Posts Tagged ‘doctor shortage’

Philippines: Doctor Shortage — Why Not Pay Tuitions With Government Funds To Get More Doctors? (Editorial)

March 20, 2017

Philippines: Doctor Shortage — Why Not Pay Tuitions With Government Funds To Get More Doctors? (Editorial)

Taxpayers spend P2.5 million over four years to produce a graduate of the Philippine Military Academy. Why not make the same investment in producing surgeons and other physicians?

The proposal was made by Senate President Pro Tempore Ralph Recto, who noted that the Department of Health already has an existing scholarship program for aspiring doctors. All that’s needed is to expand the program while at the same time making compensation and benefits more attractive for physicians working for the DOH.

Unless remuneration is improved, the nation may see its shortage of doctors worsen, especially in rural areas. Recto noted that of the 946 available slots in the government’s Doctor to the Barrios program from 2015 to 2016, only 320 were filled. The program is meant to provide at least one doctor in each low-income municipality, but there were few takers. Those 626 unfilled slots meant that millions were deprived of the services of a doctor in their communities.

The medical profession can pay handsomely – but only after many years of grueling studies and substantial financial investment in schooling and specialized training. The cost of medical textbooks alone can be beyond the reach of a low-income household.

Parents who have invested their life savings to send their child to medical school would naturally be reluctant to let the new doctor volunteer for a rural assignment that pays P56,000 a month, especially in conflict zones. The medical community is still waiting for justice for a Doctor to the Barrio volunteer, Dreyfuss Perlas, who was shot dead by still unknown assailants last March 1 while serving in Lanao del Norte.

If the government shoulders the schooling expenses of deserving medical scholars, the nation may be assured of a steady supply of physicians, even if the beneficiaries leave the DOH after a mandatory four-year service. The government may then have at least one doctor for every municipality, with the scholars encouraged to serve in their hometowns.

Health experts estimate that the country currently faces a shortage of 60,000 doctors. This means six out of every 10 Filipinos die without seeing a doctor. This need not be the case. The government is recruiting more police and military personnel. Why not boost resources to produce and recruit more doctors?

Physician Shortage: Hospital postponing elective surgeries for March break — Rural areas of the U.S. brace for doctor shortage — Foreign Medical Graduates Essential to U.S. Health Care

March 19, 2017
Maureen Coulter
Charlottetown, Prince Edward Island, Canada
Published on March 17, 2017
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Queen Elizabeth Hospital in Charlottetown.

©Guardian file photo

CHARLOTTETOWN, P.E.I. – The Queen Elizabeth Hospital is postponing all of its elective operative procedures over the March break.

An internal memo was sent out this past week notifying all medical staff and department managers that there is a planned service slowdown.

Twenty-two beds are closing in surgical, rehab and critical care units until March 27, including two beds in ICU, eight beds in Unit 1, eight beds in Unit 2 and four beds in Unit 7.

The memo states “any urgent emergency cases will proceed as usual” but that “no elective operative procedures” will be booked during this time.

A statement from Health P.E.I. says it does plan scheduled slowdowns at two main hospitals during specific times of the year, including March break, summer and Christmas, when the public demand for non-urgent elective services is lower and more people are on vacation.

“A planned slowdown during this time of year is a fairly standard practice across most health-care jurisdictions,” said the statement. “It also ensures that our hard-working staff and physicians have the opportunity to take some well-deserved time off with their families.”

Rather than closing these beds, we should be helping to free up the ER and moving those patients into these acute care beds.

James Aylward, MLA for Stratford – Kinlock

However, James Aylward, MLA for Stratford – Kinlock, told The Guardian Friday evening that he heard otherwise from an “extremely” reliable source.

“They confirmed to me that the reason for these bed closures had nothing to do with shortage of staff and vacations, but it had more to do with Health P.E.I. trying to reduce costs here coming towards the end of the fiscal year.”

Aylward, who is opposition critic for health and wellness, said he found this news about service slowdown alarming.

“This is the very first time that anyone can remember bed closures during March break.”

Aylward feels this decision did not consider the pain and suffering of Islanders as they could have been having these elective operative procedures over the course of this planned service slowdown.

The other issue he has with this is that this continues the “constant backlog of patients” in the emergency room waiting for acute care beds.

“Rather than closing these beds, we should be helping to free up the ER and moving those patients into these acute care beds.”

The statement from Health P.E.I. noted that during the March break slowdown, emergency services, including emergency surgical services, will remain fully operational.

“Slowdowns at Island hospitals are planned well in advance and we work with our health-care providers to ensure patient safety and patient care standards are never compromised. We always have a contingency plan in place to ensure that we continue to provide high quality care.”

Aylward feels at the very least the public should have been informed of this service disruption.

He adds this planned service slowdown is one of many things he plans on bringing forward during the spring session of the legislature.

Health PEI is responsible for the operation and delivery of publicly funded health services in Prince Edward Island. … Health PEI is governed by a Board of Directors, which ensures that approved programs are delivered in accordance with the direction from the Minister of Health and Wellness.


Rural areas of the U.S. brace for doctor shortage

Posted: Saturday, March 18, 2017 11:00 pm

In Coudersport, Pa., a town in a mountainous region an hour’s drive from the nearest WalMart, Cole Memorial Hospital counts on two Jordanian physicians to keep its obstetrics unit open and is actively recruiting foreign specialists.

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Charles Cole Memorial Hospital, Coudersport, Pa.

In Fargo, N.D., a gastroenterologist from Lebanon — who is among thousands of foreign physicians in the state — has risen to become vice president of the North Dakota Medical Association.

In Great Falls, Mont., 60 percent of the doctors who specialize in hospital care at Benefis Health System, which serves about 230,000 people in 15 counties, are foreign doctors on work visas.


Small-town America relies on a steady flow of doctors from around the world to deliver babies, treat heart ailments and address its residents’ medical needs. But a recent, little-publicized decision by the government to alter the timetable for some visa applications is likely to delay the arrival of new foreign doctors, and is causing concern in the places that depend on them.


While the Trump administration is fighting for its temporary travel ban affecting six countries, the slowdown in the rural doctor pipeline shows how even a small, relatively uncontroversial change can ripple throughout the country.


In Montana where nine counties do not have a single physician, it means Benefis Health does not know when a Romanian doctor trained in kidney transplants will arrive. The health care company spent months recruiting the doctor and had been expecting her in July.


“Our health system already has nine months invested in her, and now we have no idea when she can start,” said Erica Martin, who recruits doctors for the company.

The doctor, Silviana Marineci, who is completing a fellowship at the University of Minnesota, said she was frazzled by being in limbo.

.Image may contain: 2 people, people standing

“I won’t have an income, I don’t know if I will afford rent, I don’t know where I will be,” she said. “It’s insane.”


The procedural change regards temporary visas for skilled workers, known as H-1B visas. U.S. Citizenship and Immigration Services recently announced that it would temporarily suspend a “premium processing” option by which employers could pay an extra $1,225 to have H-1B applications approved in as little as two weeks, rather than several months.

Companies using that option, the government said, have effectively delayed visas for others that did not pay the extra fee.


A spokeswoman for the immigration agency, Arwen Consaul, said in a statement that the measure was necessary to “work down the existing backlogs due to the high volume of incoming petitions.”


The H-1B program has raised questions about whether it displaces American workers, particularly in computer programming and engineering jobs, for which most of the visas are issued.


H-1B recipients also include foreign physicians who practice in places shunned by American doctors for personal and professional reasons.


About 25 percent of all physicians practicing or training in the United States are foreign, but in some inner cities and most rural areas, that share is significantly higher.


There were 211,460 international medical graduates practicing in the United States in December 2015, according to the latest data available from the Educational Commission for Foreign Medical Graduates.


Sens. Amy Klobuchar, D-Minn.; Susan M. Collins, R-Maine; and Heidi Heitkamp, D-N.D., have urged the agency to continue premium processing.


“Slowing down this successful two-decade-old program and the doctors it brings to rural areas will hurt families across North Dakota and rural America,” Heitkamp wrote in an email.


The delay also could affect the roughly 400 foreign medical graduates who come each year to participate in residency programs at teaching hospitals. The doctors were matched Friday for residencies starting July 1 across the country.


“Everyone around the country will be in a mad scramble to figure out this visa situation,” said Michelle Larson-Krieg, director of international student and scholar services at the University of Colorado in Denver, which usually takes 10 or 12 residents on H-1Bs each year at its Anschutz Medical Campus.


The immigration agency said in a statement that applicants could still request an H-1B approval on an “expedited basis,” if they could prove there was an emergency or humanitarian justification.


Immigration lawyers said that it was extremely difficult to meet that standard, and that they doubted whether the agency could handle a flood of such requests.


