Thursday, January 24, 2008

CAB across The Pond: MVNHS© in a Tizzy

Dr John Crippen practices in the UK, and writes at the award-winning NHS Blog Doctor. Recently, he reported on the National Health System's "much vaunted Choose and Book (CAB) system" [ed: methinks he owes you a shilling for "much vaunted"], which is essentially a government overseen referral process for folks who need the care of a specialist.
Some group insurance plans here in the States also require a referral to a specialist. The thing is, one's primary care physician is free to recommend any qualified specialist (although it's to the insured's benefit that the specialist is "in-network").
Not so in Merry Old England: The CAB system's "commissar" requires physicians to send "a page and a half of instructions, to the patient. We no longer write to a specialist we know and trust. We send a circular to a medical tombola." In other words, the primary care physician is removed from the decision making process altogether, leaving the patient with few (if any) resources to rely in making important health care decisions.
Now, there are some who would say "but Henry, you're always touting consumer driven health care, and agitating for more personal responsibility in the process," and they would be right. But that's a patient's choice; there's no gummint bureaucrat mandating that he do so. And for seasoned citizens, the problem is exacerbated:
"Many elderly patients, particularly those who live alone, do not understand the system and do not know how to get help."
This is particularly troublesome, as these are folks who are likely to have greater health care needs than younger citizens. And it underscores another issue that seems to be growing "over there:"
"Patients are not turning up for appointments...So now the GPs are being asked to take responsibility for the system and chase the patients with a third reminder."
As Dr Crippen notes, this is an additional burden on NHS providers, and it's one that's unlikely to be successful. Not a ringing endorsement of government-sponsored health care.
Hat tip: Bob Vineyard
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