Ownership and integration are the key

Kaiser Permanente is a healthcare organisation providing managed care to 8.2 million Americans. It is widely admired for doing this in a cost effective way that is valued by both its members and its clinicians and has been closely studied over the past few years as researchers have tried to understand how it works and why it is so successful. Last year a paper by Feachem et al in the BMJ, which compared Kaiser and the NHS, provoked a sharp debate by implying that Kaiser achieved better outcomes for similar inputs.1 Now a study by Ham et al, reported in this week's BMJ, this time looking at lengths of stay in hospital (p 1257),2 has produced similar conclusions. It is time to summarise the key lessons that can be learnt from Kaiser Permanente and to consider their relevance for the NHS.

Kaiser Permanente is essentially a closed system that offers little distinction …