Paying for high intensity inpatient activities

How should hospital reimbursement be refined to support concentration of complex care services?

Concentration of certain inpatient activities is absolutely necessary to guarantee the right efficiency and outcomes that can only be achieved under a large scale. However, how to pay for this is a different and difficult issue. Usually these activities result from a blending of costs of care, teaching costs, and sometimes with research costs. Therefore, the first step is to try to split them as far as possible.
A new paper tries to disentangle in part the issue of how to pay for complex services, and says:

There is no universally agreed definition of what constitutes complex care hospital care, but in England attempts have been made to define complex care according to the  presence of specific diagnoses and procedures in each patient’s medical record. We have applied these complex care definitions to determine whether the receipt of complex care is associated with higher costs relative to patients allocated to the same HRG who did not receive complex care. To do this, we estimate random effects models using patient-level activity and cost data for all patients admitted to English hospitals during the 2013/14 financial year. Compared to otherwise equivalent patients allocated to the same HRG, costs were more than 10% higher for patients receiving 26 (out of 69) types of complex care delivered in hospitals.

And the reason behind these higher costs, maybe severity within the classification or ...

 Irving Penn, maintenant au Grand Palais

Pharmaceutical research, Wall Street and financial crime

 Black Edge_ Inside Information, Dirty Money, and the Quest to Bring Down the Most Wanted Man on Wall Street

Today I would like to recommend a book on finance, on one of the largest financial crimes up to now. It is the case of insider trading at SAC, where they plead guilty and a settlement was achieved after paying $1.8 billion. In Black Edge you'll understand better how some hedge funds have been trading on private information rather than with stocks. You'll know how research-physicians received more money from Wall Street rather than from their own salary. And specially you'll understand how the case of bapi by Elan-Wyeth evolved with plenty of details.
I have insisted in this blog that short selling strategies should be banned. This book provides an excellent argument for it. The incentive for insider trading in pharmaceutical research is huge, and those that are able to get short earlier when there are bad news, get the most!
Some statements from the epilogue:

The financial industry has evolved to be so complex that large parts of it are almost  completely beyond the reach of regulators and law enforcement. Wall Street’s most  successful enterprises are constantly pushing into the frontier; every time the law looks like it’s catching up, they move farther away. There is a perception that in the years after the Milken era, and especially since the financial crisis of 2008, it has become almost impossible, due to a lack of will or expertise, to prosecute corporate criminals who operate at the highest levels. The fear of suffering embarrassing losses after long,  expensive trials has led to a kind of paralysis in law enforcement. The Justice Department was unable, or unwilling, to bring any senior Wall Street figures to face criminal charges for the widespread fraud that swept the financial system prior to 2008. Instead, it extracted billions of dollars in fines from the world’s largest banks.

The hedge fund industry created unprecedented fortunes for a new generation of Wall Street traders whose primary innovation was to find ways to make more aggressive bets in the stock market. Cohen was a pioneer, the creator of a trading empire designed to gain an edge over less sophisticated investors. Years later, after paying the largest fines in the history of financial crime—and seeing a dozen of his employees implicated in insider trading—Cohen emerged from the crisis that engulfed his company as one of the world’s wealthiest men.

 

October 1st, in Catalonia, a documentary

Alcohol regulation as a public policy issue

Alcohol, Power and Public Health: A Comparative Study of Alcohol Policy

Nowadays, I would say that Alcohol Policy this is one of the most difficult and curcial issues in public health. Our societies have internalised its consumption without addressing its risks and the power between industry and regulators is absolutely unbalanced.
A new book that compares the situation in 5 countries is really welcome. Our country is leaving this policy for tomorrow. I would suggest a close look, just for inspiration. Maybe someday it will be the right time.

In particular, change to the alcohol policy status quo requires the convergence of various factors:

1. For alcohol harm to emerge as a significant, and visible, social problem. This means not only a raised public and political awareness of alcohol harms, but a degree of consensus in framing those harms as a particular type of problem. This, as we have seen, is often driven by concrete social change – especially increases in the amount of alcohol consumed in a given society. However, it also implies the successful framing of a problem by advocacy coalitions, often relying on the development of a more or less compelling body of scientific evidence, as well as external sociopolitical factors (such as, for instance, the crisis of the First World War in Europe) that force the political issue and place the public spotlight on alcohol as a social problem in need of tailored political solutions.
2. For proponents of change to convince sufficient relevant stakeholders of the validity of their solutions to the putative problem. These include the scientific community, key policymaking networks, influential sections of the media, and so on. As we have seen, for alcohol policy advocates, this means not only winning the argument that alcohol harms exists on a continuum, but also that the line of justifiable intervention is some distance below that commonly understood as ‘dependency’ or limited to those who behave badly when drunk.
3. For the proposed policy actions to chime sufficiently with the prevailing political context. That is, for policymakers not only to accept the diagnostic and political arguments but, crucially, to decide that implementation of the proposed solutions is politically viable, realistic, consonant with both the ‘national mood’ and internal party politics, and – of course – capable of withstanding resistance from opposing interest groups.

Sounds obvious, but first steps should be well grounded. Current hypocritical attitude should be overcome.

Marc Figueras