Abstract
Ownership and integration–two attributes that typify Kaiser Permanente, a healthcare organisation that provides managed care to 8.2 million Americans. Last year's BMJ paper by Richard Feachem and colleagues compared the NHS unfavourably with Kaiser and produced a strong reaction. Many of you argued this was a comparison of apples and oranges, fatally flawed; others believed that Kaiser could be a model for the NHS. A major difference between the two systems was bed usage–the NHS used three times the number of acute bed days. One GP reader wrote: “Senior NHS representatives should visit the US system described, try to work …
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