“If they don’t have the manpower to do premium processing, I don’t see how they are going to do special requests,” said Andrea Szew, a lawyer in Los Angeles.


Foreign Doctors Assist With Physician Shortage

The challenge in Iowa, where the shortage of physicians is more pronounced, is finding qualified doctors that will stay in the area.

| March 18, 2017, at 1:02 a.m.

By DEVAN PATEL, Quad-City Times


DAVENPORT, Iowa (AP) — Dr. Nazir Kayali settled into his chair, deep in thought.

His hand stroked his chin and a smile grew into a laugh as he considered his circuitous path to the Quad-Cities.


The Syrian-born pediatrician’s first trip outside his native country was to Ohio in 1990, where his cousins were practicing medicine.

Wishing to follow in his cousins’ paths, Kayali asked what he might expect from America.

They halfheartedly told him a joke that went along with the generalization that Americans are egotistical and care only about money.

“A stranger comes to America and finds a booth that says ‘Two questions for $100,'” Kayali began, barely able to get the words past his own laughter. “He asks a woman, ‘Is that a lot of money for two questions?’ She replies ‘Yes. What’s your second question?'”


But the international medical graduate found the opposite to be true in middle America. Here, he said, he found warmth, compassion and acceptance.


Dr. Nazir Kayali has his plate dished up by daughter, Sarah, 17, as they sit down for dinner at their home in Bettendorf. Having lived in Des Moines for his residency and in the Quad-Cities previously, Kayali, a Syrian-born pediatrician, has called Bettendorf home for the past five years.


Having lived in Bettendorf for the past five years, Kayali boasts that the Quad-Cities is his third stint in Iowa, having secured his H-1B visa to complete his residency from 1993-1996 at Iowa Methodist Medical Center in Des Moines. Out of all the hospitals in the nation, his first choice was in Iowa’s capital city.


He then came to the Quad-Cities from 1999 to 2007, returning to Syria so his children could get to know their family in Aleppo.

But his Iowa memories and experiences stayed with Kayali.


When war made Syria too dangerous, the pediatrician with a soft spot for Iowa was relieved to learn of an opportunity in the safe place he had come to know more than 6,200 miles away. And it called his family back.


“I’ve had a very positive experience,” Kayali said. “The acceptance and the people, from residents, staff, colleagues and patients; it was all so incredible.”


The sentiment is the same for many of the international medical graduates who have immersed themselves in the community, including Dr. Sarojini Ratnakar, who joked that she took the easy path to practicing medicine in the United States.


The Indian-born and -trained hospitalist for Genesis Health System did not have to jump over the same hurdles that other international medical graduates did. Her husband already had a visa, so she was able to come as a spouse.


Dr. Sarojini Ratnakar talks with patient Marcia Johnson of Bettendorf in her room at Genesis Medical Center-East Rusholme Street, Davenport.


Ratnakar’s story, however, is similar in that she, too, came to the U.S. to make a better life and has settled into the void created by the country’s physician shortage.


In America’s heartland, where the shortage is more pronounced, the challenge isn’t so much in finding qualified doctors. The real test is in convincing them to stay.


Iowa ranked seventh in medical students per 100,000 population, but the state has one of the lowest physician-to-population ratios in the country. In other words, medical students are graduating in Iowa; they just aren’t practicing here.


Even more alarming is Iowa’s consistently low ranking in retaining physicians who earned their medical degrees in-state.

Since 2006, the retention percentage for in-state graduates has fluctuated between 34 percent and 36 percent for physicians, according to data from the Association of American Medical Colleges, or AAMC.


Hospitalist Dr. Sarojini Ratnakar, who was born in India, reads a chart before going to the patient’s room at Genesis Medical Center-East Rusholme Street, Davenport.


Ratnakar said she struggled when she first came to practice in Iowa in 2004.


“I moved from Atlanta, because my family was here, but at the beginning, I really wanted to go back,” she said.


As she immersed herself in the Quad-Cities, however, something changed.


“It’s the people here,” she said. “I wanted to go back, but now I won’t leave, because this place is just fantastic. I would not trade it for anything.”


Just like Ratnakar, other international medical graduates are starting to form attachments and a sense of place and are not necessarily waiting for a door to open elsewhere.


Community Health Care CEO Tom Bowman has become familiar with the doctor shortage in his 10 years at the Davenport clinic.


Bowman said Community Health Care, or CHC, tries to fill the gaps in medical treatment in the community and, in order to do so, relies heavily on sponsorship of international medical graduates through J-1 or H-1B visas.


Foreign graduates accounted for more than 50 percent of CHC recruits in the past decade, and they haven’t always been keen on staying in the area.


“Some of it, even though we’re not as rural as some parts of country, is that they tend to gravitate to more diverse and urban areas,” Bowman said. “But we’re getting better on that front.”


In the past 15 years, Community Health Care has sponsored and employed 33 international medical graduates, but only 17 have remained here. However, when narrowing the focus to the past decade the percentage of doctors sticking around increases from 50 percent to about 65 percent, the Quad-City Times ( ) reported.

Hospitalist Dr. Sarojini Ratnakar looks over the patient board for the night at Genesis Medical Center-East Rusholme Street, Davenport.


The same can be said of the percentage of active physicians who are international medical graduates, practicing in Iowa. As of 2014, their numbers increased from 17 percent to 18.6 percent, making foreign doctors second only to Iowa-educated doctors in the recruitment pool.


From 2006-14, foreign doctors accounted for almost one-third of physician growth in Iowa, according to data from AAMC. In fact, foreign graduates have become such a mainstay in American medical care, they now account for about 1 in 4 physicians.


“Foreign graduates are very hard workers, so they really don’t mind going to any place,” Ratnakar said.


The sprawling city of Kingwood, West Virginia, county seat of Preston County, was home to just more than 3,000 people when Kayali practiced there after his three-year residency in Des Moines.


“(It’s) a small town in the mountains where no one else would go,” the Bettendorf pediatrician said.


Except for his family’s social life, Kayali said, the little town produced a positive experience. But it also was the place in which he first experienced the struggles that strike a community that is medically under-served. Some of the most basic conditions were worsened, he said, by the lack of physicians in the area.


“I would see really sick kids, and I wouldn’t imagine seeing such cases in the United States,” Kayali said.

For rural areas in the U.S. like Kingwood, it’s difficult to attract physicians, which is why foreign physicians have become such a vital resource.


A study commissioned by AAMC found that the U.S. will have a shortage of 61,700 to 94,700 physicians by 2025, and rural areas can expect to suffer the most. Those regions of the country typically lack the amenities, diversity and financial incentives available in urban areas, making them less desirable to many incoming physicians.


As an incentive, foreign graduates can prolong their stay in the U.S. by serving in medically under-served areas with modest populations where other health providers are scarce.


With J-1 visas, states can sponsor physicians through the Conrad 30 waiver, which allows 30 international medical graduates to stay in the country as long as they practice their medical specialty in shortage areas for a minimum of three years.


J-1 visas typically require participants to return to their home country for two years to apply the knowledge and training they acquired in the U.S.


Over the past 10 years, more than 10,000 physicians in the U.S. stayed and served in shortage areas under Conrad 30, according to AAMC President Darrell Kirch. In the same decade, the Iowa Department of Public Health sponsored 292 foreign doctors out of the potential maximum of 300, meaning Iowa used 97 percent of its allotment of Conrad 30 doctors. In comparison, the national average is 59 percent.


From 2007 to this year, Scott County ranked eighth in the number of Conrad 30 waivers granted in the state with 18.


But the number of state-sponsored waivers has decreased since 2012, when the Department of Health and Human Services took over applications for Federally Qualified Health Centers such as CHC.

While Scott County did not receive a single Conrad 30 waiver out of the 30 recommended by the state this year, it does not mean the need isn’t there.


Information from: Quad-City Times,




Hospitals in England cancelled record number of urgent operations last year

January 27, 2017

A total of 4,093 urgent procedures were scrapped in England in 2016 as staff shortages and lack of beds took toll

Hospital staff wheel a patient into a lift
The latest figures mean that 17,598 patients have had their urgent operation cancelled over the past five years. Photograph: Christopher Furlong/Getty

Hospitals cancelled a record number of urgent operations last year as bed shortages left them struggling to cope with the growing number of patients needing surgery, NHS figures show.

Hospitals in England cancelled 4,093 urgent procedures during 2016, equivalent to 341 per month. This was 8% more than the 3,777 scrapped in 2015 and up by 27% on the 3,216 such operations cancelled during 2014.

While some cancellations occur because of a patient’s health, the vast majority are due to hospitals having too few beds, especially in intensive care or high-dependency units in which patients can recover afterwards, often because a more urgent case has arrived. A few involve staff shortages or a surgeon unexpectedly being unavailable.

