British health reform takes seminar's center stage - British National Health Service

Healthcare Financial Management, Oct, 1991

Three months into a reform plan for the British National Health Service (NHS), healthcare financial managers in the United Kingdom see the experience as slow and frustrating.

That view was reported by HFMA members from the United States who traveled to Yorkshire, England, in late July to attend the 11th Annual HFMa UK-US Exchange and Seminar. Twenty-eight U.S. HFMA members joined a group of their British counterparts for a four-day site visit and a two-day seminar. The seminar focused on NHS reforms announced last April and designed to separate the providers of health services from the purchasers of services. But the British government has made little progress toward that goal, noted HFMA Chairman Joanne M. Judge, FHFMA, CPA.

"The changes are going slowly -- and, frankly, I was surprised that more changes had not been made," Judge said. "My understanding was that it was going to be much more free-market based. At this point, they have some control over sending some services to other districts' hospitals or buying some services from other districts if they can do it more economically."

A chief obstacle to NHS reform, Judge said, is the difficulty in holding down expenses while the demand for services grows with increased accessibility in a free-market system. "The question is whether they can provide sufficient cost savings in the system to accommodate the increased demand without increasing the overall percentage of the gross national product they spend on health care," she said. "The Americans didn't seem to feel they could. But the British government feels there are enough savings to be realized, and they can eliminate long waiting times and still provide the services."

A lack of comparative data and effective information systems to provide data pose especially stiff challenges to implementing the reforms, said HFMA Chairman-Elect Bonnie Phipps, FHFMA, CPA.

"They are concerned about not having the capability to even measure what they have done," Phipps explained. "They have a need for information systems to measure what they are doing in terms of care giving, but they don't have them in place in the hospitals right now."

According to one delegate, the hospital she visited was advanced medically and clinically, but its lack of information systems presented a serious handicap that grew even worse after reforms were implemented.

"The reforms permit hospitals to be compensated for out-of-area services, but because they don't have information systems, they don't know what type of services they are providing," said Debra S. Bruss, FHFMA, who is assistant vice president for finance at NeWell Health Care System in Newton, Mass.

Managers at NHS hospitals run into problems when attempting to identify the number and types of patients they serve, Burss added. A lack of good information complicates even theprocess of knowing how much to charge for services.

By sharing information, participants hope to assist the British as they enter areas that are now routine in the United States. Contracting and purchasing services from physicians, which is a new experience for the NHS, "is similar to what we do with health maintenance organization and preferred provider organization contracts," Phipps said.