experience of the extent to which care is
integrated. Providers and purchasers (whatever the politically correct
term is these days) can only fantasise about integration as they move
their little pieces around, thinking that integration is achieved through
some organisational alchemy.
The NHS has its strengths, but one weakness is that because patients
are insulated from costs, they are similarly insulated from the decision-
making about their care. And their choices have little real impact on the
NHS -- I can't take my money elsewhere as the NHS is a monopoly consumer
of taxpayers money.
John Hammergren of McKesson says patients need to have some 'skin in
the game'. In Germany, Spain and a host of other countries including a
favourite of mine, the Netherlands, patients do have some skin in the
game. Much of US responsiveness lies in this reality, which does not exist
for the NHS. These other systems are far more responsive to patient
preferences, despite the research on the social inequality of copayments -
- but what is the greater evil, some social inequality, or massive
misspending of taxpayers' money?
Until user interests can express themselves powerfully and I don't
mean through consultation, the interests of purchasers and providers will
dominate. We know that provider capture means supplier interests dominate.
Purchaser interests are focused on provider configuration as a proxy of
user needs and hence of the form that integration of care will take.
And so it comes back to the question, if integration is such a good
idea, what is stopping people? Perhaps the purchasers and providers are a
bit like Alice, running very hard simply to stay in the same place.
Rapid Response:
Alice in NHSland
No doubt the development of integration is better than unintegrated
care.
US reforms happened a decade ago; I have a book on integrated
delivery systems from the 1990s, and the much praised Kaisers and Mayos
have their origins many many years ago. All this is so much history.
Surveying commissioning bodies, health professionals is also well and
good but these groups remain trapped in the current paradigm of
powerlessness otherwise they would have done something. I make the simple
point that if these bodies thought integrated care were such a good idea
why is it proving so hard to achieve?
The former CEO of Kaiser made a point, gosh 10 years ago perhaps,
that only the patient has the experience of the extent to which care is
integrated. Providers and purchasers (whatever the politically correct
term is these days) can only fantasise about integration as they move
their little pieces around, thinking that integration is achieved through
some organisational alchemy.
The NHS has its strengths, but one weakness is that because patients
are insulated from costs, they are similarly insulated from the decision-
making about their care. And their choices have little real impact on the
NHS -- I can't take my money elsewhere as the NHS is a monopoly consumer
of taxpayers money.
John Hammergren of McKesson says patients need to have some 'skin in
the game'. In Germany, Spain and a host of other countries including a
favourite of mine, the Netherlands, patients do have some skin in the
game. Much of US responsiveness lies in this reality, which does not exist
for the NHS. These other systems are far more responsive to patient
preferences, despite the research on the social inequality of copayments -
- but what is the greater evil, some social inequality, or massive
misspending of taxpayers' money?
Until user interests can express themselves powerfully and I don't
mean through consultation, the interests of purchasers and providers will
dominate. We know that provider capture means supplier interests dominate.
Purchaser interests are focused on provider configuration as a proxy of
user needs and hence of the form that integration of care will take.
And so it comes back to the question, if integration is such a good
idea, what is stopping people? Perhaps the purchasers and providers are a
bit like Alice, running very hard simply to stay in the same place.
Competing interests: No competing interests