The latest figures mean 17,598 patients have had their urgent operation cancelled over the past five years, often at the last minute, despite their condition requiring surgery without delay.

Opposition parties claimed that the figures, published on Friday by NHS England, showed problems in the health service were deepening and the government was not giving it sufficient money to keep up with rising demand for treatment.

Jonathan Ashworth, the shadow health secretary, said: “Theresa May’s NHS crisis continues, and the problems are worse and more widespread than in previous years. By underfunding and overstretching the NHS, the Tories have pushed health services to the brink.”

Norman Lamb, the Liberal Democrats’ health spokesman, said: “The government’s stubborn refusal to give the NHS emergency funding means record numbers of operations are being cancelled as hospitals face weeks on end of intolerable pressure. This will inevitably have serious repercussions for patient care and the morale of NHS staff.”

The NHS England data shows that hospitals also cancelled 38,129 non-urgent elective operations between April and October, the largest number yet recorded for those six months.

Of those patients, 2,204 did not have their surgery rescheduled within 28 days, as the NHS constitution stipulates, in another sign of the huge pressures on the service.

However, NHS England’s latest winter situation reports showed that hospitals came under slightly less strain last week than during the crisis that unfolded in the early weeks of January.

Overall, 43 acute hospital trusts were forced to divert A&E patients to another emergency department because they could not cope with the large numbers of people needing care, down from 52 the week before. Similarly, 51 trusts declared some sort of alert during the week, down from 68 a week earlier.

A further eleven people died from flu last week, bringing the total to 53 since the start of December, and 65 needed to be treated in an intensive care or high-dependency unit.

NHS England and Public Health England said the number of flu cases hospitals were treating was worrying and linked to the particularly cold weather affecting much of England recently.




Britain’s National Health Service (NHS) Number of patients stuck for more than 12 hours on trolleys

January 10, 2017

Jeremy Hunt is to make an emergency statement

Jeremy Hunt

Accident and Emergency attendances and admissions are rising, despite pleas to stay away


The number of patients stuck for more than 12 hours on trolleys in Accident & Emergency units has doubled in two years – with cases among the elderly almost tripling, new figures show.

A&E department (Yanks would call this an “Emergency Room”) of the North Middlesex Hospital in Edmonton North Middlesex Hospital CREDIT: DINENDRA HARIA/REX/SHUTTERSTOCK

Official data reveal soaring numbers of patients forced to endure long waits in casualty units.

The figures show that among all ages, there were 185,017 patients waiting at least 12 hours on trolleys and chairs in 2015/16 – a rise from 87,213 cases in 2013/14.

And the steepest rise came among older patients.

The official figures from NHS digital show a tripling in the number of patients aged 60 and over who spent more than 12 hours waiting in A&E, from 43,209 to 111,498 cases.

12 Hour Waits For Emergency Care More and More Common:

Of the 12-hour waits in 2015/16, 55,969 involved patients aged 80 and over – a rise from 21,901 two years before.

Dr Mark Porter, British Medical Council chairman, said: “We already know that we have an overstretched and underfunded NHS that is failing to keep up with rising demand and these figures confirm it is getting worse year on year.

“The system is at breaking point and it’s not just our hospitals that are facing these issues – GPs are conducting millions more consultations every year while also facing a recruitment crisis.”

Jeremy Hunt
Jeremy Hunt has suggested too many patients come to A&E with minor ailments 

The data, published by NHS Digital, show record numbers of A&E attendances, with cases soaring in the depths of winter – and a surge in cases on Mondays. Overall, the figures show a 12 per cent rise in attendances when the period from January to March last year is compared with the same months in 2015. The research shows 37 per cent of people going to A&E are discharged without any follow-up needed.

It follows claims made by the Health Secretary that one third of patients attending A&E do not need to be there. 

Chris Moulton, vice president of the Royal College of Emergency Medicine, said: “These figures demonstrate that we don’t have enough acute hospital beds or enough social care for a growing and ageing population.

“These elderly people are on trolleys, waiting for a bed. These figures are from the time people arrive at A&E and show just how bad things are.”

But Mr Moulton said there were many valid cases among the 37 per cent of people discharged with no follow-up.

He said: “Many people go to A&E departments and leave with the advice and reassurance they need.

“An example is a child who has been taken to A&E with a big lump on their head after falling over. We might check them over and say we think they’re OK and they are discharged, but that is still a good and valid use of an emergency department’s time.

“Even if we did get rid of that 37 per cent of people from A&E, it still wouldn’t do anything about these old people lying on trolleys waiting for beds.”

While the number of elderly people forced to wait on trolleys is rising sharply, the vast majority of those turning up to casualty units are younger patients, the figures show.

In total, 78 per cent of attendances are under the age of 65 – suggesting the young are squeezing out those most in need. The figures suggest an overall total of more than 23 million attendances – a rise of more than 700,000 cases in a year.

patients await discharge 
Patients waiting to be discharged at the QE Hospital in Birmingham  CREDIT: ANDREW FOX 

An NHS England spokesman said: “This report confirms what we have been saying, that hospitals are coming under increasing pressure but in the main are continuing to cope. In fact these figures show that last year the median time to assessment was 11 minutes and, on average, patients left A&E just two hours and 40 minutes after arriving.

“This shows the fantastic job staff are doing in ensuring patients get the urgent care they need.

“At this time of the year, when we are incredibly busy, we would remind the public only to use A&E if it is a genuine emergency and to otherwise seek advice from NHS 111, or their local GP or pharmacist.”


Watch | NHS: Red Cross ‘over-stated’ winter crisis



Plans to cancel most surgery were drawn up so NHS trusts could free up more beds for urgent patients CREDIT: RUI VIEIRA/PA

British Red Cross Says National Health Service (NHS) Has Become a Humanitarian Crisis

January 7, 2017



Accident and Emergency attendances and admissions are rising, despite pleas to stay away CREDIT: PA 


NHS hospitals have been accused of trying to “spin their way out” of the growing winter crisis after a leaked memo revealed that managers are being instructed to play down the scale of the problem.

Yesterday figures showed that record numbers of patients in ambulances are being turned away from Accident and Emergency units because hospitals are so busy.

But the Daily Telegraph has seen an NHS memo telling health officials that the “most important thing” is to avoid language such as “black alert” – the phrase used to denote the most serious level of emergency.


A&E department (Yanks would call this an “Emergency Room”) of the North Middlesex Hospital in Edmonton North Middlesex Hospital CREDIT: DINENDRA HARIA/REX/SHUTTERSTOCK

Joyce Robins, from Patient Concern, said: “I don’t think they will be able to spin their way out of this crisis. The public deserves honesty about the state of the services on which they rely – I would simply not want to be in hospital right now.”

It comes as the British Red Cross – which has been called in to prop up struggling services – described the overcrowding in Britain’s A&E units as a “humanitarian crisis”.

The leaked memo, seen by The Telegraph, emerged as:

  • Figures revealed A&E departments have become so overwhelmed that they were forced to divert ambulances on 42 occasions last week – more than twice the figure last year
  • A woman was found to have died of a cardiac arrest after waiting on a trolley in corridor for 35 hours
  • The British Red Cross pleaded with ministers to pour extra cash into the health service to “stabilise” the situation
  • Hospitals opened an extra 3,000 emergency beds in mothballed wards and bays as demand soared.

Official data released yesterday shows record numbers of casualty units became so busy in the week ending New Year’s Day that they were forced to close their doors to ambulances.

I’m not at all surprised that people are literally dying in the corridors, this is no health service – it’s hell for the staff and patientsJohn Freeman, whose wife Pauline waited 24 hours on a trolley after suffering a stroke on New Year’s Day

They include Worcestershire Royal Hospital, which ordered ambulance “diverts” on nine occasions, as it became overwhelmed by overcrowding.

One female patient died of a cardiac arrest after being forced to wait more than 35 hours in a hospital corridor for a bed.

A man died after suffering an aneurysm while waiting on a trolley while a third patient was found hanged on a ward.

The three deaths, which happened between New Year’s Day and Tuesday emerged as senior doctors warned that A&E units across the country have reached an “acute state of distress.”

In recent days, hospitals across the country have pleaded with the public to stay away from A&E units unless their situation is life-threatening, while ambulances have declared critical incidents.

Now a leaked memo to hospital managers – sent by senior officials from NHS England – reveals a desperate attempt to play down the scale of the crisis.

The email, received by NHS directors and and communications staff, instructs hospitals of lines to take if questioned about the level of pressures on them – and sets out an identical statement for every hospital to use.

