Some patients in the United States are getting better health care than NHS patients in Britain, for roughly the same cost, finds a study in this week’s BMJ.
Richard Feachem and colleagues compare the costs and performance of the NHS with those of Kaiser Permanente, a non-profit health organisation in California, with 6.1 million members. Kaiser was chosen because it represents an integrated, NHS-like organisation, providing a similar range of services to the NHS.
After adjusting for age and socio-economic differences between the two populations, they found that although the health care costs per capita in Kaiser and the NHS were similar to within 10%, Kaiser’s performance was significantly better in several important areas.
For example, Kaiser patients have access to significantly more specialists than NHS patients, and spend one third of the time in hospital than NHS patients do. Waiting times to see a specialist are over three times as long in the NHS.
Reasons why Kaiser can achieve better performance at roughly the same cost as the NHS include better integration of care; treatment of patients at the most cost effective level of care; the benefits of competition; and better information technology, suggest the authors.
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, say the authors. Kaiser is certainly not a perfect system, and has its share of critics in the US. However, these findings point to the value that can be gained from comparing health care systems. “It is our hope that they will encourage further analysis and policy debate,” they conclude.