More lessons from Kaiser Permanente and Veterans'Affairs healthcare system

Imagine a health system that improved diabetes control from 51% to 94%, screening for cervical cancer from 62% to 93%, and use of blockers for myocardial infarction at discharge from hospital from 70% to 95%. Imagine another system that costs the same as the NHS but has consistently higher quality of care as measured by process and outcome measures. Actually you don't have to imagine them because these two systems already exist—in the United States. Between 1995 and 2000 the Veterans' Affairs healthcare system achieved these remarkable improvements in quality for its more than 3.5 million users while reducing costs per patient by 25%.1 2 In the second case, the starkly better results for the 9 million members of the Kaiser Permanente health system compared with the NHS were documented in a 2002 study published in this journal.3

That both these systems invest heavily in health services research is probably no coincidence. The Veterans' Affairs system puts in $50m (£29m; €;42m) …