A version sent by one regional outpost of NHS England earlier this week states: “Please find below suggested reactive lines for Trusts and CCGs [clinical commissioning groups] to use should they be contacted by the press this evening.

“Most important thing is to say yes to under sustained pressure, advice alternatives and avoid language such as “black alert,” senior managers are informed.

The memo, which was sent by NHS England West Midlands – but which has been replicated across the country – then sets out exactly the statement which hospital trusts should try to parrot.

“Trust name/ CCG /health economy is currently facing sustained pressure. We have an escalation process and this has been instigated to try to bring this increase in demand under control.

“As part of that process we have alerted our partners and are working with them to alleviate the situation as quickly as possible. We would urge the public to think about using alternatives such as NHS 111 if they are unsure about whether they should be going to their local Emergency Department.”

Identical and near-identical statements have been issued by a number of NHS trusts in recent days – including those in different regions.

The memo is understood to follow orders from NHS England to play down the scale of the crisis.

The real crunch point generally comes in week two or three after the Christmas breakNigel Edwards, chief executive of the Nuffield Trust

East of England ambulance trust – on the other side of the country – issued exactly the same statement earlier this week as it attempted to respond to a 30 per cent rise in calls.

The new figures show that the week ending on January 1 saw a 34 per cent rise in A&E attendances and a 19 per cent rise in emergency admissions, compared with the same period last year. The number of beds closed because of winter vomiting almost doubled, amid as levels of the bug reached a five year high.

The latest data shows that 3,191 “escalation beds” were opened by NHS hospitals in a bid to house soaring emergency admissions, with adhoc facilities set up in mothballed bays and wards.

The head of the British Red Cross on Friday called for an immediate cash injection for the health service, saying that its volunteers and staff were responding to an unfolding “humanitarian crisis”.

The charity revealed that it sent 18 volunteers in to help to East Midlands Ambulance Service earlier this week, with Land Rovers sent in to transport patients around the country, and staff sent in to help hospitals in crisis.

Mike Adamson, the charity’s chief executive, said volunteers had witnessed miserable scenes with elderly people left in danger for want of care.

“We’ve seen people sent home without clothes, some suffer falls and are not found for days, while others are not washed because there is no carer there to help them. If people don’t receive the care they need and deserve, they will simply end up returning to A&E, and the cycle begins again,” he said.

Plans to cancel most surgery were drawn up so NHS trusts could free up more beds for urgent patients CREDIT: RUI VIEIRA/PA

“We call on the UK government to allocate immediate funding to stabilise the current system and set out plans towards creating a sustainable funding settlement for the future.”

The charity said lack of social care provision was driving the crisis, with record numbers of elderly people stuck in hospital for want of care at home.

Nigel Edwards, chief executive of the Nuffield Trust, said he feared the situation would deteriorate in coming weeks.

“The real crunch point generally comes in week two or three after the Christmas break,” he warned.

Dr Taj Hassan, President of the Royal College of Emergency Medicine called for extra cash to support services, warning that cutting services back could now be “catastrophic”.

An NHS England spokesperson said: “Over the Christmas and New Year period A&E visits and everyday hospital admissions peaked on the 27th and 28th December, and NHS 111 had its busiest week ever.

However, hospitals report their bed occupancy levels were slightly lower than the same period last year, despite a higher number of beds out of action as a result of higher levels of diarrhoea and vomiting and norovirus.

“Plans remain in place to deal with additional demands during the winter period, and the public can still play their part using local pharmacy and NHS 111 for medical advice, alongside other services.”

The figures show that in total, A&E departments shut their doors to ambulances 140 times in December – a 63 per cent rise on the figure last year.

Hospitals ordering ambulance diverts

(week ending Jan 1, figure in brackets represent multiple occasions)

  1. Worcestershire Acute Hospitals NHS Trust (9 times)
  2. Northumbria Healthcare NHS Foundation Trust (7)
  3. Bolton NHS Foundation Trust (3)
  4. Pennine Acute Hospitals NHS Trust (3)
  5. Southend University Hospital NHS Foundation Trust (3)
  6. Colchester (2)
  7. Doncaster And Bassetlaw Hospitals NHS Foundation Trust (2)
  8. Heart Of England NHS Foundation Trust (2)
  9. Airedale NHS Foundation Trust
  10. City Hospitals Sunderland NHS Foundation Trust
  11. East Kent Hospitals University NHS Foundation Trust
  12. Gloucestershire Hospitals NHS Foundation Trust
  13. Hinchingbrooke Health Care NHS Trust
  14. The Princess Alexandra Hospital NHS Trust
  15. Portsmouth Hospitals NHS Trust
  16. St Helens And Knowsley Hospitals NHS Trust
  17. Stockport NHS Foundation Trust
  18. University Hospital Of South Manchester NHS Foundation Trust
  19. York Teaching Hospital NHS Foundation Trust

* Note: this story has been amended post-publication. Original figures stating 57 ambulance diverts were in place during the week ending January 1, supplied by NHS England, were incorrect.

Health Care in the UK: Woman dies after 35 hours on hospital trolley amid warnings of NHS ‘meltdown’

January 6, 2017




woman died of a heart attack after waiting in a corridor for 35 hours while new figures show record numbers of ambulances being turned away from hospitals.

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Senior doctors warned that Accident & Emergency departments are in an “acute state of distress” as new figures show mounting pressures on hospitals across the country.

New figures show that in the week ending on New Year’s Day, 42 A&E departments ordered that ambulances be diverted to other hospitals because they were unable to cope.

The figure is the highest ever recorded – it compares to 19 the previous week, and 20 in the same week last year.

In the days since, hospitals across the country have pleaded with the public to stay away, unless their situation is life-threatening, while ambulance services have been forced to declare critical incidents.


I’m not at all surprised that people are literally dying in the corridors, this is no health service – it’s hell for the staff and patientsJohn Freeman, whose wife Pauline waited 24 hours on a trolley after suffering a stroke on New Year’s Day

NHS trusts have been ordered by health officials not to use phrases like “black alerts” amid widespread pressures.

But the new figures show soaring A&E attendances and emergency admisssions, with ambulances increasing told to avoid major casualty units because they are too busy.

One hospital was today described as being “in meltdown” after a spate of deaths amid major overcrowding.

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One woman died of a heart attack after being forced to wait 35 hours on a trolley in a hospital corridor for a bed. A male patient, who was also waiting on a trolley, died after suffering an aneurysm. A third patient died after they were found hanged on a ward.


The real crunch point generally comes in week two or three after the Christmas break — Nigel Edwards, chief executive of the Nuffield Trust

The deaths happened between New Year’s Day and Tuesday at Worcestershire Royal Hospital.

Three corridors in the hospital have been converted into makeshift wards while staff try to cope with demand for beds.

The three deaths followed a week of enormous pressure on the A&E department.

On Wednesday afternoon, 30 patients were forced to wait in the corridors due to overcrowding issues, with 23 such waits on Thursday.

Relatives of those treated in the hospital in recent days said the hospital was in severe crisis.

Patient Pauline Freeman, 66, from Worcester, waited more than 24 hours on a trolley after suffering a stroke on New Year’s Day.


Plans to cancel most surgery were drawn up so NHS trusts could free up more beds for urgent patients CREDIT: RUI VIEIRA/PA

Her husband John, 64, said: “The hospital is in meltdown. There were people waiting on trollies three-deep in the corridors. “A porter told me they were sending some patients to other hospitals while they were clearing out a decontamination room to cram in more beds.

“I personally saw several nurses in tears,” Mr Freeman said.

“The staff are not to blame for this crisis, it’s a lack of resources and the closure of other health services. “Unfortunately I’m not at all surprised that people are literally dying in the corridors, this is no health service – it’s hell for the staff and patients.”

A spokesperson for Worcestershire Acute Hospitals NHS Trust, who runs the hospital, apologised for the long delays and said the hospital is doing its best to treat the most serious cases first. Patients are advised to use minor injury units as a first port of call if they can.


Over the Christmas and New Year period A&E visits and everyday hospital admissions peaked on the 27th and 28th December, and NHS 111 had its busiest week everNHS England spokesman

Dr Taj Hassan, President of the Royal College of Emergency Medicine said: “The emergency care system is on its knees, despite the huge efforts of staff who are struggling to cope with the intense demands being put upon them.

“The scale of the crisis affecting emergency care systems has reached new heights, as we predicted, mainly due to a lack of investment in both social and acute health care beds, as well ED [emergency department] staffing.

He said more funding was needed for emergency care,  warning that cutting services back could now be “catastrophic”.

The college said emergency care was now in a “state of crisis” with the worst waiting times in almost 15 years.

Nigel Edwards, chief executive of the Nuffield Trust, said he feared the situation would deteriorate in coming weeks.

