US health firm 'better value than the NHS'

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The failings of the NHS were exposed by a study which found that an American organisation provides substantially better health care at roughly the same cost.

The research, published in the British Medical Journal, is the first to compare the NHS with a not-for-profit healthcare provider in the United States. It found the American patients spent one-third of the time in hospital, had access to twice as many specialists and never waited more than five months for an operation. But the costs per head of the NHS and Kaiser Permanente, a California-based operator, were within 10 per cent of each other.

The author of the study, Professor Richard Feachem, a former dean of the London School of Hygiene and Tropical Medicine now based at the University of California, said it showed NHS problems could not be explained by lack of money. "The widely held beliefs that the NHS is efficient and that poor performance in certain areas is largely explained by under-investment are not supported by this analysis," he said.

"Kaiser achieved better performance at roughly the same cost as the NHS because of integration throughout the system, efficient management of hospital use, the benefits of competition and the greater investment in information technology."

American health care has a reputation for combining high cost with poor outcomes. But there are many competing healthcare operators, including Kaiser, which was founded in 1945 to serve the West Coast shipyards. It now serves 6.1 million patients, most of whom have insurance-based cover paid for by their employers or the state. Those who pay their own premiums have bills of about $150 to $250 a month (£100-£175). The NHS serves nearly 60 million people and has an annual budget of £60bn.

In making the comparison, the researchers adjusted for differences in the services offered, the socio-economic status and age of the populations, and for cost of living. The NHS spent $1,764 per head while Kaiser spent $1,951, according to the adjusted figures for the year ending last April. When performance was compared, Kaiser was found to provide "considerably" more specialists at its large community clinics and hospitals. There were three times more cardiologists and twice as many oncologists, obstetricians and paediatricians per 100,000 patients.

The US system relied far less heavily on hospital admissions, requiring just 327 hospital bed days per 1,000 patients per year compared with 1,000 days for the NHS. Professor Feachem said the NHS could save £10bn per year if it made such efficient use of hospital beds.

He added that Kaiser patients were not denied expensive treatments. Fewer than 20 per cent of the US patients had to wait more than two weeks to see a specialist compared with more than 13 weeks for most British patients. No Kaiser patients had to wait more than five months for an operation, but one-third of British patients endured delays longer than that, the study found.

Professor Feachem said the findings undermined the claim in the Government's NHS plan that the service "gets more and fairer health care for every pound invested than most other healthcare systems".

He added that the NHS, which faced some "very, very serious problems", could learn lessons from the Kaiser system.

"If an NHS patient moved to Kaiser they would be delighted with the experience, and if a Kaiser patient moved to the NHS they would be horrified."

The Department of Health said areas in which Kaiser was outperforming the NHS were being addressed. "These findings do not undermine the long-held view that the NHS is highly efficient compared with the great majority of healthcare systems," a spokesman said.

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