Friday, January 5, 2018

UK Plans to Enforce Decentralization of Health Care

UK Plans to Enforce Decentralization of Health Care

Perhaps the only thing that is consistent about the health care system socialized in the UK is that it is in a state of constant change, its structure is constantly changing as governments seek elusive formulas that will provide the best care for the lowest prices while costs and demand increase.

Even when the new coalition government said it would make major cuts in the public sector, it initially promised to leave health care alone. But in one of his most shocking steps so far, he has done the opposite, proposing what would be the most radical reorganization of the National Health Service, as the system was called, since its founding in 1948.

Practical details of the plan are still vague. But the goal is clear: to change Britain's annual health budget control of $ 160 billion from a centralized bureaucracy to doctors at the local level. Based on the plan, $ 100 billion to $ 125 billion per year will be given to general practitioners, who will use the money to buy services from hospitals and other health care providers.

The plan will also play down the bureaucratic apparatus, in line with the government's goal of generating $ 30 billion in "efficiency savings" in the health budget in 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs will be lost because the bureaucratic layer will be removed.

In the document, or white paper, which outlines the plan, the government acknowledges that the change will "cause significant disruption and loss of work." But it says: "Today's health system architecture has evolved little by little, involving duplication and weight. Freeing the NHS, and putting strength in the hands of patients and doctors, means we will be able to produce radical simplification, and remove layers of management.

The health secretary, Andrew Lansley, also promised to give more power to the patient. At present, how and where patients are treated, and by whom, is largely determined by decisions made by 150 entities known as primary care beliefs all of which will be abolished under the plan, with several choices given to patients. This will also eliminate many of the government's current targets, such as how long patients have to wait for treatment.

The plan, with many elements that require legislative approval to be enacted, only applies to Britain; other parts of the UK have a separate system.

The government announced this month's proposal. Reactions to them ranged from happy to very skeptical. Many critics say that the plan is too ambitious, especially in the short time given, and they doubt that general practitioners are the right people to decide how the health care budget should be spent. At present, 150 primary care beliefs make the most of these decisions. Under the proposal, general practitioners will unite in regional consortia to purchase services from hospitals and other providers.

It is likely that many such groups must spend money to hire outside managers to manage their budgets and negotiate with providers, thus canceling part of the savings. David Furness, head of strategic development at the Social Market Foundation, a study group, said that under the plan, every general practitioner in London would, basically, be responsible for a budget of $ 3.4 million.

"It's like making your waiter manage a restaurant," said Mr. Furness. "The government says that GP knows what the patient wants, like the way the waiter knows what you want to eat. But a waiter isn't always good at ordering stocks, managing places, talking to chefs, why would they? They are servants.

But advocacy groups for general practitioners welcomed the proposal. "One of the great attractions of this is that he will be able to focus on what is needed by the local community," said Prof. Steve Field, chairman of the Royal College of General Practitioners, representing about 40,000 of the 50,000 general practitioners in the country. . "It's about doctors who take responsibility for making this decision.

Dr. Richard Vautrey, deputy chairman of the general practitioners committee at the British Medical Association, said that general practitioners have long felt there were "too many bureaucratic obstacles to be skipped" in the system, hampering communication. "In many places, communication between G.P and consultants in hospitals has been divided and distant," he said.

The plan will also require all National Health Service hospitals to become "trust foundations," companies that are independent of health care controls and are accountable to independent regulators (some hospitals currently operate this way). This will result in further job losses, the health workers union said, and also opened the door to further privatize services.