Education And Debate

Can the NHS learn from US managed care organisations?

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7433.223 (Published 22 January 2004) Cite this as: BMJ 2004;328:223

This article has a correction. Please see:

  1. Jennifer Dixon, director (jdixon@kingsfund.org.uk)1,
  2. Richard Lewis, visiting fellow1,
  3. Rebecca Rosen, fellow1,
  4. Belinda Finlayson, research officer1,
  5. Diane Gray, visiting fellow1
  1. 1Health Policy, King's Fund, London W1G 0AN
  1. Correspondence to: J Dixon
  • Accepted 12 January 2004

A new King's Fund study identifies factors associated with efficient management of chronic disease in the United States

Managed care organisations in the United States have some parallels with primary care trusts in the NHS. A key aim of both is to improve health so that avoidable use of health care is reduced. Managed care organisations have strong inbuilt incentives to manage the care of enrolled patients proactively (box 1). Two studies recently reported that hospital admissions and use of day beds for the population of one managed care organisation, Kaiser Permanente North California, were less than that for a comparable population in the NHS.2 3 The findings raised hot debate, and the study by Feachem et al was criticised mainly because of the methods of comparing the US and NHS populations served and costs.4 On the assumption that the reduction is real, we examine what factors might contribute and whether the NHS could adopt them.

Background

The Department of Health is already funding two pilot projects modelled on Kaiser Permanente5 and another major managed care organisation, United Health Care, in 18 primary care trusts in England.6 Nevertheless, there seems to be no consensus about why hospital admission and day bed rates might be lower in managed care organisations or the useful lessons for the NHS.24 We studied how five relatively highly performing managed care organisations organise care for people with chronic conditions, such as asthma, diabetes, chronic obstructive pulmonary disease, and heart failure. We focused on chronic conditions because they are among the costliest to treat in the NHS and the United States,7 evidence exists that effective ambulatory care can reduce the risk of inpatient care, and the large variations in rates of hospital admission by primary care trusts suggests that care …

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