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Doubts cast on US healthcare model

Claims that US health maintenance organisation (HMO) Kaiser Permanente has similar healthcare costs to the NHS and considerably better performance are not accurate, says new research.

The article in the June edition of the British Journal of General Practice re-examines the data and methods used in an influential paper published by Feachem et al in the BMJ in 2002. It concludes that the Feachem paper has four major areas of error.

The Californian HMO combines a system of private voluntary insurance and user charges with the delivery of health services. The new paper, Questioning the Claims from Kaiser, says that crucially like is not being compared with like as the populations of patients served by Kaiser and by the NHS are fundamentally different.

It also says that NHS costs have been ‘wrongly inflated’ by leaving out substantial user charges paid by Kaiser members for care and that double counting to convert currency inflates NHS costs by about 40 per cent. In spite of this the NHS is ‘still 10.6 per cent “cheaper” than Kaiser’, it concludes.

In the Feachem study non-standardised data is used for NHS bed days from the Organisation for Economic Cooperation and Development, rather than official Department of Health statistics for England.

Finally, in response to the original claim that Kaiser is a more integrated system than the NHS, the latest article says that the NHS ‘provides healthcare to around 60 million people free at the point of delivery, long-term and psychiatric care, and continuing care after 100 days, whereas Kaiser California provides care to six million people, mainly employed and privately insured’.

It adds that important functions such as health protection, education and training of healthcare professionals and research and development are not included or properly costed in Feachem’s integrated model.

The Wanless review of NHS funding and the white paper for England Delivering the NHS plan refer positively to the Feachem article and the Kaiser model of care. Several English PCTs are piloting aspects of the model. In a speech last year about Kaiser health secretary John Reid said the NHS was a powerful social force in British society and had the ‘capacity and strength to learn from the market just as it has the capacity and strength not to copy it’.