BMJ  2003;327 (29 November), doi:10.1136/bmj.327.7426.0-g

Editor's choice

The NHS experiment

The first 150 words of the full text of this article appear below.

Ownership and integration—two attributes that typify Kaiser Permanente, a healthcare organisation that provides managed care to 8.2 million Americans. Last year's BMJ paper by Richard Feachem and colleagues compared the NHS unfavourably with Kaiser and produced a strong reaction. Many of you argued this was a comparison of apples and oranges, fatally flawed; others believed that Kaiser could be a model for the NHS. A major difference between the two systems was bed usage—the NHS used three times the number of acute bed days. One GP reader wrote: "Senior NHS representatives should visit the US system described, try to work out why patients spend far less time in hospital, and then start applying the lessons learned."

Chris Ham and colleagues followed most of that advice. They examined routine data for the 11 leading causes of acute hospital admission (p 1257). Ham interviewed Kaiser's senior clinical and managerial staff, . . . [Full text of this article]

(kabbasi@bmj.com)

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