Learning from Kaiser (part 2). Is integration the answer?

[摘要] IN 2002 the BMJ published a paper claiming that Kaiser Permanente, the long established and much respected health maintenance organisation based in California, gave better value for money than the National Health Service (NHS) in the United Kingdom (UK).1 In order to make the comparison the authors had to make a number of assumptions. Numerous letters later pointed out where many of these assumptions might have been mistaken and how they almost certainly tilted the scales against the NHS. Despite this, the paper proved influential among policy makers, who set about identifying how Kaiser manages to be so much more efficient. A second paper duly appeared a year later, confirming the original suggestion that better integration between primary and secondary care leads to much shorter hospital stays, and a more efficient, cheaper service overall.2 Two months ago, when we published a paper challenging the findings of the original article,3 the authors countered by stating that, although there were indeed problems inherent in the original comparison, the later paper confirmed that the NHS has much to learn from Kaiser in terms of better integration between inpatient and outpatient care.4 When the Talbot-Smith paper was featured in the Guardian,5 it evoked a similar response from John Reid the Secretary of State for Health: ‘Kaiser … is a model of care from which we can learn’.6

[学科分类] 卫生学