|The British Medical Journal this year published a comparison of Kaiser Permanente and the National Health Service, concluding that health care “costs per capita in Kaiser and the NHS are similar to within 10 percent and that Kaiser’s performance is considerably better in certain respects, particularly access to specialist diagnosis and treatment, and hospital waiting times."|
|Time to see a primary care physician||2001: average 3 days; <48 hours by 2004||Urgent: <24 hours; routine: 80% <7 days|
|Telephone help line and associated services||NHS direct help line available. By 2004, NHS Direct will provide gateway to advice, appointments, and out of hours care.||24-hour hot line available for advice and appointments. Appointments can also be made online.|
|Repeat prescription available without calling or visiting a doctor||Available nationwide by 2004||Available now|
|Time spent with primary care physician||8.8 minutes||Medical: 20 minutes; Ob/Gyn: 15 minutes; pediatrics: 10 minutes|
|Waiting time to see a specialist||2001: 36% <4 weeks, 20% >13 weeks, 4% >6 months; by 2005, average 5 weeks and maximum 3 months||2001: 80% <2 weeks|
|Waiting time for inpatient treatment or surgery||2001: 41% <13 weeks, 33% >5 months, 7% >12 months; by 2005: average 7 weeks and maximum 6 months||2001: 90% <13 weeks|
|Children who received various immunizations by 2 years old||DTP=95%, MMR=88%, Hib=94%||DTP=91%*, Polio=93%*, MMR=94%*, Hib=91%*, Hepatitis B=86%*, Chicken pox=83%*|
|Specialists per 100,000 people|
|Breast||69% of women age 50–64 had mammogram in past 3 years†||78% of women age 52–69 had ≥1 mammogram in the past 2 years*|
|Cervical||84% of women age 25–64 screened at least once in past 5 years‡||80% of women age 21–64 screened at least once in past 3 years*|
|People with diabetes who received annual retinal examination||60%||70% for <65 years;
80% for = 65 years
|Coronary revascularization procedures per 100,000|
|Transplantation per 100,000|
|*Data from Kaiser US (not California).
SOURCE: “GETTING MORE FOR THEIR DOLLAR: A COMPARISON OF THE NHS WITH CALIFORNIA’S KAISER,” BRITISH MEDICAL JOURNAL, JAN. 19, 2002
Managed Care’s Top Ten Articles of 2016
There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.
They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?
A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.
More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.