The future of work (2)

 A World Without Work. Technology, Automation and How We Should Respond

The struggle for subsistence was the challenge that preoccupied most of mankind. Our generation has been fortunate to wake up in a world where people need not be condemned to that fate, where there is in principle enough economic prosperity for us all to keep ourselves and our families alive. The looming problems—of inequality, power, and meaning—are just the consequences of this unprecedented
prosperity. They are the price we pay for the material abundance that some of us (though as yet not all of us) have been fortunate to enjoy. And in my view, it is a price worth  paying. 
In the twenty-first century, we will have to build a new age of security, one that no longer relies on paid work for its foundations. And we have to begin this task today. Although we cannot know exactly how long it will take to arrive at a world with less work for human beings to do, there are clear signs that we are on our way there. The problems of inequality, power, and meaning are not lurking in the distance, hidden out of sight in the remote future. They have already begun to unfold, to trouble and test our inherited institutions and traditional ways of life. It is up to us now to respond.

 

The future of work

 Work in the Age of Data

The exponential increase in data processing, transmission, and storage capacity brought about by the digital revolution, and the concomitant reduction in costs per unit, marks the start of a new era: the “Age of Data.” We are in the midst of a period of rapid transformation, in the economy, society, and our way of life. And these changes are having particularly far-reaching effects on the world of work.

Nineteen leading experts from all over the world outline the major, radical reforms needed to address  the challenges of the Age of Data and to harness technology as a powerful force for drastically improving  working conditions and living standards at a global scale.

 

CRISPR Nobel prize

 Genetic scissors: a tool for rewriting the code of life

GREAT NEWS! 

The Royal Swedish Academy of Sciences has decided to award the Nobel Prize in Chemistry 2020 to

Emmanuelle Charpentier, Max Planck Unit for the Science of Pathogens, Berlin, Germany

Jennifer A. Doudna, University of California, Berkeley, USA

“for the development of a method for genome editing”

Popular information: Genetic scissors: a tool for rewriting the code of life (pdf)

Scientific Background: A tool for genome editing (pdf)

Unfortunately, the Royal Swedish Academy of Sciences has shown its ignorance about the real discovery of CRISPR. It happened in the '90s in Salines de Santa Pola by Dr. Martinez Mojica.

Health as a priority

Prioritizing health: A prescription for prosperity

Mckinsey Global Institute has released a relevant report:

In Prioritizing health: A prescription for prosperity, we measure the potential to reduce the burden of disease globally through the application of proven interventions across the human lifespan over two decades. By intervention, we mean actions aimed at improving the health of an individual. These range from public sanitation programs to surgical procedures and adherence to medication and encompass interventions recommended by leading institutions like the World Health Organization or national medical associations. We also examine the potential to reduce the disease burden from innovations over the same period.

Health reform, a lost chance (once again)

30 MESURES PER ENFORTIR EL SISTEMA DE SALUT

In the midst of covid crisis, our government created a Comitè d’Experts per a la Transformació del Sistema Públic de Salut. It gave them 2 months to solve such a complex issue, and this is the result. The message is clear, the implementation fuzzy. My impression is that if the Parliament asked for a reform and we delivered a report 6 years ago and nothing happened, now that the government is leaving it is not the best moment to think about it. Nevertheless, health reform, public and private, is as relevant as it was 6 years ago, but unfortunately nobody is taking charge.

PS. Someday I'll explain what really happened, the enablers and the blockers, and why all this has still impact in the current situation.

Integrated care as organizational innovation

Innovative Integrated Health And Social Care Programs In Eleven High-Income Countries 

High-income countries face the challenge of providing effective and efficient care to the relatively small proportion of their populations with high health and social care needs. Recent reports suggest that integrated health and social care programs target specific high-needs population segments, coordinate health and social care services to meet their clients’ needs, and engage clients and their caregivers. We identified thirty health and social care programs in eleven high-income countries that delivered care in new ways. We used a structured survey to characterize the strategies and activities used by these programs to identify and recruit clients, coordinate care, and engage clients and caregivers. We found that there were some common features in the implementation of these innovations across the eleven countries and some variation related to local context or the clients served by these programs.

Needs segmentation, Patient coordination and Engagement are the crucial topics. More details inside the article.

 

Specialty pharmaceuticals regulation

SPENDING REVIEW FASE II. ESTUDIO GASTO HOSPITALARIO EN EL SISTEMA NACIONAL DE SALUD 

Airef has release a report on specialty pharmaceuticals in the National health service. This is a crucial issue to understand health expenditure, and the report helps a lot.

The ppt, here.

Private health insurance landscape

 Private health insurance: history, politics and performance

This is  a collection of comparative case studies analysing the history, politics and performance of private health insurance globally and its implications for universal health coverage. An essential reading.

