Public, Private, Partnership?
One of the biggest differences I have noted in the US healthcare system is one which is not immediately obvious on casual inspection, but essential as soon as one thinks properly; and that is the role of private sector non-health industries in health care. This is, of course, because they are the purchasers of much US healthcare through employment package healthcare schemes.
Their influence could, for example, be said to have contributed to the death of the HMO as a strategy for limiting health care expenditure growth. As the US economy strengthened around the millennium, the labour market tightened, and employers competed on fringe benefits provided. HMOs were increasingly unpopular (think of Helen Hunt in As Good as it Gets), and it was disadvantageous for employers to offer health insurance through them. (I’m sure this is simplistic- but arguments to this effect are made).
Before Christmas I attended a two day conference on pay for performance organised by the Puget Sound Health Alliance. The Alliance is a cross- boundary organization with the remit to publish information about efficiency and quality of local health services. It was founded basically in response to the concerns of King County as a local employer and has on its board of leadership representation from large local employers such as Starbucks (which is headquartered here), Boeing (ditto), and Washington Mutual Bank (ditto - but - er - probably not that much of a surprise). Accordingly respondents to the fairly academic sessions were from representatives of these organizations who brought insights which were sometimes simplistic, sometimes wrong, but often helpful.
The close involvement of business in public services seems to me to have some problems. The multi-purchaser nature of the US health “system” seems to have real problems in terms of transaction costs (which form do I fill in if you’re with Premier Purple Isoceles Health?), and fragmentation of care (every time you change job, you may have to change health plan, and doctor), and clearly the threats to the employers themselves are considerable – not least the death of the American motor industry (or is that just their useless cars).
This involvement contrasts with the UK where the private sector involvement with the public sector is routine ill-informed disparagement , usually on the grounds that:
1/ public sector unions have had the gumption to stop the divide and rule tactics and gross pay inequality that the fat cats have got away with in the private sector
2/ it's not fair that healthcare isn’t exactly the same as making widgets
And 3/ it’s not fair we can’t get our snouts in the trough for all this extra money.
Which is kinda ironic when the public sector is largely responsible for keeping the UK management consultant industry afloat.
For all its failings, and threat to social solidarity, the purchaser role forced on business involving the corporate world in social provision seems to demand a maturity and responsibility on their part which contrasts refreshingly with the contempt and greed normally on display in Britain. So... how to get Digby Jones to stop being so annoying?
Their influence could, for example, be said to have contributed to the death of the HMO as a strategy for limiting health care expenditure growth. As the US economy strengthened around the millennium, the labour market tightened, and employers competed on fringe benefits provided. HMOs were increasingly unpopular (think of Helen Hunt in As Good as it Gets), and it was disadvantageous for employers to offer health insurance through them. (I’m sure this is simplistic- but arguments to this effect are made).
Before Christmas I attended a two day conference on pay for performance organised by the Puget Sound Health Alliance. The Alliance is a cross- boundary organization with the remit to publish information about efficiency and quality of local health services. It was founded basically in response to the concerns of King County as a local employer and has on its board of leadership representation from large local employers such as Starbucks (which is headquartered here), Boeing (ditto), and Washington Mutual Bank (ditto - but - er - probably not that much of a surprise). Accordingly respondents to the fairly academic sessions were from representatives of these organizations who brought insights which were sometimes simplistic, sometimes wrong, but often helpful.
The close involvement of business in public services seems to me to have some problems. The multi-purchaser nature of the US health “system” seems to have real problems in terms of transaction costs (which form do I fill in if you’re with Premier Purple Isoceles Health?), and fragmentation of care (every time you change job, you may have to change health plan, and doctor), and clearly the threats to the employers themselves are considerable – not least the death of the American motor industry (or is that just their useless cars).
This involvement contrasts with the UK where the private sector involvement with the public sector is routine ill-informed disparagement , usually on the grounds that:
1/ public sector unions have had the gumption to stop the divide and rule tactics and gross pay inequality that the fat cats have got away with in the private sector
2/ it's not fair that healthcare isn’t exactly the same as making widgets
And 3/ it’s not fair we can’t get our snouts in the trough for all this extra money.
Which is kinda ironic when the public sector is largely responsible for keeping the UK management consultant industry afloat.
For all its failings, and threat to social solidarity, the purchaser role forced on business involving the corporate world in social provision seems to demand a maturity and responsibility on their part which contrasts refreshingly with the contempt and greed normally on display in Britain. So... how to get Digby Jones to stop being so annoying?
posted by Exiled in mainstream at 10:38 PM
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