September plans: a necessary rethink

After looking at this again, I think I will have to ditch the plan to rent a place to be a home base for the whole week.

First of all, it struck me that if I'm going to, say, Thurso or Wick (or Kingussie) for a concert that starts at 7.30, driving back afterwards is probably going to be a bit of a chore.

Second of all, not to put too fine a point on it, but there are few self-catering accommodations available for two people (none for one, of course--no one would be daft enough to go on holiday by themself). And the ones for four, while nice and spacious for one person are, well, pricey. When compared to the same number of nights in hotels (of course, compared to what it would cost for four people to stay a week in hotels, its a bargain, which is the idea).

So I'm thinking I had better go with travelling from place to place instead, and booking a room wherever the concert is that night.

That will, ironically, give me a bit more flexibility. Assuming that I fly into Edinburgh, would anyone like to get together that Saturday, or even Sunday (5 or 6 September) before I head north? Knowing how flights work, I'll probably be both arriving and heading out bl**dy early in the morning.

healthcare rant

I read a post in a friend's journal about the "healthcare compromise" and, in agreeing with her, got so ranty that I thought I should probably post the result here instead of there. ( Read more... )

(no subject)

Thanks to Kathy for following up on her earlier post on healthcare that got me revving up with a link to this article from the New Yorker.

One interesting passage:

Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.

In a 2003 study, another Dartmouth team, led by the internist Elliott Fisher, examined the treatment received by a million elderly Americans diagnosed with colon or rectal cancer, a hip fracture, or a heart attack. They found that patients in higher-spending regions received sixty per cent more care than elsewhere.... Yet they did no better than other patients, whether this was measured in terms of survival, their ability to function, or satisfaction with the care they received. If anything, they seemed to do worse....To make matters worse, Fisher found that patients in high-cost areas were actually less likely to receive low-cost preventive services, such as flu and pneumonia vaccines, faced longer waits at doctor and emergency-room visits, and were less likely to have a primary-care physician. They got more of the stuff that cost more, but not more of what they needed.

and another:

Local executives for hospitals and clinics and home-health agencies understand their growth rate and their market share; they know whether they are losing money or making money. They know that if their doctors bring in enough business—-surgery, imaging, home-nursing referrals—-they make money; and if they get the doctors to bring in more, they make more. But they have only the vaguest notion of whether the doctors are making their communities as healthy as they can, or whether they are more or less efficient than their counterparts elsewhere.

The author, himself a physician, contrasts this profit-driven model with instances of community-based, collegial practices like the Mayo Clinic, which keep down costs by focusing on effective, coordinated care instead of high-speed, quick-turnover, approaches that throw all the possible tests and procedures at a patient without calculating what will actualyl do the most good.

The difficulty, it seems to me fro reading the article, is persuading the sort of doctors who are already making profit their chief concern, to switch to a different style of practice in which time and care need to be taken with each patient, and the return may be greater for the recipient of care than the provider.