The miracle of bread and fish

According to the Gospels, a large crowd had gathered and was following Jesus. Jesus called his disciples to him and said:

"I have compassion for these people; they have already been with me three days and have nothing to eat. I do not want to send them away hungry, or they may collapse on the way."

His disciples answered:

"Where could we get enough bread in this remote place to feed such a crowd?"
"How many loaves do you have?" Jesus asked.
"Seven," they replied, "and a few small fish."
"Jesus told the crowd to sit down on the ground. Then he took the seven loaves and the fish, and when he had given thanks, he broke them and gave them to the disciples, and they in turn to the people. They all ate and were satisfied. Afterward the disciples picked up seven basketfuls of broken pieces that were left over. The number of those who ate was four thousand men, besides women and children. After Jesus had sent the crowd away, he got into the boat and went to the vicinity of Magadan (or Magdala)."

Now let's imagine one country and his health expenditure in 2007 and 2017, let's think about a figure, let's say 1,186€. This was the per capita expenditure in 2017. What was the per capita expenditure one decade earlier? 1€ less!!! It was 1,185€. This is a miracle, if you take inflation into account the reduction of expenditure is huge. Technology and ageing were not the drivers of expenditure growth because there was no growth!
Between 2017 and 2016 the growth was 5.9% in public expenditure. In private health insurance  expenditure it was 5,4%. That's it.
If you have to think about health expenditure miracles, have a look at Catalonia, it's incredible.
And it is so incredible that today our government is in exile, or in prison, or bail pending trial. Today the spanish police has entered in our government palace and has arrested one high official.
This is the rogue state where the majority wants to leave, and unfortunately we are alone, prosecuted and it's not possible to decide the new president. Europe forgets the attack on civil liberties. Shame.

Now

Allocating expenditures to diseases

Guidelines for Measuring Disease Episodes: An Analysis of the Effects on the Components of Expenditure Growth

One of the most interesting reports by OECD was produced 15 years ago. The title was "A Disease-based Comparison of Health Systems What is Best and at what Cost?". The approach was clear, in order to compare health systems we do need to focus on specific diseases and its costs and outcomes.
Now you can read in Health Services Research an interesting article that shows what and how you should do to measure episodes. The comparison between person based and episode based approach is useful and it depends on the goals of research. For insurers and health population managers: episode-based. For officials and statistical offices: person-based
All the stuff on decomposition of health expenditures should be readjusted after reading this article. A hard work forward.

PS. OECD made an update on 2013. Good news.

The rethorical work of modern medicine

Bodies in Flux; Scientific Methods for Negotiating Medical Uncertainty

Evidence and persuasion play a crucial role in everyday task of any physician. That is, knowing the evidence of what works, and persuading that the treatment will succeed in a specific disease.

But how are evidential worlds assembled from bodies in perpetual flux? From where does medicine’s evidential weight hail? What protocols and procedures elevate everyday
biological activities to positions of argumentative authority?

 Defining and diagnosing disease is a kind of quixotic empiricism. It requires taking what’s known now and making best guesses about what’s to come. Yet, as physicist and philosopher David Bohm (1981) argues, “all is flux”

 After nearly a decade of studying evidential construction in the biomedical backstage, I have identified four specific methods with which medical professionals attune to corporeal flux in cancer care: evidential visualization, assessment, synthesis, and computation.

These are the approaches that a new book highlights in detail. In chapter 6 I suggest you read the section "Medical care as phronesis",

Phronesis is one of “the five expressions of care discussed in Book VI of the Ethics” and is a “mode that deals with the contingent and the possible”. Typically, phronesis (defined by Aristotle in the Nicomachean Ethics as “prudence”) is set counter to another rhetorical construct, metis.

A book highly recommended for those that want a fresh perspective on evidence based medicine and rethorics.