1. Can payment reform promote better care?

    (Guest blogger)
    20 Feb 2014
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    The NHS payment system defines the mechanisms through which NHS-funded care is paid for, and the prices paid. These mechanisms and prices are levers available to commissioners to incentivise providers to achieve health care objectives, such as better health outcomes, activity targets, greater efficiency, and reduced waiting times.

    For example, the “Payment by Results” system, through which hospitals are paid according to how much treatment they provide, was introduced to incentivise more hospital activity, at a time of long and growing...

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  2. Preparing for the 'new' NHS: lessons from departing leaders

    28 Mar 2013
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    Never in the field of NHS re-organisations can so many have left so few. Well, not literally. But April 1 sees some 160 NHS organisations, including all primary care trusts and strategic health authorities, abolished as hundreds more – 211 clinical commissioning groups plus a clutch of new national bodies and their regional arms – come formally into existence.

    The result is what must be an unprecedented turnover of NHS chief executives. Some retiring, some moving on to other jobs, some taking redundancy, some leaving the direct employment of the service, some willingly, some not....

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  3. Could payment reform improve public health?

    (Guest blogger)
    18 Mar 2013
    Comments

    One of the most notable features about American health care is the use of fee-for-service as a payment model. In return for a consultation with a physician, outpatient procedure, or hospitalisation, the insurer (or the patient) pays for the individual services.

    As fee-for-service operates on an individual service basis, the incentives for doctors to make more money are relatively straightforward – especially if a physician is the equivalent of a single-handed GP or private specialist – the more billable the activity, the higher the payment.

    For example, given the choice between...

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  4. NHS budget surpluses: the law of unintended consequences

    5 Nov 2012
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    The NHS is 18 months into the toughest financial settlement it has ever experienced.

    Unsurprisingly, Monitor’s quarter one report shows 25 per cent of foundation trusts in deficit in the first quarter of 2012-13 and 20 NHS trusts are considered financially unviable in their current configuration; and last week the Special Administrator for South London Healthcare NHS Trust published his ...

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  5. Exploiting the single payer inheritance

    28 Sep 2012
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    As a nation we probably have the best information on health care in the world.

    Data on service use, cost, and increasingly quality, across the whole population and for some years, and large chunks of it available at person-level (suitably anonymised) and linkable wherever the patient receives care.

    Useable to track costs, assess substitution of care, stratify the population by risk, track cohorts of patients through time, assess impact of interventions, spot good quality and efficient care, develop business cases for invest to save innovations, shape clinical behaviour, develop...

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  6. Blinded by the average...

    20 Sep 2012
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    Earlier this year, Dr Phillip Lee MP proposed that patients should be sent an annual NHS ‘bill’ by their GPs, setting out the exact cost of the care they had received over the previous twelve months.

    The idea was that it would help people understand the value they get from the NHS and reduce the chance of our free-at-point-of-use service being taken for granted.

    The proposal remains an idea and, whatever people think for and against it (e.g. not least that cost and value are...

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  7. From Australia to England: the health care reform challenge

    30 Aug 2012
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    As the 2012 Olympics opened on a summer’s evening in London, I was taking part in a breakfast debate on a (warm) winter's morning at an international conference of primary health care organisations in Australia.

    The first question posed was: 'would Australia have put its public Medicare system centre-stage in an Olympic opening ceremony?'

    The answer was a resounding 'no' and we agreed that there is something unique about the British people's attachment to the NHS that is deeply woven into the fabric of society. Some of the reasons for this...

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  8. Payment system reform: six lessons for the NHS from Europe

    (Guest blogger)
    23 Aug 2012
    Comments

    Using the payment system is increasingly seen as one of the major levers to change the way that health care is provided.

    With responsibility for pricing architecture passing to the national Commissioning Board and the pricing function moving to Monitor, now is a good time to be reflecting on some of the lessons from the NHS and elsewhere in the world. A new report by the Nuffield Trust, produced with support from KPMG, gathers together learning from several...

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  9. Different perspectives – the challenge of health reform in the UK and US

    14 Aug 2012
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    The 13th international meeting on the quality of health care took place this year in Washington DC: twenty five leading policy makers, academics and practitioners were brought together by the Nuffield Trust and The Commonwealth Fund to share ideas and strategies for health care.

    On the US side, there was a palpable sense of relief that the most ambitious parts of the Affordable Care Act – the plans to extend coverage to millions of uninsured Americans – had been...

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  10. Ducking the social care funding question: the long-term impact on the NHS

    13 Jul 2012
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    That the Government ducked the question of social care funding should have come as a surprise to no one.

    Of course, the long awaited White Paper on social care and draft bill contained much to be welcomed. Individuals, families and carers will clearly benefit from standard eligibility criteria to access care nationally and the freedom to move without losing access; more personal budgets and better information could help make choice a...

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  11. International experience highlights need for payment reform in the NHS

    31 Jan 2012
    Comments

    I got an encouraging letter from the Secretary of State responding to our and The King’s Fund’s analysis on how integrated care could be developed in England. Our publication and other bits are a synthesis of what we know, with some concrete suggestions on how to move ahead.

    There is now a tailwind, and the Department of Health, NHS Commissioning Board (now NHS England) and Monitor are currently mulling over how best to respond. More on this in the spring.

    Meantime, for those weary of Kaiser and Torbay as examples, The...

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