He told BBC Radio Four’s Today programme: “Anecdotally what you are hearing from chief executives of trusts is that they are experiencing very, very high levels of pressure in their A&E departments.

“The growth seems to be way above what you might expect from what’s happened from the population.

“People feel that they can’t get to see their GP. The population is getting older and sicker, but I don’t think that’s the entire reason behind it.

“The other big pressure is the ability to discharge patients. If you can’t get patients out of the back of the hospital, home, then obviously, the whole system begins to seize up.

“As we know there are major problems in social care. But also NHS community services. The ability of hospitals to get people out is still really tricky.

“We felt, given the numbers of delayed transfers of care, this number of patients waiting to go elsewhere, the increase in norovirus, the obvious increase in activity that we have seen over the past year, and pressures on the workforce, which are absolutely unremitting, they are reasons to be really quite concerned.

“The real crunch point generally comes in week two or three after the Christmas break.

“I think there are early signs that there is a problem.”

Dr Taj Hassan, president of the Royal College of Emergency Medicine said hospitals were now in an “acute state of distress.”

An NHS England spokesperson said: “Over the Christmas and New Year period A&E visits and everyday hospital admissions peaked on the 27th and 28th December, and NHS 111 had its busiest week ever. However, hospitals report their bed occupancy levels were slightly lower than the same period last year, despite a higher number of beds out of action as a result of higher levels of diarrhoea and vomiting and norovirus.

“Plans remain in place to deal with additional demands during the winter period, and the public can still play their part using local pharmacy and NHS 111 for medical advice, alongside other services.”

NHS hospitals have already been ordered to stop most non-urgent surgery and  hand over swathes of operations to the private sector to fend off a winter crisis.

Health officials also instructed hospitals to discharge thousands of patients in a bid to reduce record levels of crowding.

NHS trusts were told to take a series of measures to dramatically reduce bed occupancy levels in an attempt to ensure that wards can cope as pressures mount.”

* Note: this story has been amended post-publication. Original figures stating 57 ambulance diverts were in place during the week ending January 1st, supplied by NHS England, were incorrect.

Britain’s National Health Service (NHS) To “Farm Out Surgery” to the Private Sector to Cope With Anticipated Winter Work Load

November 26, 2016


Hospitals have been told to farm out surgery to the private sector CREDIT:REX/SHUTTERSTOCK/REX/SHUTTERSTOCK

NHS hospitals have been ordered to hand over swathes of operations to the private sector to ease a looming winter crisis, according to leaked memos.

Health officials have also instructed hospitals to discharge thousands of patients in a bid to reduce record levels of crowding, while managers have been banned from declaring “black alerts”.

NHS trusts have been told to take a series of measures to dramatically reduce bed occupancy levels in an attempt to ensure that wards can cope as pressures mount.


Patients groups said the situation was “frightening”, while charities described the measures as an “extremely worrying” reflection of a system under “extraordinary pressure”.

This is evidence of an over-stretched healthcare system that the government has failed to properly fund, which must outsource patient care to private providers to cope with predictable patient demand.
Dr Mark Parker, chairman of the British Medical Association

The instructions from health officials come as hospitals are the most crowded they have ever been in the run-up to winter.

A memo from NHS England and regulators NHS Improvement, seen by the Telegraph, orders hospital trusts to take sweeping measures to bring occupancy down to a recommended safe limit of 85 per cent.

Hospitals have been ordered to “maximise elective activity” in the run-up to Christmas using the independent sector and schemes which pay NHS consultants lucrative overtime rates.

The plans have been drawn up so NHS trusts can cut the number of operations they perform – freeing up more beds for urgent patients – without lengthening waiting lists.

Under such schemes, consultants have been paid rates of up to £1,000 a shift

But the schemes and heavy use of the private sector is likely to add to financial pressures on the NHS, which last year recorded the highest deficit in its history.

It comes as a separate leaked document shows that GPs are coming under pressure to provide emergency home visits.

Local doctors groups are being asked to establish “A&E Delivery Boards” and to draw up rotas of medics able to respond to 111 requests for urgent care at home, which is currently reserved for those who are housebound.

The boards are ostensibly responsible for easing winter pressures, but the new NHS England best practice guidelines state the measures should remain in place all year round because of the unprecedented demand.

Latest official figures – for the three months ending in September – show NHS trusts have the highest levels of occupancy ever recorded in the run-up to winter with an average of 89.1 per cent of acute and general beds full, compared with 87 per cent in the same period last year.

It follows record levels of bedblocking, with high numbers of patients stuck in hospital for want of care at home.

The memo from health officials, sent to all NHS trust chief executives last month, calls for actions aimed at “lowering acute bed occupancy to 85 per cent from 19 December to 16 January.”

“Using the private sector like this, on this scale only runs down the NHS and will cost the taxpayer more in the long run.”Tim Farron, Lib Dem leader

Such measures include farming planned surgery out to the private sector, and discharging patients earlier.

“These plans will have to have full regard to both elective targets and financial delivery, as such systems will be expected to maximise activity either side of the period in an affordable way and where necessary using waiting list initiatives and the independent sector to ensure that elective throughput is not adversely affected,” the memo states.

A number of NHS trusts already have contracts with private providers, but will now be expected to ramp up activity, or agree new short-term deals.

Under waiting list initiatives, consultants can earn around £1,000 a shift on premium rates for performing an extra session in an evening or afternoon.

Dr Mark Porter, chairman of the British Medical Association, which has criticised the “creeping privatisation of the NHS” said last night: “This is evidence of an over-stretched healthcare system that the government has failed to properly fund, which must outsource patient care to private providers to cope with predictable patient demand.

“Unmanageable pressures are now facing the NHS all year round, winter or not, and this has been made worse by cuts to social care provision.”

Caroline Abrahams, charity director at Age UK, said the signals from health officials were signs of desperate measures, with hospitals under “extraordinary pressure” even before winter set in.

Hospitals had little hope of freeing up hospital beds, because social care was “in crisis” with too little funding to keep up with demand, she said.

Tim Farron
Tim Farron says running down the NHS like this will cost taxpayers more in the long run. CREDIT: GETTY IMAGES/GETTY IMAGES

Tim Farron, Lib Dem leader, said: “Using the private sector like this, on this scale only runs down the NHS and will cost the taxpayer more in the long run.”

“The NHS needs more cash and this government are trying to pull the wool over people’s eyes by pretending otherwise.”

NHS hospitals have also been sent separate guidance, requiring them to stop using terminology such as “black alert” to warn the public of impending crisis.

Instead, NHS England has devised a new system of Operational Pressure Escalation Levels (OPELs), which are numbered.

NHS hospitals have been ordered to hand over swathes of operations to the private sector to ease a looming winter crisis, according to leaked memos. CREDIT: PA/PA

Health officials said the four point scale was an attempt to ensure consistency when hospitals under strain, and needed extra help or for patients to be diverted.

But patients groups said the diktat was an attempt to spin the NHS out of crisis, by hiding the true scale of problems from the public.

The guidance from NHS England, published last month, orders hospitals to follow a national framework to track pressures, and whether help is needed to protect patient safety.

In recent years, most trusts have issued a “black alert” if they are becoming unable to cope with strain, and require ambulances to be diverted, with “red alerts” issued when services are struggling, and “amber” and “green” status declared at other times.

The new instructions instead require NHS trusts to follow the four point OPEL scale to track pressures, where OPEL 1 means services are working normally, and OPEL 4 means organisations are unable to deliver comprehensive care, with increased potential for patient care and safety to be compromised.

The levels are used to determine how much help is needed from local, regional and national services.

Joyce Robins, from Patient Concern, said the situation had become “frightening”.

An NHS England spokesman said: “Anyone who needs to be in hospital or in another care setting over Christmas, will be. Our ambition to reduce bed occupancy in hospitals over the festive period is about timely discharge and getting people to the most appropriate care setting ahead of the holidays, so there is capacity for early January when we know pressure is greatest.”


Why is the NHS under so much pressure?

An ageing population. There are one million more people over the age of 65 than five years ago

Cuts to budgets for social care. While the NHS budget has been protected, social services for home helps and other care have fallen by 11 per cent in five years

This has caused record levels of bedblocking, meaning elderly people with no medical need to be in hospital are stuck there. Latest quarterly show occupancy rates are the highest they have ever been at this stage of the year, while days lost to bedblocking are up by one third in a year

Meanwhile rising numbers of patients are turning up in A&E – around four million more in the last decade, partly fuelled by the ageing population

Shortages of GPs mean waiting times to see a family doctor have got longer, and many argue that access to doctors since a 2004 contract removed responsibility for out of hours care


BBC News

Autumn Statement: Missed opportunity for NHS?

