Hospital bed utilisation in the NHS and Kaiser Permanente
http://www.100md.com
《英国医生杂志》
EDITOR—Shapiro and Smith provide an insightful summary into possible reasons for the success of the Kaiser Permanente model compared with the disintegrated system which is clearly failing in the NHS.1
The authors say that Kaiser "employs its doctors." This is incorrect. Kaiser Permanente delivers health care through regional Permanente medical groups, which are entirely owned, led, and run by their shareholder doctors. These work in an equal and exclusive partnership with, but are totally separate from, the Kaiser health plans, which fund the medical groups to provide health care for members. Shareholder doctors agree to pay themselves competitive salaries rather than take profit shares as this arrangement is consistent with the Kaiser Permanente philosophy and allows the medical groups to attract doctors who are both of sufficiently high calibre and of a "cultural good fit" with the organisation.
The reason for the success of this model is that it allows for true medical leadership—the shareholder doctors make all decisions related to treatment and use of resources, and this basic underlying principle is accepted and supported by the health plans. As Sharon Levine, associate executive director of the Permanente medical group in northern California puts it, "the pen (and the mouse) are the most expensive items of medical equipment" (personal communication).
In the hegemony of the NHS manager and flattened clinical hierarchies this is all rather controversial and at odds with the authors' contention that distinctions between doctors and nurses may all be considered as largely obsolete.
The lessons to be learnt from Kaiser Permanente are those of true medical leadership as well as ownership and integration. These lessons are valuable to the NHS, regardless of the given method of healthcare funding. Politicians please take note.
Robert Morley, general practitioner principal
Erdington Medical Centre, Birmingham B24 8NT robert.morley@oc.birminghamha.nhs.uk
Competing interests: None declared.
References
Shapiro J, Smith S. Lessons for the NHS from Kaiser Permanente. BMJ 2003;327: 1241-2. (29 November.)
The authors say that Kaiser "employs its doctors." This is incorrect. Kaiser Permanente delivers health care through regional Permanente medical groups, which are entirely owned, led, and run by their shareholder doctors. These work in an equal and exclusive partnership with, but are totally separate from, the Kaiser health plans, which fund the medical groups to provide health care for members. Shareholder doctors agree to pay themselves competitive salaries rather than take profit shares as this arrangement is consistent with the Kaiser Permanente philosophy and allows the medical groups to attract doctors who are both of sufficiently high calibre and of a "cultural good fit" with the organisation.
The reason for the success of this model is that it allows for true medical leadership—the shareholder doctors make all decisions related to treatment and use of resources, and this basic underlying principle is accepted and supported by the health plans. As Sharon Levine, associate executive director of the Permanente medical group in northern California puts it, "the pen (and the mouse) are the most expensive items of medical equipment" (personal communication).
In the hegemony of the NHS manager and flattened clinical hierarchies this is all rather controversial and at odds with the authors' contention that distinctions between doctors and nurses may all be considered as largely obsolete.
The lessons to be learnt from Kaiser Permanente are those of true medical leadership as well as ownership and integration. These lessons are valuable to the NHS, regardless of the given method of healthcare funding. Politicians please take note.
Robert Morley, general practitioner principal
Erdington Medical Centre, Birmingham B24 8NT robert.morley@oc.birminghamha.nhs.uk
Competing interests: None declared.
References
Shapiro J, Smith S. Lessons for the NHS from Kaiser Permanente. BMJ 2003;327: 1241-2. (29 November.)