Researchers at the Institute for Global Health wanted to test the claim made by the British National Health Service that its use of resources is among the most efficient of any health care system in the world. So it compared the cost-efficiency of the NHS with the cost-efficency of Kaiser Permanente, the largest HMO in the United States. The results were recently published in the British Medical Journal and did not reflect very well on the British system.
The researchers chose Kaiser Permanente because it was similar to the NHS in a number of ways, including the way it is organized, the amount it spends to deliver health care, and services provided.
The main findings of the study were that those covered by Kaiser Permanente had significantly better medical access than those covered by the NHS.
Kaiser Permanente patients spent, on average, more than twice as long consulting with physicians. Whereas it took 13 weeks for 80 percent of patients referred to a specialists to actually see a specialist, 80 percent of similar people in Kaiser Permanente’s system saw a specialist within two weeks. Ninety percent of Kaiser Permanente’s patients who needed inpatient treatment or surgery had such surgery within 13 weeks. Only 41 percent of NHS patients who need such treatment had received it after 13 weeks.
The interesting thing is why Kaiser Permanente was able to achieve such efficiencies. It was able to do so because of limits it places on hospitalization. After adjusting for socioeconomic factors, Kaiser Permanente had the equivalent of 327 acute bed days per 1000 population. The NHS, however, had 1,000 acute bed days per 1000 population.
Most HMO’s have policies limiting the amount of hospitalization they will cover, and such policies are generally very unpopular. But the clear implication is that the more money spent on hospitalization, the less that can be spent on providing access to other forms of care, such as specialists and surgical procedures.
As Alain Enthoven notes in a Commentary that appears with the study, a major reason for the differing efficiency is competition. People who are insured by Kaiser Permanente have a lot more options to switch to an alternative provider if they are dissatisfied, whereas customers of the NHS have very limited options, since the NHS is supported by their taxes regardless of whether they would prefer an alternative system.
Source:
Getting more for their dollar: a comparison of the NHS with California’s Kaiser Permanente. Richard G A Feachem, Neelam K Sekhri, Karen L White, British Medical Journal, 2002;324:135-143.