Evidence based healthcare policy
Interesting happenings in Scotland with what appears to be genuine reappraisal of policy by the SNP administration.
The review body, led by health economist Dr Andrew Walker, said the options that would involve the most change from existing services raised the most questions.
The senior lecturer in health economics at Glasgow University added: “When a health board proposes substantial change, there is an onus on the board to prove its case.
“It needs to provide evidence that the current services is not safe or sustainable, and it needs to show the evidence that what it proposes instead will be better for patients and the public.”
The panel said some of the research evidence used by the health boards was biased and not necessarily relevant to Scotland.
Both boards cited problems recruiting senior staff as a reason for change.
However, the panel’s report said: “In 2006 there were 76 consultants in A&E medicine in Scotland but over the next five years a further 102 A&E doctors will complete their training.”
Yup, brilliant workforce planning, which would then be used to push for a sub-consultant grade to mop up those poor unemployed doctors. I wonder how the dozens of such decisions made south of the border would stand up to similar scrutiny.
I found this post from Harkness fellows visiting the USA describing the “choice” offered to them by the US model. Paternalistic models of care have something to recommend them!
Indeed, we found that choice was typically accompanied by a level of bureaucracy and micromanagement that belied the rhetoric of market efficiency. At every stage, our choices were strictly governed by which providers were “in” our health plan’s network, which medications were on the formulary, and which procedures required pre-authorization. Strictly speaking, preauthorization was the physician’s responsibility, but the financial risk of not checking fell on us. The bureaucratic burden of choice not only created uncertainty about coverage, despite being comprehensively insured, but also, as we discovered, imposed both financial and time costs.
To date there has been little in our collective exposure to U.S. health care to suggest that greater choice has increased our sense of control. More often than not, we found we were making choices to knit together different providers and fragmented parts of the system to guarantee access and continuity of care. Frequently we had to choose between different options, even when the choices offered were of little value to us, and often with little information to support informed decision making. Rather than giving us a sense of greater control, these forced choices served only to create a sense of uncertainty.
Anyone paying attention?
And the scapegoating of Maidstone Hospital continues with blood-letting from the board. The board probably needs to be beefed up with people willing & able to stand up to the DoH / SHA but my point is about the treatment of this episode as a local problem only. I would like to see a similar analysis by the Healthcare Commission of the performance of other trusts. Otherwise we are going to persist in this myopic denial of reality.