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Kaiser Permanente has much to teach on models of care

Like many others, Dr Kailash Chand has totally missed the point in his critisism of attempts to learn from Kaiser Permanente (Letters, November 24).

In the UK the NHS has a responsibility to provide comprehensive health care to all its population because it is funded to do so. Similarly, Kaiser Permanente provides comprehensive health care to all its health plan members because it is funded to do so.

If Arnold Schwarzenegger decided tomorrow to offer comprehensive free health care to all the citizens of California and chose Kaiser Permanente to deliver that health care, the company would provide it by exactly the same highly effective model that it uses at the moment.

The reason is simple. It works.

What makes Kaiser Permanente unique is that it is decidedly un-American and its values are based on exactly the same principles as those of the NHS, namely comprehensive cradle-to-grave health care with a focus on public health, prevention and continuity of care by a named primary care physician which is free at the point of delivery and non-profit making.

The point at issue when seeking to learn from Kaiser Permanente is not the method of funding but the method of care delivery.

Unlike our model, where doctors are at the bidding of politicians and managers, the Permanente Medical Group is entirely owned, led and managed by its shareholder doctors (specialists and GPs in equal partnership) and is entirely responsible for making all decisions relating to treatment and use of resources.

The Medical Group works in an exclusive partnership with the Kaiser Health Plan. Their system allows clinical freedom but incentivises (with financial bonuses playing a negligible role) doctors to follow best evidence-based practice using their own, not externally imposed, guidelines.

Permanente doctors are respected leaders as well as clinicians and have levels of job satisfaction that can only be dreamed of in the NHS.

I do not believe their model is incompatible with our given method of health funding

and in fact I could forsee tremendous opportunities for us if our leaders had the vision and courage of Henry Kaiser and Dr Sidney Garfield, who founded the Kaiser Permanente system.

Dr Robert Morley



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