Deep Cuts to Health Care Services in the UK

The rising costs of health care are an international problem, and in the United Kingdom (UK) some dramatic deep cuts are planned. According to the Telegraph, the National Health Service (NHS) and senior health service officials have already agreed to a list of cost-cutting measures.
An investigation by The Sunday Telegraph uncovered the health care cuts “buried in obscure appendices to lengthy policy and strategy documents.” It was also reported that citizens in many local communities were not aware of the changes to health care services.
Despite the UK government’s promise to protect the budget of the NHS, “efficiency savings” of up to 20 billion pounds (about $30 billion) by 2014 must be instituted. The government says it will still maintain front-line services.
Among the changes to be made include rationing of most common surgeries, including hip and knee replacements, cataract surgery, and orthodontic procedures; reduction in services for the terminally ill; closure of nursing homes; and a reduction in the number of hospital beds available for acute care, including those for the mentally ill.
The NHS also plans to cut staff at NHS hospitals, ration funding of in vitro fertilization treatment and obesity surgery, and reduce spending for pediatric and maternity services, care for the elderly, and programs that offer respite services for caregivers.
The cuts have drawn severe criticism from many quarters, including the Patients Association, which named the cuts ‘astonishingly brutal.” Katherine Murphy of the Association noted that “this is a really blatant attempt to save money by leaving people in pain.”
Dr. Peter Carter, head of the Royal College of Nursing, stated that he was “incredibly worried” about the changes. Carter urged Health Secretary Andrew Lansley to “get a grip” on what was happening in the NHS and said that Lansley “keeps saying that the Government will protect the front line from cuts—but the reality appears to be quite the opposite.”
In the UK, how, where, and by whom individuals receive health care is largely determined by the decisions made by 150 primary care trusts, all of which will be eliminated under the new approach to delivering care. Instead, general practitioners would come together in regional consortia to purchase services from hospitals and other medical and health care providers.
According to a New York Times article, the government stated that the upcoming changes would “cause significant disruption and loss of jobs,” but that “the current architecture of the health system has developed piecemeal, involves duplication and is unwieldy.” It believes that by abolishing the NHS and transferring health care decisions to patients and clinicians, “we will be able to effect a radical simplification, and remove layers of management.”
The deep cost cuts to health care and reorganization of services in the UK is an example of the critical decisions many countries are facing because of rising health care costs, an aging population, and failing economies. It remains to be seen what impact these and other measures will have on individuals and societies as a whole.

Massachusetts Considers Rising Costs, Insurance Hearings

Massachusetts Gov. Deval Patrick (D) on Monday met with health care industry executives to request that they address rising health care costs or potentially face new government regulations, the Boston Globe reports. During the meeting, which came in response to recent articles by the Globe’s Spotlight Team about the cost of medical care, Patrick said he is considering holding hearings on health insurance premiums and hospital charges to insurers for member care. Last week, Patrick said the state Division of Insurance has the power to reject hospital rates it finds excessive.
State Inspector General Gregory Sullivan asked the attending executives to refrain from signing contracts covering patient care beyond this year so that the state has an opportunity to consider possible reforms. The executives included leaders from the state’s “dominant” provider, Partners HealthCare, and its largest insurer, Blue Cross and Blue Shield of Massachusetts. Partners and BCBS last summer agreed to a multiyear contract calling for annual rate increases of about 5% to 6%.
Spokespersons for both insurers on Monday said the agreement was final. However, Sullivan believes a state insurance hearing would qualify as an unforeseen circumstance and provide an opportunity to revise or suspend the deal. Sullivan said, “Other governors haven’t used this power; he’s telling them, ‘I have this and tell me why I shouldn’t use it.’”
According to Charles Baker, CEO of Harvard Pilgrim Health Care, insurance executives at the meeting said they would welcome hearings. The Globe reports that several executives said they will support a new payment reform commission that was created by legislation last year, which will examine alternative payment models in health care (Bombardieri, Boston Globe, 1/13).
Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

Complications From Screening Endoscopic Procedures Underestimated

Screening procedures are often considered to be benign. While this is true compared to the diseases being screened for such as colon cancer, a new study reports the rate of serious side effects from endoscopic procedures (endoscopy and colonoscopy) is actually 2- to 3-fold higher than recent estimates.
Daniel A. Leffler, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues have published the results of their study in the Oct. 25 Archives of Internal Medicine. Rather than relying on the standard physician reporting method of adverse events, the researchers used electronic medical records to track patient emergency visits and hospital admissions that occurred within two weeks of their endoscopic procedure.
A total of 15 to 20 million endoscopic procedures are performed annually in the United States. The American Society for Gastrointestinal Endoscopy (ASGE) survey from 1976 remains one of the most commonly cited and states the complication rate of 0.13% for upper endoscopy and 0.35% for colonoscopy.
Leffler and colleagues evaluated 6383 upper endoscopies (EGDs) and 11 632 colonoscopies within the BIDMC system. The EMR captured 419 ED visits and 266 hospitalizations which occurred within 14 days after the procedure.
Nearly a third of the ED visits (134 of 419, 32%) and hospitalizations (76 of 266, 29%) were found to be related the procedure. Only31 of these incidents were recorded by the standard physician reporting system.
The most common reasons for the ED visits related to the endoscopic procedures were abdominal pain (47%), gastrointestinal bleeding (12%), and chest pain (11%). The mean time for a trip to the ED after a procedure was six days for EGDs, and 5.2 days for colonoscopies.
The researchers found procedure-related hospital visits occurred in 1.07% of all EGDs, 0.79% of all endoscopies, 0.84% of colonoscopies, and 0.95% of all screening colonoscopies.
This 1% incidence of related hospital visits within two weeks of outpatient endoscopy is more five times the 1976 stated risk of o.13% for upper endoscopy. It is nearly three times higher than 1976 stated risk of 0.35% for colonoscopy.
Using Medicare standardized rate, the researchers estimated the mean costs at $1403 per ED visit and $10 123 per hospitalization. Across the overall screening/surveillance colonoscopy program, these episodes added $48 per examination.
As this study could only capture the ED and hospital visits within the BIDMC, there may have been some missed if other hospitals were used by the patient. Regardless, the procedures and possible risks must be discussed and considered with patients.
This small risk should not prevent patients from screening for serious diseases such as colon cancer or Barrett’s esophagitis which may lead to esophageal cancer.