Can European health care systems learn?

In recent years the US managed care organisation Kaiser Permanente (KP) has started to influence mindsets and policy development within many European health care systems. Delegations from twenty-six countries, including thirteen from Europe have visited the organisation.1 The reason for this interest is that KP has been highlighted as a successful model of integrated cost effective care.2–4 In their influential article in the British Medical Journal (BMJ), Feachem et al. compared the costs and performance of the English NHS with those of KP in California. They concluded that KP provided much better value, largely by using only one third of the acute bed days used in the NHS. This was explained by better integration throughout the system, efficient management of hospital use, the benefits of competition and greater investment in information technology.2