Francisco Azuero's List: Health management

• One was competition—or at least the perception of having competitors.
• The researchers also found that bigger is better when it came to good  management.
• Private ownership is another factor helping hospitals score more highly.
• institutions that employ clinically qualified staff in management score better  than those that do not.
• Big, professional, autonomous, mostly independent and ferociously competitive:  elite universities seem to offer all five important characteristics for saving  lives.

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• Workers with a lot less training than doctors can  still be highly effective. Physician assistants in America can do about 85% of  the work of a general practitioner, according to James Cawley of George  Washington University. A pilot programme of rural health-care workers in  India—the type that the health ministry wants to expand—found that the workers  were perfectly able to diagnose basic ailments and prescribe appropriate drugs.  In some areas non-doctors actually look preferable. A review of studies of nurse  practitioners in Britain, South Africa, America, Japan, Israel and Australia,  published in the British Medical Journal, determined that  patients treated by nurses were more satisfied and no less healthy than those  treated by doctors.

• The doctors’ power rests on their professional prestige rather than  managerial acumen, for which they are neither selected nor trained. But it is a  power that they wish to keep. The Confederation of Medical Associations in Asia  and Oceania, a regional group of doctors’ lobbies, wants “task-shifting” limited  to emergencies. Japan’s medical lobby has vehemently opposed the creation of  nurse practitioners. India’s proposal for a rural cadre outraged the country’s  medical establishment, and legislation to create the three-and-a-half-year  degree has gone nowhere.

• As doctors become scarcer and health costs continue  to rise, more and more systems will seek to innovate, and the successes they  have will become ever more widely known. Already, programmes such as  Montefiore’s are becoming the paradigm for keeping patients healthy. In December  America’s health department chose Montefiore for a pilot to improve care and  lower costs for the old.

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