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Reds by the bed

GP blogger Dr Peter Weaving overcomes his jetlag to share some insights from a recent fact-finding trip to California

I'm back from a whirlwind tour of healthcare in California in the week the American government voted (just) for healthcare reform. My head is spinning with figures, statistics, models and mottos.

The US spends 16% of GDP on a system which provides no healthcare for 16% of its people. We spend 8% and cover 100%. Most healthcare in the US is a scrum between insurers, healthcare plans, hospitals, primary care physicians and patients. The patients have a lot to answer for – they want low cost healthcare but are deeply suspicious of any form of managed healthcare. They reserve the right not only to bear arms but also to have direct access to specialists. The latter being responsible for more deaths than the former – medical accidents causing the equivalent carnage to a jumbo jet crashing every day in the US.

In this melee the average GP has low status, usually works single handed using his own paper records and may not even have a fax machine. His philosophy is to maximise the use of resources for his patients; an aim which is supported by his patients and specialist colleagues.

Into this bleak landscape I went as part of an international group lead by Chris Ham, Professor of Health Policy and Management at the University of Birmingham. We were introduced to a radical alternative philosophy – one that originated as a workers' insurance scheme in the 1940s. Now, in its second ascendancy, Kaiser Permanente is lolloping past the entangled competition to score a touchdown in the game of affordable healthcare for the Western world.

How? I'll tell you next time. But you can bet your britches it's gonna be integration and some good ol' clinical leadership.