Private providers must be stopped from skimming off easy cases
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《英国医生杂志》
The UK government needs to act urgently to stop private providers of NHS services 揷ream-skimming?the less difficult cases, MPs warned this week.
The House of Commons Public Administration Select Committee, in a report of its inquiry into choice in public services, said government plans to bring private companies to heel were so far 搒ketchy and inadequate.?/p>
The concerns are about reforms due in December 2005 (although schemes are already in operation on a smaller scale), when all patients will be given a choice of hospital for elective treatment. The choice may include non-NHS facilities. Under the new funding system for acute hospital trusts, called payment by results, the NHS loses money if patients opt to go elsewhere. The new system lays down a fixed tariff for every operation, so a hospital cannot increase its income from primary care trusts by putting up its prices, and it will lose money if its volume of elective surgery declines.
The report quoted from the BMA抯 evidence to the inquiry, which claimed that a two tier system would result from the widening of choice of providers.
揟he BMA told us that the private sector would in future have an in-built incentive to select patients that are fit with little co-morbidity, leaving the existing NHS acute sector to cope with more complex cases,?the report said.
The health secretary, John Reid, has said he is prepared to consider the closure of hospitals in cases where patients choose not to use them under the new competitive regime.
But the report warned that choice was not the most important thing for the public, especially if it leads to the closure of hospitals. It urged the government to do more to prevent the private sector gaining an unfair advantage.
揥e did find a high risk that the introduction of alternative providers of care can generate additional costs and the creaming off of less difficult cases. We urge ministers to ensure that the private sector does not exploit choice schemes to the detriment of the public interest.?/p>
The report contained allegations that, in one part of the country at least, choosing a private sector hospital could undermine clinical priorities.
揑t is alleged that GPs in the Nottingham area are being encouraged, and sometimes financially rewarded, to send patients to new private treatment centres for routine operations, even though the centres may not have appropriate medical support available in case of complications,?it said.
The report said schemes to increase choice were valuable if they were well designed and start with specific goals of reducing unfairness. It cited several good initiatives, including the expert patients programme and the coronary heart disease choice scheme. But such initiatives needed to be greatly expanded and to be promoted with 搈uch greater vigour and commitment.?/p>
The report questioned how many patients embraced the idea of choice. Its investigations found that men were 揷onsiderably more likely?not to welcome personal choice and preferred to leave the decision to their GP. The same was found among patients aged 55 or over.
揟he relative unwillingness of older people to exercise choice is especially significant, given that they tend to be frequent users of the NHS,?said the report.
There were 揹isturbing signs?that many NHS professionals lack the skills to make choice work effectively.
揟he need for proper support and clear information in the field of health, with its complex technical language, is particularly obvious,?it said.
Commenting on the report, Mr James Johnson, the BMA抯 chairman of council, said: 揑t is important to read the detail of today抯 report before commenting on whether the Public Administration Select Committee has listened to, and heard, the BMA抯 concerns. At first view, Choice, Voice and Public Services?does reflect some of our anxieties over fragmentation of the health service. We will issue further comments when we have considered the report in full.?/p>(Rebecca Coombes)
The House of Commons Public Administration Select Committee, in a report of its inquiry into choice in public services, said government plans to bring private companies to heel were so far 搒ketchy and inadequate.?/p>
The concerns are about reforms due in December 2005 (although schemes are already in operation on a smaller scale), when all patients will be given a choice of hospital for elective treatment. The choice may include non-NHS facilities. Under the new funding system for acute hospital trusts, called payment by results, the NHS loses money if patients opt to go elsewhere. The new system lays down a fixed tariff for every operation, so a hospital cannot increase its income from primary care trusts by putting up its prices, and it will lose money if its volume of elective surgery declines.
The report quoted from the BMA抯 evidence to the inquiry, which claimed that a two tier system would result from the widening of choice of providers.
揟he BMA told us that the private sector would in future have an in-built incentive to select patients that are fit with little co-morbidity, leaving the existing NHS acute sector to cope with more complex cases,?the report said.
The health secretary, John Reid, has said he is prepared to consider the closure of hospitals in cases where patients choose not to use them under the new competitive regime.
But the report warned that choice was not the most important thing for the public, especially if it leads to the closure of hospitals. It urged the government to do more to prevent the private sector gaining an unfair advantage.
揥e did find a high risk that the introduction of alternative providers of care can generate additional costs and the creaming off of less difficult cases. We urge ministers to ensure that the private sector does not exploit choice schemes to the detriment of the public interest.?/p>
The report contained allegations that, in one part of the country at least, choosing a private sector hospital could undermine clinical priorities.
揑t is alleged that GPs in the Nottingham area are being encouraged, and sometimes financially rewarded, to send patients to new private treatment centres for routine operations, even though the centres may not have appropriate medical support available in case of complications,?it said.
The report said schemes to increase choice were valuable if they were well designed and start with specific goals of reducing unfairness. It cited several good initiatives, including the expert patients programme and the coronary heart disease choice scheme. But such initiatives needed to be greatly expanded and to be promoted with 搈uch greater vigour and commitment.?/p>
The report questioned how many patients embraced the idea of choice. Its investigations found that men were 揷onsiderably more likely?not to welcome personal choice and preferred to leave the decision to their GP. The same was found among patients aged 55 or over.
揟he relative unwillingness of older people to exercise choice is especially significant, given that they tend to be frequent users of the NHS,?said the report.
There were 揹isturbing signs?that many NHS professionals lack the skills to make choice work effectively.
揟he need for proper support and clear information in the field of health, with its complex technical language, is particularly obvious,?it said.
Commenting on the report, Mr James Johnson, the BMA抯 chairman of council, said: 揑t is important to read the detail of today抯 report before commenting on whether the Public Administration Select Committee has listened to, and heard, the BMA抯 concerns. At first view, Choice, Voice and Public Services?does reflect some of our anxieties over fragmentation of the health service. We will issue further comments when we have considered the report in full.?/p>(Rebecca Coombes)