And these are the contents:

1 Why private health insurance?

2 Private finance publicly subsidized: the case of Australian health insurance

3 Private health insurance in Brazil, Egypt and India

4 Private health insurance in Canada

5 Regulating private health insurance: France’s attempt at getting it all

6 Statutory and private health insurance in Germany and Chile: two stories of coexistence and conflict

7 Uncovering the complex role of private health insurance in Ireland

8 Integrating public and private insurance in the Israeli health system: an attempt to reconcile conflicting values

9 Private health insurance in Japan, Republic of Korea and Taiwan, China

10 The role of private health insurance in financing health care in Kenya

11 Private health insurance in the Netherlands

12 The challenges of pursuing private health insurance in low- and middle-income countries: lessons from South Africa

13 Undermining risk pooling by individualizing benefits: the use of medical savings accounts in South Africa

14 Consumer-driven health insurance in Switzerland, where politics is governed by federalism and direct democracy

15 Regression to the increasingly mean? Private health insurance in the United States of America

16 Health savings accounts in the United States of America

Patients are not consumers

 Patient-Centered Care, Yes; Patients As Consumers, No

There are numerous calls for building health care delivery systems that are more patient centered. The focus on patient-centered care has increasingly begun to rely upon, and even merge with, the concept of patients as consumers. Early references to patients as consumers were made by patient advocates who were attempting to challenge professional and corporate dominance in health care. Today, “consumer-driven” health care has become associated with neoliberal efforts to emphasize market factors in health reform and deemphasize government regulation and financing. In our view, a narrow focus on consumerism is conceptually confused and potentially harmful. The consumer metaphor wrongly assumes that health care is a market in the usual understanding of that term, that the high cost of US health care is a function of excessive consumer demand, and that price transparency and competition can deliver on the promise of reducing costs or ensuring quality. Furthermore, a consumer metaphor places disproportionate burdens on patients to reduce health care costs, and it could erode professional obligations to provide appropriate and effective care.

So, all said.

Episode based payment systems (2)

The Impact Of Bundled Payment On Health Care Spending, Utilization, And Quality: A Systematic Review

THE CURRENT STATE OF EVIDENCE ON BUNDLED PAYMENTS

The topic has already been explained in this blog. Now you may find a systematic review of what is going on in US:

We performed a systematic review of the impact of three CMS bundled payment programs on spending, utilization, and quality outcomes. The three programs were the Acute Care Episode Demonstration, the voluntary Bundled Payments for Care Improvement initiative, and the mandatory Comprehensive Care for Joint Replacement model. Twenty studies that we identified through search and screening processes showed that bundled payment maintains or improves quality while lowering costs for lower extremity joint replacement, but not for other conditions or procedures.

 While bundled payment programs maintain or improve quality while lowering costs for Lower extremity joint replacement, our systematic review suggests that the effects of the payment model on health care spending and utilization varied considerably—particularly by clinical episode type.

So what?. The drivers for success still have to be found. But there is one that is mandatory: payment systems need to be holistic, any partial design will fail. 

Social distance

When voting is useless in our country

 Inside the Mind of a Voter

A great book for a democracy, a useless book for our dictatorship. What's next?

Determinants of change in life expectancy

Contributions Of Public Health, Pharmaceuticals, And Other Medical Care To US Life Expectancy Changes, 1990-2015

Life expectancy in the US increased 3.3 years between 1990 and 2015, but the drivers of this increase are not well understood. We used vital statistics data and cause-deletion analysis to identify the conditions most responsible for changing life expectancy and quantified how public health, pharmaceuticals, other (nonpharmaceutical) medical care, and other/unknown factors contributed to the improvement. We found that twelve conditions most responsible for changing life expectancy explained 2.9 years of net improvement (85 percent of the total). Ischemic heart disease was the largest positive contributor to life expectancy, and accidental poisoning or drug overdose was the largest negative contributor. Forty-four percent of improved life expectancy was attributable to public health, 35 percent was attributable to pharmaceuticals, 13 percent was attributable to other medical care, and −7 percent was attributable to other/unknown factors. Our findings emphasize the crucial role of public health advances, as well as pharmaceutical innovation, in explaining improving life expectancy.

 A must read article. This is the kind of messages that can inform policymakers and redefine priorities. Unfortunately, there is no similar study for my country.

PS. If you want the same study over two centurys, check here

Vaquero at Marlborough

Professionalism, current challenges

 Medical Professionalism In An Organizational Age: Challenges And Opportunities

What strategies might organizations implement to make it more likely that clinicians can live up to the core responsibilities of professionalism?

This is the question. The answer in this article, at least in part.

 One useful beginning point is with institutional culture, “that which is shared between people within organizations… the shared way of thinking…the values, beliefs and assumptions.If the organizational culture does not support the responsibilities of professionalism, then people are able to fulfill them only through acts of personal heroism.

 Transparency is another controversial area where physician leadership might buttress professional responsibilities. Organizational policies vary considerably on how clinical data should be collected, identified, and shared.

Although it is simpler to identify the challenges and opportunities now confronting medical  professionalism than to propose effective responses to them, the approaches set forth here—with their focus on organizational culture, leadership, compensation, transparency, and doctor patient relationships—are intended to stimulate further discussion.

Matisse exhibition at Pompidou

 

Viruses are among us

Viruses, Pandemics, and Immunity 

A new book helps to explain our fight with infectious diseases. It splits it in two eras:

The first era of our eternal battle with infectious diseases ended with one of the major achievements of medicine, the vaccine against smallpox. We will tell the tale here of how this procedure, which ultimately eradicated the scourge of smallpox from the planet, was developed slowly by several cultures on different continents in an empirical way without any understanding of how or why it worked. In the second era we learned about the origins of infectious diseases and how to combat them.

And explains why we share our environment with viruses

 Viruses are very simple ancient organisms that have probably existed since life began. For reasons that will become clear in the next section, viruses cannot reproduce on their own. They have to colonize bacteria, plants, and animals (including humans) in order to replicate and propagate their species. Therefore, viruses have specialized skills that let them invade other species and replicate inside them. When a virus invades the human body and replicates, it can damage our cells and tissues. The immune system, about which we will learn in the next chapter, tries to kill viruses that invade us to prevent and combat viral infections. This war between viruses and our immune system has raged since time immemorial.

And this is our current fight with SARS-CoV2. Highly recommended.