Kaiser versus the NHS

The BMJ received 75 letters in response to a paper we published comparing the NHS with California's Kaiser Permanente, a not for profit health maintenance organisation. The paper concluded that Kaiser delivered substantially better care to its patients while spending no more per head than the NHS. In the letters section (p 1332) we print seven of these letters and a summary of the rest. Forty six letters comprehensively dismantled the authors' analysis; the message implicit in many of these letters is that the authors and commentators had let their ideology cloud their judgment. Twenty seven supported the paper, offering the explanation that Kaiser's superiority was due to having more of everything: more beds, more doctors, more nurses, and better information technology.