Getting more for their dollar: a comparison of the NHS with California's Kaiser PermanenteCommentary: Funding is not the only factorCommentary: Same price, better careCommentary: Competition made them do it
Sir,
This paper (1) has invoked much well deserved criticism. However, there
is much of value that could be learned from Kaiser Permanente particularly
in the areas of management and communication. There is no doubt that NHS
performance could be enhanced by more and better equipment, longer
consultations, extra doctors and nurses. As a general practitioner I
wonder how Kaiser Permanente would deal with the drug addicts, unemployed,
single parents, chronic sick, and politically fuelled expectation that is
a daily part of my workload? These can be high demand users of primary
care, some with fortnightly or even weekly contact.
An e-mail enquiry I made to Kaiser Permanente one week ago requesting
details of their patient contracts has not received an acknowledgement. It
would appear that Kaiser Permanente is not a comprehensive all embracing
health care system and should not be equated to the NHS.
I did receive a response from a relative in California, a copy of which
is enclosed for the patient insight it portrays.
“I have been a member of Kaiser Permanente for years. I have also
been very healthy until recent years, when I have had a struggle with
high blood pressure. During the time I was very healthy, they were really
good! Since then, my report is a mixed bag.
Plus side:
I like my doctor and trust him. I liked the previous one, also, but
he died. They are very into preventive care. If I do not get a mammogram
when they think I should, for example, I will hear about it. They have a
lab on the premises, so test results are available while I wait.
Down Side:
Try not to need a hospital unless you are in a Kaiser area. I fainted in
a restaurant in Newport Beach about 6pm one evening (turns out it was too
strong blood pressure medicine, but nobody knew at the time) and the
medics took me to a local, private, hospital where I got emergency room
treatment. They wanted to keep me overnight to check my heart; nothing
doing. I had to be transported by ambulance to a Kaiser hospital about 90
miles away, and it did not have a bed available until 3 am. I was mad and
very tired. (But Kaiser did pay for the Newport Beach hospital services
and the ambulance.)
Kaiser does not like to make appointments. They think they can reduce no
shows by making members phone in at 7 am on the day they want to come in.
They may, or may not, have an opening that day. This procedure makes me
mad, too.
Overall, Kaiser Permanente is not a bad choice as a supplement to the
National Health Service. Like the NHS, Kaiser runs like a big lumbering
bureaucracy that has a rule for everything, and not a lot of room for
making judgments. But they are always there, always open, and if you have
what they term "a short term emergency" (like you have just come down
with the flu, and your own doctor can't see you) they will provide a
doctor who will do what is necessary.”
C. W. G. Angus FRCGP general practitioner
Primrose Lane Medical Centre, Rosyth, Fife, KY11 2UR
1. Feacham RGA, Sekhri NK, White KL. Getting more for their dollar: a
comparison of the NHS with California’s Kaiser Permanente. BMJ 2002; 324;
135-43.
Competing interests:
No competing interests
29 January 2002
Charles W Angus
general practitioner
Primrose Lane Medical Centre, Rosyth, Fife KY11 2UR
Rapid Response:
Invalid comparison
Sir,
This paper (1) has invoked much well deserved criticism. However, there
is much of value that could be learned from Kaiser Permanente particularly
in the areas of management and communication. There is no doubt that NHS
performance could be enhanced by more and better equipment, longer
consultations, extra doctors and nurses. As a general practitioner I
wonder how Kaiser Permanente would deal with the drug addicts, unemployed,
single parents, chronic sick, and politically fuelled expectation that is
a daily part of my workload? These can be high demand users of primary
care, some with fortnightly or even weekly contact.
An e-mail enquiry I made to Kaiser Permanente one week ago requesting
details of their patient contracts has not received an acknowledgement. It
would appear that Kaiser Permanente is not a comprehensive all embracing
health care system and should not be equated to the NHS.
I did receive a response from a relative in California, a copy of which
is enclosed for the patient insight it portrays.
“I have been a member of Kaiser Permanente for years. I have also
been very healthy until recent years, when I have had a struggle with
high blood pressure. During the time I was very healthy, they were really
good! Since then, my report is a mixed bag.
Plus side:
I like my doctor and trust him. I liked the previous one, also, but
he died. They are very into preventive care. If I do not get a mammogram
when they think I should, for example, I will hear about it. They have a
lab on the premises, so test results are available while I wait.
Down Side:
Try not to need a hospital unless you are in a Kaiser area. I fainted in
a restaurant in Newport Beach about 6pm one evening (turns out it was too
strong blood pressure medicine, but nobody knew at the time) and the
medics took me to a local, private, hospital where I got emergency room
treatment. They wanted to keep me overnight to check my heart; nothing
doing. I had to be transported by ambulance to a Kaiser hospital about 90
miles away, and it did not have a bed available until 3 am. I was mad and
very tired. (But Kaiser did pay for the Newport Beach hospital services
and the ambulance.)
Kaiser does not like to make appointments. They think they can reduce no
shows by making members phone in at 7 am on the day they want to come in.
They may, or may not, have an opening that day. This procedure makes me
mad, too.
Overall, Kaiser Permanente is not a bad choice as a supplement to the
National Health Service. Like the NHS, Kaiser runs like a big lumbering
bureaucracy that has a rule for everything, and not a lot of room for
making judgments. But they are always there, always open, and if you have
what they term "a short term emergency" (like you have just come down
with the flu, and your own doctor can't see you) they will provide a
doctor who will do what is necessary.”
C. W. G. Angus FRCGP
general practitioner
Primrose Lane Medical Centre, Rosyth, Fife, KY11 2UR
willieandgina@bigfoot.com
1. Feacham RGA, Sekhri NK, White KL. Getting more for their dollar: a
comparison of the NHS with California’s Kaiser Permanente. BMJ 2002; 324;
135-43.
Competing interests: No competing interests