  • 24 November 2016
  • From the sectionHealth
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Social care

There are concerns that social care is underfunded. LIGHTHAUNTER

The NHS and social care were barely mentioned in the chancellor’s Autumn Statement, and health groups and think tanks lined up to condemn Philip Hammond within minutes of him sitting down in the Commons.

So was there a failure to resolve a looming crisis? Or did Philip Hammond simply feel that in a difficult financial climate, there were other more pressing priorities?

Warnings about cuts in social-care spending in England and the impact on the health service have become more intense in recent weeks.

There has been a steep rise in the number of patients fit to leave hospitals, but who continue to occupy beds because of problems arranging social care.

That has concentrated minds, and NHS leaders indicated they were prepared to accept there would be no new money for health as long as social care, run by local authorities, received a financial boost.

But that did not materialise. The pleas had fallen on deaf ears.

“Missed opportunity” was a verdict on the statement much repeated by health think tanks and medical profession leaders.

The Royal College of Emergency Medicine even warned government inaction would put lives at risk.

Social-care chiefs warned the chancellor’s failure to act would mean more care homes closing and growing gaps in the market.

In response to Labour claims in the Commons that there was “looming chaos” for health and social care services in England, Mr Hammond said there was a programme of investment in the NHS being delivered.

Hospital patient

Lack of social care is putting pressure on hospital beds. MONKEYBUSINESSIMAGES

He repeated the government line that an extra £10bn annually was being allocated to the NHS budget by the year 2020-21.

He said the government would work with service leaders to ensure the money was spent effectively, underlining his view that it was not so much about the volume of investment as how it was deployed.

The new clashes over money for the NHS came as the UK Statistics Authority called for more clarity by the government in its references to the extra investment.

The stats watchdog observed that the £10bn increase for “NHS funding” in England was over a six year period from 2014-15.

However, total health spending, including public health, which has seen cuts, has not grown as fast.

The Statistics Authority noted that, according to Treasury figures, over a four-year period up to 2019-20 it would increase by £2.9bn.

Ed Humpherson of the UK Statistics Authority, said he would ask the Treasury to present estimates for NHS England and total health spending separately.

He has urged officials to “ensure clarity around sources, time periods and what is being measured”.

The stresses and strains on NHS finances have been well documented, and the debate about how much money the government is investing to help tackle the problems is rising up the political agenda.

A report from the National Audit Office highlighted again the financial pressures and argued that the problems were “endemic and not sustainable”.

The NAO report, unusually, confirmed the view there were tensions at the highest levels of Whitehall.

It talked of perceived differences between the government line that funding had been adequate and in line with what health service leaders asked for and NHS England itself.

There was an eye-catching conclusion: “Confronted as NHS England is by the pressures of rising demand for services, these signs of differences do not help build a confident feel about the future of the NHS.”

Those “differences” seem unlikely to fade away.

The NHS England leadership that had called for more funding for social care only to be disappointed will hardly be thrilled by the Autumn Statement.

The chancellor may find he has a lot more explaining to do.

How the care system works across the UK


Doctor Shortages Help Drive Up Costs of Obamacare

October 31, 2016

OCT 25, 2016

A new report shows that Florida hospitals have increased their number of residency slots 19 percent since 2013.

The state faces a severe shortage of about 7,000 medical specialists through 2025.

Since Florida policymakers began focusing on graduate medical education in 2013, hospitals have filled 736 more residency slots.  A total of 310 newly filled residency slots were in physician specialties facing the most severe shortages.

The report, “Training Tomorrow’s Doctors: Graduate Medical Education in Florida 2016 Annual Report” was produced by the Safety Net Hospital Alliance of Florida (SNHAF) and the Teaching Hospital Council of Florida to document and evaluate progress toward increasing residency slots.

“This is our first glimpse at both where we are now in terms of medical residency slots and where we need to be,’’ said Carlos Migoya, president and CEO of Jackson Health System and immediate-past chairman of SNHAF, whose hospitals provide more than 70 percent of Florida’s graduate medical education programs.

“This report makes it clear that while we’re not where we want to be yet in solving the physician shortage crisis, the concerted efforts of SNHAF members to increase the training opportunities for Florida’s next generation of doctors are already paying off.’’

Doctors are more likely to practice in the area they complete their residency. With few residency slots, many doctors educated in Florida leave for other states.

David Hart, vice president of the Florida Chamber of Commerce, said it’s important for the state to continue creating residency positions, not just for health care access, but for financial reasons.

“It comes down to really protecting a tax payer investment. After all, taxpayers subsidize a pretty substantial amount of four-year degrees and medical degrees in Florida.”

According to the report, residency shortages span every Medicaid region in the state, and in specialties like psychiatry, family medicine, general surgery, adult and pediatric anesthesia, cardiology, neurology and pulmonology.

In 2013, Gov. Rick Scott and the Florida Legislature appropriated $80 million in recurring state and matching federal funds to create the Medicaid Residency Program (MRP). The MRP initially funded 3,896 residency slots and now funds 4,632. Nineteen of those hospitals that previously had no residency programs now do, raising the number of participating hospitals to 60.

In 2015, the Florida Legislature appropriated an additional $100 million for the Graduate Medical Education Startup Bonus and Retention Programs. These programs provide hospitals a one-time $100,000 bonus for every residency slot created in a shortage specialty and at the end of each fiscal year direct any remaining funding to hospitals that have slots in the shortage areas as retention incentives.

In the first year of the GME Startup Bonus Program, 66 new residency positions in seven shortage specialties qualified for the bonus. Under the GME Retention Program, the number of filled residency slots in shortage specialties grew from 1,869 to 2,179.

“We are confident that state leaders and policymakers will see not only the progress we are making together in securing Florida’s health care future, but the remarkable return on the public’s investment in GME,’’ said Dr. Jonathan Ellen, president and vice dean at Johns Hopkins All Children’s Hospital and chairman of SNHAF. “These are real results that are making a real impact on Floridians’ lives and a heck of a bargain to boot.”

(When Obamacare was first created, one of the biggest problems in the U.S. medical service was a doctor shortage. Obamacare brought millions of new patients into the medical system without working on getting more trained and qualified doctors to handle the entire work load….)


There is a shortage of physicians countrywide, not just in Redding. It isn’t because of lack of interest, but because of lack of money. No agency can feel the pain more than the Department of Veterans Affairs, which I served in for over 32 years.

In working with the VA Medical Center at Reno, we were affiliated with the University of Nevada Medical School. One of the biggest complaints of the medical students, interns and residents was the payment of their student loans. These loans can run from $250,000 to $500,000 for a medical education.

I made a suggestion to President Obama on a way to recruit physicians for the VA, and help students pay off their student loans and benefit the VA System, but it was met with an air of indifference by the White House.

The VA clinic here in Redding and other VA clinics in California are being hit hard by the lack of qualified physicians. Family nurse practitioners have their purpose, but primary medical care as well as specialists are needed in the proper care of our veterans.

I’m a veteran who worked in a VA medical center and received medical care from a private physician. There’s a need for physicians in all medical avenues of medical care. The veterans are in need of more physicians to improve care, reduce waiting lists and provide viable care before they are unable to obtain the needed care.

The public is waking up to the fact that there is a shortage of physicians here in Redding, but there is a nationwide shortage because of the cost of a good medical education. The brains are there; the bucks are not.

We don’t need walls. We need doctors.

If there’s money for political waste, there should be money for good quality medical care. The opportunity to forgive student loans is of the utmost and paramount concern if we are to remain a great nation.

Ernest Kimball lives in Redding.–3e9ace17-0ba6-2aba-e053-0100007f3d21-397115881.html

Vietnam’s Hospitals and Health Care: Patients wait for 10 hours on average after walking in — IT not effectively used

June 27, 2016

Thanh Nien News

HO CHI MINH CITY – Monday, June 27, 2016 09:51

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Vietnamese patients wait to be examined at Binh Dan Hospital in Ho Chi Minh City. Photo by Khanh An

Ho Chi Minh City’s public hospitals need to make better use of information technology to improve their services since a patient has to wait for 10 hours on average to be examined, experts said at a conference in the city Saturday.

Vu Anh Tuan, general secretary of the HCMC Computer Association, said most hospitals do not use information technology efficiently.

“Vietnam’s medical system needs effective IT use to better manage patients’ records, reduce the waiting time and improve examination and treatment services,” he said.

Tang Chi Thuong, deputy director of the city health department, said, “Cloud is not widely used.”

The city with more than 10 million inhabitants has a total of 113 hospitals with nearly 34,400 beds.

“A medical network that provides healthcare services for millions of people needs an advanced information technology system for better treatment,” Thuong said.

According to a survey by the Vietnam Posts and Telecommunications Group, city hospitals examine and treat 40 million people annually.

