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View Diary: My experiences with single-payer medicine: Norway (241 comments)

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  •  I, too, have heard lots of good about (1+ / 0-)
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    ssundstoel

    the Kaiser system and have been favorably impressed with my little bit of personal contact.  I am an OB/Gyn whose residency hospital was contracted to take Kaiser patients and in which the Kaiser doctors practiced.  The patients all seemed to have appropriate care in the offices tho I never actually witnessed that aspect.  I just got to see the records when the patient came into the hospital.  The doctors who were from Kaiser were an average lot - some excellent, some adequate.  Their outcome data for patients in our hospital was about the same as the private patients.  We also had a large Medicaid population at that hospital whose outcome data was worse - sometimes the first "prenatal visit" was when the baby's head was crowning.  A few of the Kaiser doctors seemed to figure out how to game their system.  Since they were salaried employees a few of them did exhibit less ambition.  They would schedule surgery for their surgery block, thus earning pay for that block, and then, somehow that patient would cancel but the doctor still got paid.  Eventually we residents noticed it was the same doctors and the same patient names repeatedly and we suspected.  However, even this was of a small magnitude as most of the Kaiser docs were appropriately working hard and earning their keep.  
    Additionally, I went to a training seminar at a Kaiser facility in California.  Kaiser had done some research on how to save costs on treatment for conditions that often have led to hysterectomy.  Hysterectomy is not only expensive but pretty darned tooting invasive.  They explored lots of options and decided on one particular method of endometrial ablation that would avoid hysterectomy in many cases.  They are not allowing each and every Kaiser Gyn to decide which instrumentation to use; Kaiser decided which is best by evidence.  They have subsequently saved a bundle of money and a bunch of wear and tear on many patients who have avoided a major surgery.  I was impressed that they used a systematic evidence based approach to solving the problem.
    I would like to know what the per capita expenditure is for Kaiser patients.  And do they exclude whole swaths of the population for being likely to need medical care?  Do they have something going that this silly country could learn from?

    I was wise enough to never grow up while fooling most people into believing I had. - Margaret Mead

    by fayea on Mon Jun 29, 2009 at 10:23:20 AM PDT

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    •  I work for a public entity (1+ / 0-)
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      ssundstoel

      and currently have the coverage, before that my husband was a public employee, and my father was when I was a kid. We got Kaiser. Nobody ever asked about medical history.

      I must be dreaming...

      by murphy on Mon Jun 29, 2009 at 10:42:54 AM PDT

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