LONDON (Reuters) - The problems of Britain's ailing healthcare system may not be due to underfunding but a failure to provide the most efficient and comprehensive service with the money available, doctors said on Thursday.

A study comparing the costs and performance of the state-funded National Health Service (NHS) with a California HMO showed that the US group, Kaiser Permanente, gives its patients much better healthcare for their dollars.

``Both have similar inputs but Kaiser has much better performance,'' Dr. Richard Smith, the editor of the British Medical Journal, which published the study, told a news conference.

``It is exploding the myth that we have all been brought up with in Britain that, albeit a bit shoddy, it is remarkably efficient. It may well not be,'' he added.

Richard Feachem, of the Institute for Global Health at the University of California, said he and his colleagues looked at two comparable healthcare delivery systems.

Kaiser is a non-profit, fully integrated healthcare provider for 8.2 million people. Like the NHS it employs doctors and nurses, owns and operates its own facilities and was founded about 50 years ago.

But for roughly the same per capita annual cost, Kaiser runs a more efficient service with more specialists per patient, shorter waiting times for treatment and surgery and better services.

``Many aspects of Kaiser's performance are superior,'' said Feachem, particularly prompt and appropriate diagnosis and treatment.

He attributes the difference in performance for comparable costs to better integration in the HMO, treating patients at the most cost-effective level of care and a superior information technology system. Kaiser also competes with other HMOs for business and must meet public expectations, he noted.

``The widely held belief that the NHS is efficient and that poor performance in certain areas is largely explained by underinvestment are not supported by this analysis,'' he said.

Kaiser spends $1,951 per patient per year, compared with the NHS's $1,764, but 90% of its patients wait less than 13 weeks for treatment or surgery, as opposed to 41% in Britain.

Patients in the HMO also spend twice as much time with their primary care doctor than those in the NHS, where 80% of patients see a specialist within 13 weeks. In Kaiser 80% see a specialist within two weeks.

One third of patients in Britain wait more than five months to be admitted to hospital while no one in the HMO waits that long. A wait of five months in the Kaiser system would be regarded as completely unacceptable according to Feachem.

``This study concludes with quite a lot of confidence that the costs are roughly similar but the outcomes in Kaiser are better,'' he added.

Reference Source 89

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