A change of prescription --The National Health Service *Giving patients partial control of the purse strings Doctors’ winning ways lure patients EVER since the National Health Service was set up six decades ago in the teeth of opposition by many doctors, professionals have dominated decisions over who receives which treatment, and where. The government is now poised to hand more control to patients in a package of market reforms. Discover the symptoms of what you suspect might be cancer, say, and you can make an appointment with your choice of family doctor. If he also suspects something serious, he will give you a choice of hospitals in which to be diagnosed and treated. On June 8th Andrew Lansley, the health secretary, announced that he wants to extend choice further, allowing patients to opt for one treatment over another in consultation with a medic (in England, that is; devolved regions are free to do things differently). Such choices must be informed. So he will also publish data on results, infections, waiting times and so on. Payments will be channelled through general practitioners (GPs). Like primary-care physicians in Denmark and the Netherlands, they have long acted as gatekeepers, controlling access to expensive hospital care through referrals. Mr Lansley’s reforms, which he will present to the NHS Confederation, a group of health-service organisations, on June 24th, will strengthen the role of GPs in deciding where the money is spent. Many hospital doctors are unhappy, citing the school league tables compiled by newspapers using government data, in which those that take pupils from poor families perform badly. They fear hospitals that treat very ill people might suffer a similar fate. But giving patients greater choice over where they are seen has already increased competition in some places. Recent research by the King’s Fund, a think-tank, found that hospitals solicited GP referrals at the edges of their geographical catchment areas. Choice was not a luxury afforded only to townies: the study found that patients outside city centres were more likely to attend a hospital other than their local one than were urban denizens. Some 70% of people still go local, but many who roamed further afield did so because of a poor experience closer to home. Patients did not pore over data before deciding, but relied on their own and their friends’ and families’ experiences, as well as their doctors’ advice. The researchers concluded that giving patients more choice helps to keep hospitals focused on what is important to their customers. That will matter as funding is squeezed. Unlike most other public services, the NHS will be spared real cuts, but increasing demands mean it will have to do more for its money. Last month the Department of Health published a report by McKinsey, a consulting firm, showing that the NHS in England could save between 15% and 22% of current spending over the next three to five years-as much as £20 billion-by measures such as making hospitals operate more efficiently, making drugs cheaper and dropping unnecessary treatments such as tonsillectomy. And giving patients a say in not only where but how they are treated could help the sick, as well as the bottom line. Glyn Elwyn, a professor of primary care at Cardiff University, observes that well-informed patients tend to be more conservative than doctors. Someone with advanced cancer, say, who is offered expensive, aggressive new chemotherapy that might extend life at the price of lowering its quality often opts instead for palliative care. Greater patient choice might not always increase competition between hospitals, but could yet increase happiness and save money. ese whispers------China's secret media *Not believing what they read in the papers, China’s leaders commission their own IN A country where independent information-gathering is kept in check, what China’s leaders know and how they know it matters hugely. A recently leaked speech by Xia Lin, a senior editor at Xinhua, China’s government-run news agency, suggests that even though press controls have been somewhat loosened in recent years, leaders still rely heavily on secret reports filed by Xinhua journalists. Other evidence indicates this fault-prone system is actually gaining in importance. In the speech last month Mr Xia revealed that the news agency’s public reports about an eruption of ethnic rioting in the far-western region of Xinjiang last July had played down revenge attacks by Han Chinese against members of the region’s biggest ethnic group, the Uighurs. Mr Xia said it was only after reading a classified “internal reference report on the reprisals that China’s president, Hu Jintao, cut short an overseas tour. A summary of Mr Xia’s remarks was posted online by one of the audience. Censors removed it and tried to stop it circulating elsewhere. The summary has not been verified. But filing secret bulletins to the leadership is one of Xinhua’s crucial roles. Many of China’s main newspapers also have classified versions covering news considered too sensitive for public consumption. They do not rely on secret intelligence, but merely report on issues that in most other countries would be the staple of journalism: public complaints; official wrongdoing; bad economic news; and foreign criticism. In recent years China’s open media-which, thanks to the withdrawal of government subsidies, are now more commercially driven-have also been straying into these once-forbidden realms. But despite the growing assertiveness and reliability of at least a handful of open publications, the secret media have shown no sign of withering away. Some of them have gained a new lease of life-secret-sounding information sells well. China’s rapid adoption of the internet has even provided rich material for a whole new genre of classified reporting. And China’s leaders appear to be lapping it up. The outbreak of SARS, a deadly lung disease, in 2003 exposed critical weaknesses in the “internal reference , or neican, system. Xinhua’s first SARS report, for leaders’ eyes only, did not appear until February 9th, by when there had been some 300 cases and five deaths, dating back to November 2002. Only two days later did the leadership release the news and tell the World Health Organisation. China’s secretiveness and dilly-dallying were widely blamed for the spread of SARS. It was not until April 20th that China’s leaders allowed the press to report the outbreak freely. But even as the number of open reports jumped, so too did Xinhua’s neican coverage. Between April 1st and July 10th, the news agency issued more than 2,700 public SARS-related reports in Chinese. It also filed more than 1,000 secret ones, and over six hours’ worth of classified audio-visual material. In 2003 the number of comments written by leaders in the margins of Reference Proofs, a secret bulletin on international affairs for very senior officials rose by 88% compared with the year before. Six were by President Hu. Xinhua compiles such statistics assiduously to measure the impact of its work. An even more secret version of the bulletin, Reference Proofs , published more than three times as many reports as in 2002. Internet usage in China soared after SARS, which boosted the appeal of virtual encounters and e-commerce. In parallel there was a surge in demand from China’s leaders for rapid updates on what the “netizens were up to. Xinhua compiles these into another laboriously titled bulletin, Proofs of Domestic Trends (A Digest of Online Public Sentiment). In 2007 the agency’s yearbook reported a 15% growth in the number of such reports and a 50% increase in leaders’ comments on them. It seems unbothered by the paradox: public internet chat is rehashed in top-secret reports, divulging the contents of which could result in a lengthy prison term. The plethora of information on the internet deemed too sensitive for China’s traditional media has spurred the growth of neican. Last July the Communist Party’s flagship newspaper, the People’s Daily, launched a new weekly journal for senior officials, called Online Public Sentiment: Three Rurals Internal Reference. The similarity of its title to Xinhua’s far more restricted digest might well be calculated to give the impression that it is offering inside information on the dissatisfaction-plagued “three rurals , which is the party’s way of referring to peasants, villages and agriculture. A sample edition available online is humdrum, but its aura of secrecy commands a subscription rate two or three times that of a standard (and far more informative) weekly magazine. A Chinese editor familiar with Reform Internal Reference, a secret weekly for low-level officials and academics, says much of its contents could be found online. Chinese leaders themselves sometimes seem to take neican reports, produced as they are by the party’s own faithful, with a pinch of salt. In a commentary in the People’s Daily in April, China’s prime minister, Wen Jiabao, revealed that leaders sometimes had to sneak out incognito in search of unadulterated information. The open press, subject as it is to a host of censorship directives, is usually even less reliable. At the party’s five-yearly congress in 2007, Xinhua issued more than twice as many neican reports as it had at the 2002 event. In 2009 a senior provincial official called for efforts to ensure that everyone eligible for Xinhua’s neican did subscribe. There must be no “blank spots , he said. In the realm of the censored, half-censored content is king. 【
查看更多】
题目列表(包括答案和解析)
