My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Care Oregon some news from the US

Filed Under (Health Policy, Primary Care Trusts) by Paul on 19-03-2010

I am in the US for a few days carrying out some work with a health care plan in the state of Oregon called Care Oregon. It’s an exciting week to be here because President Obama’s health bill will, or will not, make it through Congress this weekend. As that happens I will be in Arizona at a conference of all the Community Health Plans in the US. The people I will be with are great supporters of reform and for them it will either be the high spot of their decade – if it goes through – or the low spot – if it doesn’t.

So the weekend promises to be exciting, one way or another, and I will post on the outcome. My money – with 2 days to go – is on the President getting the reform Bill through (but I am not saying that to people over here who are into not counting chickens …)

Care Oregon is a community health care plan aimed totally at those that are insured by the state. They provide a plan for older people who are on Medicare but the main people that they organise cover for are poorer people on Medicaid. So they run a private “not for profit” company which receives their entire capitation from the state to organise health care for old and poor people.

When you meet people like this you realise how lazy too many people are in the UK when they say the NHS has nothing to learn from the US. It’s as if this organisation is a PCT that chooses to only work with poor and old people. They are deliberately choosing to work with these groups because of their position.

It is also the case – which not many PCTs could manage – that they have to secure the active agreement of all of their members to join Care Oregon. Poor and older people on these state schemes can choose to move their insurance money from the scheme they are on every month. That means that, if they see a better scheme, an older person has the right to chose to move their state money from one insurer to another. It would be interesting to see how many PCTs could actively go out and gain business from their residents for the NHS insurance.

I say this not to criticise PCTs but to point out that there is a lot of laziness amongst some in the NHS who want to condemn everything from the US as a capitalist system which has nothing to teach socialised medicine. How you work with poor people to get them to choose your scheme rather than another ensures that you give them the great respect that they deserve.

Care Oregon – alongside some others in the US – recognise that whatever happens in the current financial crisis it is unlikely that there will be a resumption of the steady growth in the percentage of the US GDP that is spent on health. At the moment it has reached about 17% of GDP – about twice the percentage of what is spent in the UK. The amount of US resource spent on health care has increased annually since 1960 at 2% more than GDP growth.  

That means we have an industry which has assumed for 50 years that the resources it can use will automatically go up to meet the rise in demand. This is not the case for any other industry. And that will now stop.

Care Oregon is going further than anyone else I know. They are publicly planning for a health care system that will cost between 10-11% of the GDP of Oregon by 2020. That means they are publicly saying that they think they can create better quality health care with about a third less money covering probably at least a 20% increase in demand that will have arisen by then.

 And before anyone in the UK makes the point they are saying they can do this with universal coverage.

This is impressive visionary stuff.

Comments:

One Response to “Care Oregon some news from the US”


  1. Yes it might be interesting to imagine PCTs that had to be accountable (or rather, accountable to users rather than the range of SHAs, regulators, WCC etc).

    However as you know the failures in health insurance markets are pretty strong and they are the main reason why the US competing insurance system is so inefficient (and will continue to be post-reform although the exchange will make things better).

    You have to do the best with what you’ve got so Oregan Care sounds like another oasis like Veterans, Geisinger etc and sure we can learn from it. But not by copying the competing insurers model.

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