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Vitamin D in the UK as reported by one doctor – Aug 2010

Question to one doctor about vitamin D and capitation fees in the UK:

“It would seem that a UK doctor would benefit by having a great many of his patients take vitamin D. There is so much strong evidence of reduced health costs with vitamin D that the doctor would have an economic incentive to perhaps even give his patients vitamin D. It would seem possible for the doctor to increase his patient load by say 20%, and thus his income by 20%.”

Response by Dr. David Grimes http://www.vitamin-d-deficiency.co.uk

In the UK, for interesting historical reasons that go back to King Henry VIII th, there is total separation between primary and secondary care.

Primary care (general or family practice) is based one doctor or now group of doctors (GPs) having responsibility for a group of patients, a ratio of about 1:2000. The government pays the GP a basic capitation fee per patient, with adjustments for age of patient. They would rather increase income by 20% without increasing number of patients treated, but your suggestion is basically correct. The government aim is to reduce the doctor:patient ratio towards 1:1500.

There are other payments made for other services, mainly those of screening and preventative medicine. This is an excellent way to deliver preventative care, within a close doctor-patient relationship ("cradle to grave"). GPs are becoming very keen on vitamin D screening and things are happening years ahead of government action. It looks good and I am in close contact. They feel that early pregnancy is the group on which to concentrate.

There is also a public health function based on population groups of about 250,000 working with GPs, more closely linked to central government. Again vitamin D awareness is developing quickly.

Secondary care doctors in hospitals, like me, are paid a salary, with no adjustment for number of patients treated etc. They can supplement the salary by merit awards and by private clinical practice outside the NHS, and based on fee for service.

I know that in the USA the UK NHS has a bad press. In practice it works well, with obvious frustrations of an organisation that is working under efficiency pressures, but there is a very high level of satisfaction from those treated. Delays in treatment are very brief these days.

Question came from the excellent book The Healing of America: A Global quest for better, cheaper, and fairer health care by T. R. Reid, 2009.

Ebook costs $9. The wikipedia entry for the book hour long video

Wikipedia has a nice entry on the same subject: http://en.wikipedia.org/wiki/Health_care_in_the_United_States, which has the following graph showing that the UK in 2008 spent 8% of GPD on health care whereas the US spent 16%, for far less health

This PNG, (not GIF) image is from http://en.wikipedia.org/wiki/Health_care_in_the_United_States

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See also VitaminDWiki

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