BMJ  2004;328:584-585 (6 March), doi:10.1136/bmj.328.7439.584-c

Letter

Hospital bed utilisation in the NHS and Kaiser Permanente

Ownership, integration, and medical leadership are key

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

EDITOR—Shapiro and Smith provide an insightful summary into possible reasons for the success of the Kaiser Permanente model compared with the disintegrated system which is clearly failing in the NHS.¹

The authors say that Kaiser "employs its doctors." This is incorrect. Kaiser Permanente delivers health care through regional Permanente medical groups, which are entirely owned, led, and run by their shareholder doctors. These work in an equal and exclusive partnership with, but are totally separate from, the Kaiser health plans, which fund the medical groups to provide health care for members. Shareholder doctors agree to pay themselves competitive salaries rather than take profit shares as this arrangement is consistent with the Kaiser Permanente philosophy and allows the medical groups to attract doctors who are both of sufficiently high calibre and of a "cultural good fit" with the organisation.

The reason for the success of this model is that . . . [Full text of this article]

Erdington Medical Centre, Birmingham B24 8NT robert.morley@oc.birminghamha.nhs.uk

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Lessons for the NHS from Kaiser Permanente

Jonathan Shapiro and Sarah Smith
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