Study says Kaiser outshines British health care system

But doctors in the United States and Great Britain dispute the conclusions of a report published in the British Medical Journal.

By Myrle Croasdale, amednews staff. Feb. 11, 2002.

To the assertion that Kaiser Permanente out-perform's Britain's National Health Service by giving patients faster access and better care for approximately the same cost, many doctors on both sides of the Atlantic have the same response: No bloody way.

The study, titled "Getting more for their dollar" and lead authored by Richard Feachem, president of the Institute for Global Health at the University of California, was published in the Jan. 19 issue of the British Medical Journal.

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As the article's abstract describes it, the adjusted costs of the two systems and their performance were compared with respect to inputs, use, access to services, responsiveness and limited quality indicators. The authors' conclusion was that "the per capita costs of the two systems, adjusted for differences in benefits, special activities, population characteristics and the cost environment, were similar to within 10%."

"Some aspects of performance differed. In particular, Kaiser members experience more comprehensive and convenient primary care services and much more rapid access to specialist services and hospital admissions. Age-adjusted rates of use of acute hospital services in Kaiser were one-third of those in the NHS."

A response on BMJ's Web site from a person identified as a family medicine professor in California was typical: "The comparison of Kaiser and the NHS is thought-provoking. Unfortunately, the presentation and analysis of cost data are muddled and lead to misleading inferences."

Many perceived flaws were pointed out, including the fact that the NHS exists to service all 60 million Britons, while Kaiser is a private organization with only one-tenth the membership at 6 million.

But in particular, doctors and others argued about the authors' use of a "purchasing power parity" adjustment to account for the greater expenses of health care in the United States. The authors used the figure -- 1.52 -- to compare costs if the NHS operated in California, or if Kaiser operated in England.

"No adjustment is made for cheap food or fuel costs, so why adjust for expensive items?" wrote one identified as an occupational physician in Scotland.

Still, that physician, as well as a few others, found it valuable to have a comparison of the British and U.S. health systems, despite what they saw as flawed methodology.

But a few U.S. doctors cautioned their British colleagues not to confuse Kaiser Permanente with the American managed care system as a whole, considering that Kaiser is one of this country's few staff-model HMOs --with insurers, hospitals and doctors in its stead.

Francis J. Crosson, executive director of the Permanente Federation, the umbrella organization for all Permanente medical groups, agreed with the overall findings of the study, including the impact of competition in United States. "Obviously, our members can leave and go somewhere else," Dr. Crosson said.

ADDITIONAL INFORMATION:

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Text of "Getting more for their dollar: A comparison of the NHS with California's Kaiser Permanente," British Medical Journal (http://bmj.com/cgi/content/full/324/7330/135)