Intended for healthcare professionals


Lessons for the NHS from Kaiser Permanente

BMJ 2003; 327 doi: (Published 27 November 2003) Cite this as: BMJ 2003;327:1241
  1. Jonathan Shapiro (, senior fellow,
  2. Sarah Smith, director of performance and quality improvement (
  1. Health Services Management Centre, University of Birmingham, Birmingham B15 2RT
  2. Middlesbrough Primary Care Trust, Middlesbrough TS2 1HR

    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 …

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