On average, a patient has to wait around 10 hours for being examined and a doctor sees around 90 patients a day.

Short-term health insurance fills Obamacare gaps but has risks — Republicans Unveil Replacement Plan — Birth control case is back in the lower courts

May 22, 2016


Short-term health insurance fills Obamacare gaps but has risks

By Victoria Colliver, San Francisco ChronicleSun, May 22, 2016


Sales of health insurance policies with limited benefits — plans that represent the very type of coverage and industry practices that the Affordable Care Act was designed to get rid of — appear to be on the rise.

.These short-term policies, which don’t include such basic benefits as prescription drugs or maternity coverage and can exclude applicants based on their medical history, are experiencing a resurgence among consumers willing to exchange comprehensive care and a potential tax penalty for significantly cheaper premiums than those sold under the rules of the federal health law many refer to as Obamacare.

“While Obamacare is appropriate for some people, for others it is not, and they want other choices,” said Sam Gibbs, executive director of Agile Health Insurance, a Mountain View company that operates what it calls the first website dedicated to selling these policies exclusively.

Gibbs said the year-old business, a division of Health Insurance Innovations, has been growing 100 percent each quarter and has sold 35,000 policies nationwide since last fall.

Most people who purchase these policies do so because they need to fill a gap in health coverage and just need something to protect their assets in case of a medical emergency. They don’t want the cost or hassle that comes with applying for standard health insurance.

“The reason you buy temporary insurance is so you can survive a Muni accident. … Or if you fall off a building and live,” said Kevin Sullivan, 36, of San Francisco, who bought a six-week policy when his wife, whose employers normally provide the couple’s coverage, was between jobs.

He did the math: continuing coverage under his wife’s former employer’s policy would have cost $1,100 a month, and six weeks of a temporary policy cost just over $400. Sullivan, who runs a company that sells commercial insurance, understood the downside.

“You take the risk that you’re diagnosed with cancer in the temporary period. You take the risk you’re not going to get your prescriptions filled,” he said.

Getty Images

Sullivan, who purchased the plan through Agile Health, said he didn’t he even know who the carrier was. He and his wife never used the policy. Her new job-based coverage started May 1.

When the Affordable Care Act’s major provisions went into effect in January 2014, many of the problems that plagued people who had to buy health insurance on their own, rather than getting as part of a group policy from a job, were supposed to go away.

No longer could people be rejected or charged more if they had pre-existing health conditions. No longer would they get hit with bills for basic services that weren’t covered, even if they were informed in the fine print. In exchange for ending those practices, the law requires most Americans to buy health insurance. They have to buy coverage during a specific “open enrollment” period to prevent them from buying it only when they need it, like on the way to the hospital.

Federal numbers released Tuesday show that the Affordable Care Act has pushed the percentage of uninsured Americans to a record low of 9.1 percent, the first time it has dipped into the single digits. But there are growing concerns nationwide that insurers may seek double-digit increases in premiums next year for policies sold through the health law’s insurance marketplaces.

Even the state’s health insurance exchange, Covered California, which has managed to keep rate increases relatively low, is expecting premiums to rise 8 percent on average next year. This follows two years of increases averaging just 4 percent.

Short-term policies, which can last a few months or up to a year, are virtually everything the policies that comply with the Affordable Care Act are not. They require applicants to answer some basic health questions, and those with chronic or past health problems may be rejected. They don’t cover basic benefits mandated by the law, and consumers aren’t guaranteed of getting a policy if they reapply.

While buying health coverage that doesn’t meet the new marketplace requirements is legal, people can get hit with a tax penalty if they don’t have coverage and don’t qualify for various exemptions. (Short gaps in coverage, for example, are accepted.)

Temporary health insurance that doesn’t cover mandated benefits doesn’t count under the law. The penalty started at $95 per adult in 2014, the first year the policies were sold, and will rise to $695 this year.

For Orlando Figueroa of San Leandro, the penalty wasn’t high among his priorities when he opted for a short-term policy.

A father of two, the 44-year-old was laid off from his recruiting job for a major Silicon Valley tech company. While he worked as a contractor, Figueroa’s family coverage could cost him as much as $1,300 a month.

While searching for options online, he learned about temporary health insurance and bought a short-term Aetna policy for about $850 a month. He considered buying a regular policy — his change in job status allowed him to buy outside the open enrollment period — but he didn’t qualify for a subsidy through Covered California.

“This is a lot cheaper. This can help me bridge the gap,” he said. “For a case like mine, it’s going to cover a two- to three-month gap. Then I can weigh what I’m going to do next at the time.”

Figueroa bought his plan through eHealth, a Mountain View company that sells short-term policies as well as those that comply with Affordable Care Act rules.

“The reality is, insurance doesn’t do you any good if you can’t afford it,” said Nate Purpura, vice president of consumer affairs at eHealth.

EHealth sold about 60,000 short-term policies nationwide in 2013, the year before the major Affordable Care Act provisions went into effect, Purpura said. In 2014 and 2015, its annual sales of policies jumped to about 140,000.

“We thought maybe once people understood the enrollment period better, we’d not see quite the same appetite for short-term (policies), but the demand has stayed consistent,” Purpura said.

Numbers like that pose concerns for consumer advocates like Betsy Imholz, who plans to ask state insurance commissioners to ensure that their residents understand the risks of these policies.

“I worry about people not fully understanding what they’re getting,” said Imholz, special projects director at Consumers Union, the policy and advocacy division of Consumer Reports.

Imholz said people should be asking about what the plan covers, what it doesn’t, as well as how much of their money these companies actually spend on medical claims.

Imholz said she also worries that these policies are siphoning younger, healthier consumers out of the pool of people buying coverage.

“We need to keep the larger risk pool healthy to keep rates down for everyone else,” she said.

These young, healthy consumers include people like 29-year-old Brianna Skellie, of Oakland, who lost her health insurance last fall when she finished graduate school.

Skellie said it took a bad reaction to an insect bite to remind her how much she needed coverage.

“It was such a moment of panic,” she said. “It was like anything could happen to me. I ride my bike a lot and just needed to have something more than nothing.”

She may have qualified for a subsidized policy through Covered California, but Skellie planned to quickly get a job and didn’t want to go through proving her income and citizenship and other hassles. So she purchased a short-term plan online for less than $100 a month and dropped it a couple months later when she got a full-time job with benefits.

Officials from the California Department of Insurance said they receive reports from the insurers they regulate about these policies. They said not many of them are sold in California, and they have received few complaints.

But the companies that sell these policies remain bullish on the market.

“Obamacare has left a gap. We’re entrepreneurs and innovators, so we build products to fill those gaps,” Agile Health’s Gibbs said. “Time will tell where this goes, but so far it’s just been fantastic.”


The Obamacare birth control case is back in the lower courts

The Obamacare birth control case is back in the lower courts

Lower courts must now take another look at the case, which consists of making an exception for faith-based groups so they do not have to cover the birth control costs of their female employees.

It presently provides what it describes as an “accommodation” that requires the Little Sisters of the Poor and other religious organizations to sign a form for the government that directs their insurance providers to offer the objectionable coverage through their health plan. The challengers claim this doesn’t go far enough, because their plans are still being used as vehicles for providing access to contraceptives, even if they don’t have to pay for it.

All that stands in the way is governmental stubbornness and bureaucratic convenience – neither of which amounts to a hill of beans compared with respect for religious liberty.

According to the justices, lower court should bring a solution to the issue in such a way that religious organizations’ objection to contraception is met accordingly while the benefits of Obamacare’s coverage protections could still be attained by people.

In the case now before the court, Zubik v. Burwell, the Little Sisters are joined by other plaintiffs including the Archdiocese of Washington, Bishop David Zubik of Pittsburgh, the pro-life group Priests for Life, and several Christian colleges and universities.

“On both sides there is probably ideological pressure to keep this going”, said Kevin Martin, an attorney in the Boston office of Goodwin Proctor.

In an unsigned opinion issued Monday, the court sent a series of cases back to a raft of federal appeals courts, with instructions for those courts and the parties in the lawsuits to try harder to work things out.

In a unanimous opinion issued Monday, the justices remanded the case to the respective United States Courts of Appeals for the Third, Fifth, Tenth and District of Columbia Circuits. In any event, the very real possibility is that one or more cases could end up before the Supreme Court in a later session. The Zubik case could eventually reach the Supreme Court again, after adjudication in lower courts, but that would nearly certainly occur only after a new justice had been added to the bench, allowing for a definitive ruling. “If the government desires to do so, it must do so on its own, without requiring Catholic organizations to violate their religious beliefs”.

