Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente.
OBJECTIVE
To compare the costs and performance of the NHS with those of an integrated system for financing and delivery health services (Kaiser Permanente) in California.


METHODS
The adjusted costs of the two systems and their performance were compared with respect to inputs, use, access to services, responsiveness, and limited quality indicators.


RESULTS
The per capita costs of the two systems, adjusted for differences in benefits, special activities, population characteristics, and the cost environment, were similar to within 10%. Some aspects of performance differed. In particular, Kaiser members experience more comprehensive and convenient primary care services and much more rapid access to specialist services and hospital admissions. Age adjusted rates of use of acute hospital services in Kaiser were one third of those in the NHS.


CONCLUSIONS
The widely held beliefs that the NHS is efficient and that poor performance in certain areas is largely explained by under investment are not supported by this analysis. Kaiser achieved better performance at roughly the same cost as the NHS because of integration throughout the system, efficient management of hospital use, the benefits of competition, and greater investment in information technology.
Feachem
Richard G A
RG
Institute for Global Health, University of California, San Francisco, 94105, USA. rfeachem@psg.ucsf.edu
Sekhri
Neelam K
NK
White
Karen L
KL
D002140:California; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000592:standards; D017598:Efficiency, Organizational; D017048:Health Care Costs; D006801:Humans; D008329:Managed Care Programs / Q000191:economics* / Q000592:standards; D019984:Quality Indicators, Health Care; D013222:State Medicine / Q000191:economics* / Q000592:standards; D006113:United Kingdom