Insight, analysis & opinion from Joe Paduda

Apr
1

Britain’s NHS to run US Health Insurance Exchange, control costs

As one who haas heartily criticized the health reform bill for it’s apparent avoidance of any real cost control, I was quite surprised to hear that there are two meaningful – and very significant – cost control mechanisms contained in the new law. Both rely on using proven methodologies to attack administrative and medical costs and both have been widely tested.
I don’t doubt they’ll work as intended, but I have serious doubts about the willingness of physicians and many patients to accept these provisions.
Buried deep within the 2000+ page health reform bill is a paragraph that called for sealed bids from potential vendors interested in managing the national health exchange component of health reform, bids that would have to exceed certain standards in order to be considered. Those standards, when closely examined, are the operating metrics used by Britain’s National Health Service’s External Markets Programme.
As no American company or not for profit organization has the necessary experience required by the law, it certainly appears as if this provision was intended to allow, if not require, HHS Sec. Kathleen Sibelius to award the contract for administering the National Insurance Exchange to the NHS.
This isn’t as far-fetched as it may sound. The NHS was awarded a similar contract two years ago in India, and is currently managing the health systems in the BVIs, Barbados, the Falkland Islands, and most recently is reportedly close to a deal to revamp Iceland’s troubled health system.
Details are scarce; as one might imagine the Administration is loathe to provide any information at a time when refom opponents are in full voice and the media is following reform very closely. Don’t expect to hear anyone in Washington speaking on the record about this anytime before July; with Congress out of session and vacations in full swing any uproar will be kept to a minimum.
As if that wasn’t enough, sources within HHS have confirmed the long-circulating rumors that Dr. Sir James Watson, former head of Britain’s NICE program, will be heading up the federal government’s medical guideline development project. Watson is reknowned for his ability to identify the most cost-effective procedures with minimal data, a talent that will serve him well in the grossly-underfunded new department.
Watson will have to be a quick study, as Americans will be justifiably concerned with the prospect of the architect of Britain’s medical cost control program in such an influential position.
What does this mean for you?
Less work on the part of physicians or patients as HHS will be determining which procedures are, and are not, ‘necessary’.


6 thoughts on “Britain’s NHS to run US Health Insurance Exchange, control costs”

  1. Could you direct me to a page or line # for this:
    “Buried deep within the 2000+ page health reform bill is a paragraph that called for sealed bids from potential vendors interested in managing the national health exchange component of health reform, bids that would have to exceed certain standards in order to be considered. Those standards, when closely examined, are the operating metrics used by Britain’s National Health Service’s External Markets Programme.”
    Thanks!

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Joe Paduda is the principal of Health Strategy Associates

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