“Nothing in this opinion, or in the opinions or orders of the courts below, is to affect the ability of the Government to ensure that women covered by petitioners” health plans “obtain, without cost, the full range of FDA approved contraceptives‘”.

The failure to arrive with a final ruling is also said to have been caused by the recent passing of Supreme Court Justice Scalia, leaving only 8 seats filled, with 4 conservatives and 4 liberals.


Guess Who Just Sued the Federal Government Over Obamacare

By Sean Williams Published May 21, 2016

The Affordable Care Act, or Obamacare as it’s best known, has had a bumpy ride since Jan. 1, 2014, when it became the official health law of the land.

On the one hand, Obamacare has worked to lower the rate of uninsured adults in this country to the lowest levels on record. According to first quarter data from Gallup, just 11% of respondents were uninsured, compared to 17.1% in the fourth quarter of 2013, the quarter preceding Obamacare’s full implementation. Recently released data from the Centers for Disease Control and Prevention, which also includes Medicare enrollees, shows an uninsured rate of only 9.1%, a new low.

Furthermore, millions of lower-income consumers and families have gained access to medical care through the Affordable Care Act, with 31 states choosing to take federal funds and expand their Medicaid programs. Provisions excluding insurers from rejecting people with pre-existing conditions have also allowed the previously uninsured to get the care and coverage they need.

Conversely, Obamacare has arguably made life miserable for other consumers, kicking millions off their non-Obamacare-compliant health plans and potentially forcing them to seek out new primary care physicians. Consumers are also facing what look to be steep premium increases in 2017 as health insurers large and small attempt to cope with higher medical utilization rates and a generally sicker group of enrollees in the Obamacare exchanges.

But Obamacare was dealt another bump in the road this past week: a lawsuit from a surprising source.

Guess who just sued the federal government over Obamacare

As reported by The Wall Street Journal on Tuesday, Highmark, a health insurance provider under the Blue Cross Blue Shield brand in Delaware, Pennsylvania, and West Virginia, is suing the federal government over Obamacare. “Why?” you ask? Highmark claims that it didn’t receive its promised allocation via the risk corridor.

The risk corridor has been a largely unsuccessful component of the Affordable Care Act that sought to encourage new entrants into the individual marketplace by providing a financial foundation if they were to lose excessive amounts of money. The idea was to have overly profitable insurers contribute their excessive profits to the risk corridor pool, which would then be distributed to insurers losing excessive amounts of money on Obamacare’s exchanges. The program was only designed to be in place for three years (2014-2016), since that was deemed more than enough time for insurers to correct premium pricing mistakes.

What actually happened was few insurers were excessively profitable in 2015 — mainly on account of the aforementioned higher medical utilization rates — leading to the risk corridor program disseminating only $362 million (12.6%) of the $2.87 billion that had been requested by money-losing insurers. The lack of adequate reimbursement is what caused 12 of Obamacare’s 23 approved healthcare cooperatives to shutter their doors.

However, it’s Highmark’s contention that the federal government had pledged to initially cover the difference in the risk corridor program even if excessive insurer profits didn’t cover the amount requested by money-losing insurers. Eventually, the federal government backed off this stance and went with a budget-neutral approach to the risk corridor, essentially meaning only the funds pooled from profitable insurers would be dispersed to struggling insurers.

Highmark is requesting the federal government pay it the $223 million that it was promised via the risk corridor, as well as cover interest on the $223 million and its legal fees for the lawsuit. Highmark has received just $27 million via the program to date. According to Highmark’s CEO, David Holmberg, “All we’re asking is for the federal government to do what they promised.”

If Highmark were to win its case, it could open the floodgates for a class action suit against the federal government for the remainder of unpaid risk corridor funds.

An array of concerns

Unfortunately for Obamacare, this latest lawsuit represents just one in a string of concerns for the program. While the headline enrollment numbers look good, a number of internal components of Obamacare aren’t up to par.

Aside from the risk corridor failing to live up to expectations, young adult enrollment has been subpar, even with year-over-year improvement in 2016. I suspect the biggest deterrent to getting younger and healthier people to enroll in Obamacare is that the shared responsibility payment (SRP) — the penalty paid by consumers for not purchasing health insurance — is simply too low.

I’m sure there are those out there who would argue that this is far from the case, with the average SRP in 2016 expected to be nearly $970 according to the Kaiser Family Foundation. However, an SRP of $970 pales in comparison to the annual costs of purchasing even the cheapest healthcare plan in the bronze category, which can often run $2,500+ for a full year. Even accounting for the potential tax breaks associated with paying healthcare premiums, it’s a night-and-day cost difference that’s keeping healthier young adults out of the program.

The other issue, which works somewhat hand-in-hand with the risk corridor’s shortcomings, is insurers’ ongoing losses. Health-benefit providers need to be able to turn a profit, and in order to make that happen insurers could need to enact some very large premium price hikes in 2017. Though the reports are still coming in, insurers in a number of states have requested double-digit percentage increases in premiums in order to make their Obamacare plans make ends meet. While this probably isn’t too big a problem for the roughly 85% of Americans receiving partial subsidies for the premium, it could be a big concern for the remaining Obamacare enrollees and those who are still uninsured. Obamacare was expected to entice competition and transparency, using both to keep cost inflation under control; however, it looks as if premium inflation may rise faster than it has in a decade in 2017.

There are also no guarantees Obamacare will survive much past the 2016 presidential election. Though Democratic Party front-runner Hillary Clinton wants to build upon Obamacare’s success, presumptive Republican nominee Donald Trump is itching to repeal it and start anew.

Obamacare has some serious questions to answer in the coming months, and both consumers and investors would be wise to pay close attention to what happens next.

The article Guess Who Just Sued the Federal Government Over Obamacare originally appeared on

Sean Williams has no material interest in any companies mentioned in this article. You can follow him on CAPS under the screen name TMFUltraLong, and check him out on Twitter, where he goes by the handle@TMFUltraLong.The Motley Fool has no position in any of the stocks mentioned. Try any of our Foolish newsletter services free for 30 days. We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy.


GOP lawmakers unveil ObamaCare replacement bill

By Peter Sullivan – 05/19/16 05:08 PM EDT
The Hill

Two Republican lawmakers on Thursday introduced an alternative to ObamaCare as the House develops its own healthcare plan.


The bill from Rep. Pete Sessions (R-Texas) and Sen. Bill Cassidy (R-La.) does not fully repeal ObamaCare, a notable departure from the GOP’s long-stated goal.

But it would eliminate many central aspects of the Affordable Care Act, including the mandates for individuals to have coverage and for employers to provide it, as well as requirements for what an insurance plan must cover.

The core of the plan is a $2,500 tax credit that any citizen would be eligible for and use to purchase health insurance. The lawmakers say this gives flexibility to people, whether they get employer-based insurance or not, to more directly control their healthcare spending, for example by using a health savings account.

Sessions and Cassidy are putting forward their plan as a task force set up by Speaker Paul Ryan (R-Wis.) is nearing the release of its own plan to fully repeal ObamaCare and replace it with an alternative.

Sessions, the chairman of the powerful House Rules Committee, said in an interview that his plan is not meant to compete with that effort.

“Everybody’s submitting their ideas, so it’s very complimentary,” he said.

The Ryan-backed task force, though, will not be releasing a bill; it will instead be a general outline of ideas.

“The thing that makes us different is we made a bill out of it, and that’s the hard part,” Sessions said. “It’s really easy to have ideas. It’s really hard to put it in a bill that works.”

Under the Sessions-Cassidy plan, people currently with insurance through the ObamaCare marketplaces could keep it because they would be grandfathered in.

But new ObamaCare enrollees would no longer be eligible for ObamaCare’s financial assistance. Instead, they would receive the new plan’s $2,500 tax credit, according to John Goodman, a health economist who worked with Sessions and Cassidy on the plan.

The new tax credit is a flat sum, as opposed to ObamaCare’s tax credits, which increase for lower-income people. Therefore, Goodman said, lower-income people would receive less assistance under the Sessions-Cassidy plan, but higher-income people could receive more.

Sessions defended the decision to allow current ObamaCare plans to be grandfathered in if people want to keep them.

“I want to be fair about this,” he said. “If you want that, you ought to have it; I mean, we’re in a world of options.”

The Sessions-Cassidy bill also shakes up the current system of not taxing health insurance plans provided through employers, which can be politically fraught. However, the plan allows employers to opt to stay in the current system if they want, and only opt in to the new tax credit if they choose.




Healthcare has many problems in almost every corner of our world…



The health services in Britain and the U.S. cannot possibly determine future costs because neither nation knows how many new migrants reside within their borders…. The result is that money and trained medical staff are always in a state of shortage and crisis….

Americans are suffering “the awful legacy of the last eight years,” Bill